Shamanic Healing for Veterans with PTSD: A Case Series

Author’s Accepted Manuscript SHAMANIC HEALING FOR WITH PTSD: A CASE SERIES

VETERANS

Helané Wahbeh, Lauri Shainsky, Angela Weaver, Jan Engels-Smith www.elsevier.com/locate/jsch

PII: DOI: Reference:

S1550-8307(17)30041-1 http://dx.doi.org/10.1016/j.explore.2017.02.003 JSCH2179

To appear in: Explore: The Journal of Science and Healing Cite this article as: Helané Wahbeh, Lauri Shainsky, Angela Weaver and Jan Engels-Smith, SHAMANIC HEALING FOR VETERANS WITH PTSD: A CASE SERIES, Explore: The Journal of Science and Healing, http://dx.doi.org/10.1016/j.explore.2017.02.003 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Title: Shamanic Healing for Veterans with PTSD: A Case Series

Authors: Helané Wahbeh, ND, MCR1, 2 Lauri Shainsky, PhD3 Angela Weaver, MEd3 Jan Engels-Smith MEd ShD3

1. Oregon Health & Science University, Portland, Oregon 2. Institute of Noetic Sciences, Petaluma, California 3. LightSong School of 21st Century Shamanism and Energy Medicine, Portland, Oregon

Corresponding Author Helané Wahbeh 625 2nd Street Suite 200 Petaluma CA 94952 707-779-8230 [email protected]

Acknowledgements: We would like to thank Roberto Dansie, Edward Tic, and Pamela Rico, for their support of this project and the LightSong School of 21st Century Shamanism Council for their significant contribution of wisdom. Most importantly, we would like to thank the participants for their time and willingness.

Title: Shamanic Healing for Veterans with PTSD: A Case Series Abstract: Context: Posttraumatic stress disorder (PTSD) is a serious health concern. Current evidencebased treatments for PTSD are efficacious, however, they are not appropriate or tolerated by everyone who needs them. Alternative treatment approaches are needed. Shamanic healing is one such therapy that may potentially be beneficial but no systematic research has been conducted on it for PTSD. Objective: The objectives of the case series were to: 1) develop a structured replicable shamanic treatment plan for veterans with posttraumatic stress disorder (PTSD); 2) collect preliminary data on PTSD related outcomes, and 3) explore the feasibility and potential for adverse events of the plan. Design: Case Series Setting: Clinical Patients or Other Participants: Veterans with PTSD Intervention: Shamanic Healing Main Outcome Measure(s): PTSD symptoms, quality of life, spiritual wellness Results: A semi-structured shamanic healing protocol was created with the following components: rapport building, power animal retrieval, extraction, compassionate spirit release, curse unraveling, soul retrieval, forgiveness/cord cutting, aspect maturing/soul rematrixing, and divination. Six veterans enrolled in the study (mean age 49.3 ± 13.1). Qualitative descriptions of the participants, their histories, and effects from the intervention are reported. Preliminary data was collected on PTSD related outcomes. The protocol was found to feasible and acceptable and recommendations for its future use are suggested. Future research is warranted and needed to evaluate the efficacy of shamanic healing as a potential therapy for veterans with PTSD.

Keywords: shamanic healing, shamanism, posttraumatic stress disorder, Veterans, combat, spirituality

Introduction Posttraumatic Stress Disorder (PTSD) is a serious health issue many people but especially for veterans. PTSD affects not only mental, emotional, and physical aspects of veterans' lives, but those of their families and communities. Veterans are especially vulnerable to acquiring PTSD; Veterans with chronic PTSD are a growing population. The National Vietnam Veterans Readjustment Survey reported a 30.9% lifetime prevalence of PTSD in Vietnam combat veterans (Kulka, Schlenger et al. 1990). Prevalence of PTSD among 11,441 Gulf War veterans was estimated to be 10.1% (Kang, Natelson et al. 2003). Among 2,863 Operation Iraqi Freedom soldiers, 16.6% met screening criteria for PTSD (Hoge, Terhakopian et al. 2007). Rates of veteran with PTSD are higher than Americans in the general population, reported at 3.5% prevalence in any given year and 6.8% over a lifetime (Kessler, Chiu et al. 2005). One study on military personnel deployed to Iraq and Afghanistan put the economic impact of PTSD, including medical care, productivity and suicides, at $4-6 billion over two years (Tanielian, Jaycox et al. 2008). Clearly, the economic, societal and personal costs of PTSD are high. The 2010 VA/DOD Clinical Practice Guidelines for the Management of PTSD recommend Cognitive Processing Therapy, Prolonged Exposure Therapy, Eye Movement Desensitization and Reprocessing, and Stress Inoculation Therapy as evidence-based treatment for this syndrome (Department of Veteran Affairs & Department of Defense 2010). Although current evidence-based psychological and pharmaceutical treatments such as cognitive behavioral therapy, prolonged exposure therapy, and medications may show significant benefit for some veterans, many veterans fail to respond, or the treatments may not be appropriate or tolerated in all cases (Grunert, Weis et al. 2007). Failure to respond may

result from a variety of issues including traumatic brain injury, substance use, other psychiatric or physical co-morbidities, unwillingness to take medications, and refusal to attend individual or group therapy. Another key reason why veterans may fail to respond to conventional treatments is because the spiritual or energetic components of their distress are left unaddressed. Spirituality has been noted as an important factor in PTSD (Bormann, Liu et al. , Currier, Holland et al.). Alternative treatment approaches are clearly needed for veterans with PTSD. Shamanic healing practices may be one such alternative because they address the spiritual aspects of trauma (Engels-Smith 2014). Shamanic healing practices have been used for thousands of years in many cultures around the world (Harner 1990, Ingerman and Wasserman 2010, Villaldo 2011). Shamanic healing has been a part of most first-people cultures and others’, with estimates of a 40,000-100,000 year history. The overall premise of shamanic healing is that the shaman or shamanic practitioner brings non-ordinary healing power and wisdom (from the spirit realm) into ordinary reality through their relationship with unseen spiritual entities, e.g., power animals, human-formed spirits, deities, gods and goddesses, the elements and other emissaries of power and wisdom from the spiritual realms. (Harner 1990). This healing power and wisdom is then focused on alleviating the spiritual root causes of an ailment. Few scientific studies have been performed to study shamanic healing in modern times. Vuckovic et al. demonstrated the feasibility and efficacy of using shamanic healing for alleviating the pain from TMJ (Vuckovic, Gullion et al. 2007). Krycka found that shamanic healing on people with HIV, cancer and other “incurable” diseases benefited the participants significantly, especially in their inner cosmological relationship with their bodies (Krycka 2000). Harner found that shamanic drumming reduced tension, anxiety, confusion and anger indices of well-being, with some increases in vigor also measured (Harner 1995); Winkelman corroborated these effects, demonstrating positive effects of drumming on patients with substance abuse issues

(Winkelman 2003). Although there is strong anecdotal evidence of the positive effects of shamanic healing on people with PTSD, these anecdotal effects have not been assessed in a clinical study. Studies assessing safety, feasibility, and healing effects of shamanic healing on veterans with PTSD are necessary. The long-term goal of our research is to evaluate shamanic healing’s effect on veterans with PTSD. As a first step in attaining this goal, we developed a shamanic healing protocol and conducted a case series. The objectives of the case series were to 1) develop a structured replicable treatment plan that could be implemented in veterans with PTSD; 2) collect preliminary data on PTSD symptoms, quality of life and spiritual wellness, and 3) assess feasibility, adverse events. We hypothesized that we could create a standardized shamanic healing protocol through an expert panel, that the protocol could be implemented in veterans with PTSD, and that the protocol would be acceptable to the veterans. We hypothesized that the outcomes would trend towards improvements. Due to the small number of participants, we did not anticipate statistically significant findings.

Materials and Methods

Shamanic Healing Protocol Development The human being, from a shamanic perspective, is composed of physical, mental, emotional and spiritual energetic systems that are intertwined. The energetic system is also in direct relationship with the soul—the animating life force of the human being; this relationship is pivotal in understanding shamanic healing and determining the health of the human being. Shamanic healing techniques focus on healing dimensions of the soul with consequent healing effects on the body and mind. Shamanic healing practices are based on two basic procedural categories: 1) removing energetic toxins and illness-stimulating spiritual factors in one’s life, and 2) filling with or retrieving energies and factors that promote spiritual health that have been lost through

trauma and other adverse life events or circumstances. Shamanic worldviews hold that many maladies whether they be physical, emotional and/or mental, have a spiritual component at the root of their cause. Disturbances to the soul manifest from disturbances in life, and lead to breakdowns and/or disintegration at the physical, mental, emotional, social levels of the human being (Ingerman 2008, Villaldo 2011, Engels-Smith 2014).

Through an iterative process over multiple meetings, a committee of 12 experienced shamanic practitioners developed a shamanic treatment or healing protocol that included a semistructured series of 8-session (Figure 1). Shamanic healing methods here were derived from core shamanic principles taught by the Foundation for Shamanic Studies. These methods represent a modern interpretation and titration of a broad spectrum of ethnologically researched practices, and do not necessarily represent traditional indigenous healing rituals. The specific components chosen for the protocol were based on more than 40 years of combined client experience as reported by the shamanic practitioners on what components were successful in healing clients with trauma. While the protocol components that utilize shamanic healing modalities originated from and are still widely practiced among, many indigenous shamans worldwide,, they have been adapted to meet contemporary needs (Engels-Smith 2007). Figure 1. Shamanic Healing Treatment Schema

Figure 1 shows the overall timeline of shamanic treatments administered over the course of the intervention; pacing was different for each participant. Note: This diagram is meant to reflect the flexible aspect of the progression in the intervention and the relative order of processes to administer.

The protocol incorporated the following components: Rapport building and power animal retrieval: An in-depth conversation between the shamanic practitioner (SP) and the veteran created rapport and trust which is essential for successful healing. A power animal retrieval was next performed to 1) further develop rapport and to develop a life sustaining relationship between the client and his particular spiritual ally or power animal, and 2) introduce the veteran to the shamanic landscape. The SP entered an altered state of consciousness using repetitive constant drumming (100 beats/minute on a Native American hand drum) and narrated the journey out loud in order to bring the veteran along on the shamanic journey. During the journey, the veteran was introduced to the landscape the shaman traverses, called non-ordinary reality (Harner 1995). Together they retrieved his power animal. Spiritual allies such as power animals are seen as normal, viable informants and part of normal life interactions in the shamanic tradition. Building rapport between humans is no more important than building rapport between power animals and humans. The power animal’s purpose was to be a personal emissary to the spirit world (Engels-Smith 2014), and to help assist the veteran in his or her spiritual experiences during the 8-session intervention. Power animals can also become allies for life and be used regularly for companionship, protection, and guidance in everyday life.

Extraction: Trauma from warfare can introduce “dense energies” that get trapped in the body’s energy system resulting in changes in behavior, thought processes, physiological function, and spiritual despair. Aggressive people, presence of enemies, harsh chaotic environments, loud noises and the threat of death surround a soldier in battle with intense and dense energies. Intervention: These energies are targeted for removal by the SP through the shamanic procedure called “Extraction”. Vocals, drumming, rattling, and other instruments producing sounds combine with the SP's intentions and the spirit realm’s guidance and assistance to remove these dense energies. The removal of dense energies allows the client to feel overall energetic upliftment (Villaldo 2011, Engels-Smith 2013).

Spirit Release: When a person suddenly dies, the person’s soul may be confused as to where to go when it is disconnected from its physical body (which may vary based on the person’s cultural beliefs). The lost soul, or “discarnate” spirit, can get trapped or stuck and energetically incorporated into the energy system of another person who is still alive (Fiore 1995, Salomone 2014). Soldiers on the battlefield are surrounded by death and thus are exposed and susceptible to this incorporation of discarnate spirits into their energy systems. Intervention: The SP seeks to provide a healing to both the client and the discarnate spirit through the shamanic procedure called “Compassionate Spirit Release.” Through a loving conversation and help from the spirit realm’s angelic guides, this process invites the discarnate spirit to see the wisdom of moving on to his or her spiritual home, and sends them lovingly there, leaving the client free and clear of this interfering energy (Fiore 1995, Salomone 2014).

Curse Unraveling: The concept of a “curse” holds that words, oaths, declarations, or other verbal statements contain a certain power. In combination with the power of words, it is possible for a person to use words, along with life force energy, to instigate a set of circumstances in someone’s life that can cause the person harm, repeatable follies, injuries, or perpetual unhappiness, discomfort, or misfortune. Intervention: With the assistance from the spirit realm, the SP unravels curses by helping the client locate and identify the verbal content of the curse, and to deactivate/disarm the source of the life force fueling the curse. Curse unraveling removes the dense energies and thought forms of the oaths, declarations and contracts and re-energizes the client’s soul. Through the curse process, the client’s life force is stuck or locked up in another dimension. Through the curse unraveling, there is a reinvigoration of the soul when this life force is freed, energetically cleansed, and returned to the client (Engels-Smith 2015).

Soul Retrieval: One of the most common spiritual roots of human disease is soul loss. When a person experiences trauma at various degrees of intensity such as surgery, accidents, illnesses, arguments, shaming incidents, abandonment or betrayal events, among other adverse situations or circumstance, pieces of his or her soul or soul essence splinters off, and gets lost (Ingerman 2008, Engels-Smith 2014). Soul retrieval is a powerful healing ceremony. Intervention: With assistance from the spirit realm, the SP journeys across the time span of the client’s life to find and bring back his or her lost soul essence. After soul parts are retrieved, they are reunited with the energetic system of the client. The client is then revitalized and experiences greater wellness at the mental, emotional, physical and spiritual levels.

Forgiveness and Cord-cutting: All people are connected to each other, as well as to places and things via a cord of energy. Over the course of a lifetime, a person loses soul essence due to these connections or relationships. The cords of energy typically manifest within the person as hurts or wounds created consciously or unconsciously while in relationship with another person, place or thing. Sustained psychic energy feeds these relationships and causes the person’s energy to become bound up, depleted, drained and diminished. Intervention: During the shamanic procedure, “Forgiveness and Cord-cutting Ceremony”, the SP lovingly cuts cords connecting the client to his or her past hurts, wounds, and sources of restriction and depletion. Soul essence that was bound up in those cords is returned to the client, same as the Soul Retrieval process, and the client experiences, forgiveness, release and freedom from the past, and greater energy to move forward in life (Engels-Smith 2007).

Aspect Maturation: Various aspects of a person’s personality or “ego self”, often needs to “catch up” with respect to his or her biological aging, energetic growth and soul’s healing. An “Aspect” is a set of behaviors, thought processes or emotional patterns that developed at an early age to perform a particular function that usually involves keeping the person safe and/or getting specific needs fulfilled. Intervention: During shamanic procedure, “Aspect Maturation” the SP assists the client in identifying places where he or she feels stuck and finds the root belief system or personality trait that is influencing their obstacle to healing. With the assistance from the spirit realm, the SP brings conscious awareness to the workings of the Aspect of the client and gives it a more empowering, enlightened, and mature job to do. This process assists the client with healing the central issue the Aspect had evolved to address, and at the same time provides the Aspect with a more mature, socially, and spiritually, evolved way of operating and expressing in the world (Engels-Smith 2007).

Soul Rematrixing: Engels-Smith developed the healing technique called Soul Rematrixing, a 21st century shamanic healing technique to assist her clients. Soul Rematrixing addresses root issues of the soul and assists with maximized healing after a client’s soul retrieval and forgiveness ceremony. Intervention: The SP goes on a shamanic journey with the client and together with help from the spirit realm, the SP renegotiates the developmental history of certain aspects of the interrelationship between the client’s personality (ego) and soul, providing a Soul Rematrixing for the client. This in turn allows for a more powerful and productive expression of the soul via the body and mind (Engels-Smith 2007). Study Procedures The study was approved by the Institute of Noetic Sciences Institutional Review Board. Potential volunteers were contacted from a database of previous research participants who agreed to future contact for other research studies. Approximately 40 veterans were initially contacted via email and asked to call or email if there were interested in learning more about the study. Six veterans expressed interested in the study and enrolled. Before entering into shamanic treatment, the veterans completed the PTSD Checklist (PCL) (Weathers, Litz et al. 1993) to evaluate the severity of PTSD symptoms and assess changes from the intervention; The World Health Organization Disability Assessment Schedule 2 (WHODAS 2.0)(Garin, Ayuso-Mateos et al. 2010); and The Spiritual Wellness Inventory (SWI) to assess any changes in quality of life and spiritual wellness from the intervention (Ingersoll 1995). They completed the same questionnaires after their sessions.

Measures PTSD Checklist (PCL) – The PCL was chosen to evaluate PTSD symptoms before and after the treatment in order to assess change due to treatment. The PCL is a short, 17-item questionnaire self-report inventory based on DSM-IV criteria for PTSD diagnosis and takes approximately 5-7 minutes to complete. The scale can be divided into three sub-scores corresponding to the three main syndromes of the disorder: re-experiencing, avoidance and hyperarousal, which asks specific questions about ANS hyperactivity. It has been validated in English (Weathers, Litz et al. 1993, Blanchard, Jones-Alexander et al. 1996). Evidence recommends using 5 points as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful using the PCL.

The World Health Organization Disability Assessment Schedule 2 (WHODAS 2.0) – The WHODAS 2.0 was chosen to evaluate quality of life. The WHODAS 2.0 is a 36-item questionnaire that assesses 6 functional domains: Cognition, Mobility, Self-Care, Getting Along, Life activities, and Participation (Garin, Ayuso-Mateos et al. 2010). A lower value for the overall score and subscales represents greater quality of life.

The Spiritual Wellness Inventory (SWI) – The SWI was chosen to assess any changes in Spirituality. The SWI is a 55-item self-report questionnaire designed to evaluate multiple dimensions of spiritual wellness. It results in scores for the following dimensions: Conception of Divinity, Meaning, Connectedness, Present-Centeredness, Mystery, Ritual, Hope, Forgiveness, Knowledge/Learning, Fake Good, and Spiritual Freedom (Ingersoll 1995). Participant 3 did not complete this inventory.

Analysis Means and standard deviations were calculated and reported for each variable. As a case series, statistical analysis was not warranted. .

Results Ease of Recruitment Announcements were sent out to forty veterans who had participated in previous research studies and agreed to be contacted in the future. Of those, six contacted veterans with PTSD and a diverse spectrum of service, post- and pre-combat histories replied and enrolled in the study (enrollment rate- 15%). Four completed the shamanic healing intervention (completion rate- 67%; mean age 49.3 ± 13.1; Table 1). Despite the small participant numbers, these rates are higher than seen in other veteran studies (Wahbeh, Goodrich et al. 2016). Table 1. Participant Demographics PPT Gender Age

Race

Marital

Era

#

#

Sessions

Weeks

Iraq

8

20

Vietnam

7

20

Vietnam

8

15

Status 1

2

3

M

M

M

30

67

65

Caucasian

Caucasian

Caucasian

Single

Married

Married

4

M

40

Caucasian

Married Desert

8

20

Afghanistan

4

6

Vietnam

1

1

Storm 5

6

M

M

27

67

Caucasian

Single

Native American

Married

Protocol implementation and feasibility Administering the protocol was easier than expected. Generally, the sequence of components was consistent across all four veterans that finished the series. While the protocol was intended to be completed in 8-sessions, one veteran could only manage to complete seven within the scope of his schedule, and elected to fill out the post-treatment surveys at the end of his 7th session. P5 dropped out after four sessions and P6 dropped out after the first session. Usually, ease was determined by how open each veteran was to the concepts of spiritual healing and shamanism. How engaged each participant was during the session did not seem to correlate with how soon they would come back for their next session. Due to the participants’ schedules, there was some variation in the timing of treatment delivery. At the intervention series onset, three of the four participants showed avoidance behavior; P1, P2, and P4 often rescheduled set appointments, and generally struggled to manage their impetus for change. P1 and P4 rescheduled often although they both finished the treatment cycle. P1 did not have a car, and rode 3 buses for 2 hours to get to the treatment site. P2 was successful in completing 7 sessions even without a cell phone, a residence, or internet for communication or location tracking. P3 was on time and attended every session without rescheduling. His

compliance was most likely supported by the fact that he lived 20 minutes from the treatment location. Participants’ reliability improved markedly as the different shamanic healing techniques were administered except for P4, who had to reschedule sessions due to elective surgery and temporary institutionalization caused by inordinate stresses at home. P4 also had his appointments interrupted by summer vacations and his family’s schedule. P1 and P3 showed the most marked improvement in their well-being and were relatively consistent in their receipt of healing. P2 was somewhat regular in his attendance, but regular attendance was more difficult because of his lack of access to a phone or the internet. Consistency of delivery of the treatment components was high, given that all sessions were delivered by one single practitioner, in the same location, except for P6, who received a house call for his first and only session. The practitioner had 16 years of experience working with clients in this capacity.

Quantitative Outcome Measures Overall PTSD symptoms decreased in P1, P2, P3 and remained the same in P4 (Figure 2). PTSD symptom scores decreased approximately 30 points in P1 and P3. Figure 2. PTSD Symptom Changes

Figure 2 shows the changes in each participant over time. Overall PTSD symptoms decreased in all but one participant. Overall quality of life impairment decreased in all participants (Figure 3).

Figure 3. Changes in Quality of Life.

Figure 3 shows changes in quality of life over the treatments. All participants had an improvement in quality of life (or impairment decrease).

Results Table 2 details the before and after for each outcome measure for the participants who completed the study. Table 2. Before and after shamanic healing outcome scores for completer participants. P1

P2

P3

P4

Pr

Pos Ch

Pr

Pos Ch

Pr

Pos Ch

Pr

Pos Ch

e

t

g

e

t

e

t

g

e

t

g

g

PTSD symptoms total

60

31

-29

59

57

-2

65

33

-32

61

61

0

Reexperiencing

15

10

-5

18

20

2

19

9

-10

20

19

-1

Numbing-Avoiding

30

12

-18

25

22

-3

24

11

-13

23

26

3

Hyperarousal

15

9

-6

16

15

-1

22

13

-9

18

16

-2

Quality of Life %

65

18

-47

45

38

-7

35

11

-24

62

55

-7

Understanding %

58

21

-38

29

38

8

21

13

-8

33

33

0

Getting Around %

0

0

0

50

20

-30

0

0

0

25

20

-5

SelfCare %

63

13

-50

6

0

-6

25

0

-25

44

44

0

Getting Along %

45

10

-35

75

65

-10

35

10

-25

60

40

-20

Life Activities %

38

0

-38

0

0

0

9

9

0

22

22

0

Participation in Society %

63

28

-34

38

38

0

50

9

-41

72

66

-6

Conception of Divinity

30

37

7

30

27

-3

31

11

-20

Meaning

29

37

8

29

32

3

28

25

-3

Connectedness

37

39

2

25

30

5

23

16

-7

Present-Centeredness

25

34

9

21

27

6

16

24

8

Mystery

23

37

14

26

31

5

30

32

2

Ritual

13

40

27

22

34

12

23

18

-5

Hope

28

40

12

25

38

13

15

13

-2

Forgiveness

30

37

7

26

27

1

23

20

-3

Knowledge-Learning

31

39

8

22

34

12

33

22

-11

FakeGood

20

26

6

19

17

-2

28

23

-5

Spiritual Freedom

24

28

4

13

31

18

19

23

4

Spiritual Wellness Inventory

Notes: The WHODAS 2.0 and PCL allow for overall scores and subscores. The Spiritual Wellness Inventory only has dimension scores since the dimensions overlap in concept. Quality of Life WHODAS- The World Health Organization Disability Assessment Schedule; PCL- PTSD Checklist.

Description of Participants and Results Participant 1 (P1) P1 completed eight shamanic healing sessions. P1 heard about the study from a LightSong student and had participated in sweat lodge ceremonies with the practitioner prior to entering the study. P1 served as a submariner in the Iraq war era and at the time of the study he was an artist and skilled laborer. P1 came to the study troubled particularly by his anger and the problems it was causing him socially. He reported that his anger outbursts resulted in instability and distress for his wife and child, who subsequently left him. He also indicated that he experienced trauma as a child, which intertwined with PTSD elements from his military service. His deployment was full of continuous intense stress, and he spent most of his time in compressed in a small space for long periods of time due to his specific position in the military. His job was to monitor activity and constantly evaluated whether nuclear weapons should be launched. After returning home, he first experienced sporadic work and homelessness. Eventually he was able to hold a steady job, but still felt angry as well as unsafe in his urban environment. He reported that he used marijuana at study onset. The connection P1 formed with his protecting power animal was likely the most important aspects in the improvement of his PTSD symptoms. He reported an enhanced ability to focus on his work, and move around his world, knowing that this power animal was vigilantly patrolling the boundaries of his work and home environments. For example, he reported that he could work alone at his workshop (a big warehouse) doing his art at night, because he knew and sensed that his power animal was roaming the perimeter of his workshop and keeping him safe. This phenomenon is common in people who spend much of their psychic energy monitoring their surroundings for safety or lack thereof. He felt a vast increase in freedom and peace, while also watching his self-esteem rise from being able to accomplish his artwork and creative endeavors that had become his main work and financial prosperity. Because he was

more relaxed and in a peaceful state, his use of recreational drugs declined, further increasing his vitality and sense of accomplishment. He still reported levels of anger that were near pretreatment levels, but what he did with the anger changed and outbursts with loved ones were markedly reduced. He was ready for the study because he had come to a nexus in his a life of high frustration, his preconception of the power of shamanism, he had the support of his girlfriend, and the availability and timing of this opportunity all synchronized. Statements made by P1 toward the end of the treatment include: “My heart continues to soften. It is much easier to see people as individuals. While I have fleeting moments and flashes on negative circumstances, I care and feel better about myself. These moments are shorter than they were, have less impact, and I am able to release them faster. I am more aware of myself, I have moments of “myth busting” (old ideas dying), old ideas have less of an agenda, and I find it’s easier to trust and forgive, even during the freak out moments.” P1’s progress was likely facilitated by the concurrent addressing and healing of an early childhood trauma, and it’s parallel to the nature and healing of his military trauma. His military trauma which was being in a compressed, high pressure environment for several years in a nuclear submarine was paralleled by his childhood trauma of being locked in a closet by his babysitter (also a compressed environment). Both traumas were able to be addressed simultaneously through the shamanic healing. This suggests that processing and healing similar types of trauma through shamanic protocols may address and relieve multiple layers of stress, leading to marked changes in PTSD measures and a sense of well-being reflected in the quantitative data as well.

Participant 2 (P2) P2 completed seven shamanic healing sessions. He served in the Vietnam War in flight operations and supply transport. He experienced significant loss of friends and commanding officers in the field, yet also felt “saved from death.” He characterized himself as “banged up,” and felt he was slowly becoming paralyzed. He described himself as “empathic to a fault,” and that he had spiritual abilities that were both helpful and troublesome. He shared that at times he felt “tricked by the spirits” into coming to the sessions, but also felt intrigued, as he had previously been engaged in his own conversations with spirits (of dubious nature and motivation). This feeling of being “tricked by the spirits” prevailed during most of his treatment protocol, reflecting a degree of illness the practitioner would characterize as outside the bounds of that reflected by the other participants. P2 was on a variety of medication for anxiety, depression, and pain. P2 lived in his van and remained homeless throughout his series of sessions. He was in an apparently loving relationship with a wonderful, happy well-adjusted woman (who accompanied him to all of his sessions) however, the instability of living in a van and having to frequently move it to avoid problems, people, and the authorities, as well as his dependency on a variety of medications and mistrust of the VA, seemed in to contribute to his inability to make significant shifts. He was very committed to his beliefs about how the world cannot be trusted and thus his presenting issues and struggles never appeared to significantly change. In addition, P2 frequently reported “trouble-making” spirits that would appear and interrupt his shamanic treatment process, “making him do things or think things against his will.” Because the shamanic healing process respects the presence of spirits, it was concluded that his spirits were not committed to his improvement, and seemed to be stronger in influence than the benevolent, helping ones retrieved and presented during the series of sessions. P2’s experience of “trouble-making” spirits highlights an important and interesting dilemma of interpreting spiritual experiences. Michael Harner, a leader in Western shamanism, has

suggested that the only difference between shamanism and schizophrenia is that in shamanism, the conversations with the spirits occur with great discipline, intention, and love. That is, whether we honor the presence of spirits as in shamanism versus labeling the hearing of voices and seeing spirits as psychosis, influences how these experiences are perceived and allowed to influence the person. How we interpret the spiritual experience (i.e. our interpretation of honoring vs. judged as a psychotic) sets up a pattern that determines our belief system. P2’s belief system about his “trouble-making” spirits visitations created a negative feedback loop, such that the spirits became a hindrance to accessing the helping spirits the practitioner retrieved for him. Another factor in impairing his healing was the medications he was taking. Medications certainly altar brain chemistry and can affect areas of the brain that allow spiritual experiences and metacognitive shifts to register and take hold. This, along with the lack of support from a stable home environment, the practitioner feels, contributed to his lack of significant and lasting response to shamanic treatment.

Participant 3 (P3) P3 completed eight shamanic healing sessions. He served in the Vietnam War Theater and experienced significant losses. He was particularly troubled by an incident on the battlefield where he lost a close friend, resulting in immense guilt and questioning of his own judgement during the incident. He also carried guilt about the death he brought to the enemy. P3 lived in a stable home environment in the country and enjoyed being in nature. He also shared that he was dealing with issues surrounding his daughter’s violent husband. P3 was retired and engaged somewhat with the public as a musician in a band with close friends. Prior to agreeing to participate in the study, he had experienced the power of spirit in sweat lodges poured by friends, and was thus very open and compelled to be a part of the study. He reported using marijuana at the study’s onset.

P3’s greatest improvement came through renegotiating his most traumatic battlefield experience through shamanic journeying (sessions 1, 2, 3, 4) and seeing the event from different perspectives (Soul Rematrixing—session 6). During these treatment sessions, P3 discovered and assumed a new belief about the “divinely orchestrated” events surrounding his experience that resulted in his survival. He was also able to shift his perceptions of the outcomes experienced by others in a way he could not do previously. This shift in perception created a new “healing story” about what and why certain events happened in the battle field. In shamanism, healing stories are an important part of determining sustainable success. P3 also formed very powerful relationships with the helping spirits that came in to his awareness during his early sessions. He reported that these spirits significantly intervened during his life while he was receiving the shamanic treatment protocol; specifically, they helped to prevent very dramatic and potentially destructive behavior by interrupting his anger cycles. On one occasion halfway through his treatment series, these helpers interrupted a cycle that could have resulted in him taking the life of another person. P3 reported that on one occasion he was completely enraged because his son-in-law was harming his daughter, and he had decided to go over to his son-in-law’s house with the intention of possibly killing him. On his way to his son-in-law’s house he reports that his power animal dropped into his car and therefore he pulled over, breathed deeply, felt a shift and a calming, and then turned the car around and went home. He attributes his power animal to clearly intervening in what could have been for him, a life in prison and/or loss of life. He also began to observe unusual and intimate wildlife experiences at his home right after he began his sessions. These observations fostered a strong belief in the shamanic healing he was receiving. P3 also quit using drugs and quit smoking cigarettes as a direct result of this belief, despite being exposed to an environment that supported these unhealthy behaviors. Improvements in his overall emotional and spiritual states early within his treatment appeared to fuel his excitement and support his continued participation and improvement.

Statements made by P3 in the middle and toward the end of the treatment protocol include: “I have quit smoking cigarettes and pot (after session 4), and it’s no big deal, even in the bars where I sing. I have started talking to the spirits more...I know I am getting better because the deer are getting closer, probably because I am calmer. Eagles are coming more often by the house, helping me get through...I also notice I am having a shorter angry response time, greater connection to the spirits and it’s coming sooner, I am opening to love, the overflowing cup.”

Participant 4 (P4) P4 completed eight shamanic healing sessions. He was a career military man, serving and commanding in Desert Storm, and the Bosnia uprising. He carried deep issues with authority, distress over his dealings with the VA, and troubling thoughts and feelings that lead to suicidal thoughts and bursts of anger. He had a stable home environment and he was involved with the Boy Scouts with his son. He was also very engaged in Ancient Roman era reenactment activities that were a big part of his life and a major source of normalized living. His mother was a Native American and had a deep connection to medicine people. A key counterpoint was his domineering, absent, father. P4 stated that he joined the study because of his profound, mystical experiences upon his mother’s death, along with inheriting her medicine bundle, and he hoped to gain an understanding about a life in communion with spirits. There were a number of factors that may have contributed to P4’s lack of significant improvement on the quantitative measures. P4 had pre-war family trauma that the shamanic treatments seemed to not be able to penetrate his psyche profoundly enough (through his lifetime layers of wounds) and allow him to permanently shift his awareness in order to change his world view, and / or the way he thought about himself. While he reported vivid physical, emotional, and mental experiences, awareness, and shifts during the healing sessions, these

shifts were not reflected as measureable changes in the questionnaires. P4’s reliance on daily medication reinforced his perception of himself as being psychologically ill and thus interfered with his ability to embrace a sense of wellness. Just before session 5, P4 experienced a PTSD symptom exacerbation and was committed to a psychiatric ward for a brief time. This was the result of a combination of factors, including medications, poor interactions with people at the VA, a drastic change in diet and eating habits due to lap-band surgery, continually reliving war circumstances in his Ancient Roman e-enactment past life, and repeated poor social engagement with people he perceived as domineering authority figures. All of the factors combined to create inordinate amounts of stress and contributed to this set back. He did, however, continue his sessions after his nervous system had a chance to recover, and he experienced a substantial shift in his physical body. He lost 80 pounds and felt better physically through the last several sessions. Treating a career military man with a vastly different belief system from the shamanic world view requires supporting them to drastically suspend their disbeliefs, and consider new ones. In particular, the encultured beliefs about being in adversarial relationships with their superiors, the government, their enemy, and perhaps the world in general, sets up resistance to allowing high vibrational thoughts and feelings in, which are being accessed and presented to the participant, during shamanic treatment. For P4 in particular, serious pre-military trauma (death of a child that he blamed himself for) reenforced a perpetual mental loop of selfpunishment, limiting the degree to which he could shift and make changes. This self-punishing state of being, though stemming from a traumatic non-military event, was reinforced by the regimented military culture, which encouraged his feelings of disempowerment and presented a nearly impenetrable barrier to lasting change.

Participant 5 (P5) P5 attended four shamanic healing sessions. He was the youngest participant, served in the Afghanistan war, and had recently come home from his last deployment. He reported feeling like he had a “shamanic calling,” because he had levitated at a young age. He had also read several books on shamanism, was intrigued by it, and wondered if he could and/or should become a shaman. Before and during the study, he was taking medications for his symptoms, as well as excessively drinking alcohol and smoking marijuana. He reported actively avoiding addressing his issues. His brother had told him about the study and because of his natural calling to shamanism, he enrolled. Throughout the shamanic treatment period, he experienced many life challenges, including marriage difficulties apart and having to move from one house to another (at times living with his brother). P5 completed four sessions, did not return for his fifth session and did not return any phone calls attempting to reschedule.

Participant 6 (P6) P6 completed one shamanic healing session. He was referred to the study by a past client of the practitioner. He and the practitioner engaged in several deeply spiritual telephone conversations prior to his engaging in the study. P6 lived on a reservation until he was 18 years old and had a deep knowledge and belief in medicine people and the “Natural Way”. P6 served in Vietnam. P6 was also on medication for depression, anxiety and PTSD. P6 had a high degree of optimism when he started his treatment. He remarked that the practitioner was one of the first people who he felt listened to him and was able to talk, in depth, about spiritual issues. Completing the pre-treatment surveys was psychologically taxing for him. He also reported tremendous physical discomfort and issues related to his physical disability. Due to P6’s limited mobility, the first session took place in his home environment. The session space was not private and not conducive to the focused work necessary for a successful session (e.g. loud

washing machine, wife present and wandering around the space during the session). After the first session, P6 choose not to continue.

Adverse Events In the 100 hours of session time, there was only one very minor event which might be considered bordering on adverse. P2, who had previously reported having spirits (often times not benevolent) speak to him on numerous occasions, asked the practitioner to stop what she was doing because one of his talking spirits started getting upset and discounting what was happening in the session. The disruptive spirits seemed to frequently visit P2 outside of the sessions and have more influence than the benevolent ones that were present for him during his sessions.

Discussion

The results of this case series suggest that a treatment protocol of shamanic healing can reduce the intensity of PTSD symptoms. Variation between participants appeared to stem primarily with the intensity and duration of military trauma, the intensity and nature of pre-military trauma, and the presence or absence of interfering medication, lifestyle behaviors, and home situation. These are likely similar factors that are faced as barriers to care in current evidencebased therapies such prolonged exposure therapy and Eye Movement Desensitization and Reprocessing. Unlike those therapies, the veterans’ interest to participate in the shamanic healing therapy seemed, in-part, to depend on prior experience either with Native American cosmology and ceremony, and/or non-mainstream concepts and beliefs about mysticism and “non-ordinary reality”—the realms of consciousness where shamanic healing takes place. Shamanic healing and the spiritual concepts it implies are different from other interventions such as meditation that have growing evidence for their use in PTSD (Wahbeh 2014, Wahbeh,

Goodrich et al. 2016). Most of these meditation interventions are taught in a secular format despite their Eastern spirituality formats. Some researchers have begun studying lovingkindness meditation for PTSD although again there is no explicit mention of spirituality in this practice (Kearney, Malte et al. 2013, Kearney, McManus et al. 2014). Early positive change due to shamanic treatments that was readily apparent to and accessible by the participant in their daily life was the single most important factor facilitating their sustained participation. If their experiences, feelings, and emotional and mental state achieved a certain level of change in the first few sessions, it created a positive feedback loop that promoted and rewarded their continued participation. It was apparent that their benefit from shamanic healing needed to be greater than their previously held mental and emotional habits in order for them to continue to participate. P1 and P3 had previous mystical experiences with shamanism and/or Native American cosmology, i.e., they had both participated in sweat lodge ceremonies. The SP believed that these experiences predisposed these two men to more readily engage in non-ordinary reality phenomena and trust in the unseen world and the effectiveness of shamanic healing. Thus, they showed significantly more improvements than the other participants in the study. Although P4 had also had a previous mystical Native American experience, it did not pre-dispose him to sustained improvement. Stability at home for both P1 and P3, did not seem to be a contributing factor. Even though P2 and P4 often reported feeling better and lighter at the end of their sessions, they did not experience consistent and lasting relief from their symptoms. One contributing factor may have been that both participants were taking various kinds of medications and some at what appeared to be high doses. The use of these medications may have been an important factor in inhibiting and / or preventing positive shamanic treatment outcomes like those experienced by the other P1 and P3.

Pre-service trauma affected two of the participants’ ability to respond to the shamanic intervention. At times when pre-service trauma was addressed, the awareness of their power animal’s presence appeared to make an impact. Soul Rematrixing and Aspect Maturation were used to address pre-service trauma to varying levels of success. Loss of parents or significant people in their lives was often overwhelming and while some relief was achieved, some old imprints of those losses never subsided (P2 and P4). This was in sharp contrast to P3, who discovered during one of his sessions that a person who died in combat that affected him ever since, had actually saved his life during another combat incident as an angelic intervention. This unveiling permanently changed his perception of his wartime reality. All of the participants had at least one mystical healing experience during one or more of their sessions. The weight of those experiences carried into their daily lives leaving them (as they reported) feeling more at peace, calm, safe and thinking more clearly. The most effective spontaneous intervention that occurred outside the sessions, which was reported on by several of the participants, was the times when their power animal(s) intervened or showed up and assisted them in a time of need. Three of four participants had reduced scores in total PTSD symptoms with two participants having an approximately 30 point drop in their scores. This decrease in PTSD symptoms is much larger than the 10 point change recommended as the minimum threshold for determining whether the improvement is clinically meaningful. Clinically meaningful change certainly occurred for these two participants. Larger studies are needed and warranted to evaluate the efficacy of shamanic healing for PTSD symptoms. Quality of life impairment scores improved in all participants (reflected by decreased values). Interestingly, the Participation in Society subscore improved in all participants. Isolation and avoidance are hallmark features of PTSD that also perpetuate the symptomology. One of the first steps of healing is for the person to step out of isolation and be more willing to experience people, places, and events that may or may not trigger them. The fact that the

shamanic healing allowed for more participation in society for these participants is very hopeful for its ability to break the cycle of isolation and exacerbation of their symptoms. The improvement in Participation in Society is interestingly reflected in the Numbing-Avoiding PTSD symptom being the most improved subscale by points. Spiritual wellness is now being recognized as an important aspect of healing in mental health in general (Moreira-Almeida, Sharma et al.) and it is known to be important in PTSD specifically (Bormann, Thorp et al. , Currier, Holland et al.). Many dimensions of the Spiritual Wellness Inventory improved in the participants (reflected by higher scores post-sessions). For example, the Present-centeredness subscale increased in P1, P3, and P4. The Presentcenteredness scale refers to being present in passing moments. This is incredibly important for people with PTSD who are triggered to re-experiences traumatic events from the past. Anything that supports them to be more in the present could help alleviate their symptoms. Mystery also increased in P1, P2, and P4. The Mystery dimension refers to how a person deals with ambiguity, the unexplained and the uncertainty of life. This too is an essential piece for people with PTSD who often avoid unknown situations where they perceive they may be triggered. Being able to embrace different experiences could counteract avoidance behaviors which perpetuate PTSD psychopathology. The Spiritual Freedom subscale, which increased in P1, P3, and P4, is “related to one's capacity for play, experience of life and the world as "safe," a sense of freedom from fear and desire in living, and one's willingness to make a commitment” was also improved in P1, P3, and P4. This is a core feature often missing in people with PTSD. Being able to re-instill a feeling a safety in the world and freedom from fear and desire in living, could go a long way in alleviating suffering. This study is an uncontrolled case series and results should not be interpreted as definitive evidence for efficacy of shamanic healing for any of the outcomes measured. Larger clinical trials with an appropriate control and number of participants to evaluate efficacy need to be conducted. Improvements to the protocol could include inclusion/exclusion criteria (the ability

to do covariate analysis) for alcohol and drug abuse, severe childhood trauma, unstable home environments, and severe health issues. Including additional educational material about shamanic healing and more introductory information about what the treatment will entail to ensure buy-in and follow-through with the treatment protocol is also recommended. Future studies could be done to evaluate the best number of sessions for optimal effects. While it might be tempting to reduce the number of sessions to eliminate problems with scheduling, healing requires a certain level of frequency and duration in order to ensure retention in the brain and the soul. Future trials would also include long-term follow-up to evaluate whether the gains made immediately after treatment are maintained. Should future controlled clinical trials find shamanic healing to be effective for treating PTSD, the program could be implemented nationally. Ideally, military support networks would subsidize the therapy to ensure that finances were not a “barrier-to-care”. The Department of Defense and Veterans Administration are increasingly interested in complementary and alternative medicine therapies for PTSD treatment (Department of Veteran Affairs & Department of Defense 2010). We hope that unequivocal data from rigorous trials would support the incorporation of shamanic healing programs. We are not promoting shamanic healing as the only therapy for PTSD; however, for those who are interested in such an approach, it may be another option that may incorporate the spiritual root causes of the illness. In conclusion, we found a semi-structured shamanic healing protocol, as a treatment for PTSD, to be feasible and acceptable, especially for Veterans who had some prior knowledge and acceptance of shamanistic concepts. Veterans with stable home environments, without alcohol or drug abuse, preferable without severe childhood trauma, and with schedules and motivation to commit to the sessions are most likely ideal candidates to receive the most benefit from the shamanic protocol. With a greater sample size, we would be able to discover whether these factors are truly important for encouraging efficacy or if we could assist a wider range of people. Implementation of the protocols by different practitioners would also help illuminate how

important client-practitioner relations are to inducing positive results. The results of this small study are supportive of future research in this area. Additional research is needed to evaluate the efficacy of shamanic healing with a randomized controlled trial. Future studies would include more comprehensive self-report assessment of PTSD and PTSD related symptoms like evaluating resilience, sleep, and perceived stress and also physiologic outcomes such as heart rate variability, voice stress analysis, and EEG.

References Blanchard, E. B., J. Jones-Alexander, T. C. Buckley and C. A. Forneris (1996). "Psychometric properties of the PTSD Checklist (PCL)." Behav Res Ther 8870294 34(8): 669-673. Bormann, J. E., L. Liu, S. R. Thorp and A. J. Lang (2012). "Spiritual wellbeing mediates PTSD change in veterans with military-related PTSD." Int J Behav Med 19(4): 496-502. Bormann, J. E., S. Thorp, J. L. Wetherell and S. Golshan (2008). "A spiritually based group intervention for combat veterans with posttraumatic stress disorder: feasibility study." J Holist Nurs 26(2): 109-116. Currier, J. M., J. M. Holland and K. D. Drescher (2015). "Spirituality factors in the prediction of outcomes of PTSD treatment for U.S. military veterans." J Trauma Stress 28(1): 57-64. Department of Veteran Affairs & Department of Defense (2010). VA/DoD Clinical Practice Guideline for the Management of Post-Traumatic Stress. . Washington, DC, Veterans Health Administration, Department of Veteran Affairs, Department of Defense. Engels-Smith, J. (2007). Curriculum Materials. Portland, Oregon, LightSong School of 21st Century Shamanism and Energy Medicine. Engels-Smith, J. (2013). "Extraction: rebalancing the energy system." Sedona Journey of Emergence Nov.

Engels-Smith, J. (2014). Becoming Yourself: The Journey from Head to Heart. Bloomington, IN, iUniverse, Inc. Engels-Smith, J. (2014). "The mystery and magic of power animals." Sedona Journey of Emergence April. Engels-Smith, J. (2015). "Curses, spells, oaths." Lightsong News 8. Fiore, E. (1995). The unquiet dead : a psychologist treats spirit possession. New York, N.Y., Ballantine Books. Garin, O., J. L. Ayuso-Mateos, J. Almansa, M. Nieto, S. Chatterji, G. Vilagut, J. Alonso, A. Cieza, O. Svetskova, H. Burger, V. Racca, C. Francescutti, E. Vieta, N. Kostanjsek, A. Raggi, M. Leonardi and M. Ferrer (2010). "Validation of the "World Health Organization Disability Assessment Schedule, WHODAS-2" in patients with chronic diseases." Health Qual Life Outcomes 20482853 8: 51. Grunert, B. K., J. M. Weis, M. R. Smucker and H. F. Christianson (2007). "Imagery rescripting and reprocessing therapy after failed prolonged exposure for post-traumatic stress disorder following industrial injury." J Behav Ther Exp Psychiatry 18037391 38(4): 317-328. Harner, M. J. (1990). The way of the shaman. San Francisco, Harper & Row. Harner, S. D. (1995). "Immune and affect response to shamanic drumming." ETD Collection for Fordham University Paper AAI9520609. Hoge, C. W., A. Terhakopian, C. A. Castro, S. C. Messer and C. C. Engel (2007). "Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans." Am J Psychiatry 17202557 164(1): 150-153. Ingerman, S. (2008). Soul retrieval : mending the fragmented self. San Francisco, Calif., HarperSanFrancisco. Ingerman, S. and H. Wasserman (2010). Awakening to the Spirit World: The Shamanic Path of Direct Revelation. Boulder, CO., Sounds True, Inc.

Ingersoll, R. E. (1995). Construction and initial validation of the spiritual wellness inventory. PhD, Kent State University. Kang, H. K., B. H. Natelson, C. M. Mahan, K. Y. Lee and F. M. Murphy (2003). "Post-traumatic stress disorder and chronic fatigue syndrome-like illness among Gulf War veterans: a population-based survey of 30,000 veterans." Am J Epidemiol 157(2): 141-148. Kearney, D. J., C. A. Malte, C. McManus, M. E. Martinez, B. Felleman and T. L. Simpson (2013). "Loving-kindness meditation for posttraumatic stress disorder: a pilot study." Journal of Traumatic Stress 26(4): 426-434. Kearney, D. J., C. McManus, C. A. Malte, M. E. Martinez, B. Felleman and T. L. Simpson (2014). "Loving-kindness meditation and the broaden-and-build theory of positive emotions among veterans with posttraumatic stress disorder." Med Care 52(12 Suppl 5): S32-38. Kessler, R. C., W. T. Chiu, O. Demler, K. R. Merikangas and E. E. Walters (2005). "Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication." Archives of General Psychiatry 15939839 62(6): 617-627. Krycka, K. C. (2000). "Shamanic practices and the treatment of life-threatening medical conditions." The Journal of Transpersonal Psychology 32(1): 69-87. Kulka, R., W. Schlenger, J. Fairbank, R. Hough, B. Jordan, C. Marmar and D. Weiss (1990). Trauma and the Vietnam War Generation: Report of Findings from the National Vietnam Veterans Readjustment Study. New York, Routledge. Moreira-Almeida, A., A. Sharma, B. J. van Rensburg, P. J. Verhagen and C. C. H. Cook (2015). WPA Position Statement on Spirituality and Religion in Psychiatry, WPA Section on Religion, Spirituality and Psychiatry. Salomone, P. (2014). Shamanic Depossession: A Compassionate Healing Practice. Placerville, CA, Peter Salomone. Tanielian, T., L. H. Jaycox, T. L. Schell, G. N. Marshall, M. A. Burnam, C. Eibner, B. R. Karney, L. S. Meredith, J. S. Ringel and M. E. Vaiana (2008). Invisible Wounds of War: Psychological

and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA, RAND Center fo Military Health Policy Research. Villaldo, A. (2011). Illumination: The Shaman’s Way of Healing. Carlsbad, CA, Hay House Publishing. Vuckovic, N. H., C. M. Gullion, L. A. Williams, M. Ramirez and J. Schneider (2007). "Feasibility and short-term outcomes of a shamanic treatment for temporomandibular joint disorders." Altern Ther Health Med 13(6): 18-29. Wahbeh, H. (2014). Mindfulness meditation for posttraumatic stress disorder. The Wiley Blackwell Handbook of Mindfulness. A. Ie, C. T. Ngnoumen and E. Langer. Chichester, UK, John Wiley & Sons, Ltd.: 776-793. Wahbeh, H., E. Goodrich, E. Goy and B. S. Oken (2016). "Mechanistic pathways of mindfulness meditation in combat veterans with posttraumatic stress disorder." J Clin Psych 72(4): 365-383. Weathers, F. W., B. T. Litz, D. S. Herman, J. A. Huska and T. M. Keane (1993). The PTSD checklist:reliability, validity, and diagnostic utility. Annual Meeting of the International Society for Traumatic Stress Studies San Antonia, TX. Winkelman, M. (2003). "Complementary therapy for addiction: "drumming out drugs"." Am J Public Health 93(4): 647-651.