Introduction: Despite increasing interest in complementary and alternative health (CAM) interventions for treating Veterans with post-traumatic stress disorder (PTSD), comprehensive evidence is lacking. This rapid review aimed to synthesize evidence regarding benefits of CAM interventions for improving mental health and quality of life among Veterans with PTSD in Five Eyes countries (Canada, US, UK, Australia, and New Zealand). 

Methods: We searched MEDLINE, PsycINFO, and AMED for studies that enrolled Veterans with PTSD and their families from Five Eyes countries between 2013 to December 2023, evaluated CAM interventions, and assessed changes in mental health outcomes using validated scales or evaluated cost-effectiveness. Randomized controlled trials (RCTs) with at least 10 participants in each arm, and comparative and one-arm observational studies with at least 30 participants, were included. The search strategy was defined with support from established search language and descriptions of CAM by the National Center For Complementary and Alternative Medicine. Screening took place in duplicate; data extraction and risk of bias (Cochrane RoB 2; ROBINS-I) were assessed by one reviewer and verified by a second reviewer. We pooled estimates of efficacy and effectiveness, and assessed certainty of evidence using GRADE. 

Results: Twenty-six RCTs and 14 observational studies with 3,321 participants (84.4% male, median age 51.4 years) were included. Twenty-three (88%) of the RCTs and all 14 (100%) observational studies were assessed as high risk of bias. Only one study involving service animals reported cost outcomes. Moderate-quality evidence suggests meditation (WMD: -10.66, 95% CI: -15.00 to -6.32), Emotional Freedom Technique (EFT) (MD: -27.00, 95% CI: -32.09 to -21.91), and Sudarshan Kriya Yoga (SKY) (MD: -20.50, 95% CI: -28.81 -12.19) reduce PTSD symptoms greater than the minimal important difference (MID). Meditation and EFT improve depression and anxiety, while SKY improves depression greater than one MID. SKY and EFT result in clinically meaningful improvements in PTSD and other mental health outcomes, but the evidence base is limited. High to moderate-quality evidence for mantram repetition and moderate-quality evidence for mindfulness-based stress reduction suggest reduced PTSD and depression by less than one MID, and improved quality of life.

Conclusion: Meditation may result in clinically meaningful reductions in PTSD, depression and anxiety for Veterans, but limited evidence exists assessing effects in families of Veterans with PTSD or cost-effectiveness. Further research is warranted to better understand effectiveness of these, and other CAM interventions for Veterans with PTSD.