Therapeutic Boxing + Acupuncture in the Treatment of Complex Posttraumatic Stress Disorder (CPTSD) - An Introduction to an Innovative Combination of Treatment Methods including a Case Report

Background: Complex posttraumatic stress disorder (CPTSD) results from particularly severe, often long-lasting and/or repetitive trauma. In addition to the familiar symptoms of Posttraumatic Stress Disorder (PTSD) (symptom triad of recollection, avoidance, hyperarousal), CPTSD is characterised by a complex structure of cognitive, affective and social interaction aspects. As a result, all areas of the affected person's life may be impaired. Those affected by CPTSD often experience lower self-esteem and reduced self-efficacy compared to those who are not affected (cf. Simmen-Janevska et al., 2012). Therapeutic boxing (TB) uses movements, techniques and exercises derived from boxing to enable practitioners and students to experience and relearn body awareness and needs. This can open up previously unknown or long-lost experiences of self-efficacy for the participant. As with other psychovegetative indications, acupuncture is used in the treatment of PTSD and CPTSD. The combination of acupuncture and conventional guideline-based trauma therapy has already proven to be more successful for PTSD than conventional trauma therapy alone (Engel et al., 2014). Acupuncture impacts systems involved in emotional sensation, such as the serotonergic system (Yoshimoto et al. 2006) at the transmitter level, or the limbic system and the prefrontal cortex at a functional level (Wahbeh et al., 2015), and appears to be suitable for alleviating PTSD-associated symptoms (Ding et al. 2020). Based on the observed, assumed, and proven mechanisms of action of both therapeutic methods presented here, a combined application of the two appears to be useful in the treatment of Complex Posttraumatic Stress Disorder. Goals: This article examines the combination of therapeutic boxing and acupuncture with regard to CPTSD on the basis of a case report. A hypothesis regarding the possible effectiveness of therapeutic boxing is introduced. In addition, the state of research regarding therapeutic boxing in general, and the use of acupuncture for PTSD/CPTSD in particular is explored. Case description: The TB student, who is diagnosed with CPTSD and severely impaired in various areas of her life, had far-reaching experiences of increased self-efficacy attending therapeutic boxing which had a positive effect on her everyday life outside of therapeutic boxing. Acupuncture helped her to cope better with CPTSD-related physical symptoms and intense feelings that were perceived as uncomfortable. Conclusion: Based on the observations and statements described in the case report, it can be hypothesised that practicing therapeutic boxing may lead to experiences of increased self-efficacy. (Re-)Learning to act out suppressed feelings of anger and being able to appropriately manage one's own strength might be identifiable mechanisms behind the observed experiences of increased self-efficacy of those affected by CPTSD. Therapeutic boxing and acupuncture - either on their own or in combination - appear to contribute to the alleviation of even severe complex post-traumatic stress disorders. Considering the potential scientific and social relevance, there appears to be a well-founded and urgent need for further research.