Rethinking Post-Traumatic Stress Disorder: A Systems-Level Disorder of Stress Dysregulation and the Role of Complementary and Alternative Medicine.

Post-traumatic stress disorder (PTSD) is traditionally viewed as a brain-centered disorder characterized by impaired fear extinction and dysregulated emotional processing. Despite advances in pharmacologic and psychotherapeutic interventions, treatment resistance remains a major challenge for a substantial proportion of patients, highlighting the complexity of PTSD pathophysiology beyond central neural mechanisms. In addition, PTSD is associated with persistent dysregulation of systemic stress-regulatory networks, including the autonomic nervous system, immune-inflammatory pathways, and the gut-brain axis. This Opinion proposes that complementary and alternative medicine (CAM) interventions may exert therapeutic effects in PTSD by restoring disrupted homeostatic regulation across these interconnected systems. CAM modalities, such as acupuncture, herbal medicine, yoga, and breathing-based practices, may converge on common regulatory targets, including enhancement of vagal tone, modulation of inflammation, and stabilization of gut-brain communication. We propose that inconsistent clinical outcomes of CAM interventions in patients with PTSD may reflect, in part, inadequate patient stratification and outcome measures rather than an absence of therapeutic effects. Reconceptualizing PTSD as a disorder of systemic stress dysregulation provides a framework for investigating how CAM interventions might contribute mechanistically to an integrated, precision-oriented treatment paradigm.