Healing through culture: Kava-talanoa as a PTSD therapeutic framework

Abstract

Introduction: The incidence of post-traumatic stress disorder (PTSD) is increasing, particularly among military personnel, first responders (police, fire, ambulance), and prison officers. PTSD is also a health economic burden, with costs linked to treatment, long-term morbidity, and increased mortality risk. Many cases go undiagnosed due to factors such as trauma-related avoidance behavior, which also negatively impacts PTSD therapy (Watkins et al., 2018, Front. Behav. Neurosci., 12:1-9). There is a significant unmet need for improved and culturally aligned PTSD treatments in the Pacific and beyond. Medical standards of care for acute anxiety/PTSD typically involve psychotropic drugs such as benzodiazepines, tricyclic antidepressants, and antipsychotics. These medications offer short-term relief only, carry addictive risks, are contraindicated for key populations (e.g., the elderly), and have had harmful effects in indigenous communities. Kava (Piper methysticum) is a traditional, culturally significant Pacific Island beverage known for its soporific and relaxant effects, similar to benzodiazepine (Sarris et al., 2012, J. Hum. Psychopharmacol. Clin. Exp., 27:262-9). Unlike benzodiazepines, kava is non-addictive with regular use and extremely safe—regulated as ‘food’ in several countries (Aporosa, 2019, J. Drug Sci. Policy Law, 5:1-13). Kava does not induce marked euphoria or hallucinations (Aporosa et al., 2022, J. Ethnopharm., 291:1-15), and promotes productive discussion known as talanoa—a form of ‘talk therapy’ (Vaka et al., Issues Ment. Health Nurs., 37:537-544). Methods: This ethics approved (21/372) study was guided by the faikava talanoa methodology (Aporosa et al., 2021, Pacific Dynamics, 5:74-92). Self-report experiences of Pacific-based UK and US military veterans and serving combat returnees (n=40) were documented in traditionally influenced kava-use spaces in which attendees engaged in talanoa. While exact kava consumption volumes were not measured, participants typically consumed 3.6 litres (6.33 pints) of kava—approximately 5,000 mg of kavalactones— over six hours. Focused coding was utilised to analyse participant comments. Results: Participants reported that engagement in talanoa within traditionally influenced kava-use spaces increased their relational connectedness, improved meaning making of trauma experiences and promoted better sleep. Conclusions: Aided by kava’s anxiolytic soporific effects, it is suspected that kava use with talanoa reduces the triggering of ‘fear structures’, minimizes avoidance behavior and aids sleep quality, contributing to symptom reduction. Further, we believe that kava-talanoa offers an innovative, culturally augmented, A56 ABSTRACTS group-based CBT intervention (Aporosa et al., 2025, Front. Psychol., doi:10.3389/fpsyg.2025.1460731). The f indings serve as a foundation for clinical trials (underway) to determine the efficacy of the approach as a much-needed transcultural treatment of trauma that addresses the global PTSD burden.