June 13, 2011 — Transcendental meditation (TM) may help alleviate symptoms of combat-related post-traumatic stress disorder (PTSD), new research suggests.
In a small pilot study of male veterans from Operation Enduring Freedom and Operation Iraqi Freedom, those who practiced TM showed a significant reduction in PTSD symptoms, significant increases in quality-of-life measures, and improvements in communication and sleep after 8 weeks.
"Even though the number of veterans in this study was small, the results were very impressive as their symptoms improved by 50%," Normal Rosenthal, MD, clinical professor of psychiatry at Georgetown University Medical School and director of research at Capital Clinical Research Associates in Rockville, Maryland, told Medscape Medical News.
"The participants were in extreme distress at the start and the TM technique they learned quite literally transformed their lives," said Dr. Rosenthal.
The investigators add that the participants found TM easy to perform and that the practice was well accepted.
"PTSD doesn't get better on its own very easily; it's very tenacious. So it's gratifying to see a major impact on people from a simple technique that doesn't require highly specialized personnel or equipment and can be done at any time," said Dr. Rosenthal.
This study was published in the June issue of Military Medicine.
"Desperate Need" for New Treatments
According to the study, PTSD's cost to society "ranges from $4.0 to 6.2 billion over 2 years" and affects an estimated 1 in 7 deployed soldiers.
"Although numerous treatments for combat-related PTSD are used, only 1, prolonged exposure therapy, has been deemed effective by a National Academy of Sciences report," write the investigators.
"These veterans aren't receiving the help they need and I don't fault anyone for that. I just think that our resources are being overextended and flooded with this huge mental health problem," said Dr. Rosenthal. "So there's a desperate need for alternative ways to treat these people."
Dr. Rosenthal, who previously worked at the National Institute of Mental Health for 20 years, said he became interested in TM because of its simplicity.
"I've seen lots of things as a senior psychiatrist, and it's really something when I get amazed, which I am with TM. It's not difficult. It is not a religion or philosophy, and it involves no new beliefs or change in lifestyle."
He also noted that TM has no adverse side effects and can be practiced anywhere without the stigma veterans may sometimes feel from seeing a mental healthcare provider.
For the study, 5 male veterans between the ages of 25 and 40 (mean age, 30 years) with a history of moderately severe combat-related PTSD for at least the past month were enrolled. Each had served in Operation Enduring Freedom or Operation Iraqi Freedom for 10 months to 2 years.
All participants were taught the TM technique at baseline and then instructed to practice it at home for 20 minutes twice daily for 3 months. The instructors checked in repeatedly to ensure adherence.
The primary outcome measure was the Clinician-Administered PTSD Scale (CAPS), and secondary outcomes included the Clinician's Global Inventory-Severity (CGI-S) and Improvement (CGI-I) scales, the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), the PTSD Checklist - Military Version (PCL-M), and the Beck Depression Inventory (BDI) scale.
Participants were assessed at baseline and at 8- and 12-week follow-up. For this analysis, the investigators examined data from the 8-week time point.
"Warrants Bigger Studies"
Results showed that study participants had significantly improved scores on the CAPS (mean change, 31.4; P = .02) and significant improvements on the CGI-S (mean change, 1.6; P < .04), the Q-LES-Q (mean change, -13.00; P < .01), and the PCL-M (mean change, 24.0; P < .02).
In addition, all participants reported feeling calmer, less stressed, and less anxious, with some reporting sleep improvements.
"Subjects also described getting along with and communicating better with family, friends, and coworkers and being more engaged in their daily lives," write the study authors.
Dr. Rosenthal reported that 1 veteran was also able to "get off alcohol, which he was abusing to numb his feelings," and another was able to return to college.
He hypothesized that the benefits may be due to the long-term changes in sympathetic nervous system activity that come from regular practice of TM, including decreased blood pressure and lower reactivity to stress.
TM "quiets down the nervous system and slows the elevated 'flight-or-fight' response common in those with PTSD," he explained.
In 1985, a small randomized, controlled trial of Vietnam veterans found that TM was more successful in treating combat-related PTSD than psychotherapy (J Couns Dev. 1985;64:212-215). When Dr. Rosenthal was asked why, on the basis of those findings, TM did not become more popular for treating PTSD back then, he replied, "that's a very good question."
"Sometimes things don't get picked up or followed up for some reason. However, taken together, the results of this and that earlier study support the potential role of TM in improving both PTSD symptoms and quality of life in combat veterans. And I believe it certainly warrants bigger, controlled studies," he said.
"I think we potentially have something really valuable here and I would like to see it used more widely."
Positive Outcomes "Continue to Mount"
The results "show that meditation can have a positive impact on PTSD, a pervasive problem with veterans returning from multiple battlefronts worldwide," Kofi Kondwani, PhD, National Center for Primary Care, Morehouse School of Medicine in Atlanta, Georgia, told Medscape Medical News.
"This study is a very small step that could easily escalate to [bigger] studies, and it opens the door for other mental techniques that may have similar effects to be investigated by the military," added Dr. Kondwani, who was not involved with this research. However, he recently conducted a study, reported by Medscape Medical News, showing that meditation can improve endothelial function in metabolic syndrome among African Americans.
When asked about this study's limitations, Dr. Kondwani expressed concern about the small number of patients involved.
"If 5 people could have been in the study, then 25 also could have been. The cost would not have increased that much. Because of the small [number], we cannot see if there were variations in the outcomes by gender, race, rank, wars, etc.," he said.
"I also would have liked to see other outcome measures, such as blood pressure, anxiety, or depression, as they are often confused with PTSD."
Still, Dr. Kondwani noted that the simplicity and cost-effectiveness of meditation as a serious treatment modality "is very appealing" and that every effort is warranted to investigate its use. He added that he would like to see efforts and studies organized to prevent PTSD from occurring in the first place.
"Can meditation taught to troops before they enter the battle zone reduce the occurrence of PTSD years later? I hypothesize that it can."
Overall, Dr. Kondwani said that the number of studies showing positive outcomes for meditation continues to mount.
"It can also serve as a preventative and/or treatment approach without the need to identify specific problems. Participants in this study did not meditate on reducing PTSD, they just meditated. It's a systemic practice that will serve individuals in countless ways for the rest of their lives," he concluded.
The study was funded by the Dalio Family Foundation and Center for Environmental Therapeutics. The study authors have disclosed no relevant financial relationships, but Dr. Rosenthal is author of the book Transcendence: Healing and Transformation Through Transcendental Meditation. Dr. Kondwani has disclosed no relevant financial relationships but did report teaching Consciously Resting Meditation.
Mil Med. 2011;176:626-630. Abstract
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