Meditation, Mindfulness Exercises Reduce PTSD Symptoms

Deborah Brauser

April 26, 2013

Mindfulness treatment that includes meditation, stretching, and emotional acceptance can help lower symptoms of posttraumatic stress disorder (PTSD), new research suggests.

A small pilot study of veterans with combat-related PTSD showed that 73% of those who received 8 weeks of mindfulness-based cognitive therapy (MBCT) had significant reductions in overall PTSD symptoms compared with 33% those who underwent treatment as usual (TAU). The intervention group also showed significant decreases in avoidance and numbing symptoms.

Lead author Anthony P. King, PhD, told Medscape Medical News that this intervention is generalizable to other populations struggling with PTSD — especially in light of previous research, which has suggested that it can reduce stress in several different categories of trauma-exposed individuals.

"This type of therapy can give patients tools to actively start engaging in their life. And it may help prepare them for more intensive forms of individual therapy," said Dr. King, research assistant professor of psychiatry at the University of Michigan in Ann Arbor.

The investigators note that the study findings are "particularly noteworthy" because of the intervention's short duration and that the participants had had their PTSD symptoms for 15 to 50 years.

"Mindfulness-based therapies provide a strategy that encourages active engagement without explicit cognitive restructuring or exposure to trauma memories, are relatively easy to learn, and can be administered in an efficient group format," write the researchers.

"Despite the small sample, patients who completed the MBCT...showed meaningful improvements in both PTSD symptoms and cognitions," they write, adding that future studies with larger sample sizes and a longer follow-up are now needed.

The study was published online April 17 in Depression and Anxiety.

Feasible, Acceptable

Past research has shown that mindfulness meditation used in stress reduction classes provides substantial benefits to people with a history of trauma exposure — including veterans, civilians with war-related trauma, and adults with a history of childhood sexual abuse, report the investigators.

For this study, they sought to assess "the feasibility, acceptability, and clinical outcomes" of a group MBCT intervention in veterans with combat PTSD of longer than 10 years' duration.

A total of 37 outpatients from a Veterans Affairs PTSD clinic were enrolled. The participants, who had taken part in conflicts during World War II or in Korea, Vietnam, or Operation Desert Storm, received 8 weeks of either MBCT (n = 20; mean age, 60.1 years) or TAU (n = 17; mean age, 58.3 years).

The MBCT intervention was modified for PTSD and included psychoeducation and in-class exercises such as mindful eating, focusing on pain and tension in specific parts of the body, mindful movement and stretching, and meditation that focused on breathing and emotions. In addition, the participants took part in audio-recorded exercises while going about their normal daily activities and recorded this information in weekly homework logs.

The 20 participants who received MBCT were divided into 4 smaller subgroups for the in-class portion of the intervention.

Those receiving TAU were divided into 3 subgroups. One group received 8 weekly 1-hour sessions of psychoeducation about PTSD and ways to deal with it, and the other 2 groups received 6 weekly 1.5-hour group sessions of imagery rehearsal therapy.

The clinician-administered PTSD scale (CAPS) was used at baseline and at the end of therapy. The MBCT groups also completed the self-reported Posttraumatic Diagnostic Scale (PDS) and the Posttraumatic Cognitions Inventory (PTCI). The PTCI measures such negative conditions as incompetent self, self-blame, and negative/dangerous world.

Potential as Monotherapy?

Results showed that the MBCT groups had a significant 11-point mean decrease in total CAPS score (P < .001). There was not a significant reduction in total CAPS score or any subscale score for the TAU groups.

In addition, 5 of the participants in the MBCT groups and 4 of the participants in the TAU groups discontinued treatment within their first 3 sessions. The number of study completers who showed a reduction of 10 points on the total CAPS was significantly greater in the MBCT groups than in the TAU groups (73% vs 33%, P < .05).

The intervention group also showed significant improvements in PTSD symptom severity, as shown on both the CAPS and the PDS.

"The results of our trial are encouraging for veterans trying to find help for PTSD," said Dr. King in a release.

He noted that the most noticeable area of improvement for those in the MBCT group was a reduction in CAPS avoidance (P < .001) and PDS numbing (P = .03) symptoms.

"Part of the psychological process of PTSD often includes avoidance and suppression of painful emotions and memories, which allows symptoms of the disorder to continue," he said, adding that through the MBCT intervention, patients were able to stop that pattern.

In addition, the intervention group showed a significant decrease in feelings of self-blame, as shown on the PTCI (P = .02), and a trend toward decreased perception of the world as a dangerous place.

Although the results are encouraging, Dr. King noted that more studies with larger sample sizes are needed. One such larger study is currently underway by the investigators and includes military veterans returning from Afghanistan and Iraq.

"Further research is needed to determine whether mindfulness training is more aptly considered an adjunct option to the gold-standard treatment of prolonged exposure, or whether [these therapies] can function as interventions...in their own right," write the investigators.

"Either way, mindfulness-based therapies provide a strategy that encourages active engagement for participants, are easy to learn, and appear to have significant benefits," said Dr. King.

He pointed out, though, that he does not believe that 8 weeks of MBCT are as effective as more intensive forms of therapy. "But for people who maybe aren't ready for trauma-focused therapy, it looks like there are significant, and clinically relevant, areas of improvement."

The study was funded by a grant from the Department of Defense Telemedicine and Advanced Technology Research Center and by the Mind and Life Institute Varela Award. The study authors have reported no relevant financial relationships.

Depression Anxiety. Published online April 17, 2013. Abstract

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