Mindfulness-Based Therapy for PTSD Trumps Usual Care

Liam Davenport

August 10, 2015

Veterans with posttraumatic stress disorder (PTSD) experience clinically significant improvements in symptoms with a mindfulness-based therapy over and above those seen with a standard intervention, preliminary findings from a US study indicate.

Compared with patient-centered group therapy, the researchers found that mindfulness-based stress reduction (MBSR) was associated with significant improvements in self-reported symptoms that persisted beyond the 9-week course and translated into clinically significant improvements in many cases.

Although the results are promising and warrant further study, it was noted that the therapy did not improve rates of patients no longer classified as having PTSD on clinician assessment.

"Among veterans with PTSD, mindfulness-based stress reduction therapy, compared with present-centered group therapy, resulted in a greater decrease in PTSD symptom severity," the investigators write.

"However, the magnitude of the average improvement suggests a modest effect," they add.

The research was published online August 4 in JAMA.

Significantly Greater Improvement

For the study, 116 veterans with PTSD at the Minneapolis Veterans Affairs (VA) Medical Center, in Minnesota, were randomly assigned either to nine sessions of mindfulness-based stress reduction, consisting of 8 weekly sessions of 2.5 hours and one day-long retreat, or to present-centered group therapy, comprising nine weekly 1.5-hour sessions, which served as active control.

Using the PTSD Checklist scores at baseline and at weeks 3, 6, 9, and 17, the team found that patients assigned to mindfulness-based stress reduction had significantly greater improvements in self-reported PTSD symptom severity compared with patients in the active control both during treatment (P < .002) and at 2-month follow-up (P < .001).

Furthermore, participants assigned to mindfulness-based stress reduction were significantly more likely to show a clinically significant improvement in their self-reported PTSD symptoms at 2- month follow-up compared with the patients undergoing present-centered group therapy, at 48.9% vs 28.1% (P = .03).

It was reported, however, that patients receiving MBSR were no more likely to have a loss of PTSD diagnosis on the Clinician-Administered PTSD Scale at follow-up compared with active control patients, at 53.3% vs 47.3% (P = .55).

Unexpected Finding

Speaking to Medscape Medical News, Melissa A. Polusny, PhD, of the Minneapolis Veterans Affairs Health Care System, noted: "I think one of the interesting findings that wasn't particularly expected was that, while both the treatments resulted in improvements in what veterans described as their quality of life, gains in quality of life were maintained for veterans in the mindfulness-based stress reduction 2 months after the treatment."

"But when the veterans ended present-centred therapy...their perceptions of their quality of life went back down to baseline, so those improvements weren't sustained for that group once they ended therapy.

"I think that points to the idea that in mindfulness-based stress reduction, veterans are learning skills in being mindful that are helping them to have a different relationship with their symptoms, that those mindfulness skills are related to the improvements that they see in PTSD symptoms, depression, and quality of life," she added.

Nevertheless, Dr Polusny believes that more research is required. She said: "This is one study that is showing a positive effect, and we believe that it would be important to replicate these findings in other samples of veterans across different centers."

"[We are] looking at the possibility of a multisite study that might help us to replicate/confirm these findings, which would be important before we work on rolling out or disseminating these treatments more broadly."

One factor that weighs in favor of mindfulness-based stress reduction is that it was associated with a low dropout rate.

Dr Polusny observed that although many of the established first-line treatments offered by the VA are effective, "veterans are having a hard time completing them, and if you don't complete treatment, the likelihood of benefitting from that treatment goes down."

She continued: "We found that the dropout rate from mindfulness-based stress reduction was only 22%, compared to the 30% to 50% we see with some of these other treatments."

"It might be that for some veterans that have had difficulties tolerating those other treatments, this might be a good option for them; they might benefit from this kind of treatment, whereas they've not been able to tolerate other treatments."

Durable Effect?

In an accompanying editorial, David J. Kearney, MD, and Tracy L. Simpson, PhD, of the VA Puget Sound Health Care System, Seattle, Washington, were cautious in their assessment of the findings.

"Although the results reported by Polusny et al are promising, the short duration of follow-up calls into question whether the effects of mindfulness-based stress reduction persist over time; thus, additional studies of mindfulness-based stress reduction and other mindfulness-based interventions for PTSD are warranted," they write.

Offering a broad assessment of several interventions for PTSD, including two studies in the same issue of JAMA, Dr Kearney and Dr Simpson note that many of the currently available treatments do not focus sufficiently on quality of life as an outcome.

"A potentially advantageous aspect of mindfulness-based interventions is that they may provide benefit for domains of health beyond PTSD symptomatology," they write.

"A recent VA Evidence-based Synthesis Program report indicated a benefit of mindfulness-based stress reduction for overall health status, depression, chronic illness, and possibly pain ― conditions that commonly accompany PTSD."

"Given that PTSD is a disabling and often persistent illness that can affect individuals exposed to different types of trauma, it is essential to develop therapeutic alternatives for patients to achieve their personal therapeutic goals," they conclude.

The authors and editorialists report no relevant financial relationships.

JAMA. Published online August 4, 2015. Full text, Editorial

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