Mindfulness-based therapy eases veterans' PTSD symptoms

Some veterans may experience a sharper decline in symptoms of post-traumatic stress disorder (PTSD) with mindfulness-based stress reduction therapy than with other forms of group treatment, a study suggests.

Researchers gave one group of veterans with PTSD eight weekly 2.5-hour sessions focused on mindfulness and meditation, as well as a day-long retreat, and compared their progress to their peers who received nine weekly 1.5-hour group sessions designed to address specific problems stemming from PTSD in daily life.

With mindfulness-based therapy, 49 percent of veterans reported a dramatic reduction in PTSD symptoms, compared with just 28 percent of their peers who didn’t receive this type of treatment.

“Overall, the evidence from this study suggests mindfulness-based stress reduction therapy may be a promising treatment for PTSD,” lead study author Melissa Polusny, of the Minneapolis Veterans Affairs Health Care System, said by email.

Roughly one in four veterans returning from deployments in Afghanistan and Iraq suffer from PTSD, Polusny and colleagues report in JAMA, the journal of the American Medical Association.

Mindfulness-based group sessions help veterans learn meditation techniques they can use at home to cultivate awareness of the present moment during ordinary daily activities such as driving or eating, she said. Breathing exercises and practices such as yoga are also used to help encourage body awareness and focus on the present.

The other treatment used in the study, known as present-centered group therapy, fosters concentration on the impact of trauma and PTSD symptoms on daily life, with an emphasis on problem-solving and coping mechanisms, she said.

Researchers randomly assigned 116 veterans recruited in 2012 and 2013 to receive one of the two types of therapy.

Veterans reported a greater improvement in quality of life after two months with the mindfulness-based therapy than the alternative approach.

With mindfulness-based therapy, veterans also reported a bigger reduction in depression symptoms, but the difference between the groups wasn’t big enough to rule out the possibility that it might have been due to chance.

And while the veterans in the mindfulness group were more likely to report that their PTSD symptoms had improved, those self-reported improvements didn't mean they were any likelier to be cured of their PTSD. In fact, after two months, the percentages of patients who no longer had a PTSD diagnosis were similar, at 53 percent with mindfulness training and 47 percent without it.

One limitation of the study is that the mindfulness training involved more hours of treatment than the problem-solving therapy, though the researchers say this reflects the way these treatments are typically provided in real life.

It's also possible that the two-month follow-up period was too short and that the differences in outcomes might not persist over a longer period time, Dr. David Kearney and Tracy Simpson, of the VA Puget Sound Health Care System in Seattle, noted in an editorial accompanying the study.

The mindfulness approach probably works by reducing hyper-vigilance associated with PTSD, said Dr. Charles Hoge, a senior scientist at Walter Reed Army Institute of Research in Silver Spring, Maryland.

“However, this is only one component of effective treatment,” Hoge, who wasn’t involved in the study, said by email.

Other components of PTSD treatment include narration of traumatic experiences, examining thoughts surrounding the trauma such as self-blame, and exercises focused on learning to face situations that trigger strong reactions, Hoge said.

“Service members and veterans with debilitating PTSD symptoms often need more than one approach to treatment, and may also need more than nine sessions of treatment,” Hoge added.

Even so, relaxation training and stress reduction are often seen as the “aspirin of behavioral medicine,” said Dr. Alan Peterson, a psychologist at the University of Texas Health Science Center in San Antonio who specializes in combat-related PTSD.

“Mindfulness-based stress reduction approaches are likely to work just as well for non-veterans who have been exposed to civilian traumas such as physical or sexual assaults,” Peterson, who wasn’t involved in the study, said by email.