Mindfulness therapy might help veterans with combat-related post-traumatic stress disorder

(Press-News.org) ANN ARBOR, Mich. — Mindfulness exercises that include meditation, stretching, and acceptance of thoughts and emotions might help veterans with combat-related post-traumatic stress disorder find relief from their symptoms.

A new collaborative study from the University of Michigan Health System and the VA Ann Arbor Healthcare System shows that veterans with PTSD who completed an 8-week mindfulness-based group treatment plan showed a significant reduction in symptoms as compared to patients who underwent treatment as normal.

Mindfulness-based cognitive therapy, or MBCT, combines the practice of cognitive therapy with the meditative approach of mindfulness that stresses an increased awareness of all thoughts and emotions.

Previous research has shown stress reduction classes that use mindfulness meditation have been beneficial to people with a history of trauma exposure -- including veterans, civilians with war-related trauma and adults with a history of childhood sexual abuse – but the new study is the first to examine the effect of mindfulness-based psychotherapy for PTSD with veterans in a PTSD clinic.

The study was published online today in Depression and Anxiety.

"The results of our trial are encouraging for veterans trying to find help for PTSD," says Anthony P. King, Ph.D., the study's lead author and research assistant professor in the U-M Department of Psychiatry, who performed the study in collaboration with psychologists at the VA Ann Arbor Healthcare System. "Mindfulness techniques seemed to lead to a reduction in symptoms and might be a potentially effective novel therapeutic approach to PTSD and trauma-related conditions."

Veterans in the mindfulness treatment groups participated in in-class exercises such as mindful eating, in which they focus on sensations associated with eating very slowly; "body scanning," an exercise where patients focus on physical sensations in individual parts of the body, paying special attention to pain and tension; mindful movement and stretching; and "mindfulness meditation" including focusing on the breath and emotions. The participants were also instructed to practice mindfulness at home through audio-recorded exercises and during the day while doing activities such as walking, eating and showering.

After eight weeks of treatment, 73 percent of patients in the mindfulness group displayed meaningful improvement compared to 33 percent in the treatment-as- usual groups.

King says the most noticeable area of improvement for patients in the mindfulness group was a reduction in avoidance symptoms. One of the main tenets of mindfulness therapy is a sustained focus on thoughts and memories, even ones that might be unpleasant.

"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," King says. "Through the mindfulness intervention, however, we found that many of our patients were able to stop this pattern of avoidance and see an improvement in their symptoms."

Mindfulness techniques also emphasize focus and attention to positive experiences and nonjudgmental acceptance to one's thoughts and emotions. Because of this, the researchers found that the patients in the mindfulness group experienced a decrease in feelings of self-blame and a trend toward decreased perception of the world as a dangerous place.

King says the results of this pilot study are encouraging, but further studies with a larger sample size are needed to fully explore the breadth of mindfulness intervention benefits. He added that the U-M-VA group is currently conducting a larger study including military veterans returning from Iraq and Afghanistan.

"Further studies will help us understand whether mindfulness training is more aptly considered an adjunct option to gold-standard trauma-focused treatments such as prolonged exposure or EMDR, or whether it can function as an intervention in its own right for treating avoidance and other symptoms," he says.

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

### Citation: "A Pilot Study of Group Mindfulness-Based Cognitive Therapy (MBCT) for Combat Veterans with Posttraumatic Stress Disorder (PTSD)," Depression and Anxiety (2013)

Additional authors: Thane M. Erickson, Nicholas D. Giardino, Todd Favorite, Sheila A.M. Rauch, Elizabeth Robinson, Madhur Kulkarni, Israel Liberzon

Funding: Department of Defense TATRC, grant W81XWH0820208 and Mind and Life Institute Varela Award