Complementary and integrative health approaches, such as mindfulness meditation, are intended to be integrated with evidence-based treatment, such as trauma-focused psychotherapy and antidepressant medications, wrote Lori L. Davis, M.D., the associate chief of staff for Research and Development Service at the Veterans Affairs Medical Center in Tuscaloosa, Ala., and colleagues.
Veterans with a diagnosis of PTSD were recruited from three clinical research sites and randomly assigned to receive eight weekly, 90-minute sessions (n=214) of either MBSR or PCGT. Patients were evaluated using the Clinician-Administered PTSD Scale for DSM-IV (CAPS-IV) and the 17-item PTSD Checklist-Self Report at the start of the study as well as at weeks 3, 6, 9, and 16.
MBSR is a technique taught in a series of classes that trains individuals to focus attention on thoughts, sensations, and feelings as they appear. The MBSR group received training in various meditation and stretching techniques, with a focus on mindful awareness, participated in a six-hour retreat, and were given two guided meditation CDs for home use. The PCGT treatment focused on creating an atmosphere of shared support among veterans and helping them to increase their awareness and objectivity of how PTSD affects one’s daily life. The PCGT sessions included discussion of the everyday problems of group members and of how PTSD created or intensified these problems, the authors wrote. Participants in the PCGT group were assigned to keep a journal and had a lunch gathering prior to week 8.
Both the MBSR and PCGT groups achieved significant improvement in PTSD symptoms over time (as measured by their CAPS-IV scores), with no significant differences between groups. Participants in the MBSR group did show a significant improvement in PTSD based on their self-reported PTSD Checklist scores over the nine weeks, compared with the those in the PCGT group; however, this difference was not maintained posttreatment, at week 16.
“The overall small effect sizes of mindfulness-based meditation should be viewed with caution in the context of larger effect sizes of trauma-focused behavioral psychotherapies,” Davis and colleagues concluded. “As with all complementary and integrative health approaches, mindfulness-based meditation should be a supplement to, not a replacement for, trauma-focused behavioral psychotherapies. Additional studies are needed to better understand the effects of MBSR for the treatment of PTSD.”
For related information, see the American Journal of Psychiatry article “Individual Treatment of Posttraumatic Stress Disorder Using Mantram Repetition: A Randomized Clinical Trial.”