In a randomized trial that included veterans with posttraumatic stress disorder (PTSD), those who received mindfulness-based stress reduction therapy showed greater improvement in self-reported PTSD symptom severity, although the average improvement appears to have been modest, according to a study in the August 4 issue of JAMA, a violence/human rights theme issue.
Posttraumatic stress disorder affects 23 percent of veterans returning from Afghanistan and Iraq. Left untreated, PTSD is associated with high rates of other disorders, disability, and poor quality of life. Evidence suggests that mindfulness-based stress reduction, an intervention that teaches individuals to attend to the present moment in a nonjudgmental, accepting manner, can result in reduced symptoms of depression and anxiety. By encouraging acceptance of thoughts, feelings, and experiences without avoidance, mindfulness-based interventions target experiential avoidance, a key factor in the development and maintenance of PTSD, and may be an acceptable type of intervention for veterans who have poor adherence to existing treatments for PTSD, according to background information in the article.
Melissa A. Polusny, Ph.D., of the Minneapolis Veterans Affairs Health Care System, and colleagues randomly assigned 116 veterans with PTSD to receive nine sessions of mindfulness-based stress reduction therapy (n = 58) or present-centered group therapy (n = 58), an active-control condition consisting of nine weekly group sessions focused on current life problems. Outcomes were assessed before, during, and after treatment and at 2-month follow-up.
Participants in the mindfulness-based stress reduction group demonstrated greater improvement in self-reported PTSD symptom severity during treatment and at 2-month follow-up. Although participants in the mindfulness-based stress reduction group were more likely to show clinically significant improvement in self-reported PTSD symptom severity (49 percent vs 28 percent with present-centered group therapy) at 2-month follow-up, there was no difference in rates of loss of PTSD diagnosis at posttreatment (42 percent vs 44 percent) or at 2-month follow-up (53 percent vs 47 percent).
"Findings from the present study provide support for the efficacy of mindfulness-based stress reduction for the treatment of PTSD among veterans," the researchers write. "However, the magnitude of the average improvement suggests a modest effect."
Editorial: Broadening the Approach to Posttraumatic Stress Disorder and the Consequences of Trauma
David J. Kearney, M.D., and Tracy L. Simpson, Ph.D., of the VA Puget Sound Health Care System, Seattle, comment on the findings of this study in an accompanying editorial.
"The rate of clinically significant PTSD symptom reduction of 49 percent for those randomized to mindfulness-based stress reduction (MBSR) is similar to that reported for empirically supported treatment approaches to PTSD ... and consistent with the rate of clinically significant improvement in PTSD symptoms of 48 percent found in a before-and-after study of MBSR among veterans. Although the results reported by Polusny et al are promising, the short duration of follow-up calls into question whether the effects of MBSR persist over time; thus, additional studies of MBSR and other mindfulness-based interventions for PTSD are warranted."
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