Efficacy of mindfulness-based stress reduction on mood States of veterans with post-traumatic stress disorder

Assessment of post-traumatic stress disorder symptoms during COVID-19 pandemic among medical students

Introduction and Aim: Post traumatic stress disorder is known to be a usual response to distressing experiences. Common symptoms include recurrent events of anxiousness, emotional insensibility and escape mechanism. The COVID-19 pandemic is one such recent occasion that is likely to have an enormous psychological impact on medical student based on extreme social restrictions worldwide. This study therefore aims to investigate the post pandemic PTSD symptoms among first year medical students . Materials and Methods: Department of Physiology, Lord Buddha Koshi Medical College, Saharsa, conducted this observational study for a period of four months starting from September 2020 to December 2020. One hundred and forty-six students completed the most advanced Impact Event Scale -Revised (IES-R) questionnaire. Student’s t-test was performed to analyze the strength of association between PTSD symptoms among the participants.   Results: The study concurs high level of PTSD between age-matched medical students after the occurrence of COVID-19 pandemic. The IES-R method of PTSD scoring system was used to arrive at this conclusion. However, this area of research requires multi-centric results to verify the outcome measures.   Conclusion: Post pandemic PTSD symptoms were high among the first year medical students.

Mind–Body Exercises for PTSD Symptoms, Depression, and Anxiety in Patients With PTSD: A Systematic Review and Meta-Analysis

Objectives

This study aims to systematically analyze the effects of mind–body exercises on post-traumatic stress disorder (PTSD) symptoms, depression, and anxiety in patients with PTSD. Furthermore, it intends to provide scientific evidence-based exercise prescriptions.

Methods

Chinese (i.e., China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, and Wanfang) and English (i.e., Web of Science, PubMed, the Cochrane Library, and EMBASE) databases were used as data sources to search for studies on the effects of mind–body exercises on symptoms associated with patients with PTSD from January 1980 to November 2020. After a rigorous screening, 16 eligible randomized controlled trials (RCTs) were included in the meta-analysis.

Results

Mind–body exercises exerted a significant effect on PTSD symptoms [standard mean difference (SMD) = −0.41, 95% confidence interval (CI) −0.64 to −0.19, p < 0.001], depression (SMD = −0.35, 95% CI: −0.55 to −0.15, p < 0.001), and anxiety (SMD = −0.31, 95% CI: −0.74 to −0.12, p < 0.001) among patients with PTSD. Subgroup analysis demonstrated that 60–150 min per session for 8–16 weeks of mindfulness was more effective in improving symptoms in patients with PTSD under 45 years of age compared with other subgroups. For depression, 150–180 min of yoga exercises once per week was effective. For anxiety, the frequency, timing, duration, and type of mind–body exercises that are most effective in relieving anxiety in patients with PTSD cannot be determined at this time due to the limited number of eligible RCTs.

Conclusions

Mind–body exercises were found to be significantly effective in improving PTSD symptoms, depression, and anxiety in patients with PTSD. Therefore, they can be used as an adjunct to intervention for symptoms of patients with PTSD. However, this conclusion requires further confirmation through additional scientific and objective RCTs.

Systematic Review Registration:

Unique Identifier: INPLASY2020120072.

Mediators for Effect of Mindfulness in Promoting Marital Satisfaction: Modeling Structural Equations in an Experimental Study

Objective: The present study evaluated the model of mediating variables concerning effectiveness of mindfulness in improving women's marital satisfaction. Method: This study was quasi-experimental with pre-test, post-test and control groups. The statistical population included every married woman in Tehran in the year 1396 (2017). The research sample was composed of 60 married women with moderate marital satisfaction. They were chosen using the convenient sampling technique and were randomly assigned to control and experimental groups. The experimental group attended 8 sessions of Mindfulness-Based Stress Reduction (MBSR) and the control group was on a waiting list. Both groups answered the Five Facet Mindfulness Questionnaire (FFMQ), the Depression, Anxiety, and Stress Scale (DASS), Difficulties in Emotion Regulation Scale (DERS), Interpersonal Reactivity Inventory (IRI), Needs for Intimacy Questionnaire of Bagarozi, Positive and Negative Affect Scale (PANAS) and the Couple Satisfaction Index (CSI) before and at end of intervention. The data were analyzed by Structural Equation Modeling (SEM) using PLS-22 and SPSS-23. Results: In the initial hypothetical model, which included the direct effect of mindfulness on marital satisfaction and its indirect effects through psychological distress, emotion regulation, empathy, marital intimacy and positive emotion on marital satisfaction, coefficients of all model paths were significant at 95% level except direct path of mindfulness to marital satisfaction (t = 1.14), marital intimacy to marital satisfaction (t = 0.48) and positive affection to marital satisfaction (t = 1.75). After removing the non-significant paths, the model was tested again and the model fit index (GOF = 0.47) was a very good fit for the modified overall model. Conclusion: The results identified mindfulness-based stress reduction intervention was effective in enhancing marital satisfaction through reducing psychological distress and improving emotion regulation and empathy.

Living the Full Catastrophe: A Mindfulness-Based Program to Support Recovery from Stroke

Decades of research suggest that Mindfulness-Based Stress Reduction (MBSR) training supports a greater capacity to live with chronic medical conditions and contributes to lowering stress levels. This paper introduces a model for a Mindfulness-Based Recovery from Stroke (MBRfS) for promoting stroke recovery, informed by the lived experience of the author (a stroke survivor and certified MBSR instructor), the research literature regarding MBSR training, and the specific challenges of stroke recovery. Four themes emerged from the autoethnographic analysis that informed the proposed model: Readiness to accept the stroke event and the acquired brain injury, navigating uncertainties of stroke recovery with awareness and self-responsibility for outcomes, trusting the inherent wisdom of the body as a stroke recovery "teacher", and increased capacity to integrate complex emotions with self-compassion, and a sense of wholeness. A four-component MBRfS model is offered, which consists of an integration amongst a modified MBSR framework, emergent attitudinal themes, and insights from the autoethnographic vignettes. The MBRfS model offers a path for providing participants with a supportive experience within stroke recovery. Recommendations and suggestions for future studies are offered to support the development of MBRfS for stroke survivors and their caregivers, as well as contributing to healthcare providers.

Efficacy and acceptability of mindfulness-based interventions for military veterans: A systematic review and meta-analysis

BACKGROUND

Military veterans report high rates of psychiatric and physical health symptoms that may be amenable to mindfulness-based interventions (MBIs). Inconsistent prior findings and questions of fit between MBIs and military culture highlight the need for a systematic evaluation of this literature.

OBJECTIVE

To quantify the efficacy and acceptability of MBIs for military veterans.

DATA SOURCES

We searched five databases (MEDLINE/PubMed, CINAHL, Scopus, Web of Science, PsycINFO) from inception to October 16th, 2019.

STUDY SELECTION

Randomized controlled trials (RCTs) testing MBIs in military veterans.

RESULTS

Twenty studies (k = 16 unique comparisons, N = 898) were included. At post-treatment, MBIs were superior to non-specific controls (e.g., waitlist, attentional placebos) on measures of posttraumatic stress disorder (PTSD), depression, general psychological symptoms (i.e., aggregated across symptom domains), quality of life / functioning, and mindfulness (Hedges' gs = 0.32 to 0.80), but not physical health. At follow-up (mean length = 3.19 months), MBIs continued to outperform non-specific controls on general psychological symptoms, but not PTSD. MBIs were superior to specific active controls (i.e., other therapies) at post-treatment on measures of PTSD and general psychological symptoms (gs = 0.19 to 0.25). Participants randomized to MBIs showed higher rates of attrition than those randomized to control interventions (odds ratio = 1.98). Several models were not robust to tests of publication bias. Study quality and risk of bias assessment indicated several areas of concern.

CONCLUSIONS

MBIs may improve psychological symptoms and quality of life / functioning in veterans. Questionable acceptability and few high-quality studies support the need for rigorous RCTs, potentially adapted to veterans.

Mindfulness and yoga for psychological trauma: systematic review and meta-analysis

Mindfulness-based interventions (MBIs), with postures, breath, relaxation, and meditation, such as Mindfulness-based Stress Reduction (MBSR) and yoga, are complex interventions increasingly used for trauma-related psychiatric conditions. Prior reviews have adopted a disorder-specific focus. However, trauma is a risk factor for most psychiatric conditions. We adopted a transdiagnostic approach to evaluate the efficacy of MBIs for the consequences of trauma, agnostic to diagnosis. AMED, CINAHL, Central, Embase, Pubmed/Medline, PsycINFO, and Scopus were searched to 30 September 2018 for controlled and uncontrolled trials of mindfulness, yoga, tai chi, and qi gong in people specifically selected for trauma exposure. Of >12,000 results, 66 studies were included in the systematic review and 24 controlled studies were meta-analyzed. There was a significant, pooled effect of MBIs (g = 0.51, 95%CI 0.31 to 0.71, p < .001). Similar effects were observed for mindfulness (g = 0.45, 0.26 to 0.64, p < .001), yoga (g = 0.46, 0.26 to 0.66, p < .001), and integrative exercise (g = 0.94, 0.37 to 1.51, p = .001), with no difference between interventions. Outcome measure or trauma type did not influence the effectiveness, but interventions of 8 weeks or more were more effective than shorter interventions (Q = 8.39, df = 2, p = .02). Mindfulness-based interventions, adjunctive to treatment-as-usual of medication and/or psychotherapy, are effective in reducing trauma-related symptoms. Yoga and mindfulness have comparable effectiveness. Many psychiatric studies do not report trauma exposure, focusing on disorder-specific outcomes, but this review suggests a transdiagnostic approach could be adopted in the treatment of trauma sequelae with MBIs. More rigorous reporting of trauma exposure and MBI treatment protocols is recommended to enhance future research.

Resolution of Dissociated Ego States Relieves Flashback-Related Symptoms in Combat-Related PTSD: A Brief Mindfulness Based Intervention

A novel understanding and therapeutic approach to the treatment of PTSD-related flashback triggers are described. Triggered responses are conceptualized as the result of latent dissociative structures of neural organization and psychodynamic functioning activated by current events. The dissociative structure - here described as a dissociated ego state (DES) - reflects a fracturing of executive functioning resulting in a delimited aspect of self that is not under cognitive control or subject to cognitive inhibition by the self of daily experience, and is the psychological construct behind intrusive PTSD symptoms. Use of a mindful attentional state permits regulated access to the DES (therapeutic engagement without risk of emotional dysregulation) so that dissociated cognitive resources can be recovered and the dissociated structure deactivated. This may relieve maladaptive responses and behaviors associated with the DES in a profound and durable way, without the need for exposure to or recovery of traumatic memories. Based on this understanding, a 9-step intervention is introduced with a case example of a Vietnam veteran suffering PTSD symptoms for 49 years with significant gains maintained at 21 months follow up. These findings demonstrate rapid and durable resolution of chronic PTSD symptoms through a mindfulness-based approach that focused on deactivation of dissociated ego states, in contrast to targeting trauma memories. If proven efficacious, this novel approach may result in reduced treatment costs and improved outcomes for veterans suffering with PTSD.

Increasing Mindfulness Skills of Veterans With PTSD Through Daily Mindfulness Training Incorporated Into an Intensive Treatment Program

Objectives

Mindfulness training is frequently included as part of an integrative care approach to treating PTSD in veterans. However, the utility and acceptability of daily group mindfulness training in an intensive treatment program (ITP) for PTSD have not been explored. The study objectives were to determine: (a) whether mindfulness skills significantly increased from pre- to post-treatment and (b) if daily group mindfulness training was acceptable to veterans.

Methods

Veterans (N = 170 outpatients, age M = 40.7 (SD 9.3), 67.6% male) in this prospective study were consecutively enrolled in a 3-week ITP that included daily mindfulness group sessions. Mindfulness skills were assessed using the Five Facet of Mindfulness Questionnaire (FFMQ) at intake and post-treatment. Acceptability was assessed using an anonymous post-treatment program satisfaction survey.

Results

Paired t tests demonstrated significant increases in overall mindfulness skills from pre- to post-treatment (t(169) = - 6.33, p < 0.001, d = 0.49). Small to medium effect sizes were observed across subscales: describing, (t(169) = - 5.91, p < 0.001, d = 0.38); acting with awareness, (t(169) = - 3.70, p < 0.001, d = 0.29); nonjudging, (t(169) = - 7.54, p < 0.001, d = 0.58); and nonreactivity, (t(169) = - 4.84, p < 0.001, d = 0.41). Most veterans (n = 125, 74.4%) found daily mindfulness training moderately to very helpful.

Conclusions

Veterans' mindfulness skills significantly increased over the course of a 3-week ITP, and mindfulness training was found acceptable. Mindfulness training can be delivered daily as part of an ITP for veterans with PTSD, and mindfulness skills can meaningfully increase over the course of 3 weeks. A significant limitation is the lack of control condition.

Treatment Engagement and Outcomes of Mindfulness-Based Cognitive Therapy for Veterans with Psychiatric Disorders

Objectives: The aim of this study was to evaluate utilization and outcomes of mindfulness-based cognitive therapy (MBCT) provided to veterans with psychiatric disorders.

Design: Retrospective chart review.

Settings: Veterans Administration Medical Center (VAMC).

Subjects: Ninety-eight veterans with psychiatric illness who were enrolled in an MBCT class between May of 2012 and January of 2016. Subjects were predominately white (95%), male (81%), and >50 years old (74%). The most common psychiatric conditions were any mood disorder (82%) and post-traumatic stress disorder (54%).

Intervention: Eight-week MBCT class.

Outcome measures: Session attendance and pre- to postintervention changes in numbers of emergency department (ED) visits and psychiatric hospitalizations.

Results: The average number of sessions attended was 4.87 of 8 and only 16% were present for all sessions. Veteran demographic variables did not predict the number of MBCT sessions attended. However, both greater numbers of pre-MBCT ED visits (p = 0.004) and psychiatric admissions (p = 0.031) were associated with attending fewer sessions. Among patients who experienced at least one pre- or post-treatment psychiatric admission in the 2 years pre- or postintervention (N = 26, 27%), there was a significant reduction in psychiatric admissions from pre to post (p = 0.002). There was no significant change in ED visits (p = 0.535).

Conclusions: MBCT may be challenging to implement for veterans with psychiatric illness in, at least some, outpatient VAMC settings due to a high attrition rate. Possible mediation approaches include development of methods to screen for high dropout risk and/or development of shorter mindfulness-based interventions (MBIs) and/or coupling MBIs with pleasurable activities. The finding of a significant decrease in psychiatric hospitalizations from pre- to post-MBCT suggests that prospective studies are warranted utilizing MBCT for veterans at high risk for psychiatric hospitalization.

Mindfulness-based resilience training to reduce health risk, stress reactivity, and aggression among law enforcement officers: A feasibility and preliminary efficacy trial

The primary objective of this study was to assess feasibility and gather preliminary outcome data on Mindfulness-Based Resilience Training (MBRT) for law enforcement officers. Participants (n = 61) were randomized to either an 8-week MBRT course or a no intervention control group. Self-report and physiological data were collected at baseline, post-training, and three months following intervention completion. Attendance, adherence, post-training participant feedback, and interventionist fidelity to protocol all demonstrated feasibility of MBRT for law enforcement officers. Compared to no intervention controls, MBRT participants experienced greater reductions in salivary cortisol, self-reported aggression, organizational stress, burnout, sleep disturbance, and reported increases in psychological flexibility and non-reactivity at post-training; however, group differences were not maintained at three-month follow-up. This initial randomized trial suggests MBRT is a feasible intervention. Outcome data suggest MBRT targets key physiological, psychological, and health risk factors in law enforcement officers, consistent with the potential to improve officer health and public safety. However, follow-up training or "booster" sessions may be needed to maintain training gains. A fully powered longitudinal randomized trial is warranted.

Mindfulness-Based Processes of Healing for Veterans with Post-Traumatic Stress Disorder

OBJECTIVE

U.S. veterans are at increased risk of developing post-traumatic stress disorder (PTSD). Prior studies suggest a benefit of mindfulness-based stress reduction (MBSR) for PTSD, but the mechanisms through which MBSR reduces PTSD symptoms and improves functional status have received limited empirical inquiry. This study used a qualitative approach to better understand how training in mindfulness affects veterans with PTSD.

DESIGN

Qualitative study using semistructured in-depth interviews following participation in an MBSR intervention.

SETTING

Outpatient.

INTERVENTION

Eight-week MBSR program.

OUTCOME MEASURE

Participants' narratives of their experiences from participation in the program.

RESULTS

Interviews were completed with 15 veterans. Analyses identified six core aspects of participants' MBSR experience related to PTSD: dealing with the past, staying in the present, acceptance of adversity, breathing through stress, relaxation, and openness to self and others. Participants described specific aspects of a holistic mindfulness experience, which appeared to activate introspection and curiosity about their PTSD symptoms. Veterans with PTSD described a number of pathways by which mindfulness practice may help to ameliorate PTSD.

CONCLUSIONS

MBSR holds promise as a nontrauma-focused approach to help veterans with PTSD.

Psychotherapeutic Group Intervention for Traumatized Male Refugees Using Imaginative Stabilization Techniques-A Pilot Study in a German Reception Center

Background: Due to persecution, human rights violations and armed conflicts, the prevalence of post-traumatic stress disorder (PTSD) is high in refugee populations. Previous studies indicate that trauma-focused treatments are highly effective in treating PTSD in refugees. However, these approaches rely on the stability of the therapeutic setting, treatment continuity, and safe housing. Although early treatment of PTSD is recommended, these requirements are not met in reception centers. Therefore, we conducted a pilot study to examine the effect of imaginative stabilization techniques derived from psychodynamic psychotraumatology therapy for the early stabilization of traumatized refugees in a reception center. Methods: From May 2017 to April 2018, 86 imaginative stabilization group therapy sessions have taken place. A sample of 43 out of 46 traumatized refugees completed self-report questionnaires assessing PTSD, depression, and anxiety symptoms prior to attending open imaginative stabilization group therapy sessions. Furthermore, participants filled in self-report questionnaires on distress and emotional state (valence/arousal/dominance) before and after each session. After having participated in four consecutive sessions, a sub-group of 17 participants completed a follow-up assessment of PTSD, depression, and anxiety symptoms. Follow-up interviews were conducted with 25 participants 2 weeks after their last session attendance to explore self-practice habits post intervention. Results: The pre-post-intervention comparison of scores indicated a significant reduction of distress (z = -3.35, p < 0.001, r = -0.51) and an improvement of affective reports for valence (z = -4.79, p < 0.001, r = -0.82) and dominance (z = -3.89, p < 0.001, r = -0.59), whereas arousal scores were not affected. We found a significant reduction of anxiety symptoms (z = -2.04, p < 0.05, r = -0.49), whereas PTSD and depression scores remained unchanged. Follow-up interviews revealed that 80% of the participants continued to practice the imaginative stabilization techniques after redistribution to other accommodation. Conclusion: The results indicate that imaginative stabilization techniques are a promising and feasible approach to treat refugees in unstable reception center settings. In regular imaginative stabilization group therapy sessions, we were able to reduce the participants' distress and anxiety symptoms while strengthening their internal resources and increasing their emotional stability.

Methylation of FKBP5 and SLC6A4 in Relation to Treatment Response to Mindfulness Based Stress Reduction for Posttraumatic Stress Disorder

Mindfulness Based Stress Reduction (MBSR) is an effective non-pharmacologic treatment for veterans with PTSD. Extensive work has identified epigenetic factors related to PTSD disease risk and pathophysiology, but how these factors influence treatment response is unclear. Serotonin signaling and hypothalamic-pituitary-adrenal (HPA) axis functioning may be perturbed in PTSD and are molecular pathways targeted by PTSD treatments. To identify potential biomarkers for treatment response, we utilized genomic DNA isolated from peripheral blood samples from veterans with PTSD who were responders (n = 11) or non-responders (n = 11) to MBSR as part of a clinical trial. We assessed methylation levels at CpG sites in regions of the serotonin transporter (SLC6A4) previously associated with expression and depression outcomes, as well as the Intron 7 region of the FK506 binding protein 5 (FKBP5) containing known glucocorticoid response elements suggested to regulate this gene. Selected subjects were matched across MBSR responder status by baseline symptoms, age, sex, current smoking status, and current antidepressant use. Percent methylation was compared between responders and non-responders at baseline (pre-MBSR treatment). Additionally, percent change in methylation from baseline to post-treatment was compared between responders and non-responders. There was a significant time x responder group interaction for methylation in FKBP5 intron 7 bin 2 [F _{(1, 19)} = 7.492, p = 0.013] whereby responders had a decrease in methylation and non-responders had an increase in methylation from before to after treatment in this region. Analyses of the three CpG sites within bin 2 revealed a significant time x responder group interaction for CpG_35558513 [F _{(1, 19)} = 5.551, p = 0.029] which resides in a known glucocorticoid response element (GRE). Decreases in FKBP5 methylation after treatment in responders as compared to increases in non-responders suggest that effective meditation intervention may be associated with stress-related pathways at the molecular level. These preliminary findings suggest that DNA methylation signatures within FKBP5 are potential indicators of response to meditation treatment in PTSD and require validation in larger cohorts.

Mindfulness-Based Stress Reduction (MBSR) as a Standalone Intervention for Posttraumatic Stress Disorder after Mixed Traumatic Events: A Mixed-Methods Feasibility Study

Objectives: There is promising evidence that mindfulness-based interventions are effective in reducing the symptoms of posttraumatic stress disorder (PTSD). However, until now, studies have often lacked a full clinical PTSD assessment, and interventions are often administered in addition to other interventions. This study examined the feasibility of mindfulness-based stress reduction (MBSR) as a standalone intervention in patients with PTSD who have experienced mixed traumatic events. Method: Fourteen patients participated in 8 weeks of MBSR. The patients were assessed prior to treatment, post-treatment and at a 1-month follow-up through self-ratings (e.g., the Davidson Trauma Scale) and the Clinician-Administered PTSD Scale to determine the effects of the intervention. Furthermore, after the intervention, the patients participated in qualitative interviews regarding their experiences with MBSR and their ideas for future improvements. Results: Nine patients finished the program, and these patients considered the exercises to be applicable and helpful. In the Clinician-Administered PTSD Scale, we found large effects regarding the reduction of PTSD symptoms among completers (Cohen's d = 1.2). In the Davidson Trauma Scale, the effect sizes were somewhat lower (Cohen's d = 0.6) but nevertheless confirmed the efficacy of MBSR in reducing PTSD symptoms. In the qualitative interviews, the patients reported an augmentation of wellbeing and improvement regarding the handling of difficult situations and more distance from the traumatic event. Conclusion: Despite the large effects, the high dropout rates and the results of the post-treatment interviews suggest that the intervention should be better adapted to the needs of PTSD patients, e.g., by giving more information regarding the exercises and by including shorter exercises to manage acute distress.

The Role of Mindfulness in Reducing the Adverse Effects of Childhood Stress and Trauma

Research suggests that many children are exposed to adverse experiences in childhood. Such adverse childhood exposures may result in stress and trauma, which are associated with increased morbidity and mortality into adulthood. In general populations and trauma-exposed adults, mindfulness interventions have demonstrated reduced depression and anxiety, reduced trauma-related symptoms, enhanced coping and mood, and improved quality of life. Studies in children and youth also demonstrate that mindfulness interventions improve mental, behavioral, and physical outcomes. Taken together, this research suggests that high-quality, structured mindfulness instruction may mitigate the negative effects of stress and trauma related to adverse childhood exposures, improving short- and long-term outcomes, and potentially reducing poor health outcomes in adulthood. Future work is needed to optimize implementation of youth-based mindfulness programs and to study long-term outcomes into adulthood.

Effects of mindfulness-based interventions on biomarkers in healthy and cancer populations: a systematic review

Background

Only a small number of articles have investigated the relationship between mindfulness-based interventions (MBIs) and biomarkers. The aim of this systematic review was to study the effect of MBIs on specific biomarkers (cytokines, neuropeptides and C-reactive protein (CRP)) in both healthy subjects and cancer patients.

Methods

A search was conducted using PubMed, EMBASE, PsycINFO and the Cochrane library between 1980 and September 2016.

Results

A total of 13 studies with 1110 participants were included. In the healthy population, MBIs had no effect on cytokines, but were found to increase the levels of the neuropeptide insulin-like growth factor 1 (IGF-1). With respect to neuropeptide Y, despite the absence of post-intervention differences, MBIs may enhance recovery from stress. With regard to CRP, MBIs could be effective in lower Body Mass Index (BMI) individuals. In cancer patients, MBIs seem to have some effect on cytokine levels, although it was not possible to determine which specific cytokines were affected. One possibility is that MBIs might aid recovery of the immune system, increasing the production of interleukin (IL)-4 and decreasing interferon gamma (IFN-γ).

Conclusions

MBIs may be involved in changes from a depressive/carcinogenic profile to a more normalized one. However, given the complexity and different contexts of the immune system, and the fact that this investigation is still in its preliminary stage, additional randomized controlled trials are needed to further establish the impact of MBI programmes on biomarkers in both clinical and non-clinical populations.

Mechanistic Pathways of Mindfulness Meditation in Combat Veterans With Posttraumatic Stress Disorder

OBJECTIVE

This study's objective was to evaluate the effect of two common components of meditation (mindfulness and slow breathing) on potential mechanistic pathways.

METHODS

A total of 102 combat veterans with posttraumatic stress disorder (PTSD) were randomized to (a) the body scan mindfulness meditation (MM), (b) slow breathing (SB) with a biofeedback device, (c) mindful awareness of the breath with an intention to slow the breath (MM+SB), or (d) sitting quietly (SQ). Participants had 6 weekly one-on-one sessions with 20 minutes of daily home practice. The mechanistic pathways and measures were as follows: (a) autonomic nervous system (hyperarousal symptoms, heart rate [HR], and heart rate variability [HRV]); (b) frontal cortex activity (attentional network task [ANT] conflict effect and event-related negativity and intrusive thoughts); and (c) hypothalamic-pituitary-adrenal axis (awakening cortisol). PTSD measures were also evaluated.

RESULTS

Meditation participants had significant but modest within-group improvement in PTSD and related symptoms, although there were no effects between groups. Perceived impression of PTSD symptom improvement was greater in the meditation arms compared with controls. Resting respiration decreased in the meditation arms compared with SQ. For the mechanistic pathways, (a) subjective hyperarousal symptoms improved within-group (but not between groups) for MM, MM+SB, and SQ, while HR and HRV did not; (b) intrusive thoughts decreased in MM compared with MM+SB and SB, while the ANT measures did not change; and (c) MM had lower awakening cortisol within-group (but not between groups).

CONCLUSION

Treatment effects were mostly specific to self-report rather than physiological measures. Continued research is needed to further evaluate mindfulness meditation's mechanism in people with PTSD.

Effects of mindfulness-based stress reduction on perceived stress and psychological health in patients with tension headache

Background:

Programs for improving health status of patients with illness related to pain, such as headache, are often still in their infancy. Mindfulness-based stress reduction (MBSR) is a new psychotherapy that appears to be effective in treating chronic pain and stress. This study evaluated efficacy of MBSR in treatment of perceived stress and mental health of client who has tension headache.

Materials and Methods:

This study is a randomized clinical trial. Sixty patients with tension type headache according to the International Headache Classification Subcommittee were randomly assigned to the Treatment As Usual (TAU) group or experimental group (MBSR). The MBSR group received eight weekly classmates with 12-min sessions. The sessions were based on MBSR protocol. The Brief Symptom Inventory (BSI) and Perceived Stress Scale (PSS) were administered in the pre- and posttreatment period and at 3 months follow-up for both the groups.

Results:

The mean of total score of the BSI (global severity index; GSI) in MBSR group was 1.63 ± 0.56 before the intervention that was significantly reduced to 0.73 ± 0.46 and 0.93 ± 0.34 after the intervention and at the follow-up sessions, respectively (P < 0.001). In addition, the MBSR group showed lower scores in perceived stress in comparison with the control group at posttest evaluation. The mean of perceived stress before the intervention was 16.96 ± 2.53 and was changed to 12.7 ± 2.69 and 13.5 ± 2.33 after the intervention and at the follow-up sessions, respectively (P < 0.001). On the other hand, the mean of GSI in the TAU group was 1.77 ± 0.50 at pretest that was significantly reduced to 1.59 ± 0.52 and 1.78 ± 0.47 at posttest and follow-up, respectively (P < 0.001). Also, the mean of perceived stress in the TAU group at pretest was 15.9 ± 2.86 and that was changed to 16.13 ± 2.44 and 15.76 ± 2.22 at posttest and follow-up, respectively (P < 0.001).

Conclusion:

MBSR could reduce stress and improve general mental health in patients with tension headache.

Brain and behavior changes associated with an abbreviated 4-week mindfulness-based stress reduction course in back pain patients

INTRODUCTION

Mindfulness-based stress reduction (MBSR) reduces depression, anxiety, and pain for people suffering from a variety of illnesses, and there is a growing need to understand the neurobiological networks implicated in self-reported psychological change as a result of training. Combining complementary and alternative treatments such as MBSR with other therapies is helpful; however, the time commitment of the traditional 8-week course may impede accessibility. This pilot study aimed to (1) determine if an abbreviated MBSR course improves symptoms in chronic back pain patients and (2) examine the neural and behavioral correlates of MBSR treatment.

METHODS

Participants were assigned to 4 weeks of weekly MBSR training (n = 12) or a control group (stress reduction reading; n = 11). Self-report ratings and task-based functional MRI were obtained prior to, and after, MBSR training, or at a yoked time point in the control group.

RESULTS

While both groups showed significant improvement in total depression symptoms, only the MBSR group significantly improved in back pain and somatic-affective depression symptoms. The MBSR group also uniquely showed significant increases in regional frontal lobe hemodynamic activity associated with gaining awareness to changes in one's emotional state.

CONCLUSIONS

An abbreviated MBSR course may be an effective complementary intervention that specifically improves back pain symptoms and frontal lobe regulation of emotional awareness, while the traditional 8-week course may be necessary to detect unique improvements in total anxiety and cognitive aspects of depression.

[Trauma-focused psychotherapy: Technique, area of application, and treatment outcome]

Traumatic events may lead to trauma-related disorders such as the posttraumatic stress disorder (PTSD) and constraints in quality of life. Meanwhile, there are different trauma-focused psychotherapies that aim to prevent PTSD shortly after experiencing a traumatic event and interventions that aim to treat PTSD. In Germany, cognitive-behavioral and psychodynamic trauma-focused approaches are commonly applied. While cognitive-behavioral programs aim at early exposure with the traumatic event, psychodynamic approaches emphasize the need of a period of stabilization before undergoing exposure. With regard to empirical evidence, cognitive-behavioral programs were able to prove their efficacy most often and are recommended in national and international guidelines. The German S3 guideline PTSD is currently under revision.

An Overview of the Research on Mindfulness-Based Interventions for Treating Symptoms of Posttraumatic Stress Disorder: A Systematic Review

OBJECTIVE

This systematic review aimed to collate and evaluate the existing research for the use of mindfulness-based approaches to treat posttraumatic stress disorder (PTSD). Our primary objectives were to explore the effects of mindfulness-based approaches on PTSD symptoms and associated psychological distress, with secondary objectives to explore the attrition rate, adverse effects, resource implications, and long-term effects of such interventions.

METHOD

We systematically searched research databases, EMBASE, OVID MedLine, Psycinfo, CINAHL, and PILOTS, contacted relevant authors in the field, and conducted a hand search of relevant papers.

RESULTS

The search resulted in 12 studies that met eligibility criteria, many of which studies lacked methodological rigor. The majority of the studies indicated positive outcomes with improvements in PTSD symptoms, particularly in reducing avoidance.

CONCLUSIONS

The preliminary evidence for the use of mindfulness-based approaches to treat PTSD symptoms is encouraging, although further studies with a more robust research design are required.

Maladaptive autonomic regulation in PTSD accelerates physiological aging

A core manifestation of post-traumatic stress disorder (PTSD) is a disconnection between physiological state and psychological or behavioral processes necessary to adequately respond to environmental demands. Patients with PTSD experience abnormal oscillations in autonomic states supporting either fight and flight behaviors or withdrawal, immobilization, and dissociation without an intervening “calm” state that would provide opportunities for positive social interactions. This defensive autonomic disposition is adaptive in dangerous and life threatening situations, but in the context of every-day life may lead to significant psychosocial distress and deteriorating social relationships. The perpetuation of these maladaptive autonomic responses may contribute to the development of comorbid mental health issues such as depression, loneliness, and hostility that further modify the nature of cardiovascular behavior in the context of internal and external stressors. Over time, changes in autonomic, endocrine, and immune function contribute to deteriorating health, which is potently expressed in brain dysfunction and cardiovascular disease. In this theoretical review paper, we present an overview of the literature on the chronic health effects of PTSD. We discuss the brain networks underlying PTSD in the context of autonomic efferent and afferent contributions and how disruption of these networks leads to poor health outcomes. Finally, we discuss treatment approaches based on our theoretical model of PTSD.

Mindfulness-based stress reduction (MBSR) reduces anxiety, depression, and suicidal ideation in veterans

INTRODUCTION

Anxiety, depression, and pain are major problems among veterans, despite the availability of standard medical options within the Veterans Health Administration. Complementary and alternative approaches for these symptoms have been shown to be appealing to veterans. One such complementary and alternative approach is mindfulness-based stress reduction (MBSR), a brief course that teaches mindfulness meditation with demonstrated benefits for mood disorders and pain.

METHODS

We prospectively collected data on MBSR's effectiveness among 79 veterans at an urban Veterans Health Administration medical facility. The MBSR course had 9 weekly sessions that included seated and walking meditations, gentle yoga, body scans, and discussions of pain, stress, and mindfulness. Pre-MBSR and post-MBSR questionnaires investigating pain, anxiety, depression, suicidal ideation, and physical and mental health functioning were obtained and compared for individuals. We also conducted a mediation analysis to determine whether changes in mindfulness were related to changes in the other outcomes.

RESULTS

Significant reductions in anxiety, depression, and suicidal ideation were observed after MBSR training. Mental health functioning scores were improved. Also, mindfulness interacted with other outcomes such that increases in mindfulness were related to improvements in anxiety, depression, and mental health functionality. Pain intensity and physical health functionality did not show improvements.

DISCUSSION

This naturalistic study in veterans shows that completing an MBSR program can improve symptoms of anxiety and depression, in addition to reducing suicidal ideations, all of which are of critical importance to the overall health of the patients.

Effect of mindfulness-based stress reduction on pain severity and mindful awareness in patients with tension headache: a randomized controlled clinical trial

Background:

Programs to improve the pain and health status in illnesses with pain such as headache are still in their infancy. Mindfulness-based stress reduction (MBSR) is a new psychotherapy that appears to be effective in treating chronic pain.

Objectives:

This study evaluated efficacy of MBSR in improving pain severity and mindful awareness in patients with tension headache.

Patients and Methods:

This study was a randomized controlled clinical trial that was conducted in 2012 in Shahid Beheshti Hospital of Kashan City. Sixty patients who were diagnosed with tension-type headache according to the International Headache Classification Subcommittee were randomly assigned to treatment as usual (TAU) or MBSR groups. The MBSR group received eight weekly treatments. Any session lasted 120 minutes. The sessions were based on MBSR protocol. Diary scale for measuring headache and Mindful Attention Awareness Scale (MAAS) were administered at pretreatment, and posttreatment, and three-month follow-up in both groups. The data was analyzed using repeated measures analysis of variance.

Results:

The mean of pain severity was 7.36 ± 1.25 before intervention that was significantly reduced to 5.62 ± 1.74 and 6.07 ± 1.08 after the intervention and follow-up (P < 0.001). In addition, the MBSR group showed higher scores in mindful awareness in comparison with the control group at posttest session. The mean of mindful awareness before intervention was 34.9 ± 10.5 and changed to 53.8 ± 15.5 and 40.7 ± 10.9 after the intervention and follow-up sessions (P < 0.001).

Conclusions:

MBSR could reduce pain and improve mindfulness skills in patients with tension headache. It appears that MBSR is an effective psychotherapy for treatment of patients with tension headache.