Posted 11.29.2015 | by AMRA

sand_bags_170

Depending on the arena of combat in which they were deployed, up to 31% of all veterans suffer from posttraumatic stress disorder (PTSD). The symptoms of PTSD include hyperarousal, emotional numbing, flashbacks, and nightmares coupled with avoidance of the cues that trigger them. Veterans are also at increased risk for co-morbid depression, substance abuse, relationship difficulties, and medical illness.

While the Department of Defense and the Veterans Administration employ several empirically-supported PTSD treatments, less than 30% of those who start treatment complete it, and up to 60% of those who complete treatment fail to obtain significant symptom relief.

There is a growing interest in exploring mindfulness-based interventions (MBIs) as integrative treatments for PTSD. MBIs are multidimensional interventions, however, and there is a lack of knowledge as to the relative benefit of their various intervention components (e.g., the body scan, breath awareness) on symptoms. Colgan et al. [Mindfulness] examined the efficacy of two stand-alone MBSR components (the body scan and mindful breathing) in a randomized controlled trial of veterans with PTSD.

The researchers randomly assigned 102 predominantly male (96%), middle-aged (average age = 52), Caucasian (77%) combat veterans with chronic PTSD to one of four treatment groups: two “mindful” conditions — either the Body Scan or Mindful Breathing, and two “non-mindful” control conditions — either Slow Breathing or Sitting Quietly.

The groups met for six one-hour sessions over a six-week period. Each group session included 20 minutes of practice in the designated technique along with reviews of home practice and, for the mindfulness groups only, discussions of the principles of mindfulness.

The Slow Breathing condition learned how to reduce their respiration rate through biofeedback, and the Sitting Quietly group sat quietly while listening to a neutral content book on tape. All participants were assessed before and after treatment on self-report measures of depression symptoms, mindfulness (the Five Facet Mindfulness Questionnaire), and a PTSD symptom self-report checklist.

The changes in outcome measures over time did not differ significantly between the different groups. Since this was an exploratory study, the researchers examined the pattern of significant individual pre-post and between group comparisons to see how closely they conformed to their hypotheses. The Body Scan group showed a significant increase in levels of overall mindfulness (Cohen’s d=0.44) and Acting with Awareness (d=0.68) from pre- to post-assessment. At post-intervention, the Mindful Breathing group reported higher levels of overall mindfulness than the Slow Breathing (d=0.55) and Sitting Quietly (d=0.83) groups.

Depression scores decreased for the Body Scan (d=0.65) and Mindful Breathing (d=0.41) groups, and at post-intervention, the Body Scan group reported lower depression scores than the Slow Breathing group (d=0.74). There were significant decreases in PTSD symptoms for the Body Scan group (d=0.47), the Mindful Breathing group (d=0.47), and the Sitting Quietly group (d=0.43).

The finding for the Sitting Quietly control was surprising since it was not conceived of as a credible active treatment. In the Body Scan group, improvements in Acting with Awareness were significantly correlated with decreased depression (r=-0.53), while within the Mindful Breathing group, increases in Describing (r=-0.42) and Non-reactivity (r=-0.45) were significantly correlated with decreased PTSD symptoms.

These findings only partially support the hypotheses that stand-alone mindfulness practices can increase mindfulness and reduce PTSD and depressive symptoms, and that increased mindfulness is associated with clinical improvement. The study also suggests that stand-alone mindfulness components may be less powerful in inducing change than fully integrated multi-component programs.

These results need to be interpreted with caution, however. The lack of overall significant differences in changes to the outcome measures over time between groups coupled with the large number of individual pre-post and between group comparisons increases the risk of spurious findings. The small sample size per treatment group also increases the risk of failing to detect actual differences.

Reference:

Colgan, D. D., Christopher, M., Michael, P., & Wahbeh, H. (2015). The body scan and mindful breathing among veterans with PTSD: Type of intervention moderates the relationship between changes in mindfulness and post-treatment depression. Mindfulness.

[Link to abstract]