Posted 09.18.2015 | by AMRA
Nearly a quarter of veterans returning from combat deployment suffer from post-traumatic stress disorder (PTSD). While the Veterans Administration treats many of these veterans with prolonged exposure or cognitive processing therapy, dropout rates remain high (30-44%) and up to half of those receiving therapy fail to improve. There is a need for new therapies that are well tolerated and effective. Polusny et al. [Journal of the American Medical Association] tested the impact of MBSR compared to Present-Centered Group Therapy (PCGT) on PTSD symptoms in a randomized, controlled trial.
Participants were 116 mostly Caucasian, male, and predominantly Vietnam era veterans with PTSD who were recruited from the Minneapolis VA Medical Center and randomly assigned to either MBSR or PCGT, a group treatment focused on resolving current life problems. Participants completed checklists assessing PTSD symptoms, depression, quality of life, and mindfulness (FFMQ) at baseline and again at 3, 6, 9, and 17 weeks. Additionally, participants were interviewed by clinicians before and after treatment and again at two-month follow-up to obtain independent evaluations of diagnoses and symptom severity.
Dropout rates were lower than previously observed with either prolonged exposure or cognitive processing therapy, but the dropout rate was significantly higher for MBSR (22%) than for PCGT (7%). Self-rated PTSD severity improved for both groups from baseline to two-month follow-up, but the average improvement was significantly greater for MBSR (9 points) than PCGT (3 points) participants (Cohen’s d=.40).
Clinician symptom ratings showed significantly greater improvement for MBSR participants (Cohen’s d=.41). MBSR participants also reported significantly greater improvements in mindfulness and quality of life. Increases in mindfulness were significantly associated with improvements in PTSD (r=-.46), depressive symptoms (r=-.44), and quality of life (r=-.42). Using a 10-point improvement as the cut-off for a clinically meaningful effect, more MBSR (49%) participants improved than PCGT (28%) participants.
This experimental study demonstrates MBSR to have a modest but clinically meaningful impact on PTSD symptoms when compared to a more conventional group therapy. The relatively low dropout rate suggests that MBSR may also be better tolerated than other frequently used PTSD treatments for veterans. Study limitations include fewer treatment hours for controls (13.5 hours) than MBSR participants (26.5 hours) and a relatively short follow-up period.
Polusny, M. A., Erbes, C. R., Thuras, P., Moran, A., Lamberty, G. J., Collins, R. C., . . . Lim, K. O. (2015). Mindfulness-Based stress reduction for posttraumatic stress disorder among veterans: A randomized clinical trial. JAMA : The Journal of the American Medical Association, 314(5), 456-465.