In a randomized trial including veterans with post-traumatic stress disorder, 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.

OT_News-01Findings were published in the Aug. 4 issue of JAMA, a violence/human rights theme issue.

PTSD affects 23% of veterans returning from Afghanistan and Iraq, according to a meta-analysis published in the Journal of Anxiety Disorders. Past research has shown that left untreated, PTSD is associated with high rates of other disorders, disability and poor quality of life.

Evidence suggests mindfulness-based stress reduction, an intervention that teaches individuals to attend to the present moment in a nonjudgmental and 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, according to background information in the journal article. Mindfulness-based interventions also might be an acceptable type of intervention for veterans who have poor adherence to existing treatments for PTSD, according to the article.

Melissa A. Polusny, PhD, of the Minneapolis Veterans Affairs Health Care System, and her colleagues randomly assigned 116 veterans with PTSD to receive either nine sessions of mindfulness-based stress reduction therapy (58 veterans) or present-centered group therapy (58 veterans), an active-control condition consisting of nine weekly group sessions focused on current life problems. The outcomes were assessed before, during and after treatment and at a two-month follow-up.

Participants in the mindfulness-based stress reduction group demonstrated greater improvement in self-reported PTSD symptom severity during treatment and at two-month follow-up, the study found. Although participants in the mindfulness-based stress reduction group were more likely to show clinically significant improvement in self-reported PTSD symptom severity (49% vs. 28% with present-centered group therapy) at two-month follow-up, results showed there was no difference in rates of loss of PTSD diagnosis at post-treatment (42% vs. 44%) or at two-month follow-up (53% vs. 47%).

“Findings from the present study provide support for the efficacy of mindfulness-based stress reduction for the treatment of PTSD among veterans,” the researchers wrote. “However, the magnitude of the average improvement suggests a modest effect.”

The study was conducted with resources and the use of facilities at the Minneapolis VA Health Care System. This research was supported by a VA grant to Kelvin O. Lim, MD, of the University of Minnesota, Minneapolis.

In an accompanying editorial, David J. Kearney, MD, and Tracy L. Simpson, PhD, of the VA Puget Sound Health Care System, Seattle, wrote that the study’s findings are promising but more research is needed.

“The rate of clinically significant PTSD symptom reduction of 49% for those randomized to mindfulness-based stress reduction 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% found in a before-and-after study of MBSR among veterans,” they wrote in the editorial. “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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