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Complementary/Alternative Medicine Increasingly Used for PTSD Treatment

by U.S. Medicine

March 9, 2015

Meditation Helps Relieve Symptoms

By Annette M. Boyle

SYRACUSE, NY — Both active-duty forces and veterans have widely adopted complementary and alternative medicine (CAM), and the applications for these interventions and practices have continued to expand, in many cases with strong research as well as anecdotal support.

For a number of years, researchers at the VA and DoD have focused on the use of these nonpharmacological approaches as alternatives to opioids for patients with chronic pain. Post-traumatic stress disorder (PTSD) has more recently emerged as an application for which CAM — especially meditation — offers real promise. In addition to meditation, CAM includes practices such as acupuncture, massage, biofeedback, guided imagery, qi gong, Reiki, aromatherapy and supplements.

PTSD remains a critical challenge for veterans. The lifetime prevalence of PTSD among Vietnam-era veterans is 30.9% for men and 26.9% for women, while 13.8% of veterans of Operation Enduring fFreedom and Operation Iraqi Freedom have been diagnosed with PTSD, according to the VA. The disorder is characterized by recurrent, intrusive memories of a traumatic event, persistent avoidance of stimuli associated with the event, hyperarousal, negative mood and often impaired cognition and sleep.

Conventional therapy for PTSD includes selective serotonin reuptake inhibitors (SSRIs) and prazosin. The VA also has recommended cognitive processing therapy, exposure therapy and eye movement desensitization reprocessing. Despite these options, many veterans continue to struggle with PTSD, often finding the pharmacological solutions ineffective and the psychotherapeutic approaches too time-consuming or difficult to access.

Meditation Benefits

Dessa Bergen-Cico, PhD

Dessa Bergen-Cico, PhD

Meditation offers one nontraditional option that can be delivered inexpensively to veterans in group settings or individually at home. Three studies in a recent CAM supplement in the journal Medical Care present positive results from two different forms of meditation for veterans with PTSD.

“Veterans with PTSD are somewhat of a challenge in terms of resistance to treatment and other issues,” said Dessa Bergen-Cico, PhD, assistant professor at Syracuse University.

To develop a therapeutic program that would meet the needs of veterans, who are often dubious about the benefit of psychotherapy or other treatments for PTSD, Bergen-Cico, Wilfred Pigeon, PhD, of the Canandaigua, NY, VAMC, and Kyle Possemato, PhD, of the Center for Integrated Healthcare in Syracuse, NY, designed a short course of mindfulness meditation.1

“We had seen in previous research with other populations that the greatest improvements seemed to occur in the first half of the program, so we tested a four-week program that could be integrated into primary care,” Bergen-Cico said. “Eight weeks of commitment can seem daunting, particularly for people who have previously stated that they were not willing or interested in more intensive therapies like exposure therapy or counseling.”

Participating in the study were 40 veterans with PTSD; 21 received treatment as usual, and 19 participated in the meditation program. Researchers measured effectiveness using the objective biomarker cortisol. Cortisol output increases during distress, and abnormal cortisol levels are associated with exacerbations of PTSD. After four sessions, veterans significantly reduced their cortisol awakening response (CAR), indicating that the brief program had a beneficial effect.

Cortisol measures did not change in participants who did not complete the four-session course, indicating a minimum threshold needed for neurobiological benefit.

“We saw great results in four weeks. Our hope was that, if they had initial success, they might continue with meditation or it might give them enough of a foundation to do one-on-one clinical work for which they didn’t have the emotional resources and grounding before,” Bergen-Cico said.

“Meditation helps with the complex issues involved in PTSD. It helps parts of the brain with reintegration and giving brief amount of space to not react, while fostering self-compassion and reducing explosive anger and hypervigilance,” she noted.

While effective, the program could use some tweaking. “We had just 90-minute sessions. I would expand that to a two-hour minimum and offer more of an orientation at the beginning. A lot of veterans came in thinking it would be talk therapy.”

The researchers also would like to offer a second brief four-week program or opportunities for longer meditative practice. Participants were given CDs with guided meditation for home practice as well as written materials and resources in the community that offer other programs.

In one of the other mindfulness meditation studies, researchers compared usual treatment alone to the use of a mantram repetition program (MRP) as an adjunct to usual treatment for PTSD in 146 veterans with PTSD from military-related trauma. Usual treatment continued for 75 veterans; 71 participated in a six-week MRP. 2

A mantram is a silently repeated sacred word or phrase to promote mindfulness. Mantram repetition does not require a quiet setting or particular position and can be practiced anywhere at any time.

Jill Bormann, PhD, of the VA San Diego Healthcare System and the VA Center of Excellence for Stress and Mental Health, and colleagues found that the MRP increased mindful attention, reduced PTSD symptoms and depression and improved other psychological well-being measures.

Participants in the MRP averaged eight sets of mantram repetitions per day. Researchers noted a significant dose-response effect.

The third meditation study involved a 12-week course of loving-kindness meditation among 42 veterans with PTSD. Loving-kindness meditation focuses on identification and expansion of perceived opportunities in the environment that are associated with positive emotions, a process known as “broaden and build.” In addition, it helps individuals reduce their preoccupation with past events, negativity and shame.3

Over the course of the study, the researchers found “promising changes in built personal resources over time, including environmental mastery, personal growth, purpose in life, and self-acceptance.” They also noted increases in self-compassion and mindfulness.

1 Bergen-Cico D, Possemato K, Pigeon W. Reductions in cortisol associated with primary care mindfulness-based intervention for veterans with PTSD. Med Care. 2014;52(suppl 5):S25–S31.

  • Bormann JE, Oman D, Walter KH, et al. Mantram repetition improves mindfulness awareness in military veterans with posttraumatic stress disorder: a randomized trial. Med Care. 2014;52(suppl 5):S13-S18.
  • Kearney DJ, McManus C, Malte CA, et al. Loving-kindness meditation and the broaden-and-build theory of positive emotions among veterans with posttraumatic stress disorder. Med Care. 2014;52(suppl 5):S32–S38.

4 Comments

  • Colleen Ambrozy says:

    mantra, not mantram……patients may be confused by the incorrect spelling. thank you.

  • Colleen Ambrozy says:

    mantra, not mantram……patients may be confused by the incorrect spelling. thank you.

  • Jill Bormann says:

    No, actually, in this program, the term “mantram” rather than “mantra” is purposely used to designate the origin of the program to Eknath Easwaran. For more information, see:
    http://www.easwaran.org or http://www.jillbormann.com

    Mantram (spelled with an “m”) is done to differentiate from other forms of “mantra” meditation such as Transcendental Medition (TM), for example.

  • Jill Bormann says:

    No, actually, in this program, the term “mantram” rather than “mantra” is purposely used to designate the origin of the program to Eknath Easwaran. For more information, see:
    http://www.easwaran.org or http://www.jillbormann.com

    Mantram (spelled with an “m”) is done to differentiate from other forms of “mantra” meditation such as Transcendental Medition (TM), for example.


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