Treating patient populations with significant psychiatric and neurocognitive symptomatology can present a unique clinical dilemma: progress in psychotherapy can be significantly fettered by cognitive deficits, whereas neurocognitive rehabilitation efforts can be ineffective because of psychiatric overlay. Application of mindfulness-based interventions to address either cognitive or psychiatric symptoms in isolation appears efficacious in many contexts; however, it remains unclear whether this type of intervention might help address simultaneous neurocognitive and psychiatric symptomatology. In a pre-post mixed methods design pilot study, nine Veterans with post-traumatic stress disorder (PTSD) and a history of mild traumatic brain injury with chronic cognitive complaints participated in Mindfulness-Based Stress Reduction (MBSR). Clinical interview, questionnaires, and attention and PTSD measures were administered immediately before, immediately after, and 3 months after MBSR completion. Qualitative and quantitative findings suggest high levels of safety, feasibility, and acceptability. Measurement of attention revealed significant improvement immediately following MBSR (p < 0.05, d = 0.57) and largely sustained improvement 3 months after completion of MBSR (p < 0.10, d = 0.48). Significant reduction in PTSD symptoms was found immediately after MBSR (p < 0.05, d = -1.56), and was sustained 3 months following MBSR completion (p < 0.05, d = -0.93). These results warrant a randomized controlled trial follow-up. Potential mechanisms for the broad effects observed will be explored.
This pilot study aims to investigate whether a novel mind-body intervention, Mindfulness Based Tinnitus Stress Reduction (MBTSR), may be a beneficial treatment for chronic tinnitus. Eight tinnitus patients who had previously received Tinnitus Counseling (standard of care) at the University of California, San Francisco (UCSF) Audiology Clinic participated in the MBTSR program. The program included 8 weeks of group instruction on mindfulness practice, a 1-day retreat, supplementary readings, and home-based practice using meditation CDs. Using a prepost intervention design, mean differences (paired t-tests) were calculated. Benefits were measured by a reduction in clinical symptoms, if present, and a tinnitus symptom perception shift. Tinnitus symptom activity and discomfort as well as psychological outcomes were assessed by self-report questionnaires. Both quantitative and qualitative data were gathered. Results indicate that Effect Sizes, if supported by a larger study, may be clinically significant and demonstrate a substantial decrease for items measuring perceived annoyance and perception of handicap of tinnitus. Change scores on study measures all moved in the hypothesized direction, with the exception of negligible change found for the Acting with Awareness (d=−0.05) factor of mindfulness. This pilot study provides preliminary evidence that an 8-week MBTSR program may be an effective intervention for treating chronic tinnitus and its comorbid symptoms, and may help reduce depression and phobic anxiety while improving social functioning and overall mental health. These promising findings warrant further investigation with a randomized controlled trial.
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