Mechanistic Pathways of Mindfulness Meditation in Combat Veterans With Posttraumatic Stress Disorder

Abstract

Objective This study’s objective was to evaluate the effect of two common components of meditation (mindfulness and slow breathing) on potential mechanistic pathways. Methods 102 combat veterans with posttraumatic stress disorder (PTSD) were randomized to: 1) the body scan mindfulness meditation (MM), 2) slow breathing (SB) with a biofeedback device, 3) mindful awareness of the breath with an intention to slow the breath (MM+SB), or 4) sitting quietly (SQ). Participants had six weekly one-on-one sessions with 20 minutes of daily home practice. The mechanistic pathways and measures were: 1) Autonomic Nervous System: hyperarousal symptoms, heart-rate (HR), heart-rate variability (HRV); 2) Frontal Cortex Activity: Attentional Network Task (ANT) conflict effect and event-related negativity, and intrusive thoughts; and 3) Hypothalamic-pituitary-adrenal axis: awakening cortisol. PTSD measures were also evaluated. Results Meditation participants had significant but modest within-group improvement in PTSD and related symptoms although there were no between-group effects. Perceived impression of PTSD symptom improvement was greater in the meditation arms compared to controls. Resting respiration decreased in the meditation arms compared to SQ. For the mechanistic pathways 1) Subjective hyperarousal symptoms improved within-group (but not between-group) for MM, MM+SB, and SQ while HR and HRV did not; 2) Intrusive thoughts decreased in MM compared to MM+SB and SB while the ANT measures did not change; and 3) MM had lower awakening cortisol within-group but not between-group. Conclusion Treatment effects were mostly specific to self-report rather than physiological measures. Continued research is needed to further evaluate mindfulness meditation’s mechanism in people with PTSD.

Meditation in Stressed Older Adults: Improvements in Self-Rated Mental Health Not Paralleled by Improvements in Cognitive Function or Physiological Measures

“…In contrast, there were significant improvements in most of the standardized, self-rated measures related to negative mood and stress. The finding that a meditation intervention produced benefits in psychological measures but not in cognitive or physiological measures is consistent with some meta-analyses of meditation interventions (Abbott et al, 2014; Goyal et al, 2014a) and another recent study (Wahbeh, Goodrich, Goy, & Oken, 2016). However, this trend in the literature contrasts with many individual MM intervention studies that demonstrate some effect on cognition or physiology with intervention lengths both longer and shorter than 6 weeks (Chiesa et al, 2011; Jha, Krompinger, & Baime, 2007; Jha, Stanley, Kiyonaga, Wong, & Gelfand, 2010; Kaul, Passafiume, Sargent, & O’Hara, 2010; Moore, Gruber, Derose, & Malinowski, 2012; Semple, 2010; Tang et al, 2007; Zeidan, Johnson, Diamond, David, & Goolkasian, 2010).…”

Meditation and yoga for posttraumatic stress disorder: A meta-analytic review of randomized controlled trials

“…Studies included in the current analysis evaluated mindfulness-based stress reduction (MBSR; k = 8; Bränström, Kvillemo, & Moskowitz, 2012; Davis (unpublished); Heffner et al 1, 2016; Kearney, McDermott, Malte, Martinez, & Simpson, 2013; Niles, McDermott, Malte, Martinez, & Simpson, 2012; Polusney et al, 2015; Possemato, Bergen-Cico, Treatman, Allen, Eaker, & Pigeon, 2016; Wahbeh et al, 2016) and mind-body bridging (MBB; k = 1; Nakamura, Lipschitz, Landward, Kuhn, & West, 2011). MBSR is a manualized treatment typically conducted in group format.…”

“…Of these, however, two studies used a three arm trial design (two intervention groups versus a single control group; Heffner, Crean, & Kemp 2a,b, 2016; Wahbeh, Goodrich, Goy, & Oken, 2016). Two approaches were used to handle these statistically dependent ES s. The first, and more simpler approach, was to average ES s within each of these two studies (Higgins, Meeks, & Altman, 2011; Lipsey & Wilson, 2001) using the formulas put forth by Higgins and Deeks (2011).…”

A systematic review of randomized trials of mind‐body interventions for PTSD

“…Mind–body interventions may encourage tolerance of negative physical and emotional states for individuals with PTSD and promote approach‐oriented coping (Vujanovic et al., ) that can empower individuals to engage in healthy lifestyle habits. Furthermore, these interventions may reduce persistent hyperarousal symptoms (Wahbeh, Goodrich, Goy, & Oken, ) that perpetuate physical and psychological dysregulation and thus initiate a positive cycle of enhanced health. In order to facilitate comparisons and aggregation of findings across studies, researchers should include both between‐ and within‐group effect sizes when presenting results and employ common tools that assess these broader issues.…”