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Mindfulness may enhance PTSD treatment
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Mindfulness interventions are safe, inexpensive and effective adjuncts to posttraumatic stress disorder treatment, according to Marina Khusid, MD, ND, MSA, who recently published an article on the subject in the July issue of Psychiatric Annals. The article is the last of a seven-part series on the use of complementary and alternative medicine in the treatment of PTSD.
"Mindfulness-based approaches rapidly grow in popularity and are increasingly employed to treat a number of mental health conditions," said Khusid, a member of the clinical faculty at the department of family medicine, University of Illinois at Chicago.
Marina Khusid
In her article, Khusid explores four types of mindfulness techniques that have the most supportive evidence for their use: mindfulness meditation, mantram repetition, yoga, and relaxation response training.
Although the evidence base is not robust enough to recommend either one as a first-line treatment for PTSD, these techniques can be integrated with more traditional, proven interventions, such as cognitive-behavioral therapy.
According to Khusid, mindfulness encourages veterans to self-manage their care, shifting treatment responsibility from the clinician to the patient. Recent data suggest that self-help strategies have been effective in treating patients with PTSD and anxiety disorders.
Khusid said mindfulness encourages treatment compliance and helps alleviate symptoms associated with the disorder.
"Mindfulness-based interventions decrease avoidance behaviors and negative ruminative thought patterns, improve emotion regulation and impulse control, and encourage self-compassion and successful re-integration into civilian life," she said.
Khusid mentioned that there are currently three times as many clinical trials of mindfulness interventions for PTSD registered with the federal government compared with 2010, indicating a growing interest in the field.
"Mindfulness-based approaches are acceptable in veterans and service members, safe, easy to learn, portable and cost-effective, with encouraging preliminary results in clinical and neuroimaging studies," she said. "Engaging patients in a patient-centered collaborative care model through use of mindfulness approaches to self-manage their chronic mental illness may lead to increased levels of functioning, improved health outcomes, and decreased health care costs."
Disclosure: Khusid reports no relevant financial disclosures.
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Jan Fawcett, MD
I am delighted to see evidence presented in Marina Khusid's article on the benefits of mindfulness for PTSD symptoms. I have had enough experience to know that as contrary to everything I have been taught about attaining the "good life," a life of mindfulness would be as good as it can get. Learning how to attain mindfulness can improve everyone's life.
Compassion increases, my focus increases, I am more calm, I can see the "big picture," and there is rarely a need to hurry or worry. I can appreciate the beauty that life has to offer.
Mindfulness is a way of life quite the opposite of the multitasking that we are taught will lead us to success in contemporary life. Instead of straining to perform multiple tasks at the same time to feel justified in all we have accomplished in a period of time, attaining mindfulness involves sitting quietly, doing absolutely nothing but focusing all thought on breathing (usually a very full inhale to the depths of one's belly followed by a very slow exhale; experts in meditation can take as long as 3 minutes for each breath!).
Through practice, the mind is focused on each breath while thoughts are recognized and gently let go with a focus on the breath. At first, one experiences "monkey mind" — an increase of a multitude of thoughts like monkeys swinging through the forest. But with practice, small gaps of "no thought" or "spaces between thoughts" appear.
With practice, these no-thought periods increase, leaving one with a delicious feeling of relaxation. I find it difficult to become an expert at mindfulness, since life presents so many distractions that limit practice. With even a few sessions, I am uplifted, relaxed, more aware of my surroundings and what people are saying — the beauty of nature all around me. I am living more mindfully. I am living more per unit time, focusing on what is important in life and relishing my consciousness. The more often I practice, the more benefits I feel. The problem is breaking free from the "rat race" of life to practice mindfulness.
I should stop now to practice being mindful.
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Elspeth Cameron Ritchie, MD, MPH
This is the last of the series of seven articles on complementary and alternative, or integrative, medicine to treat PTSD to appear in Psychiatric Annals.
Military service members and veterans often shy away from "traditional" treatments for PTSD, fearing side effects of medication and/or simply not wanting to talk about the trauma.
When I talk to soldiers and Marines about treatment options, they say that mindfulness is an intervention that actually complements their military training. It helps them focus and, thus, be able to shoot better.
One of the most interesting statements in the article is that there are now 28 trials of mindfulness interventions registered with the government. That has tripled from 3 years ago!
Twenty of the 28 are being done by the Department of Defense, the VA or the National Center for Complementary and Alternative Medicine.
Charles Hoge, who is perhaps the most published military psychiatrist ever, penned the commentary for this article. He reminds us that 41% of service members and veterans rely on one or more CAM treatments. As has been a theme of this series, he also stresses the need for rigorous complementary and alternative medicine research.
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