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Transcendental Meditation as effective as prolonged exposure therapy for PTSD
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Transcendental Meditation, a non-trauma-focused intervention, was noninferior to prolonged exposure therapy in reducing PTSD symptom severity and comorbid depression in veterans with PTSD, according to findings from a randomized controlled trial.
These results, published in The Lancet Psychiatry, indicated that Transcendental Meditation may be effective as an alternative therapy for veterans with PTSD.
“There is an urgent need for government agencies to discover and implement viable evidence-based treatments, including non-trauma-based, to address the problem of PTSD in veterans and other at-risk populations,” Sanford Nidich, EdD, director of the Center for Social and Emotional Health at Maharishi University of Management Research Institute, Fairfield, Iowa, told Healio Psychiatry. “The current randomized controlled clinical trial ... was funded by the U.S. Department of Defense for the purpose of evaluating the effectiveness of Transcendental Meditation, a non-trauma-focused practice, to reduce PTSD symptoms in veterans.”
Researchers compared Transcendental Meditation with prolonged exposure therapy in a noninferiority, randomized controlled trial to examine the change in PTSD symptom severity over 3 months via Clinician-Administered PTSD Scale (CAPS) score. They also compared both therapies with a control of PTSD health education, hypothesizing that reduction in self-reported PTSD symptoms via the PTSD Checklist–Military version (PCL–M) would be greater with these therapies than with PTSD health education. In addition, they examined treatment effects on comorbid depression using the Patient Health Questionnaire (PHQ)-9.
The investigators randomly allocated 203 veterans with PTSD to receive one of the three treatments provided in 12 sessions over 12 weeks with daily home practice. Participants typically received Transcendental Meditation and PTSD health education in a group setting while prolonged exposure therapy was given individually.
In total, 68 veterans were assigned to the Transcendental Meditation group, 68 to the prolonged exposure therapy group and 67 to the PTSD health education group. Overall, 61% of veterans receiving Transcendental Meditation, 42% of those receiving prolonged exposure therapy and 32% of those receiving health education showed clinically significant improvements in PTSD symptom severity.
Transcendental Meditation was significantly noninferior to prolonged exposure therapy in PTSD symptom severity measured by CAPS, self-reported PTSD symptoms measured by PCL-M and comorbid depression measured by PHQ-9 scores after adjusting for covariates.
n addition, Transcendental Meditation and prolonged exposure therapy were superior to the active control treatment. Using standard superiority comparisons, Nidich and colleagues found that both Transcendental Meditation and prolonged exposure therapy resulted in significant decreases in CAPS scores compared with PTSD health education.
“The results of the clinical trial indicate that Transcendental Meditation may provide a viable alternative option for treating veterans with PTSD,” Nidich told Healio Psychiatry.
“Transcendental Meditation could be readily implemented in government health care systems in the U.S. and other countries to help treat veterans who do not respond to or avoid treatment with trauma-focused therapies,” Nidich continued. “[It] may also be considered as an adjunctive treatment and licensed clinicians are encouraged to work with certified Transcendental Meditation instructors to provide the best possible treatment for veterans, based on veteran preference and response to treatment.”
These findings provide evidence that support Transcendental Meditation for PTSD, but more study is needed to determine the economic effect of this intervention, Vernon Anthony Barnes, PhD, from Augusta University, wrote in a related editorial. Prior research has shown health care use and costs decrease with Transcendental Meditation practice, he explained.
“Since patients with PTSD have lifelong high medical costs, especially with multiple chronic conditions, one could infer at least a cumulative savings in costs,” Barnes wrote. “[Transcendental Meditation] training could have a substantial effect on health as an adjunct to the standard of care and might have considerable value to improve the quality of life for military service members.” – by Savannah Demko
Disclosures: Nidich reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. Barnes reports no relevant financial disclosures.
Editor's Note: The perspective was updated on January 21, 2019.
Perspective
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Nils Westfall, MD
The results of this small-to-medium size randomized controlled trial carried out by Nidich et al are valuable additions to the accumulating evidence that non-trauma-focused psychotherapy can be as efficacious for treating PTSD as the gold standard, trauma-focused psychotherapy. In this study, generic transcendental meditation (TM) delivered largely in group settings by a few certified instructors was shown to be at least as efficacious for the treatment of military-related PTSD as prolonged exposure therapy (PE) delivered to subjects individually by two novice PE practitioners; one wonders how much more efficacious PE — which is a very challenging modality for therapists and patients — would have been if delivered by highly experienced PE practitioners.
It is notable that TM did not need to be geared specifically to or led by instructors with backgrounds in PTSD to achieve a large effect size. Considering also that it was delivered in group settings, the study suggests that TM may have a number of economic advantages over PE. The potential for TM to offer patients with PTSD a legitimate alternative to PE is important because many therapists and PTSD patients find PE aversive or intimidating, PE has relatively high dropout rates, there is some evidence that engaging in a preferred psychotherapy modality improves PTSD treatment outcomes, and certain PTSD patients or symptoms may respond better to TM than PE, although further research is needed to determine if and to what extent that is the case.
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