Loving-kindness meditation may reduce veterans’ PTSD symptoms

Loving-kindness meditation reduced PTSD symptoms among veterans, according to results of a randomized clinical trial published in JAMA Network Open.

“A non–trauma-focused intervention with preliminary support for treating PTSD is loving kindness meditation, a practice intended to increase feelings of kindness and compassion,” David J. Kearney, MD, of the VA Puget Sound Health Care System in Seattle, and colleagues wrote. “Loving-kindness meditation is theorized to increase the ability to tolerate, rather than avoid, distressing thoughts, images and feelings and to counteract shame, guilt and emotional numbing, which are central symptoms of PTSD. This study tested whether loving-kindness meditation was noninferior to [cognitive processing therapy].”

The researchers evaluated PTSD and depression at baseline, after treatment and 3- and 6-month follow-up among 184 veterans (mean age, 57.1 years; 83.2% men) who met DSM-5 PTSD criteria recruited from a single Veterans Affairs medical center between Sept. 24, 2014, and Feb. 5, 2018. They randomly assigned 91 participants to 12 weekly 90-minute groups sessions of loving-kindness meditation, which incorporated silent repeating of phrases meant to instill feelings of kindness for oneself and others, and 93 participants to 12 weekly 90-minute group sessions of cognitive processing therapy, which combined cognitive restructuring with emotional processing of content linked to trauma. Change in PTSD and depression scores over 6-month follow-up, evaluated via the Clinician-Administered PTSD Scale (CAPS-5) and Patient-Reported Outcome Measurement Information System (PROMIS) depression measures, served as co-primary outcomes. Further, they used five points on the CAPS-5 and four points on the PROMIS depression measure as margins for noninferiority.

Results showed a mean baseline CAPS-5 score of 35.5 and a mean baseline PROMIS depression score of 60.9. Mean CAPS-5 scores among the 121 veterans with 6-month follow-up data were 28.02 (95% CI, 24.72-31.32) for cognitive processing therapy and 25.95 (95% CI, 22.62-29.23) for loving-kindness meditation, for a difference of 2.09 (95% CI, 2.59 to 6.78). Mean PROMIS depression scores 6 months after treatment were 61.22 (95% CI, 59.21-63.23) for cognitive processing therapy and 58.88 (95% CI, 56.86-60.91) for loving kindness meditation, for a difference of 2.34 (95% CI, 0.52 to 5.19). Superiority analyses revealed no significant between-group differences in CAPS-5 scores; however, the researchers observed greater reductions in PROMIS depression scores for loving-kindness meditation compared with cognitive processing therapy.

“Further qualitative research would help to clarify the acceptability of loving-kindness meditation for PTSD,” Kearney and colleagues wrote. “Overall, loving-kindness meditation shows promise as a treatment for PTSD, and the findings warrant replication.”