PTSD

Improve the Brain’s Regulation of Emotions in PTSD with Mindfulness

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By John M. de Castro, Ph.D.

 

“Mindfulness can help people train themselves to get unstuck from a vicious cycle of negative thinking, often a cornerstone of trauma.” – Jennifer Wolkin

 

Experiencing trauma is quite common. It has been estimated that 60% of men and 50% of women will experience a significant traumatic event during their lifetime. But, only a fraction will develop Post-Traumatic Stress Disorder (PTSD). But this still results in a frightening number of people with 7%-8% of the population developing PTSD at some point in their life. For military personnel, it’s much more likely for PTSD to develop with about 11%-20% of those who have served in a war zone developing PTSD.

 

PTSD involves a number of troubling symptoms including reliving the event with the same fear and horror in nightmares or with a flashback. PTSD sufferers avoid situations that remind them of the event this may include crowds, driving, movies, etc. and may avoid seeking help because it keeps them from having to think or talk about the event. They often experience emotional numbing including difficulty experiencing positive or loving feelings toward other people, avoiding relationships, memory difficulties, or see the world as dangerous and no one can be trusted. Sufferers may feel hyperarousal, feeling keyed up and jittery, or always alert and on the lookout for danger. They may experience sudden anger or irritability, may have a hard time sleeping or concentrating, may be startled by a loud noise or surprise. Obviously, these are troubling symptoms that need to be addressed.

 

It is clear that a key problem with PTSD sufferers is a difficulty with regulating emotions. So, a technique, like mindfulness training, that improves emotion regulation may be beneficial. Indeed, mindfulness training has been found to be particularly effective for PTSD. Hence, it is important to further investigate mindfulness relationships to emotion regulation in PTSD sufferers in order to optimize treatment. In today’s Research News article “A Pilot Study of Mindfulness-Based Exposure Therapy in OEF/OIF Combat Veterans with PTSD: Altered Medial Frontal Cortex and Amygdala Responses in Social–Emotional Processing.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1407398169284105/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028840/

King and colleagues recruited combat veterans with PTSD and examined the effects of mindfulness training on the brain’s processing of emotional stimuli in veterans with PTSD. The veterans were randomly assigned to receive either 16-weeks of, 2-hour sessions, once a week, of group psychotherapy or Mindfulness-Based Exposure Therapy (MBET). MBET involved mindfulness training, self-compassion training, psycho-education, and mindfulness prolonged exposure therapy. Their brains were scanned with functional Magnetic Imaging (f-MRI) 2-weeks before and 2-weeks after training while they were presented with faces expressing either neutral, angry, or fearful emotions.

 

They found that Mindfulness-Based Exposure Therapy (MBET) produced a marked significant reduction in PTSD symptom severity that was greater than that produced by group therapy. They found that regardless of therapy type that relief of PTSD symptoms was associated with increased activation of the dorsal prefrontal cortex which is usually under active in PTSD sufferers. They also found increased activation in brain areas associated with emotion regulation, the medial prefrontal cortex and the rostral anterior cingulate cortex. In addition, the MBET trained veterans showed greater increases in amygdala and fusiform gyrus responses to angry faces, as well as increased response in medial prefrontal cortex to fearful faces. These responses suggest that the mindfulness training resulted in the veterans’ brains being more engaged in processing threatening stimuli.

 

These findings suggest that mindfulness training improves PTSD symptoms by improving the brain’s ability to process emotional stimuli. By paying greater attention to these stimuli they become better at regulating their emotional responses to them. Since, PTSD involves problems with emotions, the improved emotion regulation would be particularly beneficial to the veterans allowing them to better cope with the emotions produced in response to their memories or environmental stimuli.

 

So, improve the brain’s regulation of emotions in PTSD with mindfulness.

 

“Mindfulness can help people cope with and manage their trauma memories, explore their patterns of avoidance when confronting reminders of their trauma, and better understand their reactions to their symptoms. It helps them feel more grounded, and to notice that even very painful memories have a beginning, a middle and an end — that they can become manageable and feel safer. It’s hard work, but it can pay off.” – Anthony King

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

 

Study Summary

King, A. P., Block, S. R., Sripada, R. K., Rauch, S. A. M., Porter, K. E., Favorite, T. K., … Liberzon, I. (2016). A Pilot Study of Mindfulness-Based Exposure Therapy in OEF/OIF Combat Veterans with PTSD: Altered Medial Frontal Cortex and Amygdala Responses in Social–Emotional Processing. Frontiers in Psychiatry, 7, 154. http://doi.org/10.3389/fpsyt.2016.00154

 

Abstract

Combat-related posttraumatic stress disorder (PTSD) is common among returning veterans, and is a serious and debilitating disorder. While highly effective treatments involving trauma exposure exist, difficulties with engagement and early drop may lead to sub-optimal outcomes. Mindfulness training may provide a method for increasing emotional regulation skills that may improve engagement in trauma-focused therapy. Here, we examine potential neural correlates of mindfulness training and in vivo exposure (non-trauma focused) using a novel group therapy [mindfulness-based exposure therapy (MBET)] in Afghanistan (OEF) or Iraq (OIF) combat veterans with PTSD. OEF/OIF combat veterans with PTSD (N = 23) were treated with MBET (N = 14) or a comparison group therapy [Present-centered group therapy (PCGT), N = 9]. PTSD symptoms were assessed at pre- and post-therapy with Clinician Administered PTSD scale. Functional neuroimaging (3-T fMRI) before and after therapy examined responses to emotional faces (angry, fearful, and neutral faces). Patients treated with MBET had reduced PTSD symptoms (effect size d = 0.92) but effect was not significantly different from PCGT (d = 0.43). Improvement in PTSD symptoms from pre- to post-treatment in both treatment groups was correlated with increased activity in rostral anterior cingulate cortex, dorsal medial prefrontal cortex (mPFC), and left amygdala. The MBET group showed greater increases in amygdala and fusiform gyrus responses to Angry faces, as well as increased response in left mPFC to Fearful faces. These preliminary findings provide intriguing evidence that MBET group therapy for PTSD may lead to changes in neural processing of social–emotional threat related to symptom reduction.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028840/

 

Reduce Depression and PTSD Symptoms in Caregivers for Dying Children with Mindfulness

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By John M. de Castro, Ph.D.

 

“Mindfulness Self-Compassion turns the usual self-critical paradigm around and asks the care partner, in the midst of a difficult caregiving moment; become aware of the emotions that arise in the moment and where they reside in your body (Mindfulness), recognize that there are others who suffer in this way (Common Humanity), and then offer yourself what you need in the moment (Self-Kindness). Again, this is not to change the moment of suffering for the person you are caring for or for yourself, but because you are suffering too! In the end this supports both of you in a softer way and provides the circumstances, not necessarily for ‘cure’ but for healing.” – Sarel Rowe

 

Stress is epidemic in the western workplace with almost two thirds of workers reporting high levels of stress at work. In high stress occupations burnout is all too prevalent. This is the fatigue, cynicism, and professional inefficacy that comes with work-related stress. Burnout is associated with depression-like symptoms and often post-traumatic stress disorder (PTSD)-like symptoms. Healthcare is a high stress occupation. It is estimated that over 45% of healthcare workers experience burnout.

 

Providing care for the dying can be can be a very satisfying, rewarding, and even joyful experience. But, over time, caregiving can wear the caregiver out and can lead to burnout. Indeed, 62% of physicians involved with end of life care report symptoms of burnout. This is magnified many times when the patient is a child. This is supposed to be the beginning of life, not its end. It is often the case that caregivers for the dying become personally attached to their patient. With a child, that attachment becomes deep and profoundly emotional. This level of emotional stress is difficult to repeatedly endure. So, there is a need to find ways to help the healthcare professionals who provide care in general, but particularly for those working with children to cope with the stress and emotional drain.

 

It has recently been demonstrated that mindfulness training can help caregivers cope with the stress. It has also been shown to help to prevent burnout in multiple occupations and particularly in healthcare workers. So, it would make sense to investigate the effectiveness of mindfulness training in preventing burnout in healthcare workers providing end of life care to children. In today’s Research News article “Multimodal Mindfulness Training to Address Mental Health Symptoms in Providers Who Care for and Interact with Children in Relation to End-of-Life Care.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1308949565795633/?type=3&theater

or see summary below. O’Mahoney and colleagues recruited palliative care and other health-care professionals who were involved in caring for terminally ill children. They received a 9-week mindfulness training program meeting once a week for 2 hours in the evening. They were measured before and after training for experiential avoidance, cognitive fusion (taking thoughts as true and upsetting), depression, burnout, and PTSD symptoms.

 

They found that the mindfulness training resulted in significant decreases in depression and post-traumatic stress disorder (PTSD) symptoms. These are interesting preliminary results. But, there is a need to follow this up with a randomized controlled trial to determine unequivocally if the training was responsible for the improvements. The effects do seem reasonable as mindfulness training has been shown in different contexts to reduce depression and improve PTSD symptoms. These findings simply extend these general understandings of the effects of mindfulness training to end of life care for children. But, again demonstrate the usefulness of mindfulness training to relieve the psychological effects of caregiving.

 

So, reduce depression and PTSD symptoms in caregivers for dying children with mindfulness.

 

CMCS – Center for Mindfulness and Contemplative Studies

 

“We are set up for short-term stress, but caregiving is long-term stress. Mindfulness works to inhibit the stress response. Most of us run around listening to our thoughts, and this is particularly true of caregivers, who are driven by the To-Do list. They are never at rest.” – Griffiths Vega

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

 

Study Summary

O’Mahony S, Gerhart J, Abrams I, Greene M, McFadden R, Tamizuddin S, Levy MM. A Multimodal Mindfulness Training to Address Mental Health Symptoms in Providers Who Care for and Interact With Children in Relation to End-of-Life Care. Am J Hosp Palliat Care. 2016 Jul 21. pii: 1049909116660688. [Epub ahead of print]

 

Abstract

AIM: Medical providers may face unique emotional challenges when confronted with the suffering of chronically ill, dying, and bereaved children. This study assessed the preliminary outcomes of participation in a group-based multimodal mindfulness training pilot designed to reduce symptoms of burnout and mental health symptoms in providers who interact with children in the context of end-of-life care.

METHODS: A total of 13 medical providers who care for children facing life-threatening illness or bereaved children participated in a 9-session multimodal mindfulness session. Mental health symptoms and burnout were assessed prior to the program, at the program midpoint, and at the conclusion of the program.

RESULTS: Participation in the pilot was associated with significant reductions in depressive and posttraumatic stress disorder (PTSD) symptoms among providers (P < .05).

CONCLUSION: Mindfulness-based programs may help providers recognize and address symptoms of depression and PTSD. Additional research is needed to enhance access and uptake of programming among larger groups of participan

Recover from Sexual Abuse with Mindfulness

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By John M. de Castro, Ph.D.

 

“Our unwanted and self-destructive habits often were formed as children to help us survive. Childhood abuse, whether physical, emotional, verbal, sexual, or the covert traumas of neglect, oppression, and isolation, demands that if the child is to survive, she must create coping skills to deal with the abuse and the inherent messages about who she is. Mindfulness offers the possibility of relating differently to what’s already here by understanding that there’s nothing to get rid of and everything to accept.” – Char Wilkins

 

Childhood sexual abuse (CSA) is a horrific crime. The trauma created in the victim changes them forever. It changes the trusting innocence of childhood to a confused, guilt ridden, frightening, and traumatized existence. It not only produces short-term trauma which includes both psychological and physical injury, it has long-term consequences. It damages the victim’s self-esteem and creates difficulties entering into intimate relationship in adulthood. It can create post-traumatic stress disorder (PTSD) complete with painful flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about the event. Victims often experience depression and sometimes become suicidal. It is a heinous crime that haunts the victims for the rest of their lives.

 

Unfortunately, childhood sexual abuse (CSA) is shockingly common. It is estimated that 20% of girls and 10% of boys have experienced childhood sexual abuse and half of these were forcefully assaulted. Children between the ages of 7 and 13 are the most vulnerable but abuse is also prevalent in adolescence with 16% of children between 14 to 17 having been sexually victimized. Compounding the problem disclosure of sexual abuse is often delayed; children often avoid telling because they are either afraid of a negative reaction from their parents or of being harmed by the abuser. As such, they often delay disclosure until adulthood. This makes it unlikely that they’ll seek help and instead suffer in silence.

 

Mindfulness training has been shown to be effective in treating victims of trauma and PTSD. So, it would make sense that mindfulness training may be helpful for the treatment of adult CSA survivors. In today’s Research News article “Mindfulness Intervention for Child Abuse Survivors: A 2.5-Year Follow-Up.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1271288269561763/?type=3&theater

or below, Earley and colleagues performed a long-term (2.5 year) follow-up of adult survivors of CSA who had received treatment with an 8-week Mindfulness Based Stress Reduction (MBSR) program. MBSR involves meditation, body scan, and yoga practices. In the original study participants reported significant decreases in levels of depression, PTSD symptoms, and anxiety at treatment’s end (8 weeks), and at follow-up (24 weeks). In the present study, the participants from this original study were invited back and re-measured two and a half years after the completion of the original study.

 

Earley and colleagues found that the decreases in depression, anxiety, and PTSD symptoms and the increases in mindfulness were sustained. Improvements in PTSD symptoms of re-experiencing, avoidance/numbing/, and hyperarousal were all sustained. Hence, MBSR treatment produced significant improvements in the psychological health of the CSA survivors and these benefits were still present 2.5 years later. It is very unusual for a research study to be followed up this long after completion. But, it is very important. It demonstrates that treatment effects are are not fleeting. These results conclusively demonstrate that the benefits of MBSR treatment for CSA survivors are very long lasting.

 

Mindfulness training is known to improve all of the key symptoms of childhood sexual abuse (CSA) including depression, anxiety, self-esteem, and PTSD symptoms. It may do so by improving emotion regulation allowing the survivors to honestly feel their emotions but respond to them in an adaptive way. It may also do so by focusing the individual on the present moment and thereby reducing the rumination about the past that is so characteristic of CSA survivors. Regardless of the mechanism, the fact that the symptom relief is so long lasting supports use of MBSR training to treat adult survivors of childhood sexual abuse.

 

So, get over sexual abuse with mindfulness.

 

“Each person’s healing journey, while it will partake of some common elements, will be unique. For professionals, it’s important not to force survivors into a practice that might not work for them. For survivors, it’s important to not get discouraged if we don’t find the right practice at first. There are endless ways to practice being mindful and, sooner or later, something will resonate.” – Christopher Anderson

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

 

Study Summary

Earley, M. D., Chesney, M. A., Frye, J., Greene, P. A., Berman, B., & Kimbrough, E. (2014). Mindfulness Intervention for Child Abuse Survivors: A 2.5-Year Follow-Up. Journal of Clinical Psychology, 70(10), 933-941. doi:10.1002/jclp.22102.

 

Abstract

OBJECTIVE: The present study reports on the long-term effects of a mindfulness-based stress reduction (MBSR) program for adult survivors of childhood sexual abuse.

METHOD: Of the study participants, 73% returned to the clinic for a single-session follow-up assessment of depression, posttraumatic stress disorder (PTSD), anxiety, and mindfulness at 2.5 years.

RESULTS: Repeated measures mixed regression analyses revealed significant long-term improvements in depression, PTSD, anxiety symptoms, and mindfulness scores. The magnitude of intervention effects at 128 weeks ranged from d = .5 to d = 1.1.

CONCLUSION: MBSR may be an effective long-term treatment for adults who have experienced childhood sexual abuse. Further investigation of MBSR with this population is warranted given the durability of treatment effects described here.

Improve PTSD with Mindfulness

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By John M. de Castro, Ph.D.

 

“Very often, depression can be about the past, ruminating over and over about losses or other terrible things that happened in the past. Anxiety, meanwhile, very often involves ruminating about terrible things that you’re afraid are going to happen in the future. But in the present, very often, there’s actually nothing terrible going on, and the act of recognizing that can be helpful.” – Anthony King

 

Experiencing trauma is quite common. It has been estimated that 60% of men and 50% of women will experience a significant traumatic event during their lifetime. But, only a fraction will develop Post-Traumatic Stress Disorder (PTSD). But this still results in a frightening number of people with 7%-8% of the population developing PTSD at some point in their life. For military personnel it’s much more likely for PTSD to develop with about 11%-20% of those who have served in a war zone developing PTSD.

 

PTSD involves a number of troubling symptoms including reliving the event with the same fear and horror in nightmares or with a flashback (Experiencing). PTSD sufferers avoid situations that remind them of the event this may include crowds, driving, movies, etc. and may avoid seeking help because it keeps them from having to think or talk about the event (Avoidance). They often experience negative changes in beliefs and feelings including difficulty experiencing positive or loving feelings toward other people (Emotional Numbing), avoiding relationships, memory difficulties, or see the world as dangerous and no one can be trusted. Sufferers may feel hyperarousal, feeling keyed up and jittery, or always alert and on the lookout for danger (Hyperarousal). They may experience sudden anger or irritability, may have a hard time sleeping or concentrating, may be startled by a loud noise or surprise.

 

Obviously, these are troubling symptoms that need to be addressed. There are a number of therapies that have been developed to treat PTSD. One of which, mindfulness training has been found to be particularly effective. It is important to further investigate mindfulness relationships to PTSD symptoms in order to optimize treatment. In today’s Research News article “Changes in Mindfulness and Posttraumatic Stress Disorder Symptoms Among Veterans Enrolled in Mindfulness-Based Stress Reduction.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1248873658469891/?type=3&theater

or below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pubmed/27152480

Stephenson and colleagues investigated changes in mindfulness accompanying Mindfulness-Based Stress Reduction (MBSR) treatment for Posttraumatic Stress Disorder (PTSD) in veterans. They pooled the data from four trials of MBSR for PTSD, measuring changes in mindfulness, PTSD symptoms, and depression over the course of treatment.

 

They found that changes in mindfulness were highly related to improvement in PTSD symptoms and depression, with larger increases in mindfulness associated with larger improvements in all PTSD symptoms and also in depression. Two facets of mindfulness, Acting with Awareness and Non-reactivity particularly were strongly associated with improvements. On the other hand, increases in the Observing facet of mindfulness were sometimes associated with worsening symptoms, while the Describing and Non-judging facets were not significantly associated. The greatest changes in PTSD symptoms associated with mindfulness were in the Hyperarousal, followed by Emotional Numbing, Re-Experiencing, and Avoidance symptom clusters.

 

These are interesting results and help to clarify the nature of mindfulness effects on PTSD symptoms. The actual reasons for the associations are not known. But, some speculative hypotheses can be postulated. The fact that Non-reactivity was highly associated seems intuitively obvious as being overly reactive to the stimuli and events around them is a key symptom of PTSD. In addition, by Acting with Awareness the veterans are engaged in activities while they are more focused on the present moment. Hence, they would be less likely to bring in the past events, particularly traumatic events, into their present moment experience. A worsening of PTSD symptoms was associated with larger change in the Observing facet. By heightening awareness of their internal state, the veterans may become even more sensitive to their troubling emotional responses resulting in heightened anxiety and fear.

 

Regardless of these speculations, it is clear that improvements in PTSD symptoms with veterans are associated with heightened mindfulness. This further supports the application of MBSR for the treatment of PTSD in veterans. This treatment can be of great help in relieving the torment that is called PTSD, allowing the veterans to resume more normal lives.

 

So, improve PTSD with mindfulness.

 

“Part of the psychological process of PTSD often includes avoidance and suppression of painful emotions and memories, which allows symptoms of the disorder to continue,” King says. “Through the mindfulness intervention, however, we found that many of our patients were able to stop this pattern of avoidance and see an improvement in their symptoms.” – Anthony King

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are available on Google+ https://plus.google.com/106784388191201299496/posts

Study Summary

Stephenson, K. R., Simpson, T. L., Martinez, M. E. and Kearney, D. J. (2016), Changes in Mindfulness and Posttraumatic Stress Disorder Symptoms Among Veterans Enrolled in Mindfulness-Based Stress Reduction. J. Clin. Psychol.. doi: 10.1002/jclp.22323

 

Abstract

OBJECTIVES: The current study assessed associations between changes in 5 facets of mindfulness (Acting With Awareness, Observing, Describing, Non-Reactivity, and Nonjudgment) and changes in 4 posttraumatic stress disorder (PTSD) symptom clusters (Re-Experiencing, Avoidance, Emotional Numbing, and Hyperarousal symptoms) among veterans participating in mindfulness-based stress reduction (MBSR).

METHOD: Secondary analyses were performed with a combined data set consisting of 2 published and 2 unpublished trials of MBSR conducted at a large Veterans Affairs hospital. The combined sample included 113 veterans enrolled in MBSR who screened positive for PTSD and completed measures of mindfulness and PTSD symptoms before and after the 8-week intervention.

RESULTS: Increases in mindfulness were significantly associated with reduced PTSD symptoms. Increases in Acting With Awareness and Non-Reactivity were the facets of mindfulness most strongly and consistently associated with reduced PTSD symptoms. Increases in mindfulness were most strongly related to decreases in Hyperarousal and Emotional Numbing.

CONCLUSIONS: These results extend previous research, provide preliminary support for changes in mindfulness as a viable mechanism of treatment, and have a number of potential practical and theoretical implications.

http://www.ncbi.nlm.nih.gov/pubmed/27152480

 

Cope with Violence Trauma with Mindfulness

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By John M. de Castro, Ph.D.

 

“People with PTSD ruminate, and rumination is all about not being present. It’s all about focusing on something terrible that happened in the past or something frightening that will happen in the future, so these patients are stuck in a rut. My personal bias is that mindfulness-based therapy has a big effect on rumination, and decreasing rumination allows people to experience the present moment, which expands their awareness of different possibilities and increases their ability to pay attention to things they have avoided in the past,” – Anthony King

 

Experiencing trauma is quite common. It has been estimated that 60% of men and 50% of women will experience a significant traumatic event during their lifetime. Many, but, only a fraction will develop Post-Traumatic Stress Disorder (PTSD). But this still results in a frightening number of people with 7%-8% of the population developing PTSD at some point in their life.

 

PTSD can be produced by traumatic events occurring to anyone in a variety of different contexts. These include interpersonal violence (IPV). It is defined “as the intentional use of physical or sexual violence against another person within the context of a relationship. This includes physical or sexual violence committed by a family member, intimate partner, friend, or acquaintance.” A frequent form of IPV is intimate partner violence. Indeed, 27% of women and 11% of men have reported that they had been harmed by sexual or physical violence at some time during their lives.

 

PTSD involves a number of troubling symptoms including reliving the event with the same fear and horror in nightmares or with a flashback. PTSD sufferers avoid situations that remind them of the event this may include crowds, driving, movies, etc. and may avoid seeking help because it keeps them from having to think or talk about the event. They often experience negative changes in beliefs and feelings including difficulty experiencing positive or loving feelings toward other people, avoiding relationships, memory difficulties, or see the world as dangerous and no one can be trusted. Sufferers may feel hyperarousal, feeling keyed up and jittery, or always alert and on the lookout for danger. They may experience sudden anger or irritability, may have a hard time sleeping or concentrating, may be startled by a loud noise or surprise.

 

Obviously, these are serious and troubling symptoms that need to be addressed. There are a number of therapies that have been developed to treat PTSD. One of which, mindfulness training has been found to be particularly effective. In today’s Research News article “Trauma-Informed Mindfulness-Based Stress Reduction for Female Survivors of Interpersonal Violence: Results from a Stage I RCT.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1227840437239880/?type=3&theater

or below

Kelly and Garland randomly assigned adult female survivors of interpersonal violence (IPV) to either an 8-week mindfulness training or wait-list control condition. The intervention was a form of Mindfulness Based Stress Reduction (MBSR) that was modified for treatment with trauma survivors.

 

They found that the treatment produced a clinically significant decrease in PTSD symptoms to the point where a significant number of participants could no longer be classified as PTSD sufferers. The more the participant practiced the mindfulness training the greater the reduction in PTSD symptoms. There were also significant decreases in the mindfulness group in depression and anxious attachment. Anxious attachment is a symptom of PTSD that involves “vacillating between attempts to draw in significant others with endearing attention-seeking behaviors and attempts to attract attention through emotional outbursts of crying or anger.” Reducing anxious attachment allows the sufferer to conduct much healthier interpersonal relationships.

 

These are very promising results that suggest that the modified form of Mindfulness Based Stress Reduction (MBSR) is a safe and effective treatment for PTSD caused by interpersonal violence (IPV). It is not known how mindfulness training could be so effective for PTSD. It can be speculated that the improvement in present moment awareness might have helped by focusing on the individual on the present rather than the past when the trauma occurred and by reducing rumination about the past. In addition, mindfulness training is known to improve emotion regulation and this may allow the PTSD sufferers to not avoid but fully experience the emotions and then respond to them in a constructive fashion. Finally, mindfulness training is known to reduce the physiological and psychological responses to stress. This lowered stress levels may reduce the intensity of their response to memories of the trauma, allowing the individual to be able to internally address the events directly.

 

Regardless of the mechanism, it is clear that mindfulness training is an effective treatment for PTSD symptoms caused by interpersonal violence (IPV). So, cope with violence trauma with mindfulness.

 

“Mindfulness-based stress reduction teaches individuals to attend to the present moment, to attend to what they are experiencing — their thoughts, their feelings — in a nonjudgmental, accepting manner. We think that teaching people these mindfulness skills helps them to have a different relationship with their PTSD symptoms — a willingness to let thoughts be there without trying to push them away,” -Melissa Polusny

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Study Summary

Kelly, A. and Garland, E. L. (2016), Trauma-Informed Mindfulness-Based Stress Reduction for Female Survivors of Interpersonal Violence: Results From a Stage I RCT. J. Clin. Psychol., 72: 311–328. doi:10.1002/jclp.22273

 

Abstract

OBJECTIVE: This pilot randomized controlled trial evaluated a novel trauma-informed model of mindfulness-based stress reduction (TI-MBSR) as a phase I trauma intervention for female survivors of interpersonal violence (IPV).

METHOD: A community-based sample of women (mean age = 41.5, standard deviation = 14.6) with a history of IPV was randomly assigned to an 8-week TI-MBSR intervention (n = 23) or a waitlist control group (n = 22). Symptoms of posttraumatic stress disorder (PTSD) and depression as well as anxious and avoidant attachment were assessed pre- and postintervention.

RESULTS: Relative to the control group, participation in TI-MBSR was associated with statistically and clinically significant decreases in PTSD and depressive symptoms and significant reductions in anxious attachment. Retention in the intervention was high, with most participants completing at least 5 of the 8 sessions for the intervention. Minutes of mindfulness practice per week significantly predicted reductions in PTSD symptoms.

CONCLUSION: TI-MBSR appears to be a promising and feasible phase I intervention for female survivors of interpersonal trauma.

 

Change the Traumatized Brain with Mindfulness

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By John M. de Castro, Ph.D.

 

“Mind-body exercise offers a low-cost approach that could be used as a complement to traditional psychotherapy or drug treatments. These self-directed practices give PTSD patients control over their own treatment and have few side effects.” – Sang H. Kim

 

Experiencing trauma is quite common. It has been estimated that 60% of men and 50% of women will experience a significant traumatic event during their lifetime. But, only a fraction will develop Post-Traumatic Stress Disorder (PTSD). But this still results in a frightening number of people with 7%-8% of the population developing PTSD at some point in their life. For military personnel it’s much more likely for PTSD to develop with about 11%-20% of those who have served in a war zone developing PTSD.

 

PTSD involves a number of troubling symptoms including reliving the event with the same fear and horror in nightmares or with a flashback. PTSD sufferers avoid situations that remind them of the event this may include crowds, driving, movies, etc. and may avoid seeking help because it keeps them from having to think or talk about the event. They often experience negative changes in beliefs and feelings including difficulty experiencing positive or loving feelings toward other people, avoiding relationships, memory difficulties, or see the world as dangerous and no one can be trusted. Sufferers may feel hyperarousal, feeling keyed up and jittery, or always alert and on the lookout for danger. They may experience sudden anger or irritability, may have a hard time sleeping or concentrating, may be startled by a loud noise or surprise.

 

Obviously, these are troubling symptoms that need to be addressed. There are a number of therapies that have been developed to treat PTSD. One of which, mindfulness training has been found to be particularly effective. The nervous system is constantly changing and adapting to the environment. It will change size, activity, and connectivity in response to experience. For example, the brain area that controls the right index finger has been found to be larger in blind subjects who use braille than in sighted individuals.  Similarly, cab drivers in London who navigate the twisting streets of the city, have a larger hippocampus, which is involved in spatial navigation, than predefined route bus drivers. These changes in the brain are called neuroplasticity. Over the last decade neuroscience has been studying the effects of contemplative practices on the brain and has identified neuroplastic changes in widespread areas. This all suggests that mindfulness training would improve PTSD symptoms by producing changes to the brains of sufferers.

 

In today’s Research News article “Altered default mode network (DMN) resting state functional connectivity following a mindfulness-based exposure therapy for posttraumatic stress disorder (PTSD) in combat veterans of Afghanistan and Iraq.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1223008144389776/?type=3&theater

or below

King and colleagues perform functional Magnetic Resonance Imaging (f-MRI) before and after a 16-week mindfulness treatment program for Post-Traumatic Stress Disorder (PTSD) in veterans and compared the results to veterans treated with a present-centered group therapy for PTSD. They found that both groups showed improvement in PTSD symptoms, but only the mindfulness treatment produced significant improvement in total and intrusive, avoidant, and hyperarousal PTSD symptoms. This replicates previous results that mindfulness training is effective in treating PTSD symptoms.

 

King and colleagues also found that the mindfulness treatment produced changes in the nervous system. In particular, they found increased connectivity between the dorsolateral prefrontal cortex and dorsal anterior cingulate cortex. These are structures included in what has been termed the Default Mode Network (DMN) which is involved in producing mind wandering and intrusive thoughts. In addition, they found that the greater the increase in connectivity of these structures the greater the improvement in PTSD symptoms. These results suggest that mindfulness training changes the nervous system in such a way as to improve the ability of the individual to shift attention away from mind wandering and intrusive thoughts. These off-task thoughts are characteristic of PTSD sufferers and are a key symptom of the disorder. By being able to shift away from these thoughts and pay attention to the present moment, the mindfulness trained individuals are better able to keep these thoughts from tormenting them and thereby improve PTSD.

 

These results demonstrate the effectiveness of mindfulness training for Post-Traumatic Stress Disorder (PTSD) and suggest a mechanism by which the training produces these effects. It appears to alter the Default Mode Network (DMN) of the brain allowing the individual to better pay attention to the present moment and shift thinking away from the intrusive thoughts like flashbacks that are characteristic of PTSD.

 

So, change the traumatized brain with mindfulness.

 

“Very often, depression can be about the past, ruminating over and over about losses or other terrible things that happened in the past. Anxiety, meanwhile, very often involves ruminating about terrible things that you’re afraid are going to happen in the future. But in the present, very often, there’s actually nothing terrible going on, and the act of recognizing that can be helpful.” – Anthony King

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Study Summary

King, A. P., Block, S. R., Sripada, R. K., Rauch, S., Giardino, N., Favorite, T., Angstadt, M., Kessler, D., Welsh, R. and Liberzon, I. (2016), Altered default mode network (DMN) resting state functional connectivity following a mindfulness-based exposure therapy for posttraumatic stress disorder (PTSD) in combat veterans of Afghanistan and Iraq. Depress. Anxiety, 33: 289–299. doi: 10.1002/da.22481

 

Abstract

Background: Recent studies suggest that mindfulness may be an effective component for posttraumatic stress disorder (PTSD) treatment. Mindfulness involves practice in volitional shifting of attention from “mind wandering” to present-moment attention to sensations, and cultivating acceptance. We examined potential neural correlates of mindfulness training using a novel group therapy (mindfulness-based exposure therapy (MBET)) in combat veterans with PTSD deployed to Afghanistan (OEF) and/or Iraq (OIF).

Methods: Twenty-three male OEF/OIF combat veterans with PTSD were treated with a mindfulness-based intervention (N = 14) or an active control group therapy (present-centered group therapy (PCGT), N = 9). Pre-post therapy functional magnetic resonance imaging (fMRI, 3 T) examined resting-state functional connectivity (rsFC) in default mode network (DMN) using posterior cingulate cortex (PCC) and ventral medial prefrontal cortex (vmPFC) seeds, and salience network (SN) with anatomical amygdala seeds. PTSD symptoms were assessed at pre- and posttherapy with Clinician Administered PTSD Scale (CAPS).

Results: Patients treated with MBET had reduced PTSD symptoms (effect size d = 0.92) but effect was not significantly different from PCGT (d = 0.46). Increased DMN rsFC (PCC seed) with dorsolateral dorsolateral prefrontal cortex (DLPFC) regions and dorsal anterior cingulate cortex (ACC) regions associated with executive control was seen following MBET. A group × time interaction found MBET showed increased connectivity with DLPFC and dorsal ACC following therapy; PCC–DLPFC connectivity was correlated with improvement in PTSD avoidant and hyperarousal symptoms.

Conclusions: Increased connectivity between DMN and executive control regions following mindfulness training could underlie increased capacity for volitional shifting of attention. The increased PCC–DLPFC rsFC following MBET was related to PTSD symptom improvement, pointing to a potential therapeutic mechanism of mindfulness-based therapies.

 

Decreased Suicidality in Veterans with Spirituality

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“there are certain moral reactions to war and the experience of combat training that indicate a violation of moral conscience in war can have devastating inner consequences in soldiers.” – Rita Nakashima Brock

 

It has been widely reported that there are extremely high levels of suicides among veterans. But these reports are based upon the entire veteran population which includes large numbers of elderly veterans. Looking only at veterans discharged since 2001, the rates suicide rates observed were much lower consisting of about one suicide per day. The actual annual suicide rate these veterans was 29.5 per 100,000 veterans. This is roughly 50% higher than the rate among similar civilians. Interestingly, the rates of suicide are lower in veterans who were deployed to combat than those who were not. Deployed Veterans had a 41% higher suicide risk compared to the general U.S. population while Non-Deployed Veterans had a 61% higher suicide risk.

 

These figures are still alarming, although less so than common reports of veteran suicides. It also suggests that the transition back to civilian life may be as difficult as dealing with combat produced Post Traumatic Stress Disorder (PTSD). Regardless, it is important to investigate the causes of these suicides and discover methods that might prevent them. Mindfulness training is one important potentially helpful method to lower suicidal thoughts and prevent suicide. Mindfulness has been shown to has been shown to reduce suicidality (see http://contemplative-studies.org/wp/index.php/category/research-news/suicidality/) and to reduce the impact of trauma on the individual (see http://contemplative-studies.org/wp/index.php/category/research-news/trauma/). Another potentially important factor is spirituality. Indeed, spirituality has been shown to reduce suicide tendencies in the elderly (see http://contemplative-studies.org/wp/index.php/2015/07/17/spirituality-improves-end-of-life/). Unfortunately, there has been very little systematic research on spirituality relationships to suicide in either the general population or in veterans.

 

In today’s Research News article “Suicidal behavior and spiritual functioning in a sample of Veterans diagnosed with PTSD”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1169673129723278/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4729329/

Kopacz and colleagues studied the relationships between spirituality and suicidality in a veteran sample undergoing residential treatment for PTSD. They compared three groups, a no suicide group who had not even thought about suicide, an Ideation group who had contemplated suicide, and an Attempt group who had attempted suicide. They found that the Ideation and Attempt group had greater amounts of spiritual struggle and lower level of forgiveness. They also found that low levels of thoughts about suicide (ideations) were associated with involvement in a spiritual community and high levels of spiritual experiences.

 

It should be noted that these results were correlative and thereby do not demonstrated a causal connection between spirituality and lower levels of suicidality. In fact, less suicidal ideation may prompt veterans to seek out spiritual experiences of some third factor such as religious upbringing is associated with both. In order to demonstrate causation, it will be necessary to actively increase spirituality and observe its effects on suicidality.

 

With these caveats in mind, the results may signal that being spiritual protects the individual from suicidal thoughts. It may do so by providing other higher ideas about the meaning of life and its sacredness. Higher levels of spirituality may also provide a community that is supportive of the individual and thus helps them cope with difficult thoughts and experiences. It is also possible that a key factor may be spiritual struggles, where the inability to find higher meaning makes suicide more likely. It is also possible that inability to forgive is the key, where the individual cannot forgive, particularly themselves, making destroying the self are seemingly reasonable solution.

 

Regardless, it is clear that spirituality is an important factor influencing suicidality in veterans. This clearly suggests that further research is warranted and that spirituality may be an important factor in suicide prevention in veterans.

 

“The Army’s “spiritual fitness” encourages soldiers to see events in a neutral light, rather than labeling them as good or bad, and to create a nightly list of positive things that happened that day. The lack of awareness is startling regarding what it might mean to ask someone to think of killing a child, losing a close friend or torturing detainees as neutral or positive.” – Rita Nakashima Brock

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Control PTSD with Mindfulness

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“It is as though some old part of yourself wakes up in you, terrified, useless in the life you have, its skills and habits destructive but intact, and what is left of the present you, the person you have become, wilts and shrivels in sadness or despair: the person you have become is only a thin shell over this other, more electric and endangered self. The strongest, the least digested parts of your experience can rise up and put you back where you were when they occurred; all the rest of you stands back and weeps.” – Peter Straub

 

Experiencing trauma is quite common. It has been estimated that 60% of men and 50% of women will experience a significant traumatic event during their lifetime. But, only a fraction will develop Post-Traumatic Stress Disorder (PTSD). But this still results in a frightening number of people with 7%-8% of the population developing PTSD at some point in their life. For military personnel it’s much more likely for PTSD to develop with about 11%-20% of those who have served in a war zone developing PTSD.

 

PTSD involves a number of troubling symptoms including reliving the event with the same fear and horror in nightmares or with a flashback. PTSD sufferers avoid situations that remind them of the event this may include crowds, driving, movies, etc. and may avoid seeking help because it keeps them from having to think or talk about the event. They often experience negative changes in beliefs and feelings including difficulty experiencing positive or loving feelings toward other people, avoiding relationships, memory difficulties, or see the world as dangerous and no one can be trusted. Sufferers may feel hyperarousal, feeling keyed up and jittery, or always alert and on the lookout for danger. They may experience sudden anger or irritability, may have a hard time sleeping or concentrating, may be startled by a loud noise or surprise.

 

Obviously, these are troubling symptoms that need to be addressed. There are a number of therapies that have been developed to treat PTSD. One of which, mindfulness training has been found to be particularly effective (see links below).

 

In today’s Research News article “Mindfulness-Based Stress Reduction for Posttraumatic Stress Disorder among Veterans: A Randomized Clinical Trial”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1088524461171479/?type=1&theater

Polusny and colleagues tested Mindfulness Based Stress Reduction (MBSR) against Present Centered Group Therapy (PCGT) for the treatment of PTSD in military veterans. They found that MBSR was superior to PCGT and produced clinically significant improvements in PTSD symptoms and improved quality of life and mindfulness skills in the veterans. This superiority was enduring as it was present not only at the end of treatment but also significantly two months later.

 

These are exciting results that mindfulness practice can be of significant help for PTSD sufferers but especially because the treatment was superior to another form of therapy. In addition, its’ effectiveness continued to produce improvements even two months after the completion of therapy.

 

It is not known how mindfulness training could be so effective for PTSD. It can be speculated that the improvement in present moment awareness might have helped by focusing on the individual on the present rather than the past when the trauma occurred and by reducing rumination about the past. In addition, mindfulness training is known to improve emotion regulation and this may allow the veterans to not avoid but fully experience the emotions and then respond to them in a constructive fashion.

 

Regardless, it’s clear that PTSD sufferers benefit from mindfulness training.

 

“Often it isn’t the initiating trauma that creates seemingly insurmountable pain, but the lack of support after.” – S. Kelley Harrell

 

CMCS – Center for Mindfulness and Contemplative Studies

 

 

LINKS

Yoga has been shown to be effective in treating children who have experienced trauma http://contemplative-studies.org/wp/index.php/2015/07/17/yoga-for-trauma-in-children/ and mindfulness has been shown to improve an individual’s ability to deal with the aftermath of trauma http://contemplative-studies.org/wp/index.php/2015/07/17/dont-be-afraid-2-dealing-with-trauma/