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NRI 04-041 – HSR&D Study

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NRI 04-041
Efficacy of Mantram Repetition on PTSD Symptoms in Veterans
Jill E. Bormann PhD RN FAAN
VA San Diego Healthcare System, San Diego, CA
San Diego, CA
Funding Period: July 2005 - September 2010

BACKGROUND/RATIONALE:
Posttraumatic Stress Disorder (PTSD) is highly prevalent in military Veterans. With ongoing wars and multiple deployments in Iraq and Afghanistan, a growing number of military personnel meet criteria for PTSD. Few psycho-spiritual programs for managing PTSD symptoms have been studied and they may offer a less stigmatizing approach to treatment.


OBJECTIVE(S):
Objectives were to explore the efficacy of a spiritually-based intervention of frequently repeating a mantram--a word or phrase with spiritual associations--to manage (a) PTSD symptom severity, (b) psychological distress and to improve (c) quality of life and (d) in combat Veterans with PTSD. At 3-months post-treatment, we identified and categorized the ways that the intervention was used in response to stressful incidents.

METHODS:
This 4-year study employed a mixed-methods, prospective, randomized controlled trial with qualitative phone interviews at 3 months post-intervention to explore ways that the intervention was used. Outpatient Veterans (N=146) with military-related PTSD were recruited from a single VA site and randomly assigned to the experimental arm (n=71) which consisted of usual care and the mantram program versus usual care only control group (n=76). Outcome measures included the PTSD Checklist (PCL), Clinician Administered PTSD Scale (CAPS), Brief Symptom Inventory-18, SF-12 Health Survey, Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and the Functional Assessment of Chronic Illness Existential Spirituality Scale (FACIT-Sp). The Mantram intervention consisted of six weekly group meetings on how to choose and use a mantram for emotional self-regulation. Intent-to-treat (ITT) analysis using a 2 group (treatment and control) by 2 time (pre- and post-test) analysis of variance (ANOVA) was performed to test the hypotheses. Qualitative interviews using the Critical Incident Research Method were conducted at 3-months post-treatment to assess uses of the intervention.

FINDINGS/RESULTS:
Participants were primarily male (97%), Caucasian (58%), and ranged in age from 23 to 84 years (M=57 +10.09). They averaged 8 + 7.33 years in the military and experienced an average of 13 + 10.0 months of combat. The majority (97%) served during the Vietnam, Korean or First Gulf Wars and 5% served in Iraq or Afghanistan. A total of 136 Veterans (66 in mantram and 70 in control group) completed post-treatment assessments with a 6% dropout rate in the mantram group. The intent-to-treat analysis demonstrated that the mantram group reported significant reductions on the PTSD Checklist compared to controls (significant group x time interaction, F= 4.15, p<.05). Mantram participants also had a significant reduction in CAPS totals scores with an average reduction of -17 points compared to -10 point reduction in controls (p <.05). Twice as many Veterans in the mantram group (30%) no longer met criteria for PTSD diagnosis using the CAPS at post-treatment, compared to the control group (13%), 2=5.75, p=.02. Secondary analyses indicated that mantram participants, compared to controls, reported significant reductions in BSI-18 depression but not in anxiety; significant improvements in SF-12 mental health status and quality of life enjoyment and satisfaction. Spiritual wellbeing significantly increased in the mantram group and decreased in controls. Qualitative phone interviews of 65 mantram participants at 3 months post-treatment indicated that the most common responses to stressful incidents were symptoms of hyperarousal such as irritable/angry outbursts, anxiety or panic, and the inability to calm down or relax. Sixty Veterans (92%) reported using mantram repetition effectively and the most frequently reported outcomes of mantram use was relaxing or calming down, diverting attention away from the triggering incident and letting go of anger. These results are generalizable to older Veterans with long-term duration of PTSD symptoms. More research is warranted.

IMPACT:
A psycho-spiritual mantram intervention may be a beneficial adjunct to usual care in mitigating chronic PTSD symptoms in Veterans with military-related trauma, particularly those with fear of mental illness-related stigma. This intervention delivered in conjunction with usual care is most beneficial for managing hyperarousal. It may augment current treatments, provide more immediate care, and improve quality of life for Veterans with PTSD.

PUBLICATIONS:

Journal Articles

  1. Johnson BD, Bormann JE, Glaser D. Validation of the Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being Scale in Veterans with PTSD. Spirituality in clinical practice. 2015 Mar 1; 2(1):25-35.
  2. Oman D, Bormann JE. Mantram Repetition Fosters Self-Efficacy in Veterans for Managing PTSD: A Randomized Trial. Psychology of religion and spirituality. 2015 Jan 1; 7(1):34-45.
  3. Bormann JE, Oman D, Walter KH, Johnson BD. Mindful attention increases and mediates psychological outcomes following mantram repetition practice in veterans with posttraumatic stress disorder. Medical care. 2014 Dec 1; 52(12 Suppl 5):S13-8.
  4. Bormann JE, Hurst S, Kelly A. Responses to Mantram Repetition Program from Veterans with posttraumatic stress disorder: a qualitative analysis. Journal of rehabilitation research and development. 2013 Jan 1; 50(6):769-84.
  5. Bormann JE, Thorp SR, Wetherell JL, Golshan S, Lang AJ. Meditation-Based Mantram Intervention for Veterans with Posttraumatic Stress Disorder: A Randomized Trial. Psychological trauma : theory, research, practice and policy. 2013 Jan 1; 5(3):259-267.
  6. Bormann JE, Liu L, Thorp SR, Lang AJ. Spiritual wellbeing mediates PTSD change in veterans with military-related PTSD. International Journal of Behavioral Medicine. 2012 Dec 1; 19(4):496-502.
  7. Lang AJ, Strauss JL, Bomyea J, Bormann JE, Hickman SD, Good RC, Essex M. The theoretical and empirical basis for meditation as an intervention for PTSD. Behavior Modification. 2012 Nov 1; 36(6):759-86.
  8. Bormann JE. Spiritual wellbeing mediates the effects of a psycho-spiritual mantram program on PTSD symptoms severity in veterans with military related PTSD. International Journal of Behavioral Medicine. 2010 Aug 17; Suppl 1:187.
  9. Bormann JE, Thorp S, Wetherell JL, Golshan S. A spiritually based group intervention for combat veterans with posttraumatic stress disorder: feasibility study. Journal of Holistic Nursing. 2008 Jun 1; 26(2):109-16.
  10. Bormann JE, Smith TL, Shively M, Dellefield ME, Gifford AL. Self-monitoring of a stress reduction technique using wrist-worn counters. Journal For Healthcare Quality. 2007 Jan 1; 29(1):45-52.
  11. Bormann JE, Smith TL, Becker S, Gershwin M, Pada L, Grudzinski AH, Nurmi EA. Efficacy of frequent mantram repetition on stress, quality of life, and spiritual well-being in veterans: a pilot study. Journal of Holistic Nursing. 2005 Dec 1; 23(4):395-414.
  12. Bormann JE. Frequent, Silent Mantram Repetition: A Jacuzzi for the Mind. Topics in Emergency Medicine. 2005 Apr 1; 27(2):163-166.
Journal Other

  1. Bormann JE, Hurst S, Thorp SR, Glaser D. Spiritually-Based Mantram Repetition to Manage PTSD in Veterans: A Qualitative Analysis of Use and Outcomes. [Abstract]. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2010 Apr 1; 39(Suppl 1):216.
  2. Bormann JE. Spiritual well-being and PTSD symptoms in veterans: A predictive model. [Abstract]. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2009 Dec 1; Suppl:114.
Book Chapters

  1. Bormann JE, Pelletier LR. Mantram Repetition Program for Combat-Related PTSD Symptom Management in American Veterans. In: Martin CR, Preedy VR, Patel VB, editors. Comprehensive Guide to Post-Traumatic Stress Disorder. New York, NY: Springer International Publishing; 2015. 1-14 p.
  2. Bormann JE. Mantram repetition: A "portable contemplative practice" for modern times. In: Plante TG, editor. Contemplative Practices in Action: Spirituality, Meditation, and Health. Santa Barbara, CA: Praeger; 2010. 78-99 p.
  3. Bormann JE, Oman D. Mantram or Holy name repetition: Healing power of a portable spiritual practice. In: Ellens JH, editor. The Healing Power of Spirituality: How Faith Helps Humans Thrive. 1 ed. Santa Barbara, CA: Praeger; 2009. 83-104 p.
  4. Bormann JE, Oman D. Mantram or holy name repetition: Health benefits from a portable spiritual practice. In: Thoresen CE, Plante TG, editors. Spirit, science, and health: How the spiritual mind fuels physical wellness. 1 ed. Westport, CT: Praeger; 2007. Chapter 7. 94-112 p.
  5. Bormann JE, Becker S, Gershwin M, Kelly A. Mantram Repetition for Stress Management in Veterans. In: Hallmarks of quality : generating and using knowledge. Portland, OR: Western Institute of Nursing; 2004.
Magazine/Popular Press Articles

  1. Bormann JE, Thorp SR, Wetherell J, Gershwin M, Kelly A, Bone P, Belding W, Becker S, Pada L. Spiritually-Based Mantram (Sacred Word) Intervention Found Beneficial for Managing Chronic Posttraumatic Stress in Veterans. Plain Views: An e-newsletter for chaplins and other spiritual care providers. 2010 Apr 7; 7(5).
  2. Bormann JE. Clinical roundup: How do you treat insomnia in your practice? Mantram Repetition. Alternative and Complementary Therapies. 2010 Jan 1; 16(4):242-243.
Conference Presentations

  1. Oman D, Bormann JE. Holy Name / Prayer Word / Mantram Repetition Fosters Self-Efficacy for Managing PTSD in Veterans: A Randomized Trial. Poster session presented at: American Psychological Association Annual Convention; 2012 Aug 4; Orlando, FL.
  2. Bormann JE. A Portable Spiritual Intervention for Health and Wellbeing: Mantram Repetition. Paper presented at: Association of Professional Chaplains Annual Conference; 2012 Mar 24; Dallas, TX.
  3. Bormann JE. Psycho-Spiritual Mantram Repetition for Health and Wellbeing: Research & Clinical Applications. Paper presented at: Association of Professional Chaplains Annual Conference; 2012 Mar 24; Dallas, TX.
  4. Bormann JE, Oman D. Mantram Repetition: A Portable Contemplative Practice for Veterans with PTSD. Paper presented at: Division 36 (Psychology of Religion) of the American Psychological Association / Loyola University's Pastoral Counseling Department Annual Mid-Year Conference on Religion and Spirituality; 2011 Apr 15; Columbia, MD.
  5. Bormann JE, Thorp S, Wetherell JL, Hurst S. Empirical Findings on the Health Benefits of Mantram Repetition: A Portable Contemplative Practice. Paper presented at: American Psychological Association Annual Convention; 2010 Aug 12; San Diego, CA.
  6. Bormann JE, Thorp S, Liu L, Wetherell JL, Glaser D, Lang AJ. Empirical Findings on the Health Benefits of Mantram Repetition: A Portable Contemplative Practice. Paper presented at: International Congress of Behavioral Medicine; 2010 Aug 5; Washington, DC.
  7. Bormann JE, Thorp S, Liu L, Wetherell JL, Glaser D, Lang AJ. Spiritual Well-being Mediates the Effects of a Psycho-Spiritual Mantram Program on PTSD Symptom Severity in Veterans with Military-Related PTSD. Poster session presented at: International Congress of Behavioral Medicine; 2010 Aug 5; Washington, DC.
  8. Bormann JE, Hurst S, Thorp S, Kelly A, Bone P, von Kaenel L, Lang A. Application of a Psycho-Spiritual Mantram Intervention to Manage PTSD Symptoms in Veterans: A Qualitative Analysis. Paper presented at: VA Implementing a Public Health Model for Meeting the Mental Health Needs of Veterans Annual Mental Health Conference; 2010 Jul 27; Baltimore, MD.
  9. Warren K, Bormann JE, Klinefelter A, Regalbuto L, West R. Teleconference Support for Family Caregivers of Veterans with Dementia. Poster session presented at: VA Supporting Veterans At Home Conference; 2010 Jul 13; Washington, DC.
  10. Bormann JE, Hurst S, Thorp SR, Glaser D. Spiritually-based mantram repetition to manage PTSD in Veterans: A qualitative analysis of use and outcomes. Poster session presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2010 Apr 10; Seattle, WA.
  11. Bormann JE, Hurst S, Thorp S, Schnack J, Gershwin M, Kelly A, Becker S, Bone P. Spiritual Mantram Practice for Managing Hyperarousal in Veterans with PTSD. Paper presented at: International Conference on Violence, Abuse, and Trauma; 2009 Sep 21; San Diego, CA.
  12. Thorp S, Bormann JE, Wetherell JL, Golshan S, Gershwin M, Kelly A. Spiritually-Based Mantram Intervention on Psychological Distress in Veterans with PTSD. Paper presented at: Anxiety Disorders Association of America Annual Conference; 2009 Mar 13; Taos, New Mexico.
  13. Bormann JE, Thorp S, Wetherell JL, Golshan S, Fellows I, lang A, Gershwin M, Kelly A, Bone P, Belding W. Efficacy of a Spiritually-Based Mantram Intervention on Quality of Life in Veterans with Military-Related PTSD. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 11; Washington, DC.


DRA: Health Systems, Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders
DRE: Treatment - Efficacy/Effectiveness Clinical Trial
Keywords: Behavioral therapy, Complementary and Alternative Practices, Deployment, PTSD, Quality of Life, Self-care
MeSH Terms: none