Study Examines Effectiveness of Mindfulness-Based Stress Reduction Therapy for Veterans with PTSD
VA has invested heavily in the dissemination of prolonged exposure therapy and cognitive processing therapy as first-line treatments for PTSD; however, 30% to 50% of Veterans do not show clinically significant improvements and dropout rates are high. Evidence suggests that mindfulness-based stress reduction – an intervention that teaches individuals to attend to the present moment in a non-judgmental, accepting manner – can reduce symptoms of anxiety and depression. This randomized clinical trial compared mindfulness-based stress reduction with present-centered group therapy, a treatment that addresses current life problems. From March 2012 through December 2013, investigators randomly assigned 116 Veterans with PTSD to receive nine sessions of mindfulness-based stress reduction therapy (n=58) or nine sessions of present-centered group therapy (n=58). Outcomes were assessed before, during and after treatment, and at two-month follow-up. Exclusion criteria: substance dependence (except nicotine), psychotic disorder, suicidal or homicidal ideation, and/or cognitive impairment or medical illness that could interfere with treatment. The primary outcome was a change in self-reported PTSD symptom severity over time. Secondary outcomes included interview-rated PTSD severity scores, self-reported depression symptoms, quality of life, and mindfulness skills.
- Mindfulness-based stress reduction therapy – compared with present-centered group therapy – resulted in a greater decrease in PTSD symptom severity. However, the magnitude of the average improvement suggests a modest effect.
- Veterans in the mindfulness-based stress reduction group were more likely to show clinically significant improvement in self-reported PTSD symptom severity (49% vs. 28%) at two-month follow-up, but they were no more likely to have loss of PTSD diagnosis (53% vs. 47%).
- Veterans participating in mindfulness-based stress reduction therapy reported greater improvement in quality of life and depressive symptoms than those in present-centered group therapy; however improvement in depressive symptoms scores did not reach the level of significance.
- Improvements in quality of life made during treatment were maintained at 2-month follow-up for Veterans in the mindfulness-based stress reduction group, but reports of quality of life returned to baseline levels for those in present-centered group therapy.
- Because the intent was to study mindfulness-based stress reduction in the format it is typically taught (2.5 hour group sessions) compared with present-centered group therapy as provided in the VA system (1.5 hour group sessions), Veterans received less contact with clincians in the control group (13.5 hours) than in the mindfullness–based stress reduction (26.5 hours).
- There was a short follow-up period, and the study was limited to a single site.
Drs. Polusny and Erbes are part of HSR&D's Center for Chronic Disease Outcomes Research in Minneapolis, MN. All authors are part of the Minneapolis Veterans Affairs Health Care System.
Polusny M, Erbes C, Thuras P, et al. Mindfulness-Based Stress Reduction for Post-Traumatic Stress Disorder among Veterans. JAMA. August 4, 2015;314(5):456-65.