New Therapy for PTSD

Mindfulness-Based Stress Reduction for PTSD

Posttraumatic stress disorder (PTSD) affects 23 percent of veterans returning from Afghanistan and Iraq.  Because of the large toll that PTSD takes on health and quality of life, the U.S. government has invested heavily in its treatment, including first-line psychotherapy measures such as prolonged exposure or cognitive processing therapy.  Nevertheless, although such interventions have proven effective,  30 to 50 percent of veterans fail to feel better after such treatment and about a third of participants drop out of therapy.

  Therefore, researchers are on the lookout for alternative treatment options.  Mindfulness-based stress reduction is one new therapeutic option that has proven modestly effective in clinical trials.

What Is PTSD?

In recent years, PTSD has taken on an entity separate from other anxiety disorders.  Despite its own classification, however, there is still so much we don't know about this mental illness.

With PTSD, some people who witness traumatic events like disasters or death during war experience persistent feelings of helplessness.  Other triggers of PTSD may include rape or violence.  These people live in a state of hyperarousal during which it's common to reexperience the event (flashbacks and nightmares) or avoid reminders of the event.  Of note, there is considerable overlap between PTSD and anxious depression.  In fact, many people with PTSD also experience depression.

Here are some physical symptoms of PTSD:

  • trouble breathing (dyspnea)
  • dysphoria
  • palpitations
  • difficulty sleeping
  • unexplained pains

On a biological level, people with PTSD can demonstrate lower levels of circulating cortisol, higher levels of norepinephrine (a stress hormone) and increased sensitivity of sympathetic receptors.  (The sympathetic system is responsible for the "fight or flight" response.)

There is some evidence that SSRIs (antidepressant medications) may be helpful when treating PTSD. Currently, the only medications approved by the FDA to treat PTSD are Zoloft and Paxil; however, other medications have been used off-label to treat PTSD including Prozac (SSRI) and Effexor (SNRI).

As is generally the case with many psychiatric diagnoses, people with PTSD should limit their exposure to benzodiazepines.

Interestingly, some experts suggest that administration of narcotics and sedatives immediately after exposure to an extremely traumatic event--like wartime atrocity--may reduce the incidence and severity of PTSD.

As previously mentioned, psychotherapy is an important facet of PTSD treatment.  Specifically, people with PTSD can be taught better coping mechanisms.

Mindfulness-Based Stress Reduction

In the August 14, 2015, issue of JAMA, researchers compare the reduction in PTSD symptom severity--self-report measures of anxiety and depression--after treatment using mindfulness-based stress reduction with that of present-centered group therapy.

  During the two-month trial, they found that several weekly sessions of mindfulness-based stress reduction may be more effective than several weekly sessions of present-centered group therapy; however, the benefit of both types of therapy are modest.

With mindfulness-based stress reduction, the patient is taught to accept the present moment in a nonjudgmental manner.  Moreover, patients are taught to accept experiences, thoughts and feelings without avoidance. On the other hand, with patient-centered group therapy, patients are taught more active interventions including education about PTSD and its treatment, problem-solving and goal setting.

To date, results from research on mindfulness-based stress reduction as therapy for PTSD have been mixed.  Although this JAMA study suggests the benefit of such intervention, much like other studies examining mindfulness-based stress reduction, this trial was low power.  Nevertheless, this study hints at the benefit of mindfulness-based stress reduction even if the benefits were only to turn out to be temporary--as is the case with other studies regarding this therapy.

In conclusion, if you or a loved one suffer from PTSD, mindfulness-based stress reduction may be a good therapeutic option to consider.  Because PTSD is a particularly debilitating condition, even modest improvement in symptoms may help you feel better.  Furthermore, if you find other more conventional psychotherapies have provided you limited relief, mindfulness-based stress reduction may be worth considering.

Selected Sources

Article titled "Mindfulness Based Stress Reduction for Posttraumatic Stress Disorder Among Veterans" by MA Polusney and co-authors published in JAMA in 2015.

Ropper AH, Samuels MA, Klein JP. Chapter 24. Fatigue, Asthenia, Anxiety, and Depression. In: Ropper AH, Samuels MA, Klein JP. eds. Adams & Victor's Principles of Neurology, 10e. New York, NY: McGraw-Hill; 2014. Accessed August 17, 2015.

 

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