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Adding mindfulness to the PTSD therapist’s toolkit


Sol­diers who return home in casts and cas­kets are not the only ones struck down by the trau­ma of war. Many young mil­i­tary men and women car­ry emo­tion­al wounds far beyond the bat­tle­field in the form of post-trau­mat­ic stress dis­or­der (PTSD). This psy­cho­log­i­cal­ly crip­pling con­di­tion can­not be treat­ed with ban­dages or surgery, and often lasts for years on end.

But new research has now demon­strat­ed that mindfulness—a non-judg­men­tal aware­ness of our thoughts and feelings—might be a use­ful tool for vet­er­ans bat­tling PTSD. Rather than being stuck in dis­turb­ing mem­o­ries and neg­a­tive thoughts, they can use mind­ful­ness to active­ly shift their atten­tion out of rumi­na­tions and pro­duce last­ing changes in the brain.

The Need

PTSD is real­ly a dif­fer­ent way of see­ing the world, and is also seen at the lev­el of phys­i­ol­o­gy,” says Tony King, an assis­tant pro­fes­sor of psy­chi­a­try at the Uni­ver­si­ty of Michi­gan. “But by going through a cou­ple of months of mak­ing an effort to change thoughts and behav­iors, that phys­i­o­log­i­cal syn­drome can also change back again.”

His­tor­i­cal­ly, the most effec­tive treat­ment for PTSD has been trau­ma-focused ther­a­py, which push­es indi­vid­u­als to direct­ly con­front their dis­turb­ing mem­o­ries and rec­og­nize that they are no longer dan­ger­ous. This approach, how­ev­er, can be extreme­ly chal­leng­ing, and some patients are unable to endure it.

We want­ed to have a Plan B—a ther­a­py that could be avail­able for peo­ple who thought they weren’t ready or weren’t will­ing to do trau­ma-focused ther­a­py,” says King.

His solu­tion, called mind­ful­ness-based expo­sure ther­a­py, com­bines mind­ful­ness tech­niques such asbody scan, atten­tion to breath­ing, and self-com­pas­sion with themes from PTSD group behav­ior ther­a­py. And though the ther­a­py inten­tion­al­ly avoids any direct con­fronta­tion with trau­mat­ic mem­o­ries, it encour­ages patients to over­come their anx­i­ety in sit­u­a­tions that are objec­tive­ly safe but that they avoid due to their con­di­tion (such as sit­ting with their back to the door or dri­ving under an over­pass).

The New Study

To test the effec­tive­ness of this tech­nique, the research team recruit­ed vet­er­ans of the wars in Iraq and Afghanistan who had been diag­nosed with PTSD and mea­sured their brain activ­i­ty while at rest. Com­pared to indi­vid­u­als with­out PTSD, their brains showed less activ­i­ty in a col­lec­tion of areas called the “default mode net­work,” which is asso­ci­at­ed with day­dream­ing, and more activ­i­ty in regions that reg­u­late fear and oth­er emo­tions. This was not sur­pris­ing, says King, as PTSD patients are less like­ly to let their minds wan­der in order to stay more atten­tive to poten­tial threats in the envi­ron­ment.

Sub­jects were then split into two groups—one receiv­ing the mind­ful­ness-based expo­sure ther­a­py and the oth­er receiv­ing a stan­dard con­trol group ther­a­py.

After 16 weeks, patients who had under­gone the mind­ful­ness ther­a­py showed reduced PTSD symp­toms, though these pos­i­tive changes were not sig­nif­i­cant­ly bet­ter than the con­trol group’s. But when their brain activ­i­ty was mea­sured, only those who had engaged in reg­u­lar mind­ful­ness train­ing showed increased con­nec­tions between the default mode net­work and the dor­so­lat­er­al pre­frontal cor­tex, an area respon­si­ble for atten­tion and the abil­i­ty to con­scious­ly shift atten­tion from one thing to anoth­er. The strength of these con­nec­tions in vet­er­ans who had received mind­ful­ness train­ing was direct­ly asso­ci­at­ed with the degree of improve­ment in their PTSD symp­toms.

This type of atten­tion train­ing may help patients notice when they are stuck in a neg­a­tive pat­tern of thought or rumi­na­tion and make it a lit­tle eas­i­er to shift their atten­tion to oth­er things,” says King. “And if you think about what mind­ful­ness med­i­ta­tion is, that makes per­fect sense. The ‘mus­cle’ that you are train­ing is the abil­i­ty to catch your­self when you are not think­ing about your breath and move it to some­thing else.”

Inter­est­ing­ly, these changes in brain struc­ture are also seen in one oth­er group of peo­ple: med­i­ta­tors who have been prac­tic­ing for more than 20 years.

This could be a gen­er­al effect of mind­ful­ness train­ing,” says King. “Whether it is for 4 months or for 20 years, there seems to be a change in the phe­nom­e­nol­o­gy of how peo­ple expe­ri­ence being at rest.”

Integrating research findings

Despite these encour­ag­ing results, King believes that mind­ful­ness prac­tice alone is not suf­fi­cient to treat PTSD.

While we do think that mind­ful­ness train­ing can help, remem­ber that this was done with two trained ther­a­pists in a vet­er­ans’ PTSD clin­ic,” he says. “I would not rec­om­mend some­one with PTSD to join the local med­i­ta­tion club because it can be trig­ger­ing.” Indeed, rest­ing qui­et­ly unsu­per­vised dur­ing med­i­ta­tion can prompt dis­turb­ing mem­o­ries through a phe­nom­e­non called “relax­ation-induced anx­i­ety.”

In future stud­ies, King and his team hope to repli­cate these find­ings with a larg­er group of par­tic­i­pants, iden­ti­fy which com­po­nents of their ther­a­py are most effec­tive in pro­duc­ing improve­ments, and use mind­ful­ness train­ing to help more peo­ple suc­cess­ful­ly engage in trau­ma-focused ther­a­py.

The mem­o­ries are so painful that many live their life try­ing to avoid trig­gers,” says King. “The prob­lem is that the trig­gers are every­where.” But the devel­op­ment of bet­ter mind­ful­ness skills “might allow patients to be ful­ly present and lean into these scary or avoid­ed sit­u­a­tions.”

— Adam Hoff­man writes and works at Greater Good. Based at UC-Berke­ley, Greater Good high­lights ground break­ing sci­en­tific research into the roots of com­pas­sion and altru­ism.

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