Post-Traumatic Stress Disorder (PTSD)
There are seven types of traumatic experience: war-related trauma, physical violence, intimate partner or sexual violence, accident, unexpected death of a loved one, traumas experienced by loved ones or witnessing traumas of loved ones, and other traumas (Kessler et al., 2017). Typical symptoms are social and occupational disturbances, low physical functioning, and poor well-being (Ehlers & Clark, 2000). Trauma symptoms may be divided into four groups: re-experiencing the event, avoiding things that remind a person of the trauma, negative emotions and bad mood, and chronic hyper-arousal. Its effects are severely debilitating and affect not only victims, but their family and friends as well (Hilton et al., 2017).
Treating PTSD is an expensive proposition. Average treatment cost per veteran is $19,630 per year. Probably because of this, about 65 percent of PTSD patients have not received treatment within the past year according to 2005 estimates (Davis et al., 2022; Wang et al., 2005).
The total excess economic burden of PTSD in the US was estimated at $232.2 billion for 2018 which allots $19,630 per patient. Total excess costs were $189.5 billion (81 percent) in the civilian area and $42.7 billion (18 percent) in the military services. This corresponds to $18,640 and $25,684 per individual with PTSD in the civilian and military populations, respectively. Direct health care is the main expense in civilian treatment ($66 billion) and with an additional $42 billion in unemployment costs. In the military realm, the excess burden was driven mainly by disability treatment ($17 billion) and then direct health care ($10.1 billion). The economic burden of PTSD goes beyond direct health care costs and has been found to rival costs for other costly mental health conditions. New therapies and treatment strategies are needed to address the growing economic burdens imposed by PTSD. One area of growing interest is complimentary, alternative, integrative medicine (CAIM) modalities with mindfulness-based interventions (MBIs) in the forefront.
One example of meditation therapy in the military is Poulsny et al., 2015. This randomized clinical trial of 116 veterans with PTSD applied Mindfulness-Based Stress Reduction (MBSR) therapy along with teaching patients to accept the present, and present-centered therapy. Patients in the meditation group had the greatest improvement in self-reported symptoms although with a relatively modest effect (n=58). Even the RAND Corporation, a military think tank, gave the subject attention (Hilton, et al., 2015).
Mind-Body Interventions
Mind–body interventions (MBIs), are an essential component of component of CAIM and are a large, diverse group of techniques to treat mental and physical disorders. MBIs address the effects of emotional, mental, social, and spiritual factors. They provide “interactions among the brain, mind, body, and behavior, with the intent to use the mind to affect physical functioning and promote health” (National Center for Complementary and Alternative Medicine, 2010, p. 9). MBIs are now being applied to a wide variety of health conditions as well as being used to maintain general health and well-being (Barnes, Bloom, & Nahin, 2008).
There is a very large body of research into meditation and its effects on a variety of mental and physical conditions including attention-deficit/hyperactivity disorder, body image dissatisfaction, cancer, depression, eating disorders, exhibitionism, neuroticism, psoriasis, psychosis, smoking, substance abuse, and trauma. Most psychological disturbances share one common denominator: the inability to manage emotional distress. Practicing the experience of mindful awareness helps engage with negative emotions to understand, release, and integrate them (Chambers, Gullone, & Allen, 2009). Even brief, daily interludes of meditation show positive effects on attention, memory, mood, and emotion in healthy individuals (Basso et al., 2019).
Closing Thoughts
MBSR was the first MBI to demonstrate empirical evidence for improving emotional health (Hofmann & Gómez, 2017). Other MBIs include mindfulness training, enhancing awareness of physical, emotional, or cognitive sensations, and engaging in physical activity (e.g., yoga, tai chi, qigong, mindfulness-based stretching) (Esper & Gherardi-Donato, 2019). Interventions that focus on yoga combine physical postures, conscious breathing, and meditation (Capon et al., 2019, Cramer et al., 2018). Additionally, many other MBIs including MBSR combine formal meditation with yoga practices.
It is understandable then why the research has been hobbled by definitional inconsistencies, overlaps in intervention composition, and varied protocols which have hampered research accuracy (Van Dam et al., 2018). Other problems include poor research designs, absence of control groups, small sample sizes and variability in experimental intervention (e.g., type of MBI and/ length of administration) and varied population types being assessed (e.g., veterans vs. survivors of interpersonal violence).
Research on MBIs for PTSD has blossomed over the last decade, but unfortunately, as with other areas in CAIM, the subject is plagued by low-quality research. More research is needed on the effects of mindfulness has on improving mental and physical health, more understanding about its mechanisms, and longitudinal studies of its effects over time (Zhang et al., 2021). Using mindfulness-based techniques as supportive adjuncts to conventional treatment appears to be a promising way forward, but, as they always say (and for good reason), more research is needed.
Paul Shane, Ph.D., LMT
Director, Academic Content
References
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