Mindfulness for PTSD

Potential of Mindfulness in Treating Trauma Reactions

Written by: Vujanovic, Niles, Pietrefesa, Potter, & Schmertz

“Mindfulness is most commonly conceptualized as involving attention to and awareness of the present moment, and nonjudgmental acceptance (1-3). Awareness of the present involves observing thoughts, feelings, and sensations by focusing one’s attention on the current moment (2). While attending to the present, mindfulness also entails a stance of acceptance, or willingness to experience an array of thoughts and emotions without judgment (4).

Clinical utility of mindfulness for treatment following trauma

The potential clinical utility of integrating mindfulness-based exercises in extant PTSD treatments has yet to be examined empirically (5). However, given the beneficial effects of mindfulness practice on enhancing emotion regulation as well as decreasing anxiety and depressive symptoms (6-9), mindfulness has been increasingly discussed in the context of PTSD and its treatment (10-12). The relevant theoretical and empirical literature suggests that mindfulness may serve clinically meaningful functions in alleviating PTSD symptoms.

Regular mindfulness practice can lead to a greater present-centered awareness and nonjudgmental acceptance of potentially distressing cognitive and emotional states as well as trauma-related internal and external triggers (5, 13). Awareness and acceptance of trauma-related thoughts and feelings may serve as an indirect mechanism of cognitive-affective exposure. This may be especially useful for individuals with PTSD, as it may help decrease experiential avoidance, reduce arousal, and foster emotion regulation. For instance, among trauma-exposed individuals evaluated at a single time point, greater levels of acting with awareness and accepting without judgment were associated with lower levels of posttraumatic stress symptoms (11). Regular mindfulness practice has also been shown to decrease physiological arousal (14- 15).

Adjunct to empirically-supported treatments for PTSD

Empirically-supported treatments for PTSD, such as Cognitive Processing Therapy (CPT, 16) and Prolonged Exposure (PE, 17), are effective in decreasing symptoms for many individuals who suffer from PTSD. Both of these treatments direct the client to recall traumatic events in a controlled fashion. For the last decade, exposure to and processing of trauma-related thoughts, feelings, and memories have been considered important components of effective treatment for PTSD. However, a significant proportion of sufferers either do not seek help, drop out of treatment, refuse these treatments, or are not substantially helped by them (5, 18-19).

Combining mindfulness or other skills to strengthen emotion regulation with existing empirically-supported PTSD treatments may improve outcomes in the following ways:

Engagement. Mindfulness may appeal to clients who do not pursue evidence-based treatments or cannot tolerate them (5, 20-21). Mindfulness practice may improve symptoms and it may also help such clients become engaged with a therapist or treatment process.

Preparation. Mindfulness practice could be introduced prior to treatment. Learning to observe internal reactions without judgment and to accept feelings, sensations, and thoughts as they arise might usefully prepare patients to tolerate the unpleasant emotions that trauma processing elicits.

Less rumination. If implemented as an adjunct to CPT or PE, mindfulness could be encouraged throughout the treatment course. Increased awareness of trauma-related re-experiencing symptoms may allow patients to break a ruminative cycle by gaining some distance from trauma-related intrusive thoughts and feelings. It may foster acceptance rather than avoidance.

Compliance. Patients using mindfulness skills during treatment may be better able to persevere through trauma processing and benefit more fully from trauma-focused treatments.”

Source: http://www.ptsd.va.gov/professional/treatment/overview/mindful-PTSD.asp