By: Christine Renzulli
May 18, 2017
Mindfulness is nonjudgmental awareness of changes in internal experiences with roots in Tibetan Buddhism.1 It is made up of 2 elements: being aware in the present moment and accepting your thoughts and feelings without judgment.2 These skills support self-reflection and understanding cognitive, emotional, and behavior patterns.3
In 2010, the VA provided treatment for 96,916 OEF/OIF (Operation Enduring Freedom/Operation Iraqi Freedom) veterans who were diagnosed with PTSD.4
The Department of Veterans Affairs estimates that about 11% to 20% of OEF/OIF veterans have PTSD. 5
Of those with PTSD 20% also have substance use disorder.6
PTSD has four symptom groups:3
- Intrusion symptoms
- Negative alterations
- Alterations in arousal and reactivity
Current first-line PTSD therapies:1
- Cognitive processing therapy
- Prolonged exposure therapy
- Stress inoculation training
- Eye movement desensitization and reprocessing
MINDFULNESS AND PTSD
Mindfulness can be added to current first-line PTSD therapies and will not interfere with medications. The physical and emotional distress caused by PTSD symptoms can be decreased with mindfulness as the veteran learns to approach their thoughts and feelings with objectivity.7
Mindfulness has been shown to decrease avoidance symptoms of PTSD as well as decrease depression and anxiety.8 These benefits did not end when mindfulness training ended. Two months later the veterans continued the quality of life changes that occurred during the treatment period.8 This provides evidence that mindfulness helps the veteran with self-management of their PTSD symptoms.8
The VA states that prolonged exposure therapy and cognitive processing therapy are the most beneficial treatments for PTSD.2Having mindfulness training before beginning prolonged exposure therapy or cognitive processing therapy will help give the veteran the skills necessary to cope with difficult emotions in a healthier way.2
Combining mindfulness with other PTSD treatments improves outcomes:9
- Engagement – improve symptoms and help veteran engage with treatment process and/or provider
- Preparation – begins before traditional therapy to help prepare the veteran to cope with unpleasant emotions of the trauma they experienced
- Less rumination – increased awareness allows the veteran to accept and distance themselves from the trauma
- Compliance – mindfulness allows the veteran to cope better during treatment and continue therapy
Mindfulness can help target: 2
- Everyday stress
- Health issues such as substance abuse and chronic pain
- Negative thinking patterns
- Trouble working toward life goals
- Urges to use/misuse drugs or alcohol
BRAIN CHANGES WITH MINDFULNESS
Mindfulness increases gray matter in the brain, which is associated with memory, learning, and emotional regulation.1 It also increased prefrontal lobe function meaning when the veteran becomes angry he/she will return to baseline quicker, he/she will have better self-insight, morality, intuition, and fear regulation.1
CHALLENGES WITH MINDFULNESS GROUPS
- lack of time
- schedule conflicts
- dislike and distrust of groups
- schedule conflicts
- lack of practice time at home
- inability to attend due to medical condition
- did not understand the purpose
- frustrated that certain discussion topics were not relevant
- differing personalities and experiences
- poor management by group leader
- psychological challenges
Every veteran, whether they completed the group or not, said they would recommend mindfulness to another veteran.10
Healthcare reform and expenses are a priority in public policy. Mindfulness is an inexpensive option with benefits for many conditions such as:11
- substance abuse
- eating disorders
- sleep problems
- chronic pain
- type 2 diabetes
- rheumatoid arthritis
- Heart disease
Policies that mandate mindfulness therapy to be added to the standard medication therapy would help promote the well-being of the whole person and improve overall quality of life. There is a huge reduction in healthcare related costs when mind-body medicine, such as mindfulness, is used for both disease prevention and health promotion.11 One study showed that an 8-week mindfulness program increased brain and immune function, quality of life, and coping abilities with no negative side effects making mindfulness a cost effective and cost saving intervention.11
I am currently a Doctor of Nursing Practice (DNP) student at the University of Delaware with a concentration in mental health. I graduated from the University of Delaware in 2015 with my BSN and currently work at a level 1 trauma center on an intermediate critical care trauma-surgical unit.
1 Steinberg, C. & Eisner, D. (2015) Mindfulness-based interventions for veterans with posttraumatic stress disorder. International Journal of Behavioral Consultation and Therapy, 9(4), 11-17.
2 U.S. Department of Veterans Affairs. PTSD: National Center for PTSD. (2015c). Mindfulness practice in the treatment of traumatic stress. Retrieved from https://www.ptsd.va.gov/public/treatment/therapy-med/mindful-ptsd.asp
3 Landrum, S. (2016). Enhancing recovery from trauma: facilitating a mindfulness skills group on a Department of Veteran Affairs inpatient PTSD unit. Social Work with Groups, 39(1), 35-47.
4 Russell, M., & Figley, C. (2014). Overview of the Affordable Care Act’s impact on military and veteran mental health services: implications for significant improvements in care. Journal of Social Work in Disability & Rehabilitation, 13(1). 162-196.
5 U.S. Department of Veterans Affairs. PTSD: National Center for PTSD. (2015b). How common is PTSD? Retrieved from http://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp
6 U.S. Department of Veterans Affairs. PTSD: National Center for PTSD. (2015d). PTSD and substance abuse in veterans. Retrieved from http://www.ptsd.va.gov/public/problems/ptsd_substance_abuse_veterans.asp
7 Dahm, K., Meyer, E., Neff, K., Kimbrel, N., Gulliver, S., & Morissette, S. (2015). Mindfulness, self-compassion, posttraumatic stress disorder symptoms, and functional disability in U.S. Iraq and Afghanistan war veterans. Journal of Traumatic Stress, 28(1), 460-164.
8 Polusny, M., Erbes, C., Thuras, P., Moran, M., Lamberty, G., Collins, R., Rodman, J., & Lim, K. (2015). Mindfulness-based stress reduction for posttraumatic stress disorder among veterans: a randomized clinical trial. Journal of American Medical Association, 314(5), 456-465.
9 U.S. Department of Veterans Affairs. PTSD: National Center for PTSD. (2016b). Potential of mindfulness in treating trauma patients. Retrieved from https://www.ptsd.va.gov/professional/treatment/overview/mindful-PTSD.asp
10 Martinez, M., Kearney, D., Simpson, T., Felleman, B., Bernardi, N., & Sayre, G. (2015). Challenges to enrollment and participation in mindfulness-based stress reduction among veterans: a qualitative study. The Journal of Alternative and Complementary Medicine, 21(7), 409-421.
11 Ruff, K. & Mackenzie, R. (2009). The role of mindfulness in healthcare reform: a policy paper. Explore, 5(6), 313-323.