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Published Online: 13 September 2018

A Multisite Randomized Controlled Trial of Mindfulness-Based Stress Reduction in the Treatment of Posttraumatic Stress Disorder

Lori L. Davis, M.D. [email protected], Charles Whetsell, Ph.D., Mark B. Hamner, M.D., James Carmody, Ph.D., Barbara O. Rothbaum, Ph.D., Rebecca S. Allen, Ph.D., A.B.P.P., Al Bartolucci, Ph.D., Steven M. Southwick, M.D., and J. Douglas Bremner, M.D.Authors Info & Affiliations
Publication: Psychiatric Research and Clinical Practice
Volume 1, Number 2
https://doi.org/10.1176/appi.prcp.20180002
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Abstract

Objective:

Posttraumatic stress disorder (PTSD) is often difficult to treat, and many patients do not achieve full remission. Complementary and integrative health approaches, such as mindfulness meditation, are intended to be integrated with evidence-based treatment. This study examined the efficacy of mindfulness-based stress reduction (MBSR) in the treatment of PTSD in U.S. military veterans.

Methods:

Veterans with a diagnosis of PTSD (N=214) were randomly assigned to either 90-minute group MBSR or present-centered group therapy (PCGT) for eight weeks. Follow-up assessments were obtained at baseline and weeks 3, 6, 9 (primary endpoint), and 16.

Results:

Both the MBSR and PCGT groups achieved significant improvement in PTSD as measured by the Clinician-Administered PTSD Scale for DSM-IV (CAPS-IV), with no statistically significant differences between groups. However, compared with PCGT, the MBSR group showed a statistically significant improvement in PTSD on the self-reported PTSD Checklist for DSM-IV over the nine weeks. This difference was not maintained posttreatment, at week 16. Strengths of the study include its large sample size, multisite design, active control group, single-blind outcome ratings, fidelity monitoring, large minority representation, and randomized approach. The study was limited by its high attrition rate and low representation of women.

Conclusions:

Both MBSR and PCGT appear to have beneficial effects in treating PTSD in veterans, with greater improvement observed in self-reported PTSD symptoms in the MBSR group. No differences between groups were observed on the CAPS-IV scale.

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Information & Authors

Information

Published In

Go to Psychiatric Research and Clinical Practice
Psychiatric Research and Clinical Practice
Volume 1 • Number 2 • October 01, 2019
Pages: 39 - 48

History

Received: 15 February 2018
Revision received: 22 June 2018
Accepted: 27 June 2018
Published online: 13 September 2018
Published in print: October 01, 2019

Keywords

  1. Trauma- and Stressor-Related Disorders
  2. Posttraumatic Stress Disorder
  3. mindfulness-based stress reduction
  4. complementary integrative treatment
  5. meditation
  6. present-centered group therapy
  7. Veterans

Authors

Details

Lori L. Davis, M.D. [email protected]
Research and Development Service, Veterans Affairs Medical Center, Tuscaloosa, AL (Davis); Department of Psychiatry and Behavioral Sciences, University of Alabama School of Medicine, Birmingham (Davis); private practice, Birmingham (Whetsell); Mental Health Service, Ralph H. Johnson VA Medical Center, Charleston, SC (Hamner); Department of Psychiatry, Medical University of South Carolina, Charleston (Hamner); Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester (Carmody); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Rothbaum, Bremner); Alabama Research Institute on Aging and Department of Psychology, University of Alabama, Tuscaloosa (Allen); Department of Biostatistics, University of Alabama at Birmingham (Bartolucci); Veterans Affairs National Center for PTSD, Connecticut VA Healthcare System, West Haven, and Department of Psychiatry, Yale University, New Haven, CT (Southwick); Mental Health Service, Atlanta VA Medical Center, Decatur, GA (Bremner).
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Charles Whetsell, Ph.D.
Research and Development Service, Veterans Affairs Medical Center, Tuscaloosa, AL (Davis); Department of Psychiatry and Behavioral Sciences, University of Alabama School of Medicine, Birmingham (Davis); private practice, Birmingham (Whetsell); Mental Health Service, Ralph H. Johnson VA Medical Center, Charleston, SC (Hamner); Department of Psychiatry, Medical University of South Carolina, Charleston (Hamner); Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester (Carmody); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Rothbaum, Bremner); Alabama Research Institute on Aging and Department of Psychology, University of Alabama, Tuscaloosa (Allen); Department of Biostatistics, University of Alabama at Birmingham (Bartolucci); Veterans Affairs National Center for PTSD, Connecticut VA Healthcare System, West Haven, and Department of Psychiatry, Yale University, New Haven, CT (Southwick); Mental Health Service, Atlanta VA Medical Center, Decatur, GA (Bremner).
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Mark B. Hamner, M.D.
Research and Development Service, Veterans Affairs Medical Center, Tuscaloosa, AL (Davis); Department of Psychiatry and Behavioral Sciences, University of Alabama School of Medicine, Birmingham (Davis); private practice, Birmingham (Whetsell); Mental Health Service, Ralph H. Johnson VA Medical Center, Charleston, SC (Hamner); Department of Psychiatry, Medical University of South Carolina, Charleston (Hamner); Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester (Carmody); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Rothbaum, Bremner); Alabama Research Institute on Aging and Department of Psychology, University of Alabama, Tuscaloosa (Allen); Department of Biostatistics, University of Alabama at Birmingham (Bartolucci); Veterans Affairs National Center for PTSD, Connecticut VA Healthcare System, West Haven, and Department of Psychiatry, Yale University, New Haven, CT (Southwick); Mental Health Service, Atlanta VA Medical Center, Decatur, GA (Bremner).
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James Carmody, Ph.D.
Research and Development Service, Veterans Affairs Medical Center, Tuscaloosa, AL (Davis); Department of Psychiatry and Behavioral Sciences, University of Alabama School of Medicine, Birmingham (Davis); private practice, Birmingham (Whetsell); Mental Health Service, Ralph H. Johnson VA Medical Center, Charleston, SC (Hamner); Department of Psychiatry, Medical University of South Carolina, Charleston (Hamner); Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester (Carmody); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Rothbaum, Bremner); Alabama Research Institute on Aging and Department of Psychology, University of Alabama, Tuscaloosa (Allen); Department of Biostatistics, University of Alabama at Birmingham (Bartolucci); Veterans Affairs National Center for PTSD, Connecticut VA Healthcare System, West Haven, and Department of Psychiatry, Yale University, New Haven, CT (Southwick); Mental Health Service, Atlanta VA Medical Center, Decatur, GA (Bremner).
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Barbara O. Rothbaum, Ph.D.
Research and Development Service, Veterans Affairs Medical Center, Tuscaloosa, AL (Davis); Department of Psychiatry and Behavioral Sciences, University of Alabama School of Medicine, Birmingham (Davis); private practice, Birmingham (Whetsell); Mental Health Service, Ralph H. Johnson VA Medical Center, Charleston, SC (Hamner); Department of Psychiatry, Medical University of South Carolina, Charleston (Hamner); Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester (Carmody); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Rothbaum, Bremner); Alabama Research Institute on Aging and Department of Psychology, University of Alabama, Tuscaloosa (Allen); Department of Biostatistics, University of Alabama at Birmingham (Bartolucci); Veterans Affairs National Center for PTSD, Connecticut VA Healthcare System, West Haven, and Department of Psychiatry, Yale University, New Haven, CT (Southwick); Mental Health Service, Atlanta VA Medical Center, Decatur, GA (Bremner).
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Rebecca S. Allen, Ph.D., A.B.P.P.
Research and Development Service, Veterans Affairs Medical Center, Tuscaloosa, AL (Davis); Department of Psychiatry and Behavioral Sciences, University of Alabama School of Medicine, Birmingham (Davis); private practice, Birmingham (Whetsell); Mental Health Service, Ralph H. Johnson VA Medical Center, Charleston, SC (Hamner); Department of Psychiatry, Medical University of South Carolina, Charleston (Hamner); Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester (Carmody); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Rothbaum, Bremner); Alabama Research Institute on Aging and Department of Psychology, University of Alabama, Tuscaloosa (Allen); Department of Biostatistics, University of Alabama at Birmingham (Bartolucci); Veterans Affairs National Center for PTSD, Connecticut VA Healthcare System, West Haven, and Department of Psychiatry, Yale University, New Haven, CT (Southwick); Mental Health Service, Atlanta VA Medical Center, Decatur, GA (Bremner).
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Al Bartolucci, Ph.D.
Research and Development Service, Veterans Affairs Medical Center, Tuscaloosa, AL (Davis); Department of Psychiatry and Behavioral Sciences, University of Alabama School of Medicine, Birmingham (Davis); private practice, Birmingham (Whetsell); Mental Health Service, Ralph H. Johnson VA Medical Center, Charleston, SC (Hamner); Department of Psychiatry, Medical University of South Carolina, Charleston (Hamner); Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester (Carmody); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Rothbaum, Bremner); Alabama Research Institute on Aging and Department of Psychology, University of Alabama, Tuscaloosa (Allen); Department of Biostatistics, University of Alabama at Birmingham (Bartolucci); Veterans Affairs National Center for PTSD, Connecticut VA Healthcare System, West Haven, and Department of Psychiatry, Yale University, New Haven, CT (Southwick); Mental Health Service, Atlanta VA Medical Center, Decatur, GA (Bremner).
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Steven M. Southwick, M.D.
Research and Development Service, Veterans Affairs Medical Center, Tuscaloosa, AL (Davis); Department of Psychiatry and Behavioral Sciences, University of Alabama School of Medicine, Birmingham (Davis); private practice, Birmingham (Whetsell); Mental Health Service, Ralph H. Johnson VA Medical Center, Charleston, SC (Hamner); Department of Psychiatry, Medical University of South Carolina, Charleston (Hamner); Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester (Carmody); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Rothbaum, Bremner); Alabama Research Institute on Aging and Department of Psychology, University of Alabama, Tuscaloosa (Allen); Department of Biostatistics, University of Alabama at Birmingham (Bartolucci); Veterans Affairs National Center for PTSD, Connecticut VA Healthcare System, West Haven, and Department of Psychiatry, Yale University, New Haven, CT (Southwick); Mental Health Service, Atlanta VA Medical Center, Decatur, GA (Bremner).
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J. Douglas Bremner, M.D.
Research and Development Service, Veterans Affairs Medical Center, Tuscaloosa, AL (Davis); Department of Psychiatry and Behavioral Sciences, University of Alabama School of Medicine, Birmingham (Davis); private practice, Birmingham (Whetsell); Mental Health Service, Ralph H. Johnson VA Medical Center, Charleston, SC (Hamner); Department of Psychiatry, Medical University of South Carolina, Charleston (Hamner); Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester (Carmody); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Rothbaum, Bremner); Alabama Research Institute on Aging and Department of Psychology, University of Alabama, Tuscaloosa (Allen); Department of Biostatistics, University of Alabama at Birmingham (Bartolucci); Veterans Affairs National Center for PTSD, Connecticut VA Healthcare System, West Haven, and Department of Psychiatry, Yale University, New Haven, CT (Southwick); Mental Health Service, Atlanta VA Medical Center, Decatur, GA (Bremner).
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Notes

Send correspondence to Dr. Davis ([email protected]).

Funding Information

This work was supported by the Department of Veterans Affairs Office of Research and Development, Clinical Science Research and Development (Award 5-101-CX000687-02).Dr. Davis reports consulting fees from Bracket, Lundbeck, Otsuka, and Tonix and research funding from Allergan, Forest, Merck, the Substance Abuse and Mental Health Services Administration, Tonix, and the U.S. Department of Veterans Affairs. Dr. Rothbaum reports equity in Virtually Better, Inc.; research funding from the Brain and Behavior Research Foundation (National Alliance for Research on Schizophrenia and Affective Disorders), Department of Defense, McCormick Foundation, National Institute of Mental Health, and the Wounded Warrior Project; royalties from American Psychiatric Association Publishing, Guilford, Emory University, and Oxford University Press; and an advisory board payment from Genentech. Dr. Bremner reports research funding from the Defense Advanced Research Projects Agency; National Heart, Lung, and Blood Institute; and National Institute of Mental Health. The other authors report no financial relationships with commercial interests.

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