Meditation as a Treatment for Veteran PTSD.

Veterans’ Day, and every day, is a struggle for the 23 percent of returning Iraq and Afghanistan veterans and 30 percent of Vietnam-era veterans who currently live with posttraumatic stress disorder, or PTSD. Since 2006, two evidence-based, trauma-focused treatments for PTSD have been offered to vets throughout Department of Veterans Affairs (VA) medical facilities: prolonged exposure (PE), an emotional processing therapy, and cognitive processing therapy (CPT), a cognitive-behavioral based treatment. Both PE and CPT require that clients engage in discussion about the traumatic event in order to understand the emotions, cognitions, and behaviors that the client attaches to the trauma and which give the trauma meaning. While effective for those who are able to discuss traumatic events, dropout rates from clinical trials are as high as 39 percent, and in clinic settings, attrition is even higher, approaching 60 percent. Too many veterans are continuing to suffer as a result of treatments that they find intolerable.

Over the last several years, veterans have been demanding that the VA provide complementary and integrative medicine (CIM) treatments, such as meditation and yoga, for a range of posttraumatic stress symptoms. The VA has responded to this demand, and now approximately 90 percent of its medical facilities offer at least one form of CIM. Veterans Service Organizations have reacted similarly, with several posts offering yoga and other healthy living opportunities. While Veterans report enjoying these types of activities, evidence is needed to test their effectiveness as treatments for a range of conditions, including PTSD.

Responding to Veterans’ call for CIM, and recognizing that innovative treatments were needed, the VA issued a call for research proposals to test meditation as a treatment for veterans with military-related PTSD. The three studies funded—one involving mantram meditation and two testing Mindfulness-Based Stress Reduction, or MBSR—all showed a significant clinical improvement in veterans who were randomized to mantram meditation or MBSR, compared to the evidence-based treatment of present-centered therapy. Importantly, none of these treatments are trauma focused, and veterans remained in these studies at higher rates than studies involving PE or CPT.

How does meditation work as a treatment for PTSD? Research suggests that both mindfulness and self-compassion skills allow veterans to be kind to themselves, to accept their traumatic event and gain inner strength—skills needed to cope with everyday conflict as well as the inner turmoil brought on by PTSD. PTSD symptoms include the re-experiencing of the traumatic event, avoidance and numbing in order to disassociate from the pain of the event, and hyperarousal from and hypervigilance of one’s surroundings, which make functioning in daily life very difficult. Our own work has shown that meditation improves sleep, which is the basis for all physiological and emotional functioning. If we can teach skills to improve self-compassion and sleep, we can begin to relieve veterans of their survival guilt, nightmares, and flashbacks as a result of experiencing trauma during combat and military service.

Although evidence for meditation as a treatment for PTSD comes from studies involving veterans at only a handful of VA facilities, the clinically meaningful results mean that it’s time to take mind-body practices to veterans on a larger scale. On this federal holiday, recognizing the sacrifices that all veterans have made for our country, let’s start to include meditation as a main intervention for PTSD—not an optional or suggested component of a veteran’s treatment plan. Integrative medicine, in the form of meditation, has the ability to help veterans learn how to slow down destructive thoughts, develop one pointed attention to focus the mind, discover self-compassion, and gain the inner strength that can help them erase the symptoms of PTSD. By offering meditation as a mainstream treatment for PTSD, our message to veterans is this: You don’t have to live with your symptoms forever. Non-trauma focused, integrative medicine treatments can help.

A. Rani Elwy is an associate professor of health law, policy & management and is also the director of the Center for Information Dissemination and Education Resources (CIDER), a VA Health Services Research and Development Resource Center charged with  bringing health services research evidence to bear on VA practice and policy-making. Elwy is also an investigator with the VA HSR&D Center for Healthcare Organization and Implementation Research (CHOIR), both located at the VA Boston Healthcare System, Jamaica Plain campus.

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.