A review of the research finds that mindfulness-based programs may offer help and hope for those with post-traumatic stress.
Pain and loss are inevitable. Although healing can be lengthy and difficult, challenging events can remind us of our courage and resilience. But for those who have experienced severe stress and develop symptoms of post-traumatic stress (PTSD), the process of recovery can be more complex. A review of the research finds that mindfulness-based programs may offer help and hope for those with PTSD symptoms.
Understanding post-traumatic stress (PTSD)
Post-traumatic stress and post-traumatic stress disorder (PTSD) typically result from experiencing or witnessing a shocking or dangerous event. During the event, fear triggers a cascade of hormones like cortisol and adrenaline that flood the nervous system and mobilize the body’s defenses. Once the threat has subsided, the nervous system usually “resets”, initiating the healing and recovery process.
In some cases, or when stress is chronic, the system does not reset, and the physical and psychological effects of acute or prolonged stress manifest as symptoms of traumatic stress. Not everyone who survives a trauma develops PTSD, and not everyone with PTSD has experienced or observed a life-threatening event.
Sudden, unexpected death or loss, or persistent environmental threat can also lead to a person developing post-traumatic stress symptoms.
"It is important to note that post-traumatic stress symptoms are not, in and of themselves, pathological."
It is important to note that post-traumatic stress symptoms are not, in and of themselves, pathological. They represent the mind and body’s natural process of recovery following severe, often painful life experiences. Often more chronic and extremely traumatic events require longer periods of healing and repair. As resilience builds, symptoms often lesson and eventually subside altogether.
For some, however, post-traumatic symptoms are accompanied by significant depression, anxiety, panic, and thoughts of suicide. In these cases, evidence-based treatment approaches may be necessary to help alleviate the impacts of trauma.
Although there are many causes of trauma, people with PTSD have a great deal in common. Most have intrusive memories or bad dreams that occur in combination with physical symptoms like a racing heart and shortness of breath. Individuals also tend to avoid objects, places, or events that trigger recollection of the initial experience, and learn to numb physical and emotional sensations when under duress.
The combination of unresolved nervous system hyperactivity and emotional distress can result in tension, anger, irritability, a tendency to startle easily, or difficulties coping with life events. This is often accompanied by difficulties sleeping, eating, and concentrating, and a tendency toward sadness, depression, social isolation, guilt, and a lack of trust in others and the world.
Acute and persistent traumas are also known to impact the structure and function of the brain and nervous system. Human and animal studies find that traumatic stress is associated with decreased volume of the hippocampus and anterior cingulate cortex.
The hippocampus, a structure within the brain’s emotion processing center (limbic system), plays an important role in learning, memory and emotion processing. It is particularly vulnerable to stress.
The anterior cingulate links the limbic system to the prefrontal cortex – often referred to as the brain’s “thinking center”. It plays an important role in regulating and managing difficult emotions. This is compounded by the fact that the amygdala, the brain’s hub of emotion is often larger in those with a history of trauma, suggesting that it is more sensitized and activated.
"Post traumatic stress is not inevitable."
All told, these brain changes point to greater difficulty regulating and coping with negative thoughts, feelings and memories – a hallmark of post-traumatic stress.
Despite these commonalities, traumatic stress is not inevitable. For some, social support such as friends, family or a support group, a positive mindset, and a nervous system that is able to reset after a highly stressful event can be protective against PTSD.
For those with repeated exposure to extreme stressors, a childhood history of trauma, a lack of social support, a history of psychological problems, or prolonged or chronic environmental threat, treatment is often a viable option to move from trauma to wellbeing.
Mindfulness-based treatment for PTSD symptoms
Historically, cognitive forms of psychotherapy with or without medication was the first line of PTSD treatment. But many with PTSD avoid therapy due to social stigma, cost, guilt, shame, or an inability to seek help. In response to the need for alternative forms of treatment, more providers and trauma sufferers are turning to mindfulness-based interventions.
There is some debate among professionals as to why mindfulness-based interventions for PTSD are effective. Some suggest that an increase in mindfulness may help individuals to better cope with intrusive thoughts and memories, and be more equipped to handle emotional distress.
Correlational studies find that greater dispositional mindfulness is linked to fewer PTSD symptoms in survivors of natural disasters, victims of sexual abuse or assault, and firefighters.
Others argue that mindfulness-based therapies and practices like meditation may exacerbate PTSD symptoms and actually cause distress. And with cognitive-behavioral therapies shown to be generally effective, there is some skepticism as to whether mindfulness alternatives are necessary.
Mindfulness-based therapies may reduce trauma symptoms
The best way to resolve this controversy is to analyze all of the published research and draw an informed conclusion. To do so, a pair of Australian researchers reviewed scientific studies where the effects of mindfulness-based interventions in reducing the psychological symptoms of traumatic stress were compared to those of a randomized control group. This included data on 1,219 participants.
Results of this review yielded the following conclusions:
1. Participants in mindfulness-based interventions demonstrated significantly lower levels of PTSD symptoms following treatment than control group members.
2. The longer the mindfulness intervention, the greater the reduction in traumatic stress symptoms.
3. Individuals who received mindfulness-based interventions reported higher levels of mindfulness at the end of treatment compared to control group members.
The review also uncovered some important caveats. Among them was the discovery that increased mindfulness was not linked to fewer PTSD symptoms. Although this may have been a statistical artifact, it appears that becoming more mindful does not necessarily translate to experiencing less traumatic stress.
The severity of PTSD symptoms was also not related to changes in mindfulness or reduction of symptoms. Those with and without a PTSD diagnosis responded similarly to mindfulness-based therapies.
Lastly, although researchers anticipated that trauma-specific mindfulness-based interventions would outperform traditional programs like mindfulness based stress reduction (MBSR), results from these programs were comparable suggesting that mindfulness training on its own may be impactful.
Although these findings are encouraging, the review’s authors note of a potential source of bias known as the file drawer problem; the possible over-inflation of positive results that may occur when only studies with positive or significant statistical effects are published. Although they accounted for this in their analysis, it is important to not overlook the possibility that studies with negative outcomes are underreported or tossed out altogether.
In recent years, contemplative scientists have called into question whether the negative or harmful effects of meditation have been suppressed in the research literature. This is of particular importance when considering the use of mindfulness-based therapies with those with a trauma history, for whom meditation and contemplation may exacerbate an already unstable nervous system. This thorny dilemma will require additional, high quality studies to be resolved.
Mindfulness-based therapies may change brain structure
Brain imaging studies provide another promising research avenue that may inform our understanding of how mindfulness-based therapies aid in trauma recovery. In one study, 23 male Iraq and Afghanistan combat veterans were randomly assigned to either a Mindfulness-Based Exposure Therapy (MBET) group or a present-centered group therapy (PCGT).
Functional magnetic resonance imaging (fMRI) brain scans performed before and after treatment showed that those receiving MBET had significantly more connections between the default mode network (DMN), which is associated with mind wandering and rumination, and the dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC).
This implies that mindfulness training may enable those experiencing post-traumatic stress to reduce the pernicious cycle of negative thoughts, feelings and memories that accompany traumatic stress. MBET group participants also had fewer symptoms of post-traumatic stress, however their symptom reduction was not significantly different from those in the PCGT group.
Findings from this study of veterans with PTSD parallel those conducted with adults without PTSD in which meditation has been found to benefit physical and mental healthand change the structure and function of the DMN, amygdala, and hippocampus.
Although many questions remain unanswered, including whether or not these brain changes translate to greater health, happiness, and wellbeing, they suggest that mindfulness may be beneficial for healing from the adversity that most of us experience during the course of our lives.