Mindful Based Stress Reduction being trialled for combat PTSD

Researchers are testing a new method for treating post-traumatic stress disorder (PTSD) they hope will help soldiers deal with troubling memories before depression, memory loss, drug abuse, and other health problems begin to occur.

Principal investigator, J. Douglas Bremner, MD, director of mental health research at the Atlanta Veterans Affairs Medical Center and assistant director in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine, says that his team is testing a novel alternative treatment for PTSD called Mindful Based Stress Reduction (MBSR).

"As long as the war in Iraq continues, the stress of being in battle will take its toll on some returning soldiers," says Dr. Bremner, who is also director of the Center for Positron Emission Tomography at Emory University Hospital.

"It is critical to intervene early while the memories of combat are still malleable and the veterans still retain their social and work supports," says Dr. Bremner. "We know that as time goes on, traumatic memories become indelible and resistant to treatment.

"Soldiers deployed to Iraq in Operation Iraqi Freedom are exposed to higher levels of stress than anyone had previously anticipated," says Dr. Bremner. "We were too late in starting treatments for our soldiers after the war in Vietnam."

In the eight-week MBSR program, an instructor trained at the Center for Mindfulness in Worcester, Mass., will teach participants how to "intentionally pay attention to present-moment experiences" such as physical sensations or perceptions, without evaluating those experiences. During each session, participants will be introduced interactively to techniques such as yoga and meditation. There will be no 'patients' and 'therapists,' rather the approach will be to use 'teachers' and 'students.' Dr. Bremner notes, "If MBSR works, it will mean we will have the ability to teach our returning soldiers the skill to control their reaction to those painful memories, without the use of medication, and before the stress from the memories causes further damage.

"We know that medications sometimes have unpleasant side effects, or don't work at all. MBSR is an intervention that not only teaches the soldier how to cope with painful memories from battle, but can be beneficial as a coping skill for life in general."

"Consciously controlling, or accepting, intrusive thoughts is considered to be effective in reducing avoidance of distressing thoughts, thus increasing tolerance for those thoughts," says Dr. Bremner. "Reduction of negative thoughts and behaviors may also promote self-healing through the promotion of positive behaviors and coping styles, rather than negative ones."

Study participants will be male and female Iraqi veterans age 18-50 who are being discharged from active duty and have two or more symptoms of PTSD. The participants will be randomized into two groups: one group will participate in the MBSR program, and the other group will have conventional supportive psychotherapy.

Both groups will undergo brain imaging and assessment of stress hormones before and after treatment to compare brain and hormonal responses to the intervention.

Dr. Bremner was a pioneer in the study of PTSD as the first medical director of the first inpatient unit for PTSD at the National Center for Post-Traumatic Stress Disorder in New Haven, Conn. At that time there was essentially no research being done on post-traumatic stress disorder: diagnosis was established in 1980, but not used until 1988.

The study is funded by a grant from the Department of Veterans Affairs.