A non-trauma-focused therapy, transcendental meditation (TM), may be a viable option to decrease symptom severity of posttraumatic stress disorder (PTSD) in veterans, according to a new study published in The Lancet Psychiatry. This study was the first comparative effectiveness trial comparing TM with an established psychotherapy for PTSD.1
Although prolonged exposure (PE) therapy is beneficial for many types of PTSD trauma, studies have shown high dropout rates in randomized trials and clinic-based visits (30% to 44%)2,3 as well as low efficacy in some patients receiving PE therapy (30% to 50% of veterans).4,5 To evaluate reductions in PTSD symptom severity, researchers compared Clinician-Administered PTSD Scale (CAPS) scores in veterans receiving TM with those receiving PE and PTSD health education (HE) between June 10, 2013, and Oct 7, 2016, at the Department of Veterans Affairs San Diego Healthcare System in California.
The research team randomly assigned 203 veterans with a current diagnosis of PTSD resulting from active military service to either 12 sessions of TM therapy (n=68), PE therapy (n=68), or PTSD HE (n=67) over 12 weeks.
Investigators found that from baseline to 3-month posttest, TM was significantly noninferior to PE on change in CAPS score for trauma symptom severity (difference between groups in mean change, −5.9; 95% CI, −14.3 to 2.4; P =.0002). In addition, the TM group showed significantly greater percentages of improvements on the CAPS score (61%), compared with the PE (42%) and HE (32%) groups.
There was a significantly greater reduction on symptoms of PTSD and depression in both TM and PE groups compared with the HE group. In addition, improvements in total mood disturbance and the overall quality of life was better in participants in the TM group and the PE group displayed improvements in total mood disturbance only.
According to the researchers, “These findings suggest the feasibility and efficacy of TM as an alternative therapy for veterans with PTSD.” However, they continued, “the study lacked a follow-up period that could have offered valuable information regarding further reduction of PTSD symptoms and the durability of the PE and TM benefits observed.”1 Further research may provide opportunities to explore therapeutic options for veterans who prefer not to receive or who do not respond to traditional exposure-based treatments of PTSD.
In conclusion, the investigators note that, “TM was non-inferior compared with PE for treating PTSD symptom severity and comorbid depression in veterans with PTSD.”
- Nidich S, Mills PJ, Rainforth M, et al. Non-trauma-focused meditation versus exposure therapy in veterans with post-traumatic stress disorder: a randomised controlled trial [published online November 9, 2018]. Lancet Psychiatry. doi: 10.1016/S2215-0366(18)30384-5
- Steenkamp MM, Litz BT, Hoge CW, Marmar CR. Psychotherapy for military-related PTSD: a review of randomized clinical trials. JAMA. 2015;314(5):489-500.
- Jeffreys MD, Reinfeld C, Nair PV, Garcia HA, Mata-Galan E, Rentz TO. Evaluating treatment of posttraumatic stress disorder with cognitive processing therapy and prolonged exposure therapy in a VHA specialty clinic. J Anxiety Disord. 2014;28(1):108-114.
- Schnurr P, Friedman M, Engel C, et al. Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial. JAMA. 2007;297(8):820-830.
- Forbes D, Lloyd D, Nixon RD, et al. A multisite randomized controlled effectiveness trial of cognitive processing therapy for military-related posttraumatic stress disorder. J Anxiety Disord. 2012;26(3):442-452.