Ruwan M Jayatunge M.D.
Post traumatic stress disorder (PTSD) is a clinical syndrome that may develop following extreme traumatic stress (APA). It is an important, albeit relatively uncommon, consequence of exposure to traumatic events (Greenberg, Brooks & Dunn, 2015) presumably the result of life threats and conditioned fear (Ramage et al., 2015).
According to the DSM-IVTR (the Diagnostic and Statistical Manual from the American Psychological Association, 2000) the symptoms of PTSD include: a) re-experiencing the traumatic event through intrusive memories, flashbacks, nightmares, and physiological responses similar to when the traumatic event was occurring b) avoidance and numbing such as avoiding situations and people that remind them of the trauma, amnesia for trauma related information, loss of interest in activities, social and emotional detachment, emotional numbing especially for feelings associated with intimacy, and feelings of a limited future; and c) increased arousal manifested by angry outbursts, problems sleeping, problems concentrating or completing tasks, exaggerated startle response, and hypervigilance.
PTSD is a global health issue (Tanielian, 2009; Jindani, 2015) and alleged to be associated with high rates of concurrent psychological disorders (Keane &, Wolfe, 1990) and highly impairing condition (Kessler, 2000). Patients with post-traumatic stress disorder have complex and multiple symptoms (Hawkins et al., 2015) causing significant economic and social burden.
Posttraumatic stress disorder (PTSD) develops in approximately 20% of people exposed to a traumatic event (Freedman et al., 2015). PTSD is more prevalent in females than in males: typically about twice the rate (Jaycox et al., 2004). PTSD affects 7-8% of the general U.S. population at some point during their lifetime (Gates et al., 2012). The prevalence rate of lifetime PTSD in Canada was estimated to be 9.2%, with a rate of current (1-month) PTSD of 2.4% (Van Ameringen et al., 2008). According to the Canadian Forces Mental Health Survey (2013) 5.3 per cent of soldiers reported experiencing PTSD.
Risk factors for PTSD in adults vary across studies. The 3 factors identified as having relatively uniform effects are 1) preexisting psychiatric disorders, 2) a family history of disorders, and 3) childhood trauma (Breslau, 2002). According to Kessler et al (1995) the risk of developing PTSD after a traumatic event is 8.1% for men and 20.4% for women.
Patients with PTSD have a severe clinical profile. Therefore treating patients suffering from PTSD pose significant challenges. Pharmacologic and psychotherapeutic interventions are indicated for the treatment of PTSD.
A variety of psychotherapy treatments have been developed for PTSD (Schäfer & Najavits, 2007) and psychological interventions play an important role (Bisson & Andrew, 2007). Among the psychological interventions meditation has been recognized as one of the effective modes. Meditation is an empirically-validated treatment for PTSD. A growing body of evidence suggests meditation-based interventions have the potential to reduce symptoms and improve well-being (Mitchell et al., 2014; Seppälä et al., 2014).
Meditation is a mind-body practice. Meditation is an essential element in all of the world’s major contemplative spiritual and philosophical traditions (Walsh, 1999; Shapiro, 2008). According to Manocha (2000) meditation is a discrete and well-defined experience of a state of “thoughtless awareness” or mental silence, in which the activity of the mind is minimized without reducing the level of alertness. Walsh and Shapiro (2006) described meditation as self-regulation practices that aim to bring mental processes under voluntary control through focusing attention and awareness.
Effects of meditation on health are based on the principle of mind-body connection and there is a growing body of literature showing the efficacy of meditation on various health related problems (Hussain & Bhushan, 2010). Mind-body practices are increasingly used in the treatment of PTSD and are associated with positive impacts on stress-induced illnesses such as depression and PTSD in most existing studies (Kim et al., 2013). As described by Cloitre et al (2011) meditation has been identified as an effective second-line approach for emotional, attentional, and behavioral (e.g., aggression) disturbances in PTSD. Lang and team (2012) further suggest that meditation as an intervention for PTSD.
Anapanasati meditation or mindfulness of breathing meditation can be used to treat PTSD. Deo and colleagues (2015) emphasize that breathing is an exquisite tool for exploring subtle awareness of mind and life itself. Mindfulness of breathing helps to oxygenate the body and reduce stress and anxiety. Breathing interventions have boosted emotion regulatory processes in healthy populations (Arch & Craske , 2006; Seppälä et al., 2014). Sack, Hopper, Lamprecht and Low (2004) indicate that breathing-based meditation practices may be beneficial for PTSD. Seppälä and team (2014) reported that breathing-based meditation decreased posttraumatic stress disorder symptoms in U.S. military veterans.
Mindfulness meditation which is a non-concentrative technique helps individuals to cultivate awareness and acceptance of all mental events (Steinberg & Eisner, 2015). The term “mindfulness” has been used to refer to a psychological state of awareness, a practice that promotes this awareness, a mode of processing information, and a characterological trait (Davis & Hayes, 2011). Germer et al (2005) defines mindfulness as moment-by-moment awareness. The evidence concur that mindfulness helps to develop effective emotion regulation in the brain (Siegel, 2007; Davis & Hayes, 2011).
Mindfulness is associated with low levels of neuroticism, anxiety, and depressive symptoms, as well as high levels of self-esteem and satisfaction with life (Brown & Ryan, 2003; Tanner et al., 2009). Mindfulness meditation is indicated in PTSD. Follett, Palm and Pearson (2006) discuss positive outcome on trauma survivors after using Mindfulness. Furthermore Christelle et al (2014) suggest mindfulness meditation for Posttraumatic Stress Disorder.
Vedananupassana meditation or awareness of sensations and feelings is a form of mindfulness meditation which is useful in the treatment of PTSD. Chronic pain and post-traumatic stress disorder (PTSD) commonly co-occur in the aftermath of a traumatic event (Palyo & Beck, 2005) In addition chronic pain and PTSD are mutually maintaining conditions (Sharp & Harvey, 2001) and pain sensations can trigger PTSD symptoms. People with chronic pain and comorbid posttraumatic stress disorder report poorer quality of life (Morascoet al., 2013). Vedananupassana meditation is beneficial in alleviating pain in the individuals with PTSD.
Loving-kindness meditation (LKM) is a practice designed to enhance feelings of kindness and compassion for self and others (Kearney et al., 2013). Self-compassion is considered a promising change agent in the treatment of PTSD (Hoffart , Øktedalen & Langkaas , 2015). Kearney et al., (2014) conducted Loving-kindness meditation pilot study with 42 veterans impacted by active PTSD and found increased positive emotions among them. According to Kearney and colleagues (2013) loving-kindness meditation appeared safe and acceptable and was associated with reduced symptoms of PTSD and depression. According to Hinton et al (2013) LKM has potential for increasing emotional flexibility, decreasing rumination, serving as emotional regulation techniques, and forming part of a new adaptive processing mode centered on psychological flexibility.
Research has shown that transcendental meditation (TM) can be an effective technique to treat PTSD. Transcendental Meditation (TM) is derived from ancient yogic teachings (Lansky et al, 2006) and it is an effortless purely mental technique (Rees, 2011) and this technique falls within the category of “automatic self-transcending” because the practice allows the mind to effortlessly settle inward, beyond thought, to experience the source of thought, pure awareness ( Travis & Shear ,2010). Chhatre et al (2013) describe TM as a behavioral stress reduction program that incorporates mind-body approach, and has demonstrated effectiveness in improving outcomes via stress reduction.
Rees, Travis, Shapiro and Chant (2013) indicate that reduction in posttraumatic stress symptoms in Congolese refugees practicing transcendental meditation. Rosenthal and colleagues (2011) highlight the successful use of TM meditation on the veterans of Operation Enduring Freedom and Operation Iraqi Freedom with posttraumatic stress disorder. Furthermore Orme-Johnson and Barnes (2014) elucidate anxiety reduction effect of TM meditation.
Meditation is an important part of health and spiritual practice. It is a form of mental exercise that has an extensive therapeutic value. There are three major types of meditative practices: mindfulness, transcendental meditation and compassion meditation. There is evidence to suggest that meditation can be used to treat PTSD. Studies demonstrated that meditation is associated with reductions in PTSD symptoms and improve quality of life. Therefore meditation-based approaches are indicated in the treatment of PTSD.
- Rev Harispaththuwe Ariyawansalankara Thero – Vipassana Meditation Center Colombo Sri Lanka
- David R. Leffler, PhD Executive Director Center for Advanced Military Science (CAMS) Institute of Science, Technology and Public Policy Iowa USA
- Fred Travis – Post Doctoral Fellow, University of California, Davis, in Basic Sleep Research
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