Mindfulness-Based Interventions for Psychological Trauma and Posttraumatic Stress Disorder (PTSD)

Lifetime trauma exposure affects about 70% of the global population, yet PTSD prevalence is about 6%. FDA-approved medications have small-to-medium effects, while trauma-focused psychotherapies show large effects but high dropout and refusal rates. Mindfulness-Based Interventions (MBIs) for PTSD show high engagement and patient satisfaction. Meta-analyses report mixed findings, with low to medium-high effect sizes depending on the population and protocol. MBIs with well-established protocols produce medium-high effects in some groups, promoting acceptance and emotion regulation while reducing self-blame, avoidance, and hyperarousal. The authors argue that trauma-specific adaptations are needed and that MBIs may be most effective as adjunctive treatments or for those unwilling or unable to complete trauma-focused therapies.

Study at a glance

Abstract

Abstract Purpose of Review Lifetime exposure to trauma is extremely common, affecting ~ 70% of global population, whereas lifetime prevalence of PTSD is ~ 6%. FDA-approved medications for PTSD have small-medium effect sizes. Trauma-focused psychotherapies are considered first-line treatments and have large effect sizes, but also high rates of dropout and refusal, and most patients retain PTSD diagnosis. Mindfulness-Based Interventions (MBIs) as treatments for PTSD have high levels of engagement, retention, and patient satisfaction. Here we briefly describe MBIs and review empirical support for MBIs in the treatment of trauma and PTSD in military veterans, survivors of intimate partner violence and childhood maltreatment, and among substance users with trauma. Recent Findings Meta-analyses of MBIs for PTSD symptoms have mixed findings, with low to medium-high effect sizes, and quality of studies and range of MBIs vary greatly. MBIs with well-established protocols have medium-high effects for PTSD in some populations and promote acceptance and emotion regulation, and reduce self-blame, avoidance, and hyperarousal. Summary MBIs may target specific mechanisms leading to overall improvements in symptoms and quality of life. Trauma-specific adaptations to MBIs must be made to maximize acceptability, safety, and efficacy. MBIs may be most effective as adjunctive treatments for PTSD, for those unwilling to do trauma-focused empirically supported treatments (ESTs), who drop out or have high residual symptoms. Clinical Opinion In my opinion, informed client treatment preference to the extent feasible is ethically imperative and empirically supported for optimal outcomes in persons with PTSD. I would first discuss and recommend “first line” ESTs for PTSD that have the largest effect sizes and best quality of empirical support, including exposure-based psychotherapies (e.g. PE) and CPT (both of which I am trained in) as well as EMDR, and also refer for a medication consult. I would describe MBIs such as “trauma sensitive” MBCT and MBSR as interventions that are often helpful as adjunctive treatments useful for improving grounding and physiological and emotional self-regulation skills, and can themselves lead to moderate improvements in PTSD symptoms without trauma exposure. For clients with PTSD who decline trauma-focused therapy, drop out early, or do not benefit from empirically supported treatments (ESTs) I would recommend a trauma sensitive MBI, optimally one led by a trauma therapist as a second-line therapy to gain skills and stabilization, or as an adjunct to medication, ongoing cognitive therapy, present-centered therapy, or IPT. I would not recommend a MBI (i.e. community mindfulness group) delivered by a person who does not have experience in trauma therapy as a stand-alone treatment in the absence of other treatment or support.