Enhancing Traumatic Stress Recovery Through Nonattachment Principles: A Scoping Review

Background: Nonattachment is an important component of Mindfulness-Based Interventions (MBIs), including its application within post-traumatic stress (PTS) contexts. However, within trauma contexts, there is limited understanding of the role and effectiveness of MBIs that integrate nonattachment.

Objective: This study aimed to identify and evaluate evidence regarding the effectiveness of MBIs with nonattachment elements used with PTS populations.

Methods: This review followed the PRISMA scoping guideline framework with searches conducted using Science Direct, PsycINFO, PubMed, and Google Scholar for peer-reviewed studies of MBIs with nonattachment principles or practices, and outcome measures related to PTS. The final search was conducted in January 2024, with no date restrictions for eligible studies.

Results: Fourteen studies met the inclusion criteria including 7 randomized controlled trials, 4 cohort studies, and 1 quasi-experimental, 1 cross-sectional, and 1 qualitative study. Individual study samples ranged from 9 to 209 participants (n = 913). All studies showed promising results for interventions integrating nonattachment applied to PTS populations, with the MBI outperforming control conditions in 6 of 7 RCTs, and all cohort studies showing significant improvements. Improvements included reductions in PTSD assessment scores, stress and anxiety, negative self-concept, disturbances in relationships, expressive suppression and rumination, and experiential avoidance, as well as increased acceptance and compassion. Various quality issues were identified such as a lack of or poorly defined randomization, blinding procedures, controls for confounding variables, and small sample sizes. MBIs integrating nonattachment that target physiological stabilization, coupled with participant input into intervention decisions, appear most promising.

Conclusions: MBIs that incorporate nonattachment elements may offer meaningful support for individuals experiencing PTS, particularly by fostering more flexible and less self-fixated ways of relating to thoughts and emotions.