Spiritual Wellbeing Mediates PTSD Change in Veterans with Military-Related PTSD
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
A portable practice of repeating a mantram—a sacred word or phrase—has been shown to reduce the severity of posttraumatic stress disorder (PTSD) symptoms in veterans with military trauma. It is thought that the intervention re-directs attention and initiates relaxation to decrease symptom severity, but there may be other mechanisms that may contribute to this improvement.
We tested the hypothesis that increases in existential spiritual wellbeing (ESWB) would mediate reductions in self-reported PTSD symptoms following a group mantram intervention.
Veterans diagnosed with PTSD from war-related trauma completed 6 weeks of case management plus a group mantram intervention (n = 66) as part of a randomized trial. Measures included PTSD Checklist (PCL) and Functional Assessment of Chronic Illness Therapy–Spiritual Wellbeing. Path analysis was conducted on those who completed treatment to assess ESWB as a possible mediator of change in PCL from baseline to post-treatment.
A significant indirect effect, −2.24, 95% CI (−4.17, −1.05) of the mantram intervention on PCL change was found. The path from the mantram intervention to ESWB change was significant and positive (B = 4.89, p < 0.0001), and the path from ESWB change to PCL change was significant and negative (B = −0.46, p = 0.001), thus supporting the hypothesis.
Findings suggest that one contributing mechanism that partially explains how the mantram intervention reduces PTSD symptom severity in veterans may be by increasing levels of ESWB.
- RAND. Invisible wounds of war: mental health and cognitive care needs of America’s returning veterans. Santa Monica, CA: RAND Corporation; 2008.
- RAND. Invisible wounds of war: psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica, CA: RAND Corporation; 2008.
- Witvliet CVO, Phipps KA, Feldman ME, Beckman JC. Posttraumatic mental and physical health correlates of forgiveness and religious coping in military veterans. J Trauma Stress. 2004;17(3):269–73. CrossRef
- Carrico AW, Ironson G, Antoni MH, Lechner SC, Duran RE, Kumar M, et al. A path model of the effects of spirituality on depressive symptoms and 24-hour urinary-free cortisol in HIV-positive persons. J Psychosom Res. 2006;61(1):51–8. CrossRef
- Ironson G, Stuetzle R, Fletcher MA. An increase in religiousness/spirituality occurs after HIV diagnosis and predicts slower disease progression over 4 years in people with HIV. J Gen Intern Med. 2006;21(S5):S62–8. CrossRef
- Litwinczuk KM, Groh CJ. The relationship between spirituality, purpose in life, and wellbeing in HIV-positive persons. J Assoc Nurses AIDS Care. 2007;18(3):13–22. CrossRef
- Margolin A, Beitel M, Schuman-Oliver Z, Avants SK. A controlled study of a spiritually-focused intervention for increasing motivation for HIV prevention among drug users. AIDS Educ Prev. 2006;18(4):311–22. CrossRef
- Tarakeshwar N, Pearce MJ, Sikkema KJ. Development and implementation of a spiritual coping group intervention for adults living with HIV/AIDS: a pilot study. Ment Health Relig Cult. 2005;8(3):179–90. CrossRef
- Gansler T, Kaw C, Crammer C, Smith T. A population-based study of prevalence of complementary methods use by cancer survivors. Cancer. 2008;113(5):1048–57. CrossRef
- Lin HR, Bauer-Wu SM. Psycho-spiritual wellbeing in patients with advanced cancer: an integrative review of the literature. J Adv Nurs. 2003;44(1):69–80. CrossRef
- Targ EF, Levine EG. The efficacy of a mind–body–spirit group for women with breast cancer: a randomized controlled trial. Gen Hosp Psychiatr. 2002;24(4):238–48. CrossRef
- Falsetti SA. Cognitive–behavioral therapy in the treatment of posttraumatic stress disorder. Prim Psychiatr. 2003;10(5):78–83.
- Chiu L, Emblen JD, Van Hofwegen L, Sawatzky R, Meyerhoff H. An integrative review of the concept of spirituality in the health sciences. West J Nurs Res. 2004;26:405–28. CrossRef
- Hill PC, Pargament KI. Advances in the conceptualization and measurement of religion and spirituality: implications for physical and mental health research. Am Psychol. 2003;58(1):64–74. CrossRef
- Zandipour T. The role of religious beliefs and thoughts of holy defence veterans inaccepting the difficulties of imposed war. Couns Psychol Q. 2008;21(1):75–83. CrossRef
- Fontana A, Rosenheck R. Trauma, change in strength of religious faith, and mental health service use among veterans treated for PTSD. J Nerv Ment Disord. 2008;579–584.
- Hughes B, Handzo G. Specialty interventions: spiritual mantram repetition. In: Dept. of Navy DoD, US Government, ed. 2010;80–84.
- Bormann JE, Smith TL, Becker S, Gershwin M, Pada L, Grudzinski A, et al. Efficacy of frequent mantram repetition on stress, quality of life, and spiritual wellbeing in veterans: a pilot study. J Holistic Nurs. 2005;23(4):394–413. CrossRef
- Bormann JE, Thorp S, Wetherell JL, Golshan S, Fellows I, Lang A, et al. (2009, February). Efficacy of a spiritually-based mantram intervention on quality of life in veterans with military-related PTSD. Poster session presented at the Health Services Research & Development National Meeting, Baltimore, MD.
- Easwaran E. The mantram handbook. 4th ed. Tomales, CA: Nilgiri Press; 2001.
- Bormann JE, Becker S, Gershwin M, Kelly A, Pada L, Smith TL, et al. Relationship of frequent mantram repetition to emotional and spiritual wellbeing in healthcare workers. J Educ Contin Nurs. 2006;37(5):218–24.
- Bormann JE, Oman D, Kemppainen JK, Becker S, Gershwin M, Kelly A. Mantram repetition for stress management in veterans and employees: a critical incident study. J Adv Nurs. 2006;53(5):502–12. CrossRef
- Richards TA, Oman D, Hedberg J, Thoresen CE, Bowden J. A qualitative examination of a spiritually-based intervention and self-management in the workplace. Nurs Sci Q. 2006;19(3):231–9. CrossRef
- Bormann JE, Gifford AL, Shively M, Smith TL, Redwine L, Kelly A, et al. Effects of spiritual mantram repetition on HIV outcomes: a randomized controlled trial. J Behav Med. 2006;29(4):359–76. CrossRef
- Wolf DB, Abell N. Examining the effects of meditation techniques on psychosocial functioning. Res Soc Work Pract. 2003;13(1):27–42. CrossRef
- Bormann JE, Oman D. Mantram or holy name repetition: health benefits from a portable spiritual practice. In: Plante TG, Thoresen C, editors. Spirit, science and health: how the spiritual mind fuels physical wellness. Westport, CT: Praeger; 2007. p. 94–112.
- Jacobs GD. Clinical applications of the relaxation response and mind–body interventions. J Altern Compl Med. 2001;7 Suppl 1:S93–S101. CrossRef
- Jacobs GD. The physiology of mind–body interactions: the stress response and the relaxation response. J Altern Compl Med. 2001;7 Suppl 1:S83–92. CrossRef
- Bormann JE, Carrico AW. Increases in positive reappraisal coping during a group-based mantram intervention mediate sustained reductions in anger in HIV-positive persons. Int J Behav Med. 2009;16:74–80. CrossRef
- Wachholtz A, Pargament K. Secular vs. spiritual meditation on mental health, spiritual health, and pain control. Ann Behav Med. 2006;31(Suppl):S074.
- Wachholtz A, Pargament KI. Is spirituality a critical ingredient of meditation? Comparing the effects of spiritual meditation, secular meditation, and relaxation on spiritual, psychological, cardiac, and pain outcomes. J Behav Med. 2005;28:369–84. CrossRef
- Wachholtz A, Pargament KI. Migraines and meditation: does spirituality matter? J Behav Med. 2008;31(4):351–66. CrossRef
- Weathers F. Pyschometric review of Clinician-Administered PTSD Scale (CAPS). In: Stamm BB, editor. Measurement of stress, trauma, and adaptation. Lutherville, MD: Sidran Press; 1996. p. 106–7.
- Easwaran E. Strength in the storm: creating calm in difficult times. Tomales, CA: Nilgiri Press; 2005.
- Bormann JE. Frequent, silent mantram repetition: a jacuzzi for the mind. Top Emerg Med. 2005;27(2):163–6.
- Weathers FW, Litz BT, Herman JA, Huska JA, Keane TM. PTSD Checklist (PCL) (1993): reliability, validity and diagnostic utility. Proceedings of the 9th Annual Conference of International Society for Traumatic Stress Studies, Chicago, IL.
- Weathers FW, Keane TM, Davidson JR. Clinician-administered PTSD scale: a review of the first ten years of research. Depress Anxiety. 2001;13:132–56. CrossRef
- Spitzer RL, Williams JB, Gibbons M, First MB. Structured clinical interview for DSM-IV: patient version (SCID-P, version 2.0). Washington, DC: American Psychiatric Press; 1995.
- Peterman AH, Fitchett G, Brady MJ, Hernandez L, Cella D. Measuring spiritual wellbeing in people with cancer: the Functional Assessment of Chronic Illness Therapy–Spiritual Wellbeing Scale. Ann Behav Med. 2002;24(1):49–58. CrossRef
- Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers. 1991;59:143–78. CrossRef
- Efron B, Tibshirani RJ. An introduction to the bootstrap. Palo Alto, California: Chapman and Hall/CRC; 1993.
- Preacher KJ, Hayes A. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Meth Instrum Comput. 2004;36(4):717–31. CrossRef
- R Development Core Team. R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2008.
- Bormann JE. Mantram repetition: a “portable contemplative practice” for modern times. In: Plante TG, editor. Contemplative practices in action: spirituality, meditation, and health. Santa Barbara, CA: ABC-CLIO; 2010. p. 78–99.
- Holmbeck GN. Post-hoc probing of significant moderational and mediational effects in studies of pediatric populations. J Ped Psychol. 2002;27:87–9. CrossRef
- MacKinnon DP, Lockwood CM, Hoffman JM, West SG, Sheets V. A comparison of methods to test mediation and other intervening variable effects. Psychol Meth. 2002;7:83–104. CrossRef
- Spiritual Wellbeing Mediates PTSD Change in Veterans with Military-Related PTSD
International Journal of Behavioral Medicine
Volume 19, Issue 4 , pp 496-502
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Posttraumatic stress disorder
- Author Affiliations
- 1. Center of Excellence for Stress and Mental Health (CESAMH), Veterans Affairs San Diego Healthcare System (VASDHS), 3350 La Jolla Village Drive (111N-1), San Diego, CA, 92161, USA
- 2. School of Nursing, College of Health and Human Services, San Diego State University, San Diego, CA, USA
- 5. Department of Nursing and Patient Care Services, VA San Diego Healthcare System, 3350 La Jolla Village Drive (111N-1), San Diego, CA, 92161, USA
- 3. Department of Family and Preventive Medicine, University of California San Diego, San Diego, CA, USA
- 4. Department of Psychiatry, University of California San Diego, San Diego, CA, USA