Predictors of Depression and PTSD Treatment Response Among Veterans Participating in Mindfulness-Based Stress Reduction
- 1.5k Downloads
Posttraumatic stress disorder (PTSD) and depression are prevalent and often co-occur among veterans. There is growing interest in the effects of mindfulness-based interventions among veterans. This study examined PTSD and depression outcomes, and baseline predictors of response, among veterans who participated in mindfulness-based stress reduction (MBSR). Participants included 116 veterans with PTSD before and after MBSR. Multilevel modeling assessed baseline predictors of change in PTSD and depressive symptoms. There were clinically significant reductions in PTSD and depression symptoms posttreatment and at 4 months follow-up. For PTSD, effect sizes were in the medium range posttreatment (d = −.63) and at follow-up (d = −.69), and for depression posttreatment (d = −.58) and at follow-up (d = −.70). Baseline PTSD was a significant predictor of slope (β = .03, p = .04) on PTSD outcomes; higher baseline PTSD predicted greater rate of reduction in symptoms. For depression (β = .04, p < .01,), those with severe or moderately severe depression exhibited the greatest rate of improvement. However, veterans with high symptom severity did remain symptomatic post-MBSR. These findings show preliminary support for MBSR in facilitating symptom reduction for veterans with severe PTSD and co-occurring depression.
KeywordsMindfulness PTSD Depression Treatment
This material is the result of work supported by resources from the VA Puget Sound Health Care System, Seattle, WA. We would also like to thank the Veterans involved in this study at VA Puget sound for their willingness to participate in this research. Thank you to Amy Mezulis, Ph.D., for her thoughtful feedback and guidance with statistical analyses.
Compliance with ethical standards
Conflict of Interest
None of the authors have financial or other conflicts of interest related to this work.
- Başoglu, M., Livanou, M., Crnobarić, C., Francisković, T., Suljić, E., Durić, D., & Vranesić, M. (2005). Psychiatric and cognitive effects of war in former Yugoslavia: association of lack of redress for trauma and posttraumatic stress reactions. JAMA: The Journal of the American Medical Association, 294(5), 580–590.CrossRefPubMedGoogle Scholar
- Blanchard, E.B., Hickling, E.J., Devineni, T., Veazey, C.H., Galovski, T.E., Mundy, E., … Buckley, T.C. (2003). A controlled evaluation of cognitive behavioral therapy for posttraumatic stress in motor vehicle accident survivors. Behaviour Research and Therapy, 41(1), 79–96. doi: 10.1016/S0005-7967(01)00131-0.
- Cella, D., Yount, S., Rothrock, N., Gershon, R., Cook, K., Reeve, B., … Rose, M. (2007). The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH roadmap cooperative group during its first two years. Medical Care, 45(5,Suppl1), S3–S11. doi: 10.1097/01.mlr.0000258615.42478.55.
- Choi, S., Podrabsky, T., McKinney, N., Schalet, B., Cook, K., Cella, D. (2012). PROsetta stone methodolgy: a rosetta stone for patient reported outcomes. http://www.nihtoolbox.org.
- Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Lawrence Erlbaum Associates.Google Scholar
- Ehlers, A., Grey, N., Wild, J., Stott, R., Liness, S., Deale, A., … Manley, J. (2013). Implementation of cognitive therapy for PTSD in routine clinical care: effectiveness and moderators of outcome in a consecutive sample. Behaviour Research and Therapy, 51(11), 742–752.Google Scholar
- Institute of Medicine (IOM) (2012). Treatment for posttraumatic stress disorder in military and veteran populations: initial assessment. Washington, D.C. http://iom.edu/militaryptsd.
- Kabat-Zinn, J. (1990). Full catastrophe living: using the wisdom of your mind to face stress, pain and illness. New York: Dell Publishing.Google Scholar
- Kearney, D. J., McDermott, K., Malte, C., Martinez, M., & Simpson, T. L. (2012). Association of participation in a mindfulness program with measures of ptsd, depression and quality of life in a veteran sample. Journal of Clinical Psychology, 68(1), 101–116. doi: 10.1002/jclp.20853.CrossRefPubMedGoogle Scholar
- Kearney, D. J., McDermott, K., Malte, C., Martinez, M., & Simpson, T. L. (2013). Effects of participation in a mindfulness program for veterans with posttraumatic stress disorder: a randomized controlled pilot study. Journal of Clinical Psychology, 69(1), 14–27. doi: 10.1002/jclp.21911.CrossRefPubMedGoogle Scholar
- Kehle-Forbes, S. M., Meis, L. A., Spoont, M. R., & Polusny, M. A. (2016). Treatment initiation and dropout from prolonged exposure and cognitive processing therapy in a VA outpatient clinic. Psychological Trauma: Theory, Research, Practice, and Policy, 8(1), 107–114. doi: 10.1037/tra0000065.CrossRefGoogle Scholar
- King, A.P., Erickson, T.M., Giardino, N.D., Favorite, T., Rauch, S.M., Robinson, E., … Liberzon, I. (2013). A pilot study of group mindfulness‐based cognitive therapy (MBCT) for combat veterans with posttraumatic stress disorder (PTSD). Depression and Anxiety, 30(7), 638–645. doi: 10.1002/da.22104.
- Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9. Journal of General Internal Medicine, 16, 606–613. doi: 10.1046/j.1525-1497.2001.016009606.x.
- Monson, C. M., Gradus, J. L., Young-Xu, Y., Schnurr, P. P., Price, J. L., & Schumm, J. A. (2008). Change in posttraumatic stress disorder symptoms: do clinicians and patients agree? Psychological Assessment, 20(2), 131–138. doi: 10.1037/1040-35184.108.40.206.
- National Alliance on Mental Illness (NAMI) (2009). Depression and veterans fact sheet. Arlington: VA. http://www.nami.org.
- Niles, B. L., Klunk-Gillis, J., Ryngala, D. J., Silberbogen, A. K., Paysnick, A., & Wolf, E. J. (2012). Comparing mindfulness and psychoeducation treatments for combat-related ptsd using a telehealth approach. Psychological Trauma: Theory, Research, Practice, and Policy, 4(5), 538–547. doi: 10.1037/a0026161.CrossRefGoogle Scholar
- Polusny, M.A., Erbes, C.R., Thuras, P., Moran, A., Lamberty, G.J., Collins, R.C., … Lim, K.O. (2015). Mindfulness-based stress reduction for posttraumatic stress disorder among veterans: a randomized clinical trial. JAMA, 314(5), 456–465. doi: 10.1001/jama.2015.8361.
- Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models (2nd ed.). Thousand Oaks: Sage Publications.Google Scholar
- Rizvi, S. L., Vogt, D. S., & Resick, P. A. (2009). Cognitive and affective predictors of treatment outcome in cognitive processing therapy and prolonged exposure for posttraumatic stress disorder. Behaviour Research and Therapy, 47(9), 737–743. doi: 10.1016/j.brat.2009.06.003.CrossRefPubMedPubMedCentralGoogle Scholar
- Segal, Z. V., Williams, J. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse. New York: Guilford Press.Google Scholar
- Strauss, C., & Lang, A.J. (2012). Complementary and alternative treatments for PTSD. National Center for PTSD: PTSD Research Quarterly, 23(2). http://www.ptsd.va.gov/professional/newsletters/research-quarterly/v23n2.pdf.
- Strauss, C., Cavanagh, K., Oliver, A., Pettman, D. (2014). Mindfulness-based interventions for people diagnosed with a current episode of an anxiety or depressive disorder: a meta-analysis of randomized controlled trials. PLoS One, 9(4). doi: 10.1371/journal.pone.0096110.
- Teasdale, J. D., Segal, Z. V., Williams, J. G., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68(4), 615–623. doi: 10.1037/0022-006X.68.4.615.CrossRefPubMedGoogle Scholar
- van Aalderen, J. R., Donders, A. T., Giommi, F. F., Spinhoven, P. P., Barendregt, H. P., & Speckens, A. M. (2012). The efficacy of mindfulness-based cognitive therapy in recurrent depressed patients with and without a current depressive episode: a randomized controlled trial. Psychological Medicine, 42(5), 989–1001. doi: 10.1017/S0033291711002054.CrossRefPubMedGoogle Scholar
- Weathers, F., Litz, B., Herman, D., Huska, J., & Keane, T. (1993). The PTSD checklist (PCL): reliability, validity, and diagnostic utility. Paper presented at the Annual Convention of the International Society for Traumatic Stress Studies, San Antonio, TX.Google Scholar
- Wolitzky-Taylor, K. B., Arch, J. J., Rosenfield, D., & Craske, M. G. (2012). Moderators and non-specific predictors of treatment outcome for anxiety disorders: a comparison of cognitive behavioral therapy to acceptance and commitment therapy. Journal of Consulting and Clinical Psychology, 80(5), 786.CrossRefPubMedGoogle Scholar
- Woltman, H., Feldstain, A., MacKay, C., & Rocchi, M. (2012). An introduction to multilevel modeling. Tutorials in Quantitative Methods for Psychology, 8(1), 52–69.Google Scholar