Utilization and Perceived Effectiveness of Mindfulness Meditation in Veterans: Results from a National Survey

Abstract

Objectives

Complementary and integrative health (CIH) approaches are increasingly utilized in health care, and mindfulness meditation is one such evidence-based CIH practice. More information is needed about veterans’ utilization of mindfulness to inform integration within the Veterans Health Administration (VHA).

Methods

This study involved secondary data analysis of a national survey to evaluate utilization and perceived effectiveness of mindfulness relative to other CIH approaches among military veterans. Military veterans (n = 1230) enrolled in VHA reported CIH utilization rates, reasons for use, perceived effectiveness, treatment barriers, and demographics.

Results

Approximately 18% of veterans reported using mindfulness meditation in the past year, exceeding the proportion using all other CIH approaches (p < .001), with the exception of massage and chiropractic care. Mindfulness was most commonly used for stress reduction and addressing symptoms of depression and anxiety. Among mindfulness users, veterans rated mindfulness with a mean score of 3.18 out of 5 (SD = 0.82) in terms of effectiveness, reflecting a response in the “somewhat helpful” to “moderately helpful” range. This was similar to ratings of other CIH approaches (mean = 3.20, p = .391). Of those who used mindfulness, nearly all (78%) reported only using it outside the VHA. Veterans identified not knowing if the VHA offered mindfulness as the most common reason for using mindfulness outside VHA.

Conclusions

In summary, veterans use mindfulness for a range of reasons and report receiving benefit from its use. Low awareness and potentially low availability of VHA’s mindfulness programs need to be addressed to increase access.

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Fig. 1

References

  1. Arch, J. J., Ayers, C. R., Baker, A., Almklov, E., Dean, D. J., & Craske, M. G. (2013). Randomized clinical trial of adapted mindfulness-based stress reduction versus group cognitive behavioral therapy for heterogeneous anxiety disorders. Behaviour Research and Therapy, 51(4), 185–196.

    Article  Google Scholar 

  2. Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13, 27–45.

    Google Scholar 

  3. Baldwin, C. M., Long, K., Kroesen, K., Brooks, A. J., & Bell, I. R. (2002). A profile of military veterans in the southwestern United States who use complementary and alternative medicine: implications for integrated care. Archives of Internal Medicine, 162(15), 1697–1704.

    Article  Google Scholar 

  4. Barnes, P. M., Bloom, B., & Nahin, R. L. (2008). Complementary and alternative medicine use among adults and children; United States, 2007. National Health Statistics Report, 12, 1–23.

    Google Scholar 

  5. Bland, J. M., & Altman, D. G. (1995). Multiple significance tests: the Bonferroni method. BMJ, 310(6973), 170.

    Article  Google Scholar 

  6. Bormann, J. E., Thorp, S. R., Wetherell, J. L., Golshan, S., & Lang, A. J. (2013). Meditation-based mantram intervention for veterans with posttraumatic stress disorder: a randomized trial. Psychological Trauma: Theory, Research, Practice, and Policy, 5(3), 259–267. https://doi.org/10.1037/a0027522.

    Article  Google Scholar 

  7. Bormann, J., Beck, D., Plumb, D., Osei-Bonsu, P., Johnston, J., Rodgers, C., … & Kelly, A. (2018). Mind-body-spirituality based program for veterans with post traumatic stress disorder: a randomized trial. American Journal of Occupational Therapy, 72, 7211520316p1. https://doi.org/10.5014/ajot.2018.72S1-PO5023.

    Article  Google Scholar 

  8. Burke, A., Lam, C. N., Stussman, B., & Yang, H. (2017). Prevalence and patterns of use of mantra, mindfulness and spiritual meditation among adults in the United States. BMC Complementary and Alternative Medicine, 17(316). https://doi.org/10.1186/s12906-017-1827-8.

  9. Comprehensive Addiction and Recovery Act of 2016. (2016). 524 U.S.C. §§ 931–933.

  10. Cramer, H., Hall, H., Leach, M., Frawley, J., Zhang, Y., … & Lauche, R. (2016). Prevalence, patterns, and predictors of meditation use among US adults: a nationally representative survey. Scientific Reports, 6(36760). https://doi.org/10.1038/srep36760.

  11. Davis, L. L., Whetsell, C., Hamner, M. B., Carmody, J., Rothbaum, B. O., Allen, R. S., et al. (2019). A multisite randomized controlled trial of mindfulness-based stress reduction in the treatment of posttraumatic stress disorder. Psychiatric Research and Clinical Practice. https://doi.org/10.1176/appi.prcp.20180002.

    Article  Google Scholar 

  12. Denneson, L. M., Corson, K., & Dobscha, S. K. (2011). Complementary and alternative medicine use among veterans with noncancer pain. Journal of Rehabilitation Research & Development, 48(9), 1119–1128. https://doi.org/10.1682/JRRD.2010.12.0243.

    Article  Google Scholar 

  13. Department of Veteran Affairs. (2017). About VHA. Available at: https://www.va.gov/health/aboutVHA.asp. Accessed 27 Dec 2017.

  14. Eisenberg, D. M., Kessler, R. C., Foster, C., Norlock, F. E., Calkins, D. R., & Delbanco, T. L. (1993). Unconventional medicine in the United States: prevalence, costs, and patterns of use. New England Journal of Medicine, 328, 246–252.

    Article  Google Scholar 

  15. Eisenberg, D. M., Davis, R. B., Ettner, S. L., Appel, S., Wilkey, S., ... & Kessler, R. C. (1998). Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA, 280, 1569–1575.

  16. Elwy, A. R., Johnston, J. M., Bormann, J. E., Hull, A., & Taylor, S. L. (2014). A systematic scoping review of complementary and alternative medicine mind and body practices to improve the health of veterans and military personnel. Medical Care, 52, S70–S82.

    Article  Google Scholar 

  17. Fletcher, C. E., Mitchinson, A. R., Trumble, E. L., Hinshaw, D. B., & Dusek, J. A. (2014). Perceptions of providers and administrators in the Veterans Health Administration regarding complementary and alternative medicine. Medical Care, 52, S91–S96.

    Article  Google Scholar 

  18. Garland, E. L., Manusov, E. G., Froeliger, B., Kelly, A., Williams, J. M., & Howard, M. O. (2014). Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: results from an early-stage randomized controlled trial. Journal of Consulting and Clinical Psychology, 82(3), 448–459. https://doi.org/10.1037/a0035798.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Goldberg, S. B., Tucker, R. P., Greene, P. A., Davidson, R. J., Wampold, B. E., Kearney, D. J., & Simpson, T. L. (2018). Mindfulness-based interventions for psychiatric disorders: a meta-analysis. Clinical Psychology Review, 59, 52–60. https://doi.org/10.1016/j.cpr.2017.10.011.

    Article  PubMed  Google Scholar 

  20. Goldberg, S. B., Tucker, R. P., Greene, P. A., Simpson, T. L., Hoyt, W. T., Kearney, D. J., & Davidson, R. J. (2019). What can we learn from randomized clinical trials about the construct validity of self-report measures of mindfulness? A meta-analysis. Mindfulness, 10(5), 775–785. https://doi.org/10.1007/s12671-018-1032-y.

    Article  PubMed  Google Scholar 

  21. Gotink, R. A., Chu, P., Busschbach, J. J., Benson, H., Fricchione, G. L., & Hunink, M. M. (2015). Standardised mindfulness-based interventions in healthcare: an overview of systematic reviews and meta-analyses of RCTs. PLoS One, 10(4), e0124344.

    Article  Google Scholar 

  22. Hayes, S. C., Strosahl, K., & Wilson, K. (1999). Acceptance and commitment therapy: an experiential approach to behavior change. New York: Guilford Press.

    Google Scholar 

  23. Heffner, K. L., Crean, H. F., & Kemp, J. E. (2016). Meditation programs for veterans with posttraumatic stress disorder: aggregate findings from a multi-site evaluation. Psychological Trauma: Theory, Research, Practice, and Policy, 8(3), 365–374. https://doi.org/10.1037/tra0000106.

    Article  Google Scholar 

  24. Held, R. F., Santos, S., Marki, M., & Helmer, D. (2016). Dissemination and implementation of an educational tool for veterans on complementary and alternative medicine: a case study. BMC Complementary and Alternative Medicine, 16(340). https://doi.org/10.1186/s12906-016-1297-4.

  25. Heppner, P. P., Wampold, B. E., & Kivlighan, D. M., Jr. (2008). Research design in counseling (3rd ed.). Belmont: Brooks/Cole.

    Google Scholar 

  26. Herman, P. M., Yuan, A. H., Cefalu, M. S., Chu, K., Zeng, Q., Marshall, N., et al. (2019). The use of complementary and integrative health approaches for chronic musculoskeletal pain in younger US Veterans: an economic evaluation. PLoS One, 14(6), e0217831.

    Article  Google Scholar 

  27. Kabat-Zinn, J. (2013). Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness (Revised ed.). New York: Random House.

    Google Scholar 

  28. 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, 14–27. https://doi.org/10.1002/jclp.21911.

    Article  PubMed  Google Scholar 

  29. King, A. P., Block, S. R., Sripada, R. K., Rauch, S., Giardino, N., Favorite, T., et al. (2016). Altered default mode network (DMN) resting state functional connectivity following a mindfulness-based exposure therapy for posttraumatic stress disorder (PTSD) in combat veterans of Afghanistan and Iraq. Depression and Anxiety, 33(4), 289–299. https://doi.org/10.1002/da.22481.

    Article  PubMed  Google Scholar 

  30. Kuyken, W., Hayes, R., Barrett, B., Byng, R., Dalgleish, T., Kessler, D., et al. (2015). Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial. Lancet, 386(9988), 63–73. https://doi.org/10.1016/S0140-6736(14)62222-4.

    Article  PubMed  Google Scholar 

  31. McNemar, Q. (1947). Note on the sampling error of the difference between correlated proportions or percentages. Psychometrika, 12(2), 153–157.

    Article  Google Scholar 

  32. National Academies of Sciences, Engineering, and Medicine. (2018). Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. https://doi.org/10.17226/24915.

    Book  Google Scholar 

  33. National Center for Complementary and Integrative Health. (2017). Complementary, alternative, or integrative health: what’s in a name? Available at: https://nccih.nih.gov/health/integrative-health. Accessed 19 Dec 2017.

  34. Nidich, S., Mills, P. J., Rainforth, M., Heppner, P., Schneider, R. H., Rsosenthal, N. E., ... & Rutledge, T. (2018). Non-trauma-focused meditation versus exposure therapy in veterans with post-traumatic stress disorder: a randomised controlled trial. The Lancet Psychiatry, 5(12), 975–986.

  35. 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, 538–547.

    Article  Google Scholar 

  36. Nisbett, R. E., & Wilson, T. D. (1977). The halo effect: evidence for unconscious alteration of judgments. Journal of Personality and Social Psychology, 35(4), 250–256.

    Article  Google Scholar 

  37. 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. https://doi.org/10.1001/jama.2015.8361.

    Article  Google Scholar 

  38. Possemato, K., Bergen-Cico, D., Treatman, S., Allen, C., Wade, M., & Pigeon, W. (2016). A randomized clinical trial of primary care brief mindfulness training for veterans with PTSD. Journal of Clinical Psychology, 72(3), 179–193. https://doi.org/10.1002/jclp.22241.

    Article  PubMed  Google Scholar 

  39. R Core Team. (2018). R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing.

    Google Scholar 

  40. Reinhard, M. J., Nassif, T. H., Bloeser, K., Dursa, E. K., Barth, S. K., Benetato, B., & Schneiderman, A. (2014). CAM utilization among OEF/OIF veterans: findings from the National Health Study for a New Generation of US Veterans. Medical Care, 52, S45–S49.

    Article  Google Scholar 

  41. Serpa, J. G., Taylor, S. L., & Tillisch, K. (2014). Mindfulness-based stress reduction (MBSR) reduces anxiety, depression, and suicidal ideation in veterans. Medical Care, 52, S19–S24.

    Article  Google Scholar 

  42. Stahl, J. E., Dossett, M. L., LaJoie, A. S., Denninger, J. W., Mehta, D. H., Goldman, R., … & Benson, H. (2015). Relaxation response and resiliency training and its effect on healthcare resource utilization. PLoS One, 10(10), e0140212. https://doi.org/10.1371/journal.pone.0140212.

    Article  Google Scholar 

  43. Taylor, S. L., Hoggatt, K., & Kligler, B. (2019). Complementary and integrated health approaches: what do veterans use and want. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-019-04862-6.

    Article  Google Scholar 

  44. Vickers, A. J., Cronin, A. M., Maschino, A. C., Lewith, G., MacPherson, H., Foster, N. E., … & Acupuncture Trialists’ Collaboration. (2012). Acupuncture for chronic pain: individual patient data meta-analysis. Archives of Internal Medicine, 172(19), 1444–1453. https://doi.org/10.1001/archinternmed.2012.3654.

    Article  Google Scholar 

  45. Vujanovic, A. A., Niles, B., Pietrefesa, A., Schmertz, S. K., & Potter, C. M. (2011). Mindfulness in the treatment of posttraumatic stress disorder among military veterans. Professional Psychology: Research and Practice, 42(1), 24–31. https://doi.org/10.1037/a0022272.

    Article  Google Scholar 

  46. Wielgosz, J., Goldberg, S. B., Kral, T. R. A., Dunne, J. D., & Davidson, R. J. (2019). Mindfulness meditation and psychopathology. Annual Review of Clinical Psychology, 15, 1–32. https://doi.org/10.1146/annurev-clinpsy-021815-093423.

    Article  Google Scholar 

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Funding

This work was supported by the Department of Veterans Affairs Quality Enhancement Research Initiative program (PEC 16-354). The views expressed in this article are those of the authors and do not necessarily represent the position or policy of the Department of Veterans Affairs or the US Government. Support for this research was also provided by the University of Wisconsin-Madison, Office of the Vice Chancellor for Research and Graduate Education with funding from the Wisconsin Alumni Research Foundation.

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Contributions

SBG: conceptualized and executed the secondary data analysis and wrote the paper. SBZ: collaborated on study conceptualization and interpretation of results and edited the paper. KJH: collaborated on design of the primary study, collaborated on interpretation of results, and edited the paper. TLS and JCF: collaborated on study conceptualization and interpretation of results and edited the paper. SLT: lead the design of the primary study, collaborated on study conceptualization and interpretation of results, and edited the paper.

Corresponding author

Correspondence to Simon B. Goldberg.

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The views expressed in this article are those of the authors and do not necessarily represent the position or policy of the Department of Veterans Affairs or the United States government.

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This research was conducted in compliance with human subject research ethical standards and approval from relevant governing bodies. The status of this work as quality improvement and not research was confirmed following review by the Research and Development Committee at the VA Greater Los Angeles Healthcare System.

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Goldberg, S.B., Zeliadt, S.B., Hoggatt, K.J. et al. Utilization and Perceived Effectiveness of Mindfulness Meditation in Veterans: Results from a National Survey. Mindfulness 10, 2596–2605 (2019). https://doi.org/10.1007/s12671-019-01214-7

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Keywords

  • Mindfulness
  • Meditation
  • Complementary and integrative health
  • Complementary and alternative medicine
  • Veterans