Abstract
Objectives
This study evaluates the effects of treatment with mindfulness-based stress reduction (MBSR) compared to the active control, present-centered group therapy (PCGT), on morning plasma cortisol, interleukin-6 (IL-6), and C-reactive protein (CRP) in veterans diagnosed with post-traumatic stress disorder (PTSD).
Methods
In a post hoc exploratory analysis, we pooled biomarkers and clinical outcomes of mindfulness, PTSD, and depression from two randomized controlled trials comparing MBSR (n = 104) to PCGT (n = 106) in U.S. military veterans diagnosed with PTSD. Linear mixed-effects modeling was used to evaluate associations between changes in biomarkers and clinical outcomes from baseline to 9-week primary endpoint and 16-week follow-up endpoint.
Results
Cortisol levels were inversely related to self-reported PTSD symptoms at baseline (p = 0.02). Cortisol increased from baseline to 9-week endpoint for both groups, but significantly less so in the MBSR group compared to PCGT group (mean difference 1.69 ± 0.8 SE; p = 0.035). Changes in IL-6 and CRP did not differ between groups at either baseline or week 9. From baseline to week 9, increased mindfulness was significantly associated with increased cortisol (p = 0.02) and decreased PTSD and depression severity (p < 0.01). Increased IL-6 and CRP were significantly associated with decreased PTSD severity (p < 0.05), but not depression. Pooled analysis corroborated earlier findings that MBSR is significantly better than PCGT in improving clinical outcomes. Increased mindfulness was strongly associated with improved symptoms.
Conclusions
Increased mindfulness is associated with a recalibration of cortisol levels which may be indicative of therapeutic response, especially in patients with lower baseline cortisol. Furthermore, mindfulness-based practices improve symptoms of PTSD and depression in a significant correlation with self-reported levels of mindfulness.
Clinical Trial Registration (clinicaltrials.gov)
NCT01532999 and NCT01548742.
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Acknowledgements
This work was supported by the Department of Veterans Affairs (VA) Office of Research and Development, Clinical Science Research and Development and National Institutes of Health.
Funding
The research leading to these results received funding from the VA Office of Clinical Science Research & Development under Award No 1-I01-CX000687-01 and 1-I01-CX000683-01. Mr. Shapira received funding from a National Institute of Health (NIH) training grant (NIH T35 HL00747). Dr. Richman received research funding from VA and NIH. Dr. Pace received research funding from NIH. Dr. Lim received research funding from VA and NIH. Dr. Polusny received research funding from received research funding from VA and NIH National Center for Complementary and Integrative Health (NIH-NCCIH). Dr. Hamner received consulting fees from Otsuka, research funding from VA, National Institute of Mental Health, and Otsuka. Dr. Bremner received research funding from VA and NIH, and device support from ElectroCore LLC. Dr. Mumba received research funding from VA and NIH-NCCIH. Dr. Jacobs received research funding from VA. Dr. Pilkinton received research funding and/or materials from Department of Defense, VA, SAMSHA, Aptinyx, Tonix, and Avanir Pharmaceuticals. Dr. Davis received consulting fees from Otsuka, Lundbeck, Janssen, Boehringer Ingelheim and Signant Health, and research funding and/or materials from Department of Defense, VA, SAMSHA, Aptinyx, Alkermes, Avanir Pharmaceuticals, and Tonix.
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LD, KL, DB, MH, MP, MM, LJ, and PP were responsible for the conceptualization and completion of the original randomized trials from which data were gathered. JR and IS were responsible for pooling the data and conducting the analyses. IS, JR, and LD wrote the original draft of the manuscript, and all authors contributed to review and editing of the final draft.
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Both sites included in the analysis obtained approvals from the Tuscaloosa VA and Minneapolis VA Medical Centers’ Institutional Review Boards and Research and Development Committees prior to engaging in human subject research and were monitored by an independent VA data and safety monitoring board. After reviewing and explaining the purpose, procedures, risks, benefits, and alternatives to treatment, all participants signed informed consent and privacy authorization prior to participating in research procedures. Data collection occurred between January 2012 and April 2014.
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Shapira, I., Richman, J., Pace, T.W.W. et al. Biomarker Response to Mindfulness Intervention in Veterans Diagnosed with Post-traumatic Stress Disorder. Mindfulness 13, 2448–2460 (2022). https://doi.org/10.1007/s12671-022-01969-6
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DOI: https://doi.org/10.1007/s12671-022-01969-6