Credit: sidkid

Credit: sidkid

Mindfulness-based therapies are useful for stress, PTSD, relapse prevention

Search stock photo sites for “mindfulness” and you’ll see that the people in the images are usually wearing spandex. They are solemn white women with perfect teeth often situated in a sunny meadow or at the edge of the sea.

These ladies aren’t the only ones who could benefit from mindfulness, if you can believe it. The benefits of mindfulness-based therapies have been studied for numerous conditions, including depression, chronic pain, addiction, and PTSD. Veterans are disproportionately affected by these health conditions, so it stands to reason that mindfulness-based approaches would be offered to this high-need population.

That is indeed a trend.

Shaddy Saba, LSW, is leading a pilot project here in Pittsburgh that brings a mindfulness-based group intervention to clients at a transitional housing agency for homeless or recently-homeless vets.

I asked him whether mindfulness might be beside the point for folks who need transitional housing.

“Is mindfulness something you worry about after you have something to eat and a place to live?” I asked.

“It’s a good question,” Saba said. “When I first met with the group, I asked them about their short and long-term goals. And they went around in a circle and said things like ‘getting more money’ or ‘getting a place of my own.’ And for a moment I was worried about the relevance of what I was offering.

“But,” he continued, “Then I asked them what was standing in the way of those goals. And they said things like ‘mental health’ or ‘difficult relationships’ or ‘I get in my own way’ or ‘stress.’ And these are all things that mindfulness can help with. Of course, it’s always vital to address immediate, basic needs. But I think that we can all benefit from learning self-regulation skills like mindfulness.”

What is Mindfulness? What is Mindfulness Meditation?

There are quite a few definitions of mindfulness floating around. Here’s a good one: “Paying attention in a particular way; on purpose, in the present moment, and nonjudgmentally.”

“It’s a description of a state of being, and it’s also a practice,” Saba explained. “For example, while I am talking to you right now, I can be mindful. I can give my full attention to this conversation in the present moment. This sounds simple but it’s not always easy. We have minds that naturally wander – to the past, to the future, to ‘What’s for dinner?’ – so I can also practice mindfulness by meditating.

“With mindfulness practice, I set aside some time each day to practice paying attention to one thing, like my breathing or my body, in order to cultivate the ability to pay attention in my life.”

Approaches to mindfulness meditation vary, but as Saba described, it is common for the meditator to focus on a sensation (or sensations) in the body.

According to Dave Fox, who helps Saba facilitate the mindfulness group for veterans, a key element of mindfulness meditation is not attaching judgments or beliefs to the thoughts that come forth.

“It’s watching a parade, but not getting into the parade,” Fox said.

What are Mindfulness-Based Interventions?

A number of therapeutic interventions have been developed from basic mindfulness principles and practices. A partial list appears below.

Mindfulness Chart

These interventions typically consist of an orientation session, eight two-hour group sessions, a six-hour “retreat day,” and daily home practice.

What is the Evidence for Mindfulness-Based Interventions?

The evidence for mindfulness-based therapies is encouraging but incomplete. Currently, Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy have enough empirical support to be listed in SAMHSA’s National Registry of Evidence-based Programs and Practices (NREPP).

A 2014 review by the federal Agency for Healthcare Research and Quality (AHRQ) concluded, “Our review found moderate [strength of evidence] that mindfulness meditation programs are beneficial for reducing anxiety, depression, and pain severity.” However, the AHRQ review was based on 41 randomized controlled trials with a wide variety of research questions, settings, populations, and measures. Because of this diversity, its authors commented that the review should be interpreted with caution.

Last month, Military Medicine published a more focused review of mindfulness-based approaches for conditions that tend to affect veterans. At this point, there’s a shortage of clinical research on mindfulness specifically for service members and veterans, so some studies of civilian populations were included. The review yielded a B-level recommendation of mindfulness-based therapies for chronic pain, substance use disorders, smoking cessation, and insomnia. Along the lines of the AHRQ recommendation, this B-grade indicates moderate evidence of effectiveness.

Responding, Rather than Reacting

“It’s like putting an ice pack on your amygdala.”

Along with Saba, Fox is helping to implement the mindfulness pilot project for veterans in Pittsburgh. Fox is himself a veteran who sustained a traumatic brain injury. He has personally experienced the benefits of mindfulness meditation to reduce stress and treat PTSD.

Mindfulness can help you respond, rather than react, Fox said.

“Many veterans say they’re control freaks,” he said. “But their past shows that they’re not in control at all. They’re reacting. They get upset and they drink. They have anger issues. They’re very reactive.”

Mindfulness is a path to more genuine control, he said.

“It’s like putting an ice pack on your amygdala,” he said. “If I have a daily practice of meditation, I can now respond to the world. I can now respond to the trigger instead of reacting to it.”

Of course, triggers can be a big issue for veterans with substance use disorders.

Fox continued, “In the context of relapse prevention, we talk a lot about knowing your triggers and how to deal with them. Mindfulness can help you realize that a trigger is just a thought. Thoughts are harmless. We have thousands a day.”

Resources

Free Online Mindfulness-Based Stress Reduction Training – Complete online curriculum for people who cannot attend live MBSR trainings

Save a Warrior – Program for veterans that emphasizes mindfulness meditation for healing and self-care

Critical Issues Faces Veterans and Military Families – Overview by SAMHSA