Ritu Bhatnagar, MD, MPH
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 19, Number 11, 2013, pp. 860–861
ª Mary Ann Liebert, Inc.
DOI: 10.1089/acm.2012.0602
Post-traumatic stress disorder (PTSD) can be a chronic and disabling condition with detrimental effects on an individual’s psychological, medical, social, and occupational functioning.1 PTSD has been conceptualized as a dysregulated stress-response system2 with increased sympathetic activation and decreased parasympathetic tone.3 These abnormal responses have been associated with increased mortality in multiple conditions.2 Heart rate variability (HRV) is an objective measure that helps quantify the level of autonomic response in vivo. Although many factors affect HRV, overall variability depends on vagal modulation4 and provides a noninvasive way to measure the interplay between the two autonomic systems. While HRV has been investigated in veterans with PTSD,5,6 its change with mindfulness-based stress reduction (MBSR) treatment has not been investigated.
MBSR is an 8-week, manual-based group therapy that uses mindfulness meditation and Hatha yoga to reduce distress associated with physical and mental health disorders.7 MBSR has demonstrated benefit for a variety of diagnoses in both mental and physical health8,9 and is specifically designed to improve emotional acceptance. Therefore, it may be a useful way to facilitate clinical improvement during exposure therapy for PTSD.
The aim of this pilot study was to determine whether MBSR training would reduce PTSD symptoms and improve HRV in veterans with combat-related PTSD. A second objective was to determine whether changes in HRV correlate with changes in the Clinician Administered PTSD Scale (CAPS), such that HRV could potentially serve as a potential biologic marker of disease and treatment response. Eight male and female veterans who had PTSD, as determined by the Structured Clinical Interview for DSM Disorders, and a total score of 50 or higher on CAPS were recruited from the Madison Veterans Affairs hospital to participate in the MBSR course. Individuals with comorbid mood disorders were eligible, as long as PTSD was the primary diagnosis.
The main outcome measures were the CAPS and the pNN50 measure of HRV (the number of pairs of adjacent normal-to-normal [NN] intervals differing by more than 50 milliseconds divided by the total number of all NN intervals). These were collected by interview and 24-hour Holter monitoring at baseline (week 0), upon completion of the course (week 8), and 1 month after completion (week 12). Data were analyzed using SPSS software (SPSS Inc., Chicago, Illinois) for the HRV and CAPS scales. Eight veterans completed the MBSR training, and 5 completed the HRV measures. All participants had PTSD and at least one other psychiatric illness; major depression and generalized anxiety were the most common comorbid conditions. The sample (n = 8) had an average age of 59.5 years (range, 42–71 years) and was composed of 7 men from the Vietnam era and 1 woman from Operation Enduring Freedom/Operating Iraqi Freedom, and all participants were of Caucasian descent.
One month after course completion, PTSD symptoms had decreased frombaseline by an overallCAPS score of 14.8 points; this reduction was clinically significant according to prior studies.10 TheCAPS data are shown in Table 1. Parasympathetic functioning increased for all five participants. The measure of sympathetic function (low frequency to high frequency) did not show any significant trend. Limitations of the study include absence of a control group, the mostly male sample, the small cohort size, and the short duration of the study. In conclusion, for this small sample, MBSR for veterans with PTSD showed an overall reduction in symptoms as measured by the CAPS. HRV might be a potential marker for treatment and response for MBSR in PTSD, but larger studies are needed.
Acknowledgments
No outside funding was received.
Disclosure Statement
No competing financial interests exist.
References
1. Qureshi SU, Pyne JM, magruder KM, Schulz PE, Kunik ME. The link between post-traumatic stress disorder and physical comorbidities: a systematic review. Psychiatric Q 2009; 80:87–97.
2. Kubzansky LD, Koenen KC, Spiro A, Vokonas PS, Sparrow D. Prospective study of posttraumatic stress disorder symptoms and coronary heart disease in the Normative Aging Study. Arch Gen Psychiatry 2007;64:109–116.
3. Cohen H, Benjamin J, Geva AB, Matar MA, Kaplan Z, Kotler M. Autonomic dysregulation in panic disorder and in posttraumatic stress disorder: application of power spectrum analysis of heart rate variability at rest and in response to recollection of trauma or panic attacks. Psychiatr Res 2000;
96:1–13.
4. Malik M, Camm AJ, eds. Dynamic Electrocardiography. Elmsford, NY: Futura Publishing; 2004.
5. Hauschildt M, Peters MJ, Moritz S, Jelinek L. Heart rate variability in response to affective scenes in posttraumatic stress disorder. Biol Psychol 2011;88:215–222.
6. Zucker TL, Samuelson KW, Muench F, Greenberg MA, Gevirtz RN. The effects of respiratory sinus arrhythmia biofeedback on heart rate variability and posttraumatic stress disorder symptoms: a pilot study. Pain Med 2009;10:
1237–1245.
7. Kabat-Zinn J. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York: Delacorte; 1990.
8. Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and mental health benefits: aA meta-analysis. J Psychosom Res 2004;57:35–43.
9. Schmidt S, Grossman P, Schwarzer B, Jena S, Naumann J, Walach H. Treating fibromyalgia with mindfulness-based stress reduction: results from a 3-armed randomized controlled trial. Pain 2011;152:361–369.
10. Krystal JH, Rosenheck RA, Cramer JA, et al. Adjunctive risperidone treatment for antidepressant-resistant symptoms of chronic military service-related PTSD. JAMA 2011;306: 493–502.
Address correspondence to:
Ritu Bhatnagar, MD, MPH
University of Wisconsin Hospitals and Clinics
600 Highland Avenue
Madison, WI 53705
E-mail: ritusb@yahoo.com