Compassion Meditation for Distressed Older Veterans: A Feasibility Study.

OBJECTIVES: Older Veterans are at elevated risk for psychological distress and may encounter barriers to accessing mental health services. Compassion Meditation (CM) promotes positive emotions and outcomes among distressed individuals; thus, we conducted a preliminary feasibility study of CM among distressed older Veterans. METHODS: Participants included 25 Veterans aged 55+ (M = 69.0, SD = 10.6) with anxiety and/or depressive symptoms, recruited from primary care, mostly male (76.0%), and White (60.0%). CM consisted of 10 groups, which were transitioned from in-person to telehealth due to COVID-19. Feasibility indices included rates of intervention initiation and completion, and attendance. Participants completed measures of symptom severity and well-being pre- and post-intervention. RESULTS: Of 25 enrolled participants, 88.0% (n = 22) attended at least one session, and 52% (n = 13) completed the intervention (attended six or more sessions). Among intervention completers, the average number of sessions attended was 9.46. Seven Veterans withdrew from intervention due to difficulties engaging via telehealth. CONCLUSIONS: These findings support the feasibility of CM training in older Veterans with psychological distress, though dropouts highlighted potential need for additional strategies to facilitate telehealth participation. CLINICAL IMPLICATIONS: Older Veterans appear amenable to meditation-based practices, provided they are easy to access.

The Management of Posttraumatic Stress Disorder and Acute Stress Disorder: Synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline.

DESCRIPTION: The U.S. Department of Veterans Affairs (VA) and Department of Defense (DoD) worked together to revise the 2017 VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder. This article summarizes the 2023 clinical practice guideline (CPG) and its development process, focusing on assessments and treatments for which evidence was sufficient to support a recommendation for or against. METHODS: Subject experts from both departments developed 12 key questions and reviewed the published literature after a systematic search using the PICOTS (population, intervention, comparator, outcomes, timing of outcomes measurement, and setting) method. The evidence was then evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method. Recommendations were made after consensus was reached; they were based on quality and strength of evidence and informed by other factors, including feasibility and patient perspectives. Once the draft was peer reviewed by an external group of experts and their inputs were incorporated, the final document was completed. RECOMMENDATIONS: The revised CPG includes 34 recommendations in the following 5 topic areas: assessment and diagnosis, prevention, treatment, treatment of nightmares, and treatment of posttraumatic stress disorder (PTSD) with co-occurring conditions. Six recommendations on PTSD treatment were rated as strong. The CPG recommends use of specific manualized psychotherapies over pharmacotherapy; prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing psychotherapy; paroxetine, sertraline, or venlafaxine; and secure video teleconferencing to deliver recommended psychotherapy when that therapy has been validated for use with video teleconferencing or when other options are unavailable. The CPG also recommends against use of benzodiazepines, cannabis, or cannabis-derived products. Providers are encouraged to use this guideline to support evidence-based, patient-centered care and shared decision making to optimize individuals' health outcomes and quality of life.

Measures of empathy and compassion: A scoping review.

Evidence to date indicates that compassion and empathy are health-enhancing qualities. Research points to interventions and practices involving compassion and empathy being beneficial, as well as being salient outcomes of contemplative practices such as mindfulness. Advancing the science of compassion and empathy requires that we select measures best suited to evaluating effectiveness of training and answering research questions. The objective of this scoping review was to 1) determine what instruments are currently available for measuring empathy and compassion, 2) assess how and to what extent they have been validated, and 3) provide an online tool to assist researchers and program evaluators in selecting appropriate measures for their settings and populations. A scoping review and broad evidence map were employed to systematically search and present an overview of the large and diverse body of literature pertaining to measuring compassion and empathy. A search string yielded 19,446 articles, and screening resulted in 559 measure development or validation articles reporting on 503 measures focusing on or containing subscales designed to measure empathy and/or compassion. For each measure, we identified the type of measure, construct being measured, in what context or population it was validated, response set, sample items, and how many different types of psychometrics had been assessed for that measure. We provide tables summarizing these data, as well as an open-source online interactive data visualization allowing viewers to search for measures of empathy and compassion, review their basic qualities, and access original citations containing more detail. Finally, we provide a rubric to help readers determine which measure(s) might best fit their context.

Relationships among race, ethnicity, and gender and whole health among U.S. veterans.

Racial, ethnic, and gender health care disparities in the United States are well-documented and stretch across the lifespan. Even in large integrated health care systems such as Veteran Health Administration, which are designed to provide equality in care, social and economic disparities persist, and limit patients' achievement of health goals across multiple domains. We explore Veterans' Whole Health priorities among Veteran demographic groups. Participants who were enrolling in Veteran Health Administration provided demographics and Whole Health priorities using eScreening, a web-based self-assessment tool. Veterans had similar health care goals regardless of demographic characteristics but differences were noted in current health appraisals. Non-White and women Veterans reported worse health-relevant functioning. Black Veterans were more likely to endorse a low rating for their personal development/relationships. Multiracial Veterans were more likely to endorse a low rating of their surroundings. Asian Veterans were less likely to provide a high rating of their surroundings. Women Veterans reported lower appraisals for body and personal development but higher appraisals of professional care. Results indicated that demographic factors such as race and gender, and to a lesser extent ethnicity, were associated with health disparities. The Whole Health model provides a holistic framework for addressing these disparities. These findings may inform more culturally sensitive care and enhance Veteran Health Administration equal access initiatives. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Mitigating the health effects of systemic racism: Evaluation of the Race-Based Stress and Trauma Empowerment intervention.

BACKGROUND: Disparities in physical and mental health among Black, Indigenous, and People of Color (BIPOC) are well-documented and mirrored in the Veteran population. Chronic stress due to racism and discrimination is one possible mechanism driving these negative health outcomes. The Race-Based Stress and Trauma Empowerment (RBSTE) group is a novel, manualized, health promotion intervention designed to address the direct and indirect impacts of racism among Veterans of Color. This paper describes the protocol of the first pilot randomized controlled trial (RCT) of RBSTE. This study will examine the feasibility, acceptability, and appropriateness of RBSTE compared to an active control (an adaptation of Present-Centered Therapy; PCT) in a Veterans Affairs (VA) healthcare setting. A secondary aim is to identify and optimize strategies for holistic evaluation. METHODS: Veterans of Color (N = 48) endorsing perceived discrimination and stress will be randomized to RBSTE or PCT; both groups will be delivered in 8 weekly, 90-min virtual group sessions. Outcomes will include measures of psychological distress, discrimination and ethnoracial identity, holistic wellness, and allostatic load. Measures will be administered at baseline and post-intervention. CONCLUSION: This study will inform future interventions targeting identity-based stressors and represents an important step in advancing equity for BIPOC in medicine and research. CLINICAL TRIAL REGISTRATION NUMBER: NCT05422638.

Higher frequency of mantram repetition practice is associated with enhanced clinical benefits among United States Veterans with posttraumatic stress disorder.

Background: There is increasing support for the use of meditation-based treatments for US military Veterans with posttraumatic stress disorder (PTSD). The Mantram Repetition Program (MRP), which is a portable meditative practice that features mindful repetition of a sacred phrase, is associated with significant reductions in PTSD symptom severity. Although regular practice is emphasized in meditation-based interventions, associations between frequency of practice and clinical outcomes are often not reported. Objectives: This study will examine whether the frequency of mantram repetition is associated with greater improvements in clinical outcomes. Methods: Veterans with PTSD participating in MRP (N = 160; combined experimental groups from two randomized controlled trials). Participants completed pre- and post-treatment self-report measures of anger and well-being and a clinician-administered interview of PTSD severity (CAPS-IV-TR). Veterans also reported average daily mantram repetition practice at post-treatment. We conducted a series of hierarchal multiple regression analyses. Results: When controlling for race/ethnicity and pre-treatment severity, higher frequency of mantram repetition practice was associated with significantly greater improvements (small effect sizes) in PTSD symptom severity (F(3,128) = 6.60, p < .001, ß = .21, p = .007), trait anger (F(3,128) = 31.23, p < .001, ß = .25, p < .001), state anger (F(3,110) = 17.62, p < .001, ß = .16, p = .04), mental health well-being (F(3,128) = 28.38, p < .001, ß = .14, p = .04), and spiritual well-being (F(3,127) = 13.15, p < .001, ß = .23, p = .003), but not physical health well-being. Conclusions: Higher frequency of mantram repetition practice appears to have beneficial effects on clinical outcomes for Veterans with PTSD. Strategies that promote skills practice may be an important target for improving clinical outcomes for meditation-based interventions. HIGHLIGHTS: Higher frequency of meditation practice during Mantram Repetition Program was associated with greater reductions in PTSD symptoms and anger as well as improvements in well-being.Strategies to promote at-home meditation practice may optimize the benefits of MRP.

An integrated mindfulness meditation and acceptance and commitment therapy intervention for chronic pain: Rationale, design, and methodology of a pilot randomized controlled trial of Acting with Mindfulness for Pain (AMP).

Acceptance and commitment therapy (ACT) is an evidence-based psychosocial intervention for chronic pain; however, in its present form ACT produces modest improvements in function and is no more effective than cognitive behavioral therapy (CBT), the current gold standard. This protocol paper describes the Acting with Mindfulness for Pain (AMP) protocol, which emphasizes and integrates formal mindfulness meditation practice within an ACT-based approach. This paper presents the rationale, design and methodology of an ongoing pilot randomized controlled trial (RCT) comparing AMP to CBT among Veterans with chronic pain (N = 86). Specifically, we argue that formal meditation practice is a necessary treatment component that directly targets key ACT processes which will help facilitate large treatment effects on function (e.g., general activity, social relationships, life enjoyment) among individuals with chronic pain. This study will be the first to consider formal mindfulness meditation practice as a principal treatment ingredient in the context of ACT for chronic pain. The purpose of this trial is to evaluate the feasibility of recruitment and collection of measures, and to examine preliminary treatment effects to determine the appropriateness of a subsequent full-scale RCT. This study will also explore within and between group change on primary and secondary outcomes including pain interference, pain acceptance, trait mindfulness, pain catastrophizing, values-based living, quality of life, practice adherence, and objective measures of physical activity. This study will help delineate the role of formal mindfulness practice within an ACT-based approach for chronic pain and provide preliminary data for a future fully powered RCT.

Patient experiences and reported effectiveness of a multimodal short-term pilot therapy group for veteran men with military sexual trauma.

OBJECTIVE: Despite recognition of its prevalence and impact, little is known about treatment for veteran men with a history of military sexual trauma (MST). While research suggests that such veterans may suffer from gender-based distress that poses unique treatment challenges, MST-focused treatment draws upon contemporary PTSD best practices that may overlook gender. The current initial pilot study evaluated a multimodal, time-limited men's MST group therapy that integrated exposure- and mindfulness-based, psychoeducational, and psychodynamic group interventions. METHOD: This study examined pre- and posttreatment data from patients who completed group treatment (n = 24). Three-fourths of patients were 60 years or older, over 80% Black, Indigenous, People of Color. Assessment data were collected using the PTSD Checklist (PCL-5), an adaptation of the Recovery Assessment Scale, and open-ended written responses. Paired-samples t tests and effect sizes (Hedge's g) were calculated. Indictive thematic analysis was used for qualitative analysis. RESULTS: Qualitative and quantitative data showed improvements in shame, self-forgiveness, and belonginess. There were significant reductions from pre- to posttreatment in total PCL-5 score (g = -0.69) and all 4 symptom clusters (g = -0.51--0.71), and significant improvements in 8 out of 10 recovery items (g = 0.44-2.46). CONCLUSIONS: More research is needed to assess whether veteran men with a history of MST benefit from treatment that provides multimodal, multitheoretical interventions that address gender-based symptoms in addition to PTSD. The results of this study support future research in a randomized controlled study.

Pilot Study of Compassion Meditation Training to Improve Well-being Among Older Adults.

OBJECTIVES: Compassion meditation (CM) training has demonstrated potential in improving well-being and psychosocial functioning. However, most prior studies of CM training have focused on younger adults. The generalizability of the effectiveness of CM training with older adults requires further study. This pilot study was intended to inform future randomized controlled studies of CM training in older adults. METHODS: Participants included 24 older adults who attended a 10-week group CM training. Exploratory outcome measures were administered prior to, during, and after the intervention. Participants also completed logs of mood and meditation practice, and provided descriptive comments in response to open-ended questions administered at the end of treatment. RESULTS: High treatment completion rates (87.5%) and reported adherence (85.7% of assigned meditation) were observed. Descriptive feedback from participants indicated older adults are interested in and capable of learning and applying new concepts and skills in support of their well-being. Pre- to post-intervention changes were explored with a variety of self-report measures. Weekly journals suggested increased feelings of love, closeness, or trust, and decreased feelings of stress, nervousness, or being overwhelmed. CONCLUSIONS: These findings provide preliminary support for the feasibility of CM training in community-dwelling older adults, and suggest the need for future efficacy and effectiveness clinical trials. CLINICAL IMPLICATIONS: CM training offers potential benefits for improving well-being among older adults, and, as an example of a strengths-based approach, can be tailored to the specific needs of older adults.

A randomized controlled trial of yoga vs nonaerobic exercise for veterans with PTSD: Understanding efficacy, mechanisms of change, and mode of delivery.

BACKGROUND AND OBJECTIVES: Posttraumatic stress disorder (PTSD) is a chronic, disabling, and prevalent mental health disorder among Veterans. Despite the availability of empirically supported psychotherapies, many Veterans remain symptomatic after treatment and/or prefer to seek complementary and integrative health approaches, including yoga, to manage PTSD. The randomized controlled trial (RCT) described herein will evaluate the efficacy of a manualized yoga program as compared to nonaerobic exercise in reducing PTSD severity among Veterans. A secondary aim of this study is to better understand the mechanisms of change. METHODS: Veterans (N = 192) with PTSD will be randomized to hatha yoga or nonaerobic physical activity control; both groups consist of 12 weekly, 60-min group or online training sessions with 15-20 min of daily at-home practice. Outcome measures will be administered at baseline, mid-treatment, posttreatment, and 12-week follow-up. PROJECTED OUTCOMES: This study will evaluate changes in PTSD severity (primary outcome) as well as depression, anxiety, anger, sleep problems, and psychosocial disability (secondary outcomes). We will also use multiple mediation to examine two potential models of the mechanisms of clinical effect: the Attention Model (i.e., yoga increases attentional control, which reduces PTSD symptoms), the Coping Model (i.e., yoga increases distress tolerance, which improves coping, which reduces PTSD symptoms), and the combination of these models. This aspect of the study is innovative and important given the absence of an existing, comprehensive model for understanding yoga's impact on PTSD. Ultimately, we hope to develop guidelines for application of yoga to PTSD recovery.

Compassion Meditation for Veterans with Posttraumatic Stress Disorder (PTSD): a Nonrandomized Study.

Compassion meditation (CM) is a contemplative practice that is intended to cultivate the ability to extend and sustain compassion toward self and others. Although research documents the benefits of CM in healthy populations, its use in the context of psychopathology is largely unexamined. The purpose of this study was to refine and initially evaluate a CM protocol, Cognitively Based Compassion Training (CBCT®), for use with Veterans with PTSD. To this end, our research team developed and refined a manualized protocol, CBCT-Vet, over 4 sets of groups involving 36 Veterans. This protocol was delivered in 8-10 sessions, each lasting 90-120 min and led by a CBCT®-trained clinical psychologist. Quantitative and qualitative data were used to identify areas to be improved and to assess change that occurred during the treatment period. Based on pooled data from this series of groups, CM appears to be acceptable to Veterans with PTSD. Group participation was associated with reduced symptoms of PTSD (partial eta squared = .27) and depression (partial eta squared = .19), but causality should not be inferred given the nonrandomized design. No change was observed in additional outcomes, including positive emotion and social connectedness. The results of this open trial support additional exploration of CM as part of the recovery process for Veterans with PTSD.

Compassion Meditation for Posttraumatic Stress Disorder in Veterans: A Randomized Proof of Concept Study.

There is considerable interest in developing complementary and integrative approaches for ameliorating posttraumatic stress disorder (PTSD). Compassion meditation (CM) and loving-kindness meditation appear to offer benefits to individuals with PTSD, including symptom reduction. The present study was a pilot randomized controlled trial of CM for PTSD in veterans. The CM condition, an adaptation of Cognitively-Based Compassion Training (CBCT®), consists of exercises to stabilize attention, develop present-moment awareness, and foster compassion. We compared CM to Veteran.calm (VC), which consists of psychoeducation about PTSD, rationale for relaxation, relaxation training, and sleep hygiene. Both conditions consist of 10 weekly 90-min group sessions with between-session practice assignments. A total of 28 veterans attended at least one session of the group intervention and completed pre- and posttreatment measures of PTSD severity and secondary outcomes as well as weekly measures of PTSD, depressive symptoms, and positive and negative emotions. Measures of treatment credibility, attendance, practice compliance, and satisfaction were administered to assess feasibility. A repeated measures analysis of variance revealed a more substantive reduction in PTSD symptoms in the CM condition than in the VC condition, between-group d = -0.85. Credibility, attendance, and satisfaction were similar across CM and VC conditions thus demonstrating the feasibility of CM and the appropriateness of VC as a comparison condition. The findings of this initial randomized pilot study provide rationale for future studies examining the efficacy and effectiveness of CM for veterans with PTSD.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Meditación de compasión para el trastorno de estrés postraumático en veteranos: un estudio aleatorio de prueba de concepto MEDITACIÓN DE COMPASIÓN PARA EL TEPT Existe un interés considerable en desarrollar enfoques complementarios e integrativos para mejorar el trastorno de estrés postraumático (TEPT). La meditación de compasión (CM en su sigla en inglés) y la meditación de bondad amorosa (LKM, en su sigla en inglés) parecen ofrecer beneficios a las personas con trastorno de estrés postraumático, incluida la reducción de síntomas. El presente estudio fue un ensayo piloto controlado aleatorizado de CM para el TEPT en veteranos. La condición de CM, una adaptación del entrenamiento de compasión de base cognitiva (CBCT® en sus siglas en inglés), consiste en ejercicios para estabilizar la atención, desarrollar la conciencia del momento presente y fomentar la compasión. Comparamos CM con Veteran.calm (VC en sus siglas en inglés), que consiste en psicoeducación sobre el TEPT y las razones para la relajación, entrenamiento de relajación e higiene del sueño. Ambas condiciones consisten en 10 sesiones de grupo semanales de 90 minutos con tareas de práctica entre sesiones. Un total de 28 veteranos asistieron al menos a una sesión de la intervención grupal y completaron las medidas previas y posteriores al tratamiento de la gravedad del TEPT y resultados secundarios, así como las medidas semanales de TEPT, síntomas depresivos y emociones positivas y negativas. Las medidas de credibilidad del tratamiento, asistencia, cumplimiento de la práctica y satisfacción se administraron para evaluar la viabilidad. Un análisis de la varianza de medidas repetidas reveló una reducción más sustancial en síntomas de TEPT en la condición de CM que en la condición de VC, d de Cohen = -0.85 entre grupos. La credibilidad, la asistencia y la satisfacción fueron similares en todas las condiciones de CM y VC y demostraron la viabilidad de CM y la idoneidad de VC como condición de comparación. Los hallazgos de este estudio piloto aleatorizado inicial proporcionan una base para futuros estudios que examinan la eficacia y la efectividad de CM para los veteranos con TEPT.

Mindfulness in PTSD treatment.

In recent years, the field has witnessed considerable enthusiasm for the ancient practice of mindfulness. The skills derived from this experience, including focused attention, nonjudgmental acceptance of internal experiences and reduced autonomic reactivity, may be helpful in counteracting pathological responses to trauma. Several types of interventions that incorporate principles of mindfulness have been examined for treatment of posttraumatic stress disorder (PTSD). This nascent literature is inconsistent and methodologically limited but does suggest that mindfulness is a potentially important tool for creating psychological change. The interventions described herein generally would not yet be considered first-line treatments for PTSD. Nonetheless, evidence is building, and mindfulness may provide an impetus for better understanding how to personalize psychological interventions and to evaluate their outcomes.

The theoretical and empirical basis for meditation as an intervention for PTSD.

In spite of the existence of good empirically supported treatments for posttraumatic stress disorder (PTSD), consumers and providers continue to ask for more options for managing this common and often chronic condition. Meditation-based approaches are being widely implemented, but there is minimal research rigorously assessing their effectiveness. This article reviews meditation as an intervention for PTSD, considering three major types of meditative practices: mindfulness, mantra, and compassion meditation. The mechanisms by which these approaches may effectively reduce PTSD symptoms and improve quality of life are presented. Empirical evidence of the efficacy of meditation for PTSD is very limited but holds some promise. Additional evaluation of meditation-based treatment appears to be warranted.

Spiritual wellbeing mediates PTSD change in veterans with military-related PTSD.

BACKGROUND: A portable practice of repeating a mantram-a sacred word or phrase-has been shown to reduce the severity of posttraumatic stress disorder (PTSD) symptoms in veterans with military trauma. It is thought that the intervention re-directs attention and initiates relaxation to decrease symptom severity, but there may be other mechanisms that may contribute to this improvement. PURPOSE: We tested the hypothesis that increases in existential spiritual wellbeing (ESWB) would mediate reductions in self-reported PTSD symptoms following a group mantram intervention. METHOD: Veterans diagnosed with PTSD from war-related trauma completed 6 weeks of case management plus a group mantram intervention (n = 66) as part of a randomized trial. Measures included PTSD Checklist (PCL) and Functional Assessment of Chronic Illness Therapy-Spiritual Wellbeing. Path analysis was conducted on those who completed treatment to assess ESWB as a possible mediator of change in PCL from baseline to post-treatment. RESULTS: A significant indirect effect, -2.24, 95% CI (-4.17, -1.05) of the mantram intervention on PCL change was found. The path from the mantram intervention to ESWB change was significant and positive (B = 4.89, p < 0.0001), and the path from ESWB change to PCL change was significant and negative (B = -0.46, p = 0.001), thus supporting the hypothesis. CONCLUSIONS: Findings suggest that one contributing mechanism that partially explains how the mantram intervention reduces PTSD symptom severity in veterans may be by increasing levels of ESWB.