A 12-week integrative exercise program improves self-reported mindfulness and interoceptive awareness in war veterans with posttraumatic stress symptoms
Open accessAbstract
Objective: Innovative approaches to the treatment of war‐related posttraumatic stress disorder (PTSD) are needed. We report on secondary psychological outcomes of a randomized controlled trial of integrative exercise (IE) using aerobic and resistance exercise with mindfulness‐based principles and yoga. We expected—in parallel to observed improvements in PTSD intensity and quality of life—improvements in mindfulness, interoceptive bodily awareness, and positive states of mind. Method: A total of 47 war veterans with PTSD were randomized to 12‐week IE versus waitlist. Changes in mindfulness, interoceptive awareness, and states of mind were assessed by self‐report standard measures. Results: Large effect sizes for the intervention were observed on Five‐Facet Mindfulness Questionnaire Non‐Reactivity (d = .85), Multidimensional Assessment of Interoceptive Awareness Body Listening (d = .80), and Self‐Regulation (d = 1.05). Conclusion: In a randomized controlled trial of a 12‐week IE program for war veterans with PTSD, we saw significant improvements in mindfulness, interoceptive bodily awareness, and positive states of mind compared to a waitlist.
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Mindfulness meditation interventions are effective in improving interoceptive awareness in clinical populations with somatic symptoms such as PTSD and SUDs.
“Mindfulness meditation interventions have been shown to be effective in improving interoceptive awareness in clinical populations that involve somatic symptoms such as post-traumatic stress disorder (PTSD) and substance use disorders (SUDs).”
From Brief structured respiration practices enhance mood and reduce physiological arousal (2023) · cites this paper as [47]
The Abstract (page unavailable) reports improved self-reported interoceptive awareness in veterans with PTSD after a 12-week integrative exercise program incorporating mindfulness principles and yoga. It does not establish that mindfulness meditation alone was effective, and the study did not test people with substance use disorders. The claim extends the finding beyond the intervention and population studied. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMost mindfulness trainings or mindfulness-based interventions are believed to cultivate interoceptive awareness, resulting in a shift away from thinking about body sensations to an immediate feeling of body sensations.
“Most mindfulness trainings or mindfulness-based interventions (Mindfulness-Based Stress Reduction – MBSR, for example) are believed to cultivate IA resulting in a shift away from thinking about body sensations to an immediate feeling of body sensations (Farb et al., 2013, 2015; Mehling et al., 2017).”
From Mindfulness, Interoception, and the Body: A Contemporary Perspective (2019) · cites this paper as Mehling et al., 2017
The source says changes in interoceptive awareness have been suggested as a mechanism of common mindfulness interventions (Abstract, page unavailable). It describes the shift from thinking about bodily sensations to immediately feeling them specifically as an aim of its integrative exercise program, not as an established aim of most mindfulness trainings or MBSR. (LLM, conf=0.85)
Experimental — accuracy not yet measuredMost mindfulness-based interventions encourage interoceptive awareness.
“Most mindfulness-based interventions, including body scans, yoga, and other meditation elements, encourage interoceptive awareness resulting from a shift away from thinking about body sensations to an immediate feeling of body sensations [17, 18].”
In the same randomized veteran sample, the exercise program was also associated with increased self-reported mindfulness and interoceptive awareness.
“Additional findings from the same sample suggest that the exercise program was also associated with increased self-reported mindfulness and interoceptive awareness”
From Exercise Intervention in PTSD: A Narrative Review and Rationale for Implementation (2019) · cites this paper as [67]
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Cites
Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment
THE WHOQOL GROUP (1998) · Psychological Medicine · doi:10.1017/s0033291798006667 · Cited by 7,933 · see citing works
Using Self-Report Assessment Methods to Explore Facets of Mindfulness
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006) · Assessment · doi:10.1177/1073191105283504 · Cited by 7,511 · cited 1× · see citing works
“The 39-item Five FacetMindfulness Questionnaire (FFMQ; Baer et al., 2006; Baer et al., 2008) assesses the five facets of mindfulness: Observing, Describing, Acting with Awareness, Non-Judging, and Non-Reactivity to Inner Experience.”
MethodThe development of a Clinician-Administered PTSD Scale
Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., & Keane, T. M. (1995) · Journal of Traumatic Stress · doi:10.1002/jts.2490080106 · Cited by 5,024 · see citing works
Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care
Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L. (2004) · New England Journal of Medicine · doi:10.1056/nejmoa040603 · Cited by 4,778 · see citing works
Hölzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011) · Perspectives on Psychological Science · doi:10.1177/1745691611419671 · Cited by 3,024 · see citing works
Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., Walsh, E., Duggan, D., & Williams, J. M. G. (2008) · Assessment · doi:10.1177/1073191107313003 · Cited by 2,930 · see citing works
Diagnostic and Statistical Manual of Mental Disorders
Raber, G., & Spokas, M. (2024) · doi:10.4135/9781071886229.n145 · Cited by 2,806 · see citing works
Interoception: the sense of the physiological condition of the body
(Bud) Craig, A. (2003) · Current Opinion in Neurobiology · doi:10.1016/s0959-4388(03)00090-4 · Cited by 2,556 · see citing works
The multidimensional assessment of interoceptive awareness (MAIA)
Mehling, W. E., Price, C., Daubenmier, J. J., Acree, M., Bartmess, E., & Stewart, A. (2012) · PLoS ONE · doi:10.1371/journal.pone.0048230 · Cited by 1,429 · see citing works
Self-citationThe nature of feelings: evolutionary and neurobiological origins
Damasio, A., & Carvalho, G. B. (2013) · Nature Reviews Neuroscience · doi:10.1038/nrn3403 · Cited by 1,280 · cited 1× · see citing works
“According to the James-Lange theory and somatic marker hypothesis (Damasio & Carvalho, 2013), emotions have been understood more recently by neuroscientists (Barrett & Satpute, 2017) as being based on the central processing of interoceptive sensations and feelings.”
Body awareness: construct and self-report measures.
Mehling, W. E., Gopisetty, V., Daubenmier, J., Price, C. J., Hecht, F. M., & Stewart, A. (2009) · PLoS ONE · doi:10.1371/journal.pone.0005614 · Cited by 653 · see citing works
Self-citationInteroception, contemplative practice, and health
Farb, N., Daubenmier, J., Price, C. J., Gard, T., Kerr, C., Dunn, B. D., Klein, A. C., Paulus, M. P., & Mehling, W. E. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.00763 · Cited by 650 · see citing works
Self-citationThe role of anterior insular cortex in social emotions
Lamm, C., & Singer, T. (2010) · Brain Structure and Function · doi:10.1007/s00429-010-0251-3 · Cited by 566 · see citing works
Interoception: The Inside Story—A Model for Psychosomatic Processes
Cameron, O. G. (2001) · Psychosomatic Medicine · doi:10.1097/00006842-200109000-00001 · Cited by 535 · see citing works
Body Awareness: a phenomenological inquiry into the common ground of mind-body therapies
Mehling, W. E., Wrubel, J., Daubenmier, J. J., Price, C. J., Kerr, C. E., Silow, T., Gopisetty, V., & Stewart, A. L. (2011) · Philosophy, Ethics, and Humanities in Medicine · doi:10.1186/1747-5341-6-6 · Cited by 475 · see citing works
Self-citationSeal, K. H., Maguen, S., Cohen, B. E., Gima, K. S., Metzler, T. J., Ren, L., Bertenthal, D., & Marmar, C. R. (2010) · Journal of Traumatic Stress · doi:10.1002/jts.20493 · Cited by 418 · see citing works
Self-citationConceptualizing mindfulness and acceptance as components of psychological resilience to trauma
Thompson, R. W., Arnkoff, D. B., & Glass, C. R. (2011) · Trauma, Violence, & Abuse · doi:10.1177/1524838011416375 · Cited by 387 · see citing works
Can interoception improve the pragmatic search for biomarkers in psychiatry?
Khalsa, S. S., & Lapidus, R. C. (2016) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2016.00121 · Cited by 366 · see citing works
Bornemann, B., Herbert, B. M., Mehling, W. E., & Singer, T. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2014.01504 · Cited by 349 · cited 1× · see citing works
“MAIA Self-Regulation stood out as the largest positive standardized effect size, which is in line with results from a study of a 6-month Presence training using a body scan and mindful attention to breathing in healthy volunteers (Bornemann et al., 2014).”
Self-citationPolusny, M. A., Erbes, C. R., Thuras, P., Moran, A., Lamberty, G. J., Collins, R. C., Rodman, J. L., & Lim, K. O. (2015) · JAMA · doi:10.1001/jama.2015.8361 · Cited by 315 · see citing works
Marx, B. P., & Sloan, D. M. (2005) · Behaviour Research and Therapy · doi:10.1016/j.brat.2004.04.004 · Cited by 310 · see citing works
Kearney, D. J., McDermott, K., Malte, C., Martinez, M., & Simpson, T. L. (2012) · Journal of Clinical Psychology · doi:10.1002/jclp.20853 · Cited by 291 · cited 1× · see citing works
“…with PTSD undergoing MBSR training that found increases in specific aspects of mindfulness, particularly self-reported Non-Reactivity, associated with reduced PTSD symptoms of hyperarousal (Kearney, McDermott, Malte, Martinez, & Simpson, 2012; Stephenson, Simpson, Martinez, & Kearney, 2016).”
How does yoga reduce stress? A systematic review of mechanisms of change and guide to future inquiry
Riley, K. E., & Park, C. L. (2015) · Health Psychology Review · doi:10.1080/17437199.2014.981778 · Cited by 287 · cited 1× · see citing works
“Positive affect has been shown to mediate stress-reducing effects with fitness exercise (Zschucke, Renneberg, Dimeo, Wustenberg, & Strohle, 2015) and reduced perceived stress with yoga (Riley & Park, 2015).”
Differentiating attention styles and regulatory aspects of self-reported interoceptive sensibility
Mehling, W. (2016) · Philosophical Transactions of the Royal Society B: Biological Sciences · doi:10.1098/rstb.2016.0013 · Cited by 261 · see citing works
Self-citationThe stress-buffering effect of acute exercise: evidence for HPA axis negative feedback
Zschucke, E., Renneberg, B., Dimeo, F., Wüstenberg, T., & Ströhle, A. (2015) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2014.10.019 · Cited by 253 · see citing works
Lanius, R. A., Frewen, P. A., Tursich, M., Jetly, R., & McKinnon, M. C. (2015) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v6.27313 · Cited by 246 · see citing works
Tuerk, P. W., Yoder, M. S., Grubaugh, A. L., Myrick, H., Hamner, M. B., & Acierno, R. E. (2010) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2010.11.002 · Cited by 208 · see citing works
Garland, E. L., Geschwind, N., Peeters, F., & Wichers, M. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.00015 · Cited by 199 · see citing works
Forbes, D., Lloyd, D., Nixon, R. D. V., Elliott, P., Varker, T., Perry, D., Bryant, R. A., & Creamer, M. (2012) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2012.01.006 · Cited by 193 · see citing works
Self-focused attention and mechanisms of change in mindfulness-based treatment
Baer, R. A. (2009) · Cognitive Behaviour Therapy · doi:10.1080/16506070902980703 · Cited by 187 · see citing works
Historical pitfalls and new directions in the neuroscience of emotion
Barrett, L. F., & Satpute, A. B. (2019) · Neuroscience Letters · doi:10.1016/j.neulet.2017.07.045 · Cited by 180 · see citing works
Brief body-scan meditation practice improves somatosensory perceptual decision making
Mirams, L., Poliakoff, E., Brown, R. J., & Lloyd, D. M. (2013) · Consciousness and Cognition · doi:10.1016/j.concog.2012.07.009 · Cited by 157 · see citing works
A scale for measuring the occurrence of positive states of mind: a preliminary report.
Horowitz, M. J., Adler, N. E., & Kegeles, S. M. (1988) · Psychosomatic Medicine · doi:10.1097/00006842-198809000-00004 · Cited by 144 · see citing works
Aerobic exercise reduces symptoms of posttraumatic stress disorder: a randomized controlled trial
Fetzner, M. G., & Asmundson, G. J. G. (2015) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2014.916745 · Cited by 139 · see citing works
The impact of an exercise program on posttraumatic stress disorder, anxiety, and depression.
Manger, T. A., & Motta, R. W. (2005) · PubMed · Cited by 138 · see citing works
Self-reported interoceptive awareness in primary care patients with past or current low back pain
Mehling, Daubenmier, J., Price, Acree, Bartmess, & Stewart (2013) · Journal of Pain Research · doi:10.2147/jpr.s42418 · Cited by 137 · see citing works
Cramer, H., Lauche, R., Langhorst, J., & Dobos, G. J. (2016) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2016.02.015 · Cited by 129 · see citing works
Nicholson, A. A., Sapru, I., Densmore, M., Frewen, P. A., Neufeld, R. W. J., Théberge, J., McKinnon, M. C., & Lanius, R. A. (2016) · Psychiatry Research: Neuroimaging · doi:10.1016/j.pscychresns.2016.02.002 · Cited by 128 · see citing works
Goldstein, L. A., Mehling, W. E., Metzler, T. J., Cohen, B. E., Barnes, D. E., Choucroun, G. J., Silver, A., Talbot, L. S., Maguen, S., Hlavin, J. A., et al. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.11.002 · Cited by 109 · see citing works
Self-citationStephenson, K. R., Simpson, T. L., Martinez, M. E., & Kearney, D. J. (2017) · Journal of Clinical Psychology · doi:10.1002/jclp.22323 · Cited by 89 · see citing works
Macy, R. J., Jones, E. D., Graham, L. M., & Roach, L. (2015) · Trauma Violence & Abuse · doi:10.1177/1524838015620834 · Cited by 88 · see citing works
Additional Validation of a Scale to Assess Positive States of Mind
Adler, N. E., Horowitz, M. J., Garcia, A., & Moyer, A. E. (1998) · Psychosomatic Medicine · doi:10.1097/00006842-199801000-00006 · Cited by 79 · see citing works
Simmons, A., Strigo, I. A., Matthews, S. C., Paulus, M. P., & Stein, M. B. (2009) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3181a56ed8 · Cited by 64 · see citing works
Yoga for military service personnel with PTSD: A single arm study.
Johnston, J. M., Minami, T., Greenwald, D. P., Li, C., Reinhardt, K. M., & Khalsa, S. B. S. (2015) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000051 · Cited by 44 · see citing works
Crawford, C. C., Wallerstedt, D. B., Khorsan, R., Clausen, S. S., Jonas, W. B., & Walter, J. A. G. (2013) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2013/747694 · Cited by 44 · see citing works
Effect of Aerobic Exercise on Negative Affect, Positive Affect, Stress, and Depression
Dua, J. K., & Hargreaves, L. (1992) · Perceptual and Motor Skills · doi:10.2466/pms.1992.75.2.355 · Cited by 33 · see citing works
Brewer, J. A. (2014) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2014.14040501 · Cited by 25 · see citing works
Broadening the Approach to Posttraumatic Stress Disorder and the Consequences of Trauma
Kearney, D. J., & Simpson, T. L. (2015) · JAMA · doi:10.1001/jama.2015.7522 · Cited by 21 · see citing works
(2014) · Institutional Repository University of Antioquia (University of Antioquia) · doi:10.1371/journal.pone
Flagged first, then by citations
Research works printed but not linked: 2
- [13]13. Craig, A. D. (2008). Interoception and emotion: A neuroanatomical perspective. In M. Lewis, J. M. Haviland-Jones, & L. Barrett (Eds.), Handbook of emotion (3rd ed., pp. 272-290). New York: Guilford Press.
- [23]23. Hoge, C. W. (2010). Once a warrior, always a warrior. Globe Pequote Press, Guilford, CT.
Cited by
Sorted by citations
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Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023) · Cell Reports Medicine · doi:10.1016/j.xcrm.2022.100895 · Cited by 284 · see citing works
Mindfulness, Interoception, and the Body: A Contemporary Perspective
Gibson, J. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.02012 · Cited by 278 · see citing works
Differentiating attention styles and regulatory aspects of self-reported interoceptive sensibility
Mehling, W. (2016) · Philosophical Transactions of the Royal Society B: Biological Sciences · doi:10.1098/rstb.2016.0013 · Cited by 261 · see citing works
Self-citationExercise Intervention in PTSD: A Narrative Review and Rationale for Implementation
Hegberg, N. J., Hayes, J. P., & Hayes, S. M. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00133 · Cited by 154 · see citing works
“Additional findings from the same sample suggest that the exercise program was also associated with increased self-reported mindfulness and interoceptive awareness (67).”
Interoceptive Ability and Emotion Regulation in Mind–Body Interventions: An Integrative Review
Lazzarelli, A., Scafuto, F., Crescentini, C., Matiz, A., Orrù, G., Ciacchini, R., Alfì, G., Gemignani, A., & Conversano, C. (2024) · Behavioral Sciences · doi:10.3390/bs14111107 · Cited by 49 · see citing works
Eggart, M., Valdés-Stauber, J., Müller-Oerlinghausen, B., & Heinze, M. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05168-y · Cited by 13 · see citing works
Walker, R. A. J., Smith, P. M., Limbert, C., & Colclough, M. (2020) · Military Behavioral Health · doi:10.1080/21635781.2020.1746445 · Cited by 12 · see citing works
Lee, N., Kim, M., & Jung, M. (2024) · Journal of Research and Health · doi:10.32598/jrh.14.1.2358.1 · Cited by 3 · see citing works
- Authors
- Mehling, W. E., Chesney, M. A., Metzler, T. J., Goldstein, L. A., Maguen, S., Geronimo, C., Agcaoili, G., Barnes, D. E., Hlavin, J. A., & Neylan, T. C.
- Affiliations
- San Francisco VA Medical Center (US)
- Corresponding author
- Mehling, Wolf E.
- ORCID
- Venue
- Journal of Clinical Psychology
- Publisher
- Wiley
- Published
- 2017-10-27
- Volume
- 74
- Issue
- 4
- Pages
- 554-565
- ISSN
- 0021-9762 (ISSN-L)
- 1097-4679
- OpenAlex
- W2766733239
- Semantic Scholar
- ee05c6ee3b974335236209d234a56882f75af808
- Cited by
- 130
- References
- 49
- Citations by year
- 2026: 11 · 2025: 21 · 2024: 25 · 2023: 17 · 2022: 12 · 2021: 20 · 2020: 14 · 2019: 6 · 2018: 3 · 2016: 1
- FWCI
- 7.80
- Type
- journal article
- Language
- en
- Open access
- green
- escholarship.org
- Locations
- Journal of Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Northern California Institute for Research and Education
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- war veterans, post-traumatic stress disorder, mindfulness, interoceptive awareness, yoga, aerobic exercise, resistance training, self-regulation
- MeSH terms
- Adult, Aged, Awareness, Exercise Therapy, Female, Humans, Male, Middle Aged, Stress Disorders, Post-Traumatic, Veterans, Yoga, Outcome Assessment, Health Care, Young Adult, Mindfulness, Interoception
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