Mindfulness-Based Stress Reduction (MBSR) as a Standalone Intervention for Posttraumatic Stress Disorder after Mixed Traumatic Events: A Mixed-Methods Feasibility Study

“75, which indicated good agreement between the raters (Landis and Koch, 1977).”

“Intercoder reliability was calculated using Cohen’s kappa (Cohen, 1960).”

“Treatment effect sizes were calculated for the entire sample (ITT based on the last observation carried forward for the dropouts) and for the completers by using Cohen’s d: effect sizes were defined as small (d = 0.20), medium (d = 0.50), and large (d = 0.80; Cohen, 1988).”

“8%, PTSD is an important health care problem (Kessler et al., 2005).”

“To develop a system of categories, as a first step, the material of one interview was categorized inductively (Charmaz, 2006) by two raters sticking closely to the raw data.”

“This interview corresponded to approximately 10% of the data material, as proposed by Neuendorf (2002).”

“…interventions may help to reduce PTSD is that reexperiencing symptoms are thought to be maintained by perceiving the trauma as a current threat (Ehlers and Clark, 2000) and that mindfulness practice through an awareness of the present moment may improve the ability to distinguish between past…”

“Clinician-Administered PTSD Scale (CAPS; Blake et al., 1995; Schnyder and Moergeli, 2002).”

“, emotional and physical reactions (Baer, 2003).”

“…to directly address the traumatic event; therefore, compliance with trauma-focused treatment is often low (Scott and Stradling, 1997), non-response rates are high (Schottenbauer et al., 2008), and a substantial number of patients still have residual symptoms after treatment (Bradley et al., 2005).”

“After traumatic events were identified with the Life Event Checklist (LEC; Gray et al., 2004) at baseline, the symptoms regarding the three most distressing events (e.”

“Additionally, practicing mindfulness may decrease PTSD-related hyperarousal, because the exercises produce stress reduction and relaxation effects (Chiesa and Serretti, 2009), which has been demonstrated by a lower cortisol level at awakening in PTSD patients after mindfulness meditation (Wahbeh et…”

“Studies show that avoidance leads to an increase of intrusions (Wegner and Zanakos, 1994; Steil and Ehlers, 2000), traumarelated thoughts (Shipherd and Beck, 2005) and associated emotions (Beck et al., 2006).”

“Meta-analyses regarding PTSD treatment demonstrate the efficacy of trauma-focused interventions (Watts et al., 2013; Cusack et al., 2016), such as prolonged exposure (Foa et al., 2007), cognitive processing therapy (Resick and Schnicke, 1993), and eye movement desensitization and reprocessing…”

“Davidson Trauma Scale (DTS; Davidson et al., 1997).”

“An additional difficulty is that exposure-based techniques are underutilized in clinical practice and lack acceptance because of therapists’ concerns regarding problematic behaviors, such as suicide attempts or substance abuse (Becker et al., 2004).”

“…PTSD treatment demonstrate the efficacy of trauma-focused interventions (Watts et al., 2013; Cusack et al., 2016), such as prolonged exposure (Foa et al., 2007), cognitive processing therapy (Resick and Schnicke, 1993), and eye movement desensitization and reprocessing (Shapiro and Forrest, 2001).”

“We used the recommended scoring rule that requires a frequency score of 1 and an intensity score of 2 to consider a symptom to be fulfilled (Weathers et al., 1999).”

“However, clinical experience indicates that many severely affected patients are unwilling to directly address the traumatic event; therefore, compliance with trauma-focused treatment is often low (Scott and Stradling, 1997), non-response rates are high (Schottenbauer et al., 2008), and a substantial number of patients…”

“Furthermore, there are often high dropout rates in PTSD treatments (Imel et al., 2013), sometimes up to 54% (Schottenbauer et al.”

“Support for the idea that the teaching style may be the problem comes from studies that demonstrated yoga to be applicable and helpful to PTSD sufferers (van der Kolk et al., 2014).”

“Studies show that avoidance leads to an increase of intrusions (Wegner and Zanakos, 1994; Steil and Ehlers, 2000), traumarelated thoughts (Shipherd and Beck, 2005) and associated emotions (Beck et al., 2006).”

“The idea that mindfulness-based interventions are helpful to reduce PTSD symptoms is supported by promising experiences with approaches that include mindfulness and acceptance exercises in PTSD treatment, such as dialectical behavior therapy for PTSD (Steil et al., 2011; Bohus et al., 2013) and acceptance and commitme…”

“Furthermore, in a randomized controlled trial (RCT) also with veterans, MBSR has proven to be superior in reducing PTSD symptoms compared with present-centered group therapy (Polusny et al., 2015).”

“Furthermore, many studies define completion as attending four or more sessions, which is a very low dose of treatment, and have percentages of non-completers that vary from 11 to 26% (Kimbrough et al., 2010; Kearney et al., 2012).”

“In particular, many of the participants reported having difficulties with the yoga exercises, which were associated with the lack of a demonstration of these exercises and with physical problems that are often found among PTSD patients due to an increased prevalence of physical diseases (Spitzer et al., 2009).”

“Training in mindfulness may thus reduce PTSD symptoms by increasing the ability of patients to tolerate contact with distressing memories, thoughts and feelings (Follette et al., 2006).”

“These reviews include different techniques, such as mindfulness-based stress reduction (MBSR; e.g., Kearney et al., 2013), mindfulness-based cognitive therapy (King et al., 2013), yoga (e.g., van der Kolk et al., 2014), and a mantram repetition program (e.g., Borman et al., 2013).”

“Furthermore, many studies define completion as attending four or more sessions, which is a very low dose of treatment, and have percentages of non-completers that vary from 11 to 26% (Kimbrough et al., 2010; Kearney et al., 2012).”

“The idea that mindfulness-based interventions are helpful to reduce PTSD symptoms is supported by promising experiences with approaches that include mindfulness and acceptance exercises in PTSD treatment, such as dialectical behavior therapy for PTSD (Steil et al., 2011; Bohus et al., 2013) and acceptance and commitme…”

“Another problem of existing studies is that patients were often allowed to participate simultaneously in more comprehensive psychological treatment (e.g., Kearney et al., 2013; Felleman et al., 2016), which impedes clear conclusions regarding the unique effects of mindfulness interventions.”

“Furthermore, the avoidance of distressing memories is considered to be crucial to the maintenance of PTSD (O’Donnell et al., 2007).”

“Nevertheless, this evidence is limited due to the methodological deficits of most studies (Banks et al., 2015; Hilton et al., 2016).”

“In the Clinician-Administered PTSD Scale, we found large effects regarding the reduction of PTSD symptoms among completers (Cohen’s d = 1.2).”

“These reviews include different techniques, such as mindfulness-based stress reduction (MBSR; e.g., Kearney et al., 2013), mindfulness-based cognitive therapy (King et al., 2013), yoga (e.g., van der Kolk et al., 2014), and a mantram repetition program (e.g., Borman et al., 2013).”

“…of PTSD patients that resulted from the qualitative interviews is to provide more information regarding the exercises and their utility to reduce PTSD, which has been successfully implemented in a “trauma-informed MBSR program” for survivors of interpersonal violence (Kelly and Garland, 2016).”

“Studies show that avoidance leads to an increase of intrusions (Wegner and Zanakos, 1994; Steil and Ehlers, 2000), traumarelated thoughts (Shipherd and Beck, 2005) and associated emotions (Beck et al., 2006).”

“Additionally, practicing mindfulness may decrease PTSD-related hyperarousal, because the exercises produce stress reduction and relaxation effects (Chiesa and Serretti, 2009), which has been demonstrated by a lower cortisol level at awakening in PTSD patients after mindfulness meditation (Wahbeh et al., 2016).”

“…is supported by promising experiences with approaches that include mindfulness and acceptance exercises in PTSD treatment, such as dialectical behavior therapy for PTSD (Steil et al., 2011; Bohus et al., 2013) and acceptance and commitment therapy (ACT; Twohig, 2009; Woidneck et al., 2014).”

“…severely affected patients are unwilling to directly address the traumatic event; therefore, compliance with trauma-focused treatment is often low (Scott and Stradling, 1997), non-response rates are high (Schottenbauer et al., 2008), and a substantial number of patients still have residual…”

“…is supported by promising experiences with approaches that include mindfulness and acceptance exercises in PTSD treatment, such as dialectical behavior therapy for PTSD (Steil et al., 2011; Bohus et al., 2013) and acceptance and commitment therapy (ACT; Twohig, 2009; Woidneck et al., 2014).”

“Correspondingly, one study found non-reactivity to inner experiences to be associated with lower PTSD symptoms (Kalill et al., 2014).”

“Nevertheless, there is promising evidence from several studies that have used MBSR successfully for veterans with a secured PTSD diagnosis (Bhatnagar et al., 2013; Kearney et al., 2013; Omidi et al., 2013).”

“Nevertheless, there is promising evidence from several studies that have used MBSR successfully for veterans with a secured PTSD diagnosis (Bhatnagar et al., 2013; Kearney et al., 2013; Omidi et al., 2013).”

“Meta-analyses regarding PTSD treatment demonstrate the efficacy of trauma-focused interventions (Watts et al., 2013; Cusack et al., 2016), such as prolonged exposure (Foa et al., 2007), cognitive processing therapy (Resick and Schnicke, 1993), and eye movement desensitization and reprocessing…”

“However, a new systemic review on emerging interventions for PTSD determines that the quality of the studies that assess MBSR as a treatment for PTSD still remains very low because of the described limitations of many studies (Metcalf et al., 2016).”

“Arguments for an individual treatment setting may be that individual treatment for PTSD has been proven to be superior to group interventions (Taylor and Harvey, 2009) and that dropout rates are usually lower in individual treatment (Imel et al.”

“Another problem of existing studies is that patients were often allowed to participate simultaneously in more comprehensive psychological treatment (e.g., Kearney et al., 2013; Felleman et al., 2016), which impedes clear conclusions regarding the unique effects of mindfulness interventions.”

“Regarding the reported lack of group cohesion, it is important to consider that in groups of PTSD patients, who often have lost confidence in others, it is a key task of the therapist to establish trustful interactions among the group members (Knaevelsrud et al., 2012).”

“Mindfulness interventions can help the sufferers to improve the ability to distinguish the past and present, so as to lower the re-experiencing symptoms [99] of post-traumatic stress disorder.”

“Similarly, the use of coping techniques through mindfulness programs has been shown in other patient groups (Bogosian et al., 2016; Malpass et al., 2015; Müller-Engelmann et al., 2017).”

“Furthermore, the intervention was tailored to the specific needs of PTSD patients, e.g., by including explanations regarding the aims of the exercises in response to the high need for control that is characteristic of PTSD patients (Müller-Engelmann et al. 2017).”

“…previous studies on other clinical groups—although none were related to fatigue—that have described the use of meditative tools and practices learned from mindfulness-based interventions (MBIs, including MBSR and MBCT) as a means to address challenges related to medical conditions 33,45,55,56 .”