Simultaneous Treatment of Neurocognitive and Psychiatric Symptoms in Veterans with Post-Traumatic Stress Disorder and History of Mild Traumatic Brain Injury: A Pilot Study of Mindfulness-Based Stress Reduction

• Published in: Military medicine 2015-09, Vol.180 (9), p.956-963
• Main Authors: Cole, Michael A, Muir, James J, Gans, Jennifer J, Shin, Lisa M, D'Esposito, Mark, Harel, Brian T, Schembri, Adrian
• Format: Article
• Language: English
• Subjects: Adult; Attention; Brain Concussion - psychology; Humans; Middle Aged; Mindfulness; Neurocognitive Disorders - etiology; Neurocognitive Disorders - therapy; Patient Satisfaction; Pilot Projects; Stress Disorders, Post-Traumatic - psychology; Stress Disorders, Post-Traumatic - therapy; Stress, Psychological; Symptom Assessment; Veterans - psychology
• ISSN: 0026-4075; 1930-613X; 1930-613X
• DOI: 10.7205/MILMED-D-14-00581

Treating patient populations with significant psychiatric and neurocognitive symptomatology can present a unique clinical dilemma: progress in psychotherapy can be significantly fettered by cognitive deficits, whereas neurocognitive rehabilitation efforts can be ineffective because of psychiatric overlay. Application of mindfulness-based interventions to address either cognitive or psychiatric symptoms in isolation appears efficacious in many contexts; however, it remains unclear whether this type of intervention might help address simultaneous neurocognitive and psychiatric symptomatology. In a pre-post mixed methods design pilot study, nine Veterans with post-traumatic stress disorder (PTSD) and a history of mild traumatic brain injury with chronic cognitive complaints participated in Mindfulness-Based Stress Reduction (MBSR). Clinical interview, questionnaires, and attention and PTSD measures were administered immediately before, immediately after, and 3 months after MBSR completion. Qualitative and quantitative findings suggest high levels of safety, feasibility, and acceptability. Measurement of attention revealed significant improvement immediately following MBSR (p < 0.05, d = 0.57) and largely sustained improvement 3 months after completion of MBSR (p < 0.10, d = 0.48). Significant reduction in PTSD symptoms was found immediately after MBSR (p < 0.05, d = -1.56), and was sustained 3 months following MBSR completion (p < 0.05, d = -0.93). These results warrant a randomized controlled trial follow-up. Potential mechanisms for the broad effects observed will be explored.