Transcendental Meditation May Be as Effective as Exposure Therapy for PTSD

Exposing people with posttraumatic stress disorder (PTSD) to their traumatic memories has been regarded as an important, if not essential, part of the therapeutic process. This is the basis of prolonged exposure therapy, in which people with PTSD relive their trauma in a safe environment, so that the memories are no longer associated with fear, distress, and other negative emotions.

A study of veterans with PTSD now shows that transcendental meditation is comparable to prolonged exposure therapy—considered the gold standard psychotherapy for PTSD. Transcendental meditation involves the silent repetition of a personal mantra to achieve restful alertness and avoid distracting thoughts.

The study findings were published November 15, 2018, in Lancet Psychiatry.

“Our findings provide further evidence that PTSD treatments can be effective without an exposure component. Because trauma exposure can be difficult for patients, similarly effective treatments that do not require exposure could be appealing to veterans and other groups with PTSD,” wrote lead author Sanford Nidich, Ed.D., a professor of physiology and education at the Maharishi University of Management Research Institute in Iowa, and colleagues.

Transcendental meditation might be an especially appealing alternative since it is a relatively effortless technique, Nidich said. “There is no intense concentration or contemplation needed; a person just learns to progressively experience a quieter and calmer state of mind.”

Transcendental meditation is also consistent with military culture, noted Vernon Barnes, Ph.D., of Augusta University, in an editorial that accompanied the study: “Transcendental meditation is self-empowering, completely transportable, and inconspicuous. The technique can be practiced anywhere at any time, without specialized equipment or the need for personnel support.”

The study by Nidich and colleagues included 203 veterans from the Veterans Administration San Diego Healthcare System who had a current diagnosis of PTSD resulting from an event during active military service. The participants were randomly assigned to receive 12 sessions of transcendental meditation, prolonged exposure therapy, or PTSD health education (which served as the control group) over 12 weeks. The meditation and health education sessions were provided in group settings, while the exposure therapy was given in one-on-one settings.

The researchers used the clinician-administered PTSD scale (CAPS) and participant-administered PTSD Checklist–Military version (PCL-M) to assess PTSD symptoms at the start of the study and again after 12 weeks. The study participants were also asked about depressive symptoms using the nine-item Patient Health Questionnaire (PHQ-9).

After 12 weeks, the veterans undergoing transcendental meditation and exposure therapy experienced comparable results in terms of reducing clinician- and patient-rated PTSD symptoms as well as depressive symptoms. Both treatments were superior to providing health education.

Nidich noted that patients who received transcendental meditation had greater improvements on all three behavioral scales (CAPS, PCL-M, and PHQ-9) compared with those who received prolonged exposure, though these results were in the statistical margin of error. CAPS scores, for example, decreased by an average of 16 points in the meditation group, 11 points in the prolonged exposure group, and 2.5 points in the health education group. (A reduction of 10 points or more is considered clinically meaningful.)

The goal of the study was not to prove one method is superior to the other, Nidich said. Rather, the goal was to examine whether these two treatments are on equal footing, so that veterans with PTSD would have another evidence-based option to choose from when considering treatment.

It is also possible that transcendental meditation and exposure therapy can be used together for even greater PTSD improvements, he continued. “This approach hasn’t been tested yet, but I don’t see any reason why they can’t work together, even though one intervention is trauma focused and the other is not,” he said. Such an approach would just need to involve good communication between the psychotherapist and the certified meditation instructor to avoid any potential confusion on behalf of veterans as to when they should think about their trauma.

This study was supported by grants from the U.S. Department of Defense. ■