The Lancet 2018: Non-trauma-focused meditation versus exposure therapy in veterans with post-traumatic stress disorder: a randomised controlled trial
The Study Summary
A key challenge in military medicine has been the treatment of the mental health of military service members who have been deployed in operations in recent years.
The most effective course of treatment for post-traumatic stress disorder (PTSD) has been highly debated and is a central focus in the military community because of the large number of service members returning from deployment with PTSD. More than a third of patients with PTSD do not recover even after many years, showing PTSD to be a chronic and costly illness to service members, their families, and society as a whole.
Traditional treatment of PTSD has not been uniformly successful because of comorbidities, side-effects of drug therapy, and time and energy needed for psychotherapy.
Pharmacotherapy has shown insufficient benefit in the treatment of PTSD, while adherence and the treatment success of various psychotherapies has been disappointing. When patients with PTSD do not respond to traditional treatment, new approaches should be considered.
Post-traumatic stress disorder (PTSD) is a complex and difficult-to-treat disorder, affecting 10–20% of military veterans.
Previous research has raised the question of whether a non-trauma-focused treatment can be as effective as trauma exposure therapy in reducing PTSD symptoms.
This study aimed to compare the non-trauma-focused practice of Transcendental Meditation (TM) with prolonged exposure therapy (PE) in a non-inferiority clinical trial, and to compare both therapies with a control of PTSD health education (HE).
We did a randomised controlled trial at the Department of Veterans Affairs San Diego Healthcare System in CA, USA. We included 203 veterans with a current diagnosis of PTSD resulting from active military service randomly assigned to a TM or PE group, or an active control group of HE, using stratified block randomisation. Each treatment provided 12 sessions over 12 weeks, with daily home practice. TM and HE were mainly given in a group setting and PE was given individually.
The primary outcome was change in PTSD symptom severity over 3 months, assessed by the Clinician-Administered PTSD Scale (CAPS). Analysis was by intention to treat. We hypothesised that TM would show non-inferiority to PE in improvement of CAPS score (?=10), with TM and PE superior to PTSD HE. This study is registered with ClinicalTrials.gov, number NCT01865123.
Between June 10, 2013, and Oct 7, 2016, 203 veterans were randomly assigned to an intervention group (68 to the TM group, 68 to the PE group, and 67 to the PTSD HE group).
TM was significantly non-inferior to PE on change in CAPS score from baseline to 3-month post-test (difference between groups in mean change -5·9, 95% CI -14·3 to 2·4, p=0·0002). In standard superiority comparisons, significant reductions in CAPS scores were found for TM versus PTSD HE (–14·6 95% CI, -23·3 to -5·9, p=0·0009), and PE versus PTSD HE (–8·7 95% CI, -17·0 to -0·32, p=0·041). 61% of those receiving TM, 42% of those receiving PE, and 32% of those receiving HE showed clinically significant improvements on the CAPS score.
A non-trauma-focused-therapy, TM, might be a viable option for decreasing the severity of PTSD symptoms in veterans and represents an efficacious alternative for veterans who prefer not to receive or who do not respond to traditional exposure-based treatments of PTSD.
Department of Defense, US Army Medical Research.