Jill E. Bormann

The theoretical and empirical basis for meditation as an intervention for PTSD.

In spite of the existence of good empirically supported treatments for posttraumatic stress disorder (PTSD), consumers and providers continue to ask for more options for managing this common and often chronic condition. Meditation-based approaches are being widely implemented, but there is minimal research rigorously assessing their effectiveness. This article reviews meditation as an intervention for PTSD, considering three major types of meditative practices: mindfulness, mantra, and compassion meditation. The mechanisms by which these approaches may effectively reduce PTSD symptoms and improve quality of life are presented. Empirical evidence of the efficacy of meditation for PTSD is very limited but holds some promise. Additional evaluation of meditation-based treatment appears to be warranted.

Measurement of Fatigue in HIV-Positive Adults: Reliability and Validity of the Global Fatigue Index

Fatigue is among the most common and distressing symptoms in patients with HIV/AIDS. Little is known about the clinical assessment of fatigue, especially in patients using highly active antiretroviral regimens. The purpose of this study was to evaluate the psychometric properties of the Global Fatigue Index (GFI) in a community-based sample of 209 patients with HIV/AIDS. The GFI is a measure that quantifies five dimensions of fatigue from the Multidimensional Assessment of Fatigue instrument into one score. To assess construct validity, the study included measures of depression, perceived stress, activities of daily living (ADLs), health behaviors, and clinical markers. Cronbachs alpha was calculated for internal consistency reliability, and factor analysis and bivariate correlations were conducted. The GFI was found to be easily self-administered, reliable, and a valid measure of overall fatigue burden in an HIV population. This instrument may be used by clinicians and researchers for assessing fatigue.

Relationship of frequent mantram repetition to emotional and spiritual well-being in healthcare workers.

BACKGROUND Healthcare workers report high levels of stress in the workplace. To determine how to reduce stress, the authors examined the effectiveness of frequently repeating a mantram (a word with spiritual meaning) on emotional and spiritual well-being. METHODS A pretest-posttest design was used to measure stress, state/trait anxiety and anger, quality of life, and spiritual well-being in a convenience sample (N=42) of hospital workers completing a mantram intervention program. RESULTS Significant improvements were found in stress (p < .001), trait-anxiety (p = .002), trait-anger (p = .02), quality of life (p = .001), and spiritual well-being (p = .003). When examining the effects of mantram practice, trait-anxiety and religious and spiritual well-being were significant (p < .05). CONCLUSION Improvements in emotional and spiritual well-being may be mediated by frequent mantram repetition.

A spiritually based caregiver intervention with telephone delivery for family caregivers of veterans with dementia.

Caring for veterans with dementia is burdensome for family caregivers. This exploratory study tested the efficacy of an innovative, spiritually based mantram caregiver intervention delivered using teleconference calls. A prospective, within-subjects, mixed-methods, and 3-time repeated-measures design with 36-week follow-up telephone interviews was conducted. Sixteen caregivers (94% women, 94% Whites with mean age 69.2 years, SD = 10.35 years) completed the intervention. Significant effects for time and linear terms were found for decreasing caregiver burden, perceived stress, depression, and rumination and for increasing quality of life enjoyment and satisfaction, all with large effect sizes. Findings suggest that teleconference delivery of a spiritually based caregiver intervention is feasible.

Mindful attention increases and mediates psychological outcomes following mantram repetition practice in veterans with posttraumatic stress disorder.

Background:Several evidence-based treatments are available to veterans diagnosed with posttraumatic stress disorder (PTSD). However, not all veterans benefit from these treatments or prefer to engage in them. Objectives:The current study explored whether (1) a mantram repetition program (MRP) increased mindful attention among veterans with PTSD, (2) mindful attention mediated reduced PTSD symptom severity and enhanced psychological well-being, and (3) improvement in mindful attention was due to the frequency of mantram repetition practice. Research Design:Data from a randomized controlled trial comparing MRP plus treatment as usual (MRP+TAU) or TAU were analyzed using hierarchical linear models. Subjects:A total of 146 veterans with PTSD from military-related trauma were recruited from a Veterans Affairs outpatient PTSD clinic (71 MRP+TAU; 75 TAU). Measures:The Clinician Administered PTSD Scale (CAPS), PTSD Checklist (PCL), the Brief Symptom Inventory-18 depression subscale, Health Survey SF-12v2, and Mindfulness Attention Awareness Scale (MAAS) were used. Frequency of mantram repetition practice was measured using wrist-worn counters and daily logs. Results:Intent-to-treat analyses indicated greater increases in mindful attention, as measured by the MAAS, for MRP+TAU as compared with TAU participants (P<0.01). Mindful attention gains mediated previously reported treatment effects on reduced PTSD symptoms (using both CAPS and PCL), reduced depression, and improved psychological well-being. Frequency of mantram repetition practice in turn mediated increased mindful attention. Conclusions:The MRP intervention and specifically, mantram practice, improved mindful attention in veterans with PTSD, yielding improved overall psychological well-being. MRP may be a beneficial adjunct to usual care in veterans with PTSD.

Predictors of complementary/alternative medicine use and intensity of use among men with HIV infection from two geographic areas in the United States.

&NA; This descriptive, cross‐sectional study explored the factors associated with frequency and intensity of complementary/alternative medicine (CAM) use in 301 HIV‐infected men from southern California (n = 75) and northern Florida/southern Georgia (n = 226). Logistic regression analysis was conducted to identify which demographic, biomedical, psychosocial, and health behavior variables (risk and health‐promoting behaviors) were predictors of CAM use and intensity of use. The majority (69%) of participants reported CAM use. The types of CAM most frequently cited were dietary supplements (71%) and spiritual therapies (66%). Odds of CAM use increased with more depressive symptoms and more health‐promoting behaviors. The odds of CAM use intensity increased with greater symptom frequency and more health‐promoting behaviors. Living in California was predictive of both use frequency and intensity of CAM use. High levels of CAM use should alert health care providers to assess CAM use and to incorporate CAM‐related patient education into their clinical practices.

A Systematic Scoping Review of Complementary and Alternative Medicine Mind and Body Practices to Improve the Health of Veterans and Military Personnel

Background:Meditation, imagery, acupuncture, and yoga are the most frequently offered mind and body practices in the Department of Veterans Affairs. Yet, the research on mind and body practices has been critiqued as being too limited in evidence and scope to inform clinical treatment. Objectives:We conducted a systematic scoping review of mind and body practices used with veterans or active duty military personnel to identify gaps in the literature and make recommendations for future primary research. Research Design:Following systematic literature review methodology, we searched 5 databases using 27 different National Center for Complementary and Alternative Medicine-defined mind and body practices as text words, keywords, and MeSH terms through June 30, 2014. We also conducted handsearches of 4 previous reviews. Subjects:Active duty military members or veterans 18 years or older participating in mind and body practice interventions globally. Measures:Data were extracted from studies meeting 5 inclusion criteria. The quality of randomized controlled trials (RCTs) was assessed using an existing checklist. Results:Of 1819 studies identified, 89 interventions (50 RCTs) published between 1976 and 2014, conducted in 9 countries, using 152 different measures to assess 65 health and well-being outcomes met our inclusion criteria. Most interventions took place in the United States (n=78). Meditation practices (n=25), relaxation techniques including imagery (n=20), spinal manipulation including physical therapy (n=16), and acupuncture (n=11) were the most frequently studied practices. Methodological quality of most RCTs was rated poorly. Conclusions:Meditation and acupuncture practices are among the most frequently offered and studied mind and body practices. Future research should include yoga as it is currently understudied among veterans and military personnel. A repository of mind and body intervention outcome measures may further future research efforts, as would conducting pragmatic trials and more robust RCTs.

Chapter 5 mantram repetition: an evidence-based complementary practice for military personnel and veterans in the 21st century.

Today in the digital age, with our advances in modern technology and communication, there are additional stressors for our military personnel and Veterans. Constant dangers exist both on and off the battlefield, unlike prior wars that had clearly-defined war zones. In addition, medical advances have assisted in saving the lives of many more gravely injured troops than ever previously possible. As the wars in Iraq and Afghanistan come to an end, large numbers of service men and women are returning home with multiple injuries. This group of Veterans has significantly higher rates of posttraumatic stress disorder (PTSD) and traumatic brain injury than ever before reported. Although existing PTSD therapies have been found to be highly effective for many Veterans, there is a substantial minority unsatisfactorily treated. Mantram repetition, an innovative, complementary, evidence-based treatment, is proving to be successful for these new Veterans. When used regularly it helps with “road rage, impatience, anger, frustration, and being out of control.” A mantram is a brief, sacred word or phrase that embodies divine power or the greatest positive energy one can imagine (Easwaran, 2008a). Mantram repetition is a simple, quick, personal, portable, and private complementary practice that may be used as an adjunct to current treatments for PTSD. Growing research evidence supports mantram repetitions value for dissemination and adoption in the 21st century. This chapter summarizes Mantram Program research conducted from 2003 to 2014. It describes the health-related benefits of the Mantram Program in various populations. The current research focuses on benefits for managing psychological distress and promoting quality of life in Veterans. Future areas for research are suggested.

Quality Toolbox: Self-Monitoring of a Stress Reduction Technique Using Wrist-Worn Counters

&NA; In a study of 59 veterans and healthcare workers, the reliability of a self‐monitoring method used to track the frequency of a spiritually oriented stress reduction technique was assessed. During a 5‐week program of silently repeating a mantram (a spiritual word or phrase) to lower stress and anger and improve spiritual well‐being, portable wrist‐worn counters were used to track daily mantram practice sessions. All outcomes significantly improved in the hypothesized direction. Mantram practice tracked by the counters was highly correlated (r= .84) with retrospective self‐reports, indicating that such counters may be a reliable self‐monitoring tool and could be used to measure a variety of other behavioral health quality indicators.

Readiness to Change in Heart Failure Patients: Adaptation of a Pain Readiness to Change Measure

Abstract Heart failure (HF) is a significant health problem among the elderly often requiring multiple lifestyle changes for optimal management. Unfortunately, not all patients are ready to make the needed changes. The objective of this study was to evaluate psychometric properties of a readiness to change (RTC) questionnaire. Outpatient (N = 116) Veterans with heart failure who agreed to participate in a 4-month interdisciplinary behavioral management intervention were included for this study. Principal components analysis suggested a 6-factor structure, which generally corresponded to stage of change theoretical stages (i.e., precontemplation, contemplation, preparation, action, and maintenance). One additional factor, resistance, was identified. Internal consistency ranged from high (i.e., precontemplation, action, maintenance) to low (i.e., contemplation, preparation). The adapted RTC measure shows some promise, but requires revision to distinguish factors more clearly. Additional development in new and more representative samples should be conducted.