trauma

ANN ARBOR, Mich. — Like an endlessly repeating video loop, horrible memories and thoughts can keep playing over and over in the minds of people with post-traumatic stress disorder. They intrude at the quietest moments, and don’t seem to have an off switch.

But a new study in veterans with PTSD shows the promise of mindfulness training for enhancing the ability to manage those thoughts if they come up, and not get “stuck”. Even more surprising, it actually shows the veterans’ brains changed — in ways that may help them find their own off switch for that endless loop.

The findings, published in Depression and Anxiety by a team from the University of Michigan Medical School and VA Ann Arbor Healthcare System, come from a study of 23 veterans of the wars in Iraq and Afghanistan. All of them got some form of group therapy. After four months of weekly sessions, many reported that their PTSD symptoms eased up.

But only in those who got mindfulness training – a mind-body technique that focuses on in-the-moment attention and awareness – did the researchers see the brain changes that surprised even them.

Shifting brain connections
The changes showed up on functional MRI, or fMRI, brain scans that can visualize brain activity as different areas of the brain “talk” to one another through networks of connections between brain cells.

Before the mindfulness training, when the veterans were resting quietly, their brains had extra activity in regions involved in responding to threats or other outside problems. This is a sign of that endless loop of hypervigilance often seen in PTSD.

But after learning mindfulness, they developed stronger connections between two other brain networks: the one involved in our inner, sometimes meandering, thoughts, and the one involved in shifting and directing attention.

“The brain findings suggest that mindfulness training may have helped the veterans develop more capacity to shift their attention and get themselves out of being “stuck” in painful cycles of thoughts,” says Anthony King, Ph.D., a U-M Department of Psychiatry researcher who led the new study in collaboration with VA psychologists.

“We’re hopeful that this brain signature shows the potential of mindfulness to be helpful for managing PTSD for people who might initially decline therapy involving trauma processing,” he adds. “We hope it may provide emotional regulation skills to help bring them to a place where they feel better able to process their traumas.”

King, who has experience providing individual and group therapy for veterans from many conflicts, worked with a team of brain-imaging experts and PTSD specialists including senior author Israel Liberzon, M.D. They used an fMRI scanner at the VA Ann Arbor that’s dedicated to research.

In all, 14 of the veterans finished the mindfulness sessions and completed follow-up fMRI scans, and 9 finished the comparison sessions and had scans. The small size of the group means the new results are only the start of an exploration of this issue, King says.

A palatable option
Before they launched the study, the researchers weren’t sure that they could find enough veterans to try mindfulness-based training. After all, it has a reputation as an “alternative” approach and has a relationship to traditionally East and South Asian practices like meditation and yoga

But in fact, more of the initial group of veterans stuck with mindfulness-based therapy sessions – held each week for two hours with a trained mindfulness teacher and psychotherapist – than made it all the way through the comparison psychotherapy group that didn’t get mindfulness training.

“Once we explained the rationale behind mindfulness, which aims to ground and calm a person while also addressing mental phenomena, they were very interested and engaged – more than we expected,” says King. “The approach we took included standard elements of exposure therapy as well as mindfulness, to help lead veterans to be able to process the trauma itself.”

The comparison group received a VA-developed intervention that was designed for “control group” use. It included problem-solving and group support but not mindfulness or exposure therapy.

He emphasizes that people with PTSD should not see mindfulness alone as a potential solution for their symptoms, and that they should seek out providers trained specifically in PTSD care.The mindfulness group saw improvement in PTSD symptoms, in the form of decreased scores on a standard scale of PTSD severity, that was statistically significant and considered clinically meaningful, whereas the control group did not. However, the between-group effects in this small study were not considered statistically significant, and therefore King wants to explore the trend further in larger groups, and in civilians.

That’s because mindfulness sessions can sometimes actually trigger symptoms such as intrusive thoughts to flare up. So, it is very important for people with PTSD to have help from a trained counselor to use mindfulness as part of their therapy for PTSD.

“Mindfulness can help people cope with and manage their trauma memories, explore their patterns of avoidance when confronting reminders of their trauma, and better understand their reactions to their symptoms,” says King. “It helps them feel more grounded, and to notice that even very painful memories have a beginning, a middle and an end — that they can become manageable and feel safer. It’s hard work, but it can pay off.”

Network shifts
At the start of the study, and in previous U-M/VA work, the fMRI scans of veterans with PTSD showed unusual activity. Even when they were asked to rest quietly and let their minds wander freely, they had high levels of activity in brain networks that govern reactions to salient, or meaningful, external signals such as threats or dangers. Meanwhile, the default mode network, involved in inwardly focused thinking and when the mind is wandering, was not as active in them.

But at the end of the mindfulness course, the default mode area was more active – and showed increased connections to areas of the brain known as the executive network. This area gets involved in what scientists call volitional attentional shifting – purposefully moving your attention to think about or act upon something.

Those with the greatest easing of symptoms had the largest increases in connections.

“We were surprised by the findings, because there is thinking that segregation between the default mode network and the salience network is good,” says King. “But now we are hopeful that this brain signature of increased connection to areas associated with volitional attention shifting at rest may be helpful for managing PTSD, and may help patients have more capacity to help themselves get out of being stuck in painful ruts of trauma memories and rumination.”

REFERENCE: Depression and Anxiety, DOI 10.1002/da.22481, and a presentation April 1 at the Anxiety and Depression Association of America annual conference

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Becoming mindful can help to deal with trauma

June 9, 2015

Brian Levine, The Star: Pushing away bad memories can be unproductive.

Imagine learning about the death of your father, but then feeling the surprise and pain freshly each time you hear about it for years afterwards. That was the experience of the world’s most famous amnesiac, Henry Molaison, the subject of the book Permanent Present Tense.

These days, we’re constantly being encouraged to “live in the present” to reduce anxiety and improve well-being. It’s good advice, but pushing away bad memories — or being cut off from them like Henry Molaison — is unproductive. Nobody would enjoy living in the permanent present tense …

Breathing, meditation and helping PTSD

September 19, 2014

British Psychological Society: Servicemen and women with post-traumatic stress disorder (PTSD) could benefit from trying breathing-based meditation, a new study suggests.

Research by the University of Wisconsin-Madison, published in the Journal of Traumatic Stress, found that a practice known as Sudarshan Kriya Yoga can help sufferers better manage the condition.

This, it stated, is because this form of breathing directly affects the autonomic nervous system, which means it can have an effect on symptoms of PTSD such as hyperarousal – when a person constantly feels on guard and jumpy.

Richard Davidson, one of the authors of the study, is keen for additional research to …

Mindfulness training may assuage early-life trauma

August 12, 2014

Thaddeus Pace, Scientific American:

We live in an increasingly stressful world. There’s an aspirational sense things should improve with time, witness the U.S. War on Poverty or the U.N. Millennium Development Goals. But in the last 50 years, many risks, perceived and real, have grown worse: extreme weather, violent conflict, economic dislocation, poverty (especially for children), abuse and domestic violence. Traumatic and chronic stress affects millions. Many become sick and marginalized because of it; others manage to survive and thrive. What explains the difference?

“Resilience” is a popular answer these days. But it’s a buzzword in danger of losing its meaning through overuse. As the need for resilience grows, it’s important to be specific about the term. A new white paper, “The Human Dimensions of Resilience,” of which I’m a co-author, reviews relevant research and proposes evidence-based ways of defining and building resilience. Published by the Garrison Institute, a non-profit that promotes “contemplative” solutions to social and environmental concerns, the paper is intended to advance conversations about our wellbeing.

Science views resilience as part of the response to stress. Not all stress is bad; short stressors can inspire outstanding performance. But extreme or acute stress can be traumatizing and damaging. When physiological responses to stress like cortisol, adrenaline and inflammation persist even after a stressor has ended, they can undermine mental and physical health. Unchecked behavioral responses to stress can lead to sleep and diet problems. Besides PTSD, exposure to chronic and/or traumatic stress can also lead to other serious conditions including heart disease, hypertension, type 2 diabetes, anxiety, depression and cognitive problems – maybe even DNA damage.

Traumatic stress can undermine and shorten peoples’ lives, especially if they’re exposed before age 18. They’re more likely to have lower achievement and wellness, and experience more illness. “Early life adversity”–experiencing abuse or household dysfunction during childhood–correlates not only with more psychological problems, but also with elevated inflammatory markers like C-reactive protein or higher insulin levels that persist into adulthood. Studies show a strong, graded relationship between early life adversity and risk factors for the leading causes of death in adults.

Resilience can mitigate those effects. Extraordinarily resilient people can thrive in adversity and use difficult experiences as opportunities for growth. But resilience isn’t an inscrutable, innate personality trait you’re either born with or not. It’s likely a spectrum of qualities that people possess in varying degrees that help them survive challenges, shut off aspects of stress response when they’re no longer needed, and return to a pre-stressor, baseline state. As such, resilience is something we should be able to analyze and teach, and anyone should be able to learn.

Studies show contemplative practices such as mindfulness meditation, compassion training, yoga, etc. can reduce harmful impacts of stress, and they can be helpful in building resilience. However, recent media coverage gushing over how contemplative practices like mindfulness make you happier, healthier, sharper and richer spreads confusion about how those practices work.

Contemplative practices weren’t invented to fight cancer or boost performance, but rather to tackle big issues like living purposefully and facing death with equanimity. One fundamental skill they build is attention, the simple act of consciously choosing what to focus on instead of letting the mind wander. Having strong attention is an important component of resilience, because it develops a sense of agency and choice in directing one’s thoughts and influencing one’s inner landscape – a powerful counterweight to the sense of helplessness or passivity that traumatic stress can produce.

Colleagues and I recently studied teenagers in foster care in Georgia who were exposed to early life adversity. They were taught a form of meditation called Cognitively Based Compassion Training. After six weeks, the kids who really practiced not only reported feeling better and coping better with anger and stress (“At school, someone threw M&M’s at me and I ignored him. Normally I would have thrown things back and been negative.”). Pre- and post- saliva testing also showed their C-reactive protein levels dropped, which means they actually had less inflammation in their bodies. That suggests increased resilience, because it shows some better functioning and movement back toward baseline.

We recently launched a similar Cognitively Based Compassion Training program in Arizona. The next horizon for research is determining whether kids in such programs perform better in school and generally thrive. Failure to thrive–not taking advantage of the opportunities that arise in life and work–is a symptom of traumatization. Effective resilience building should be able to ameliorate it.

If contemplative practice can help accomplish that for these kids, imagine what it might do for people working in fields with high trauma exposure and burnout risk, like first responders or humanitarian aid and relief workers. For example the Garrison Institute’s Contemplative-Based Resilience Training program designs trainings for aid workers that incorporate meditation, yoga and other contemplative techniques to help them cope with stress, avoid burnout, and thrive in their work. It hypothesizes that more resilient individuals make for more resilient communities, but how and why that’s the case is a subject for another blog.

New brain-based understanding of mindfulness & meditation strategies for addiction treatment

May 30, 2014

PRWeb: Mindfulness and meditation have been shown to aid addiction recovery, but which strategy is best? Here Constance Scharff, PhD, Director of Addiction Research at Cliffside Malibu Treatment Center, describes our evolving understanding of the brain-based effects of meditation and mindfulness.

When included in addiction treatment and relapse prevention programs, mindfulness and meditation strategies have been shown to reduce anxiety and help to prevent relapse. But mindfulness and meditation are separate practices and even within meditation, not all styles produce the same results. Which is best?

“Anxiety is universal to the human condition, but addicts experience it to an extreme because they have real problems. Meditation and mindfulness practices can help an addict stop worrying about the past, stop fussing about the future, and can help keep an addict from being caught up in racing thoughts about things they can’t control,” says Constance Scharff, PhD, Director of Addiction Research at Cliffside Malibu Treatment Center.

The more stress and anxiety your brain experiences, the more prone you are to addiction. The same is true of trauma – people who have experienced traumatic events are more likely to abuse substances than people without trauma histories. It’s these two challenges – stress and the influence of traumatic memories – that meditation or mindfulness training are thought to heal in people undergoing addiction treatment.

Scharff describes mindfulness as awareness of the present moment. Within meditation practices, there are two major schools – concentrative meditation in which a person focuses on a thought, a sound or on breathing, and nondirective meditation in which a person gently unfocuses his or her mind and lets thoughts wander.

“What we’re learning is that these practices physically change the way the brain works,” Scharff says.

For example, a new study published in the journal Frontiers in Human Neuroscience used fMRI imaging to look inside the brains of 14 experienced meditators. First, the researchers had people chant a sound while focusing their minds on the meditation syllables. Then researchers had people meditate again, but this time letting their minds wander. They also compared both meditation strategies to rest.

The group from the Norwegian University of Science and Technology found that unfocused meditation led to the most activation of brain areas that deal with the processing of memories and emotions. In fact, unfocused mediation far outperformed both focused meditation and rest in its activation of these areas essential for stress reduction and the successful processing of traumatic experiences.

The authors write that, “These techniques are thought to facilitate mental processing of emotional experiences, thereby contributing to wellness and stress management.”

Likewise, a host of studies show long-term changes in brain structures due to mindfulness and meditation practices, including increased gray matter density, increased neuroplasticity (the brain’s ability to create new synapses), increased activation in brain areas that control attention, and even temperature changes in the brain. New research at the UCLA Mindful Awareness Research Center and elsewhere shows these visible, physical changes are sculpted by the practice of meditation – the more you meditate, the more your brain is changed.

“In addition to long-term changes in the mechanics of the brain, at Cliffside we see another, more short-term benefit – we see addicts making an effort to focus on the things that are happening right now and there’s a calm from making that effort,” Scharff says.

Even outside the ways in which meditation changes the brain, and outside the effects of mindfulness practice on focusing attention on the present, the process of learning to the skill itself may provide a valuable forum in which to practice self change.

“For me, the important part is learning to be non-judgmental,” Scharff says. “A person may only go three seconds before a thought intrudes, and that’s OK. It’s the process of accepting current limitations and learning to fail safely without self-judgment that is beneficial.”

Healing vets’ PTSD with transcendental meditation

August 16, 2013

Megan Cloherty, Washington, WTOP: Wild and reckless — that’s how Iraq Army veteran David George describes his lifestyle after returning from combat. He says he hit rock bottom after five years of living with untreated post traumatic stress disorder.

“I was really at a low point. I didn’t know if I was going to go drink until I was dead under a bridge or go to school. It was just one or the other,”says George, who was injured after a suicide bomber detonated an explosive at the gates of an American military base in Tel Afar, Iraq on Dec. 3, 2003.

A Maryland native…

Meditation helping war veterans

June 9, 2013

Tim Barlass,The Syndney Morning Herald: Veterans with post-traumatic stress disorder can be treated with transcendental meditation, says a leading US expert on the practice.

Fred Travis of the Maharishi University of Management in Iowa has won a $2.4 million grant from the US Department of Defence for research on the use of meditation to help veterans from the Afghanistan and Iraq conflicts cope with stress.

Dr Travis, who is speaking in Sydney this week, believes its application with Australian Defence Force staff should also be investigated.

Three US studies have shown that transcendental meditation can have remarkable results…

After struggling with PTSD, Navy veteran uses meditation, counseling to help others overcome trauma

May 24, 2013

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Transcendental Meditation significantly reduces posttraumatic stress in African refugees

April 8, 2013

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