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.
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.
Veterans Affairs Northern California Health Care System, 150 Muir Road, Martinez, CA 94553.
Michael A
MA
Cole
Veterans Affairs Northern California Health Care System, 150 Muir Road, Martinez, CA 94553.
James J
JJ
Muir
Veterans Affairs Northern California Health Care System, 150 Muir Road, Martinez, CA 94553.
Jennifer J
JJ
Gans
Department of Psychology, Tufts University, 490 Boston Avenue, Medford, MA 02155.
Lisa M
LM
Shin
Veterans Affairs Northern California Health Care System, 150 Muir Road, Martinez, CA 94553.
Mark
M
D'Esposito
Cogstate Inc., 195 Church Street, New Haven, CT 06510.
Brian T
BT
Harel
Cogstate Inc., 195 Church Street, New Haven, CT 06510.
Adrian
A
Schembri
D000328:Adult; D001288:Attention; D001924:Brain Concussion / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D064866:Mindfulness; D019965:Neurocognitive Disorders / Q000209:etiology / Q000628:therapy*; D017060:Patient Satisfaction; D010865:Pilot Projects; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology* / Q000628:therapy*; D063189:Symptom Assessment; D014728:Veterans / Q000523:psychology*; D013315:Stress, Psychological