PTSD symptom reduction with mindfulness-based stretching and deep breathing exercise: randomized controlled clinical trial of efficacy.

CONTEXT Abnormal cortisol levels are a key pathophysiological indicator of post-traumatic stress disorder (PTSD). Endogenous normalization of cortisol concentration through exercise may be associated with PTSD symptom reduction. OBJECTIVE The aim of the study was to determine whether mindfulness-based stretching and deep breathing exercise (MBX) normalizes cortisol levels and reduces PTSD symptom severity among individuals with subclinical features of PTSD. DESIGN AND SETTING A randomized controlled trial was conducted at the University of New Mexico Health Sciences Center. PARTICIPANTS Twenty-nine nurses (28 female) aged 45-66 years participated in the study. INTERVENTION Sixty-minute MBX sessions were conducted semiweekly for 8 weeks. MAIN OUTCOME MEASURES Serum cortisol was measured, and the PTSD Checklist-Civilian version (PCL-C) was performed at baseline and weeks 4, 8, and 16. RESULTS Twenty-nine participants completed the study procedures, 22 (79%) with PTSD symptoms (MBX, n = 11; control, n = 11), and 7 (21%) without PTSD (BASE group). Eight-week outcomes for the MBX group were superior to those for the control group (mean difference for PCL-C scores, -13.6; 95% confidence interval [CI], -25.6, -1.6; P = .01; mean difference for serum cortisol, 5.8; 95% CI, 0.83, 10.8; P = .01). No significant differences were identified between groups in any other items. The changes in the MBX group were maintained at the 16-week follow-up (P = .85 for PCL-C; P = .21 for cortisol). Our data show that improved PTSD scores were associated with normalization of cortisol levels (P < .05). CONCLUSIONS The results suggest that MBX appears to reduce the prevalence of PTSD-like symptoms in individuals exhibiting subclinical features of PTSD.

[1]  R. Ryan,et al.  Mindfulness: Theoretical Foundations and Evidence for its Salutary Effects , 2007 .

[2]  P. Grossman,et al.  Mindfulness-based stress reduction and health benefits. A meta-analysis. , 2004, Journal of psychosomatic research.

[3]  J. Davidson,et al.  The corticotropin-releasing hormone test in patients with posttraumatic stress disorder , 1989, Biological Psychiatry.

[4]  R. Yehuda,et al.  Cortisol levels in adult offspring of Holocaust survivors: relation to PTSD symptom severity in the parent and child , 2002, Psychoneuroendocrinology.

[5]  S. Telles,et al.  Yoga Reduces Symptoms of Distress in Tsunami Survivors in the Andaman Islands , 2007, Evidence-based complementary and alternative medicine : eCAM.

[6]  C. A. Morgan,et al.  An Increased Capacity for Adrenal DHEA Release is Associated with Decreased Avoidance and Negative Mood Symptoms in Women with PTSD , 2004, Neuropsychopharmacology.

[7]  R. Lanius,et al.  Emotion modulation in PTSD: Clinical and neurobiological evidence for a dissociative subtype. , 2010, The American journal of psychiatry.

[8]  E. Blanchard,et al.  Psychometric properties of the PTSD Checklist (PCL). , 1996, Behaviour research and therapy.

[9]  J. Douglas Bremner,et al.  Marked Lability in Urinary Cortisol Levels in Subgroups of Combat Veterans With Posttraumatic Stress Disorder During an Intensive Exposure Treatment Program , 2002, Psychosomatic medicine.

[10]  Andreas Papassotiropoulos,et al.  Low-dose cortisol for symptoms of posttraumatic stress disorder. , 2004, The American journal of psychiatry.

[11]  D. Gates,et al.  Secondary traumatic stress in nurses who care for traumatized women. , 2008, Journal of obstetric, gynecologic, and neonatal nursing : JOGNN.

[12]  S. Orr,et al.  Twenty-four hour urinary cortisol and catecholamine excretion in combat-related posttraumatic stress disorder , 1990, Biological Psychiatry.

[13]  B. Adelson,et al.  Effects of a yoga breath intervention alone and in combination with an exposure therapy for post‐traumatic stress disorder and depression in survivors of the 2004 South‐East Asia tsunami , 2010, Acta psychiatrica Scandinavica.

[14]  R. Yehuda.  POST-TRAUMATIC STRESS DISORDER , 1985, The Lancet.

[15]  Hagit Cohen,et al.  Analysis of heart rate variability in posttraumatic stress disorder patients in response to a trauma-related reminder , 1998, Biological Psychiatry.

[16]  J. Pruessner,et al.  Cortisol as a marker for improvement in mindfulness-based stress reduction. , 2010, Complementary therapies in clinical practice.

[17]  G. Brandenberger,et al.  Influence of timing and intensity of musclar exercise on temporal patterns of plasma cortisol levels. , 1975, The Journal of clinical endocrinology and metabolism.

[18]  K. Acker.  Do critical care nurses face burnout, PTSD, or is it something else?: getting help for the helpers. , 1993, AACN clinical issues in critical care nursing.

[19]  R. Saper,et al.  Treating survivors of torture and refugee trauma: a preliminary case series using qigong and t'ai chi. , 2008, Journal of alternative and complementary medicine.

[20]  S. Southwick,et al.  Elevated CSF corticotropin-releasing factor concentrations in posttraumatic stress disorder. , 1997, The American journal of psychiatry.

[21]  Olga V. Demler,et al.  Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. , 2005, Archives of general psychiatry.

[22]  D Neuhauser,et al.  Shuffle the deck, flip that coin: randomization comes to medicine , 2004, Quality and Safety in Health Care.

[23]  C. Coe,et al.  Abuse-Related Posttraumatic Stress Disorder: Evidence for Chronic Neuroendocrine Activation in Women , 1995, Psychosomatic medicine.

[24]  R. Kraemer,et al.  Effects of estrogen replacement therapy on dehydroepiandrosterone, dehydroepiandrosterone sulfate, and cortisol responses to exercise in postmenopausal women. , 1997, Fertility and sterility.

[25]  R. Yehuda,et al.  Cortisol metabolic predictors of response to psychotherapy for symptoms of PTSD in survivors of the World Trade Center attacks on September 11, 2001 , 2009, Psychoneuroendocrinology.

[26]  Ravinder Jerath,et al.  Physiology of long pranayamic breathing: neural respiratory elements may provide a mechanism that explains how slow deep breathing shifts the autonomic nervous system. , 2016, Medical hypotheses.

[27]  B. Rothbaum,et al.  Increased prevalence of post-traumatic stress disorder symptoms in critical care nurses. , 2007, American journal of respiratory and critical care medicine.

[28]  C. Pilver,et al.  Complementary and alternative medicine use among individuals with posttraumatic stress disorder. , 2013 .

[29]  Janet B W Williams,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[30]  R. Yehuda,et al.  Is there a rationale for cortisol-based treatments for PTSD? , 2009, Expert review of neurotherapeutics.

[31]  Yoshio Nakamura,et al.  Heart rate variability, trait anxiety, and perceived stress among physically fit men and women. , 2000, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[32]  D. D. de Quervain,et al.  Efficacy of Hydrocortisone in Preventing Posttraumatic Stress Disorder Following Critical Illness and Major Surgery , 2006, Annals of the New York Academy of Sciences.

[33]  P. Potter,et al.  Compassion fatigue and burnout: prevalence among oncology nurses. , 2010, Clinical journal of oncology nursing.

[34]  E. Twamley,et al.  Neuropsychological function in college students with and without posttraumatic stress disorder , 2004, Psychiatry Research.

[35]  B. McEwen.  The neurobiology and neuroendocrinology of stress. Implications for post-traumatic stress disorder from a basic science perspective. , 2002, The Psychiatric clinics of North America.

[36]  L. Alden,et al.  Posttraumatic stress disorder in the emergency room: exploration of a cognitive model. , 2003, Behaviour research and therapy.

[37]  R. Sapolsky,et al.  How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions. , 2000, Endocrine reviews.

[38]  J. Boscarino.  Posttraumatic stress disorder, exposure to combat, and lower plasma cortisol among Vietnam veterans: findings and clinical implications. , 1996, Journal of consulting and clinical psychology.

[39]  Florian Holsboer,et al.  Gene Expression Patterns Associated with Posttraumatic Stress Disorder Following Exposure to the World Trade Center Attacks , 2009, Biological Psychiatry.