Like an endlessly repeating video loop, horrible memories and thoughts can play over and over in the minds of people with post-traumatic stress disorder (PTSD). They intrude at the quietest moments, and don’t seem to have an off switch.
Now, a small new study of veterans with PTSD shows the promise of mindfulness training for enhancing the ability to manage those thoughts if they come up, and to keep them from getting “stuck.” Even more surprising, the findings actually show the veterans’ brains changed—in ways that may help them find their own off switch for that endless loop.
For the study, published in the journal Depression and Anxiety, 23 veterans of the wars in Iraq and Afghanistan received some form of group therapy. After four months of weekly sessions, many reported that their PTSD symptoms eased up.
But in those who participated in mindfulness training—a mind-body technique that focuses on in-the-moment attention and awareness—researchers were surprised to see significant brain changes as well.
Stronger 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 of the psychiatry department at the University of Michigan.
“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. We hope it may provide emotional regulation skills to help bring them to a place where they feel better able to process their traumas.”
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.
Because of mindfulness-based training’s reputation as an “alternative” approach and its relationship to traditionally East and South Asian practices like meditation and yoga, researchers were initially unsure they would find enough veterans to try it.
But, 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.
People with PTSD should not see mindfulness alone as a potential solution for their symptoms, should seek out providers trained specifically in PTSD care, King says.
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. 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’s 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.”
At the start of the study, and in previous 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.”
The US Defense Department and a Mind and Life Institute Varela award funded the work.