Skip to main content

Advertisement

SpringerLink
Log in

The Body Scan and Mindful Breathing Among Veterans with PTSD: Type of Intervention Moderates the Relationship Between Changes in Mindfulness and Post-treatment Depression

  • ORIGINAL PAPER
  • Published:
Mindfulness Aims and scope Submit manuscript

Abstract

Mindfulness-based stress reduction (MBSR) is a promising intervention for veterans with post-traumatic stress disorder (PTSD) and depression; however, a more detailed examination of the different elements of MBSR and various facets of mindfulness to determine what works best for whom is warranted. One hundred and two veterans with PTSD were randomly assigned to one of four arms: (a) body scan (BS; n = 27), (b) mindful breathing (MB; n = 25), (c) slow breathing (SB; n = 25), or (d) sitting quietly (SQ; n = 25). The purpose of this study was to (a) examine two separate components of MBSR (i.e., body scan and mindful breathing) among veterans with PTSD when compared to a nonmindfulness intervention (SB) and a control group (SQ), (b) assess if changes in specific mindfulness facets were predictive of post-treatment PTSD and depression for individuals who participated in a mindfulness intervention (BS vs. MB), and (c) investigate if type of mindfulness intervention received would moderate the relationship between pre- to post-treatment changes in mindfulness facets and post-treatment outcomes in PTSD and depression. Participants in the mindfulness groups experienced significant decreases in PTSD and depression symptom severity and increases in mindfulness, whereas the nonmindfulness groups did not. Among veterans who participated in a mindfulness group, change in the five facets of mindfulness accounted for 23 % of unique variance in the prediction of post-treatment depression scores. Simple slope analyses revealed that type of mindfulness intervention moderated the relationship among changes in facets of mindfulness and post-treatment depression.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed. Text rev.). Washington, DC: American Psychiatric Association Publishing.

  • Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45.

    Article  PubMed  Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory. San Antonio: Psychological Corporation.

    Google Scholar 

  • Bernstein, A., Tanay, G., & Vujanovic, A. A. (2011). Concurrent relations between mindful attention and awareness and psychopathology among trauma-exposed adults: preliminary evidence of transdiagnostic resilience. Journal of Cognitive Psychotherapy, 25(2), 99–113.

    Article  Google Scholar 

  • Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., & Devins, G. (2004). Mindfulness: a proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230–241.

    Google Scholar 

  • Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., & Keane, T. M. (1995). The development of a clinician‐administered PTSD scale. Journal of Traumatic Stress, 8(1), 75–90.

    Article  PubMed  Google Scholar 

  • Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996). Psychometric properties of the PTSD Checklist (PCL). Behavior Research and Therapy, 34(8), 669–673.

  • Boden, M. T., Bernstein, A., Walser, R. D., Bui, L., Alvarez, J., & Bonn-Miller, M. O. (2012). Changes in facets of mindfulness and posttraumatic stress disorder treatment outcome. Psychiatry Research, 200(2), 609–613.

    Article  Google Scholar 

  • Bohlmeijer, E., Peter, M., Fledderus, M., Veehof, M., & Baer, R. (2011). Psychometric properties of the Five Facet Mindfulness Questionnaire in depressed adults and development of a short form. Assessment, 1073191111408231.

  • Bormann, J. E., Oman, D., Walter, K. H., & Johnson, B. D. (2014). Mindful attention increases and mediates psychological outcomes following mantram repetition practice in veterans with posttraumatic stress disorder. Medical Care, 52, S13–S18.

    Article  PubMed  Google Scholar 

  • Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D. (2005). A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162(2), 214–227. doi:10.1176/appi.ajp.162.2.214.

    Article  PubMed  Google Scholar 

  • Cai, H., Xia, J., Xu, D., Gao, D., Yan, Y. (2006). A generic minimization random allocation and blinding system on web. Journal of Biomedicine Information, 39(6), 706–19.

  • Carmody, J., & Baer, R. A. (2008). Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. Journal of Behavioral Medicine, 31(1), 23–33.

    Article  PubMed  Google Scholar 

  • Carmody, J., Baer, R. A., LB Lykins, E., & Olendzki, N. (2009). An empirical study of the mechanisms of mindfulness in a mindfulness‐based stress reduction program. Journal of Clinical Psychology, 65(6), 613–626.

    Article  PubMed  Google Scholar 

  • Cohen J. (1992). A power primer. Psychological Bulletin, 112(1), 155.

  • Conrad, A., Müller, A., Doberenz, S., Kim, S., Meuret, A. E., Wollburg, E., & Roth, W. T. (2006). Psychophysiological effects of breathing instructions for stress management. Applied Psychophysiology and Biofeedback, 32(2), 89–98.

    Article  Google Scholar 

  • Davidson, J. R. T., Stein, D. J., Shalev, A. Y., & Yehuda, R. (2004). Posttraumatic stress disorder: acquisition, recognition, course, and treatment. Journal of Neuropsychiatry & Clinical Neurosciences, 16(2), 135–147.

    Article  Google Scholar 

  • Delizonna, L. L., Williams, R. P., & Langer, E. J. (2009). The effect of mindfulness on heart rate control. Journal of Adult Development, 16(2), 61–65.

  • Derosiers, A., Klemanksi, D., & Nolen-Hoeksema, S. (2013). Mapping mindfulness facets onto dimensions of anxiety and depression. Behavior Therapy, 44, 373–384.

    Article  Google Scholar 

  • Dreeben, S., Mamber, M., & Salmon, P. (2013). The MBSR body scan in clinical practice. Mindfulness, 4, 394–401.

    Article  Google Scholar 

  • Feldman, G., Greeson, J., & Senville, J. (2010). Differential effects of mindful breathing, progressive muscle relaxation, and loving-kindness meditation on decentering and negative reactions to repetitive thoughts. Behaviour Research and Therapy, 48(10), 1002.

    Article  PubMed  PubMed Central  Google Scholar 

  • Follette, V., Palm, K. M., & Pearson, A. N. (2006). Mindfulness and trauma: implications for treatment. Journal of Rational-Emotive and Cognitive-Behavior therapy, 24(1), 45–61.

    Article  Google Scholar 

  • Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351(1), 13–22.

    Article  PubMed  Google Scholar 

  • Hoge, C. W., Grossman, S. H., Auchterlonie, J. L., Riviere, L. A., Milliken, C. S., & Wilk, J. E. (2014). PTSD treatment for soldiers after combat deployment: low utilization of mental health care and reasons for dropout. Psychiatric Services.

  • Hölzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6, 537–559. doi:10.1177/1745691611419671.

    Article  PubMed  Google Scholar 

  • IBM Corp. (2013). IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.

  • Institute of Medicine. (2010). Returning home from Iraq and Afghanistan: preliminary assessment of readjustment needs of veterans, service members, and their families. Washington, DC: National Academies.

    Google Scholar 

  • Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12.

  • Jacobson, N. S., Roberts, L. J., Berns, S. B., & McGlinchey, J. B. (1999). Methods for defining and determining the clinical significance of treatment effects: description, application, and alternatives. Journal of Consulting and Clinical Psychology, 67(3), 300.

  • Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. General Hospital Psychiatry, 4(1), 33–47.

    Article  PubMed  Google Scholar 

  • Kabat-Zinn, J. (2002). Commentary on Majumdar et al.: Mindfulness meditation and health. Journal of Alternative and Complementary Medicine, 8(6), 731–735.

    Article  Google Scholar 

  • Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine, 8(2), 163–190.

    Article  PubMed  Google Scholar 

  • Kang, H., & Bullman, A. (2008). Risk of suicide among US Veterans after returning from the Iraq or Afghanistan war zones. JAMA, 300, 652–653.

    Article  PubMed  Google Scholar 

  • Kearney, D. J., McDermott, K., Malte, C., Martinez, M., & Simpson, T. L. (2013). Effects of participation in a mindfulness program for veterans with posttraumatic stress disorder: a randomized controlled pilot study. Journal of Clinical Psychology, 69(1), 14–27.

    Article  PubMed  Google Scholar 

  • Kimbrough, E., Magyari, T., Langenberg, P., Chesney, M., & Berman, B. (2010). Mindfulness intervention for child abuse survivors. Journal of Clinical Psychology, 66(1), 17–33.

    PubMed  Google Scholar 

  • Libby, D. J., Pilver, C. E., & Desai, R. (2014). Complementary and alternative medicine in VA specialized PTSD treatment programs. Psychiatric Services.

  • Lund, M., Foy, D., Sipprelle, C., & Strachan, A. (1984). The combat exposure scale: a systematic assessment of trauma in the Vietnam War. Journal of Clinical Psychology, 40, 1323–1328. doi:10.1002/1097-4679(198411)40:6<1323::AID-JCP2270400607>3.0.CO;2-I.

    Article  PubMed  Google Scholar 

  • Management of Post-Traumatic Stress Working Group. (2010). VA/DoD clinical practice guideline: Management of post-traumatic stress. Washington, DC: Department of Veterans Affairs/Department of Defense. Retrieved from http://www.healthquality.va.gov/PTSD-FULL-2010c.pdf.

  • Marshall, A. D., Panuzio, J., & Taft, C. T. (2005). Intimate partner violence among military veterans and active duty servicemen. Clinical Psychology Review, 25, 862–876.

    Article  PubMed  Google Scholar 

  • McDevitt-Murphy, M. E., Murphy, J. G., Monahan, C. J., Flood, A. M., & Weathers, F. W. (2010). Unique patterns of substance misuse associated with PTSD, depression, and social phobia. Journal of Dual Diagnosis, 6(2), 94–110.

    Article  PubMed  PubMed Central  Google Scholar 

  • McDonald, S. D., & Calhoun, P. S. (2010). The diagnostic accuracy of the PTSD Checklist: a critical review. Clinical Psychology Review, 30(8), 976–987.

    Article  PubMed  Google Scholar 

  • Mehling, W., Gopisetty, V., Daubenmier, J., Price, C., Hecht, F., & Stewart, A. (2008). Body awareness: construct and self-report measures. Plus One, 4(5), 1–18.

    Google Scholar 

  • Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3(5), 400–424.

    Article  PubMed  Google Scholar 

  • Owens, G. P., Walter, K. H., Chard, K. M., & Davis, P. A. (2012). Changes in mindfulness skills and treatment response among veterans in residential PTSD treatment. Psychological Trauma: Theory, Research, Practice, and Policy, 4(2), 221.

    Article  Google Scholar 

  • Pocock, S. J. & Simon, R. (1975). Sequential treatment assignment with balancing for prognostic factors in the controlled clinical trial. Biometrics, 31, 103–115.

  • Possemato, K., Wade, M., Andersen, J., & Ouimette, P. (2010). The impact of PTSD, depression, and substance use disorders on disease burden and health care utilization among OEF/OIF veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 2(3), 218.

    Article  Google Scholar 

  • Sauer-Zavala, S. E., Walsh, E. C., Eisenlohr-Moul, T. A., & Lykins, E. L. (2013). Comparing mindfulness-based intervention strategies: differential effects of sitting meditation, body scan, and mindful yoga. Mindfulness, 4(4), 383–388.

    Article  Google Scholar 

  • Sayadaw, M. (1994). The progress of insight: a treatise on satipatthana meditation. Buddhist Publication Society.

  • Seal, K. H., Metzler, T. J., Gima, K. S., Bertenthal, D., Maguen, S., & Marmar, C. R. (2009). Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002–2008. American Journal of Public Health, 99(9), 1651.

    Article  PubMed  PubMed Central  Google Scholar 

  • Seal, K. H., Maguen, S., Cohen, B., Gima, K. S., Metzler, T. J., Ren, L., & Marmar, C. R. (2010). VA mental health services utilization in Iraq and Afghanistan veterans in the first year of receiving new mental health diagnoses. Journal of Traumatic Stress, 23(1), 5–16.

    PubMed  Google Scholar 

  • Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression. Guilford.

  • Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62(3), 373–386.

    Article  PubMed  Google Scholar 

  • Sharp, J. (2004). The prevalence of post-traumatic stress disorder in chronic pain patients. Current Pain and Headache Reports, 8, 111–1115.

    Article  PubMed  Google Scholar 

  • Shiner, B. (2011). Health services use in the Department of Veterans Affairs among returning Iraq War and Afghan War veterans with PTSD. PTSD Research Quarterly, 22(2), 1–10.

    Google Scholar 

  • Stecker, T., Shiner, B., Watts, B. V., Jones, M., & Conner, K. R. (2013). Treatment-seeking barriers for veterans of the Iraq and Afghanistan conflicts who screen positive for PTSD. Psychiatric Services, 64(3), 280–283.

    Article  PubMed  Google Scholar 

  • Stevanovic, A., Franciskovic, T., Klaric, M., & Rebic, J. (2012). P-981-Secondary traumatic stress in wives of war veterans with PTSD. European Psychiatry, 27(1).

  • Sullivan-Kalill, K. S., Treanor, M., & Roemer, L. (2013). The importance of non-reactivity to posttraumatic stress symptoms: a case for mindfulness. Mindfulness, 1–8.

  • Tanielian, T. J. L. (Ed.). (2008). Invisible wounds of war: psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica, CA: RAND Corporation.

  • Thompson, B. L., & Waltz, J. (2010). Mindfulness and experiential avoidance as predictors of posttraumatic stress disorder avoidance symptom severity. Journal of Anxiety Disorders, 24(4), 409–415.

    Article  PubMed  Google Scholar 

  • Thompson, R. W., Arnkoff, D. B., & Glass, C. R. (2011). Conceptualizing mindfulness and acceptance as components of psychological resilience to trauma. Trauma, Violence & Abuse, 12(4), 220–235.

    Article  Google Scholar 

  • Treanor, M. (2011). The potential impact of mindfulness on exposure and extinction learning in anxiety disorders. Clinical Psychology Review, 31(4), 617–625.

    Article  PubMed  Google Scholar 

  • Vujanovic, A. A., Youngwirth, N. E., Johnson, K. A., & Zvolensky, M. J. (2009). Mindfulness-based acceptance and posttraumatic stress symptoms among trauma-exposed adults without axis I psychopathology. Journal of Anxiety Disorders, 23(2), 297–303.

    Article  PubMed  PubMed Central  Google Scholar 

  • Vujanovic, A. A., Bonn-Miller, M. O., Bernstein, A., McKee, L. G., & Zvolensky, M. J. (2010). Incremental validity of mindfulness skills in relation to emotional dysregulation among a young adult community sample. Cognitive Behaviour Therapy, 39(3), 203–213.

    Article  PubMed  PubMed Central  Google Scholar 

  • Vujanovic, A. A., Niles, B., Pietrefesa, A., Schmertz, S. K., & Potter, C. M. (2011). Mindfulness in the treatment of posttraumatic stress disorder among military veterans. Professional Psychology: Research and Practice, 42(1), 24–31. doi:10.1037/a0022272.

    Article  Google Scholar 

  • Wahbeh, H., Lu, M., & Oken, B. (2011). Mindful awareness and non-judging in relation to posttraumatic stress disorder symptoms. Mindfulness, 2(4), 219–227.

    Article  PubMed  PubMed Central  Google Scholar 

  • Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD Checklist (PCL): reliability, validity, and diagnostic utility. In: Annual convention of the International Society for Traumatic Stress Studies. San Antonio: International Society for Traumatic Stress Studies.

Download references

Author information

Authors and Affiliations

  1. School of Professional Psychology, Pacific University, 190 SE 8th Avenue, Hillsboro, OR, 97123, USA

    Dana Dharmakaya Colgan, Michael Christopher & Paul Michael

  2. Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA

    Helané Wahbeh

Authors
  1. Dana Dharmakaya Colgan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Christopher
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul Michael
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Helané Wahbeh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dana Dharmakaya Colgan.

Ethics declarations

Research reported in this publication was supported by the National Center for Complementary and Alternative Medicine of the National Institutes of Health (grant numbers T32AT002688, K01AT004951, and K24AT005121). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. All relevant APA ethical standards and the code of ethics of the World Medical Association (Declaration of Helsinki) were followed in the conduct of the study. Additionally, IRB approval was granted by the institutions at which authors are located.

Conflict of Interest

The authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Colgan, D.D., Christopher, M., Michael, P. et al. The Body Scan and Mindful Breathing Among Veterans with PTSD: Type of Intervention Moderates the Relationship Between Changes in Mindfulness and Post-treatment Depression. Mindfulness 7, 372–383 (2016). https://doi.org/10.1007/s12671-015-0453-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12671-015-0453-0

Keywords

Search

Navigation