Treating the Wounds of War

By Barbara L. Niles, Amy K. Silberbogen, Julie Klunk-Gillis | May 19, 2010 | 0 comments

How mindfulness is helping veterans adjust to life on the home front.

In the spring of 2005, veterans from Iraq and Afghanistan began to trickle into the VA Boston Healthcare System, the system of veterans’ hospitals in the greater Boston area, seeking treatment for emotional problems, including Post Traumatic Stress Disorder (PTSD). Veterans with PTSD often experience intrusive memories and nightmares, feel emotionally numb, and show symptoms of hyperarousal, such as intense anger and the need to constantly be on the lookout for danger.

At the time, a growing body of research suggested two important findings: that tens of thousands of veterans were suffering from these mental health problems, and that, despite treatment available through the military and the Department of Veterans Affairs, only a minority were willing to seek treatment.

We wanted to find some way to help these veterans readjust to civilian life, but we knew we had to overcome some of the barriers that often kept them from seeking treatment, such as inconvenience and the stigma associated with mental health care. As we investigated various approaches, we found that Jon Kabat-Zinn’s Mindfulness-Based Stress Reduction program had proven to be effective at alleviating chronic pain and depression, two common problems for veterans with symptoms of PTSD. What’s more, when practiced regularly, research suggests mindfulness can also calm the body and mind, making it a good fit for addressing the hyperarousal symptoms of PTSD, such as intense irritability and trouble sleeping.

To make this program more accessible to veterans, we decided to use a “telehealth” method and deliver part of the treatment over the phone. We secured funding from the Samueli Institute for Information Biology to conduct a small pilot research study to see if veterans with PTSD could benefit from a mindfulness intervention delivered this way. In eight sessions of treatment (two in-person and six over the phone), we covered some basic concepts of mindfulness with a group of 17 veterans.

For instance, we helped them learn to pay closer attention to their sensations, thoughts, and emotions so that they would be more present in each moment; individuals with PTSD tend to be extremely avoidant, often failing to acknowledge or engage in their emotional experiences and their surroundings. Veterans also received a mindfulness education handbook, covering core concepts of mindfulness, and CDs of guided mindfulness exercises, along with instructions to practice for five to 20 minutes per day.

When these 17 veterans completed their weekly sessions and came in for a six-week follow-up visit, we were pleasantly surprised that most of them had read the handbook and practiced using the CDs much more than we had asked them to (an average of 130 minutes per week). We were also happy to find that they reported being highly satisfied with the mindfulness treatment and experienced some relief from their PTSD symptoms afterwards. They were less likely to have intrusive memories of traumatic events, for instance, and they didn’t feel as numb emotionally as they had before; a comparison group of veterans, who received a different treatment for PTSD, didn’t show a reduction in their symptoms.

However, the changes in PTSD symptoms among the mindfulness group didn’t last through the six-week follow-up period, suggesting the need to maintain one’s mindfulness practice in order to continue to enjoy its positive effects.

Still, these 17 veterans reported some important changes in their day-to-day lives that were not necessarily captured by our standardized measures. Some told us how they weren’t always on edge like they used to be: Where they used to look only for danger, some of the veterans began to notice their environments in new ways. While walking outside, for example, instead of looking behind trees for threats, they began to notice the trees themselves, seeing them as if for the first time. Others mentioned how they weren’t as quick to anger as they used to be; they started to notice and acknowledge their emotional reactions rather than immediately acting on them.

This study offered evidence that veterans could really tolerate and benefit from a mindfulness intervention. Because it was a pilot study, we are looking for ways to replicate these preliminary findings in a larger population—perhaps with “booster” sessions after the eight weeks to ensure that the effects of mindfulness endure. While the traumas of war are not easily overcome, we believe mindfulness—either alone or along with other research-proven treatments—can offer veterans some relief, encouragement, and hope.

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About The Author

Barbara Niles, Ph.D., is a staff psychologist in the Behavioral Science Division of the National Center for Post-Traumatic Stress Disorder within the VA Boston Healthcare System. Amy K. Silberbogen, Ph.D., is a clinical psychologist and the director of the VA Boston Psychology Postdoctoral Fellowship Program at the VA Boston Healthcare System. Julie Klunk-Gillis, Ph.D., is the assistant director of the PTSD Clinic and a staff psychologist in the Center for Returning Veterans at the Brockton VA, which is part of the VA Boston Healthcare System.


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