PTSD Symptom Reduction with Mindfulness-based Stretching and Deep Breathing Exercise: Randomized Controlled Clinical Trial of Efficacy

Overview

Journal J Clin Endocrinol Metab

Publisher Oxford University Press

Specialty Endocrinology

Date 2013 May 31

PMID 23720785

Citations 31

Authors

Sang Hwan Kim

Suzanne M Schneider

Margaret Bevans

Len Kravitz

Christine Mermier

Clifford Qualls

Mark R Burge

Affiliations

Soon will be listed here.

Abstract

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.

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References

Sapolsky R, Romero L, Munck A . How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions. Endocr Rev. 2000; 21(1):55-89. DOI: 10.1210/edrv.21.1.0389. View

Telles S, Naveen K, Dash M . Yoga reduces symptoms of distress in tsunami survivors in the andaman islands. Evid Based Complement Alternat Med. 2008; 4(4):503-9. PMC: 2176139. DOI: 10.1093/ecam/nem069. View

Rasmusson A, Vasek J, Lipschitz D, Vojvoda D, Mustone M, Shi Q . An increased capacity for adrenal DHEA release is associated with decreased avoidance and negative mood symptoms in women with PTSD. Neuropsychopharmacology. 2004; 29(8):1546-57. DOI: 10.1038/sj.npp.1300432. View

Twamley E, Hami S, Stein M . Neuropsychological function in college students with and without posttraumatic stress disorder. Psychiatry Res. 2004; 126(3):265-74. DOI: 10.1016/j.psychres.2004.01.008. View

McEwen B . The neurobiology and neuroendocrinology of stress. Implications for post-traumatic stress disorder from a basic science perspective. Psychiatr Clin North Am. 2002; 25(2):469-94, ix. DOI: 10.1016/s0193-953x(01)00009-0. View

Lanius R, Vermetten E, Loewenstein R, Brand B, Schmahl C, Douglas Bremner J . Emotion modulation in PTSD: Clinical and neurobiological evidence for a dissociative subtype. Am J Psychiatry. 2010; 167(6):640-7. PMC: 3226703. DOI: 10.1176/appi.ajp.2009.09081168. View

Boscarino J . Posttraumatic stress disorder, exposure to combat, and lower plasma cortisol among Vietnam veterans: findings and clinical implications. J Consult Clin Psychol. 1996; 64(1):191-201. DOI: 10.1037//0022-006x.64.1.191. View

Neuhauser D, Diaz M . Shuffle the deck, flip that coin: randomization comes to medicine. Qual Saf Health Care. 2004; 13(4):315-6. PMC: 1743871. DOI: 10.1136/qhc.13.4.315. View

Dishman R, Nakamura Y, Garcia M, Thompson R, Dunn A, Blair S . Heart rate variability, trait anxiety, and perceived stress among physically fit men and women. Int J Psychophysiol. 2000; 37(2):121-33. DOI: 10.1016/s0167-8760(00)00085-4. View

10.

Yehuda R, Cai G, Golier J, Sarapas C, Galea S, Ising M . Gene expression patterns associated with posttraumatic stress disorder following exposure to the World Trade Center attacks. Biol Psychiatry. 2009; 66(7):708-11. DOI: 10.1016/j.biopsych.2009.02.034. View

11.

Jerath R, Edry J, Barnes V, Jerath V . Physiology of long pranayamic breathing: neural respiratory elements may provide a mechanism that explains how slow deep breathing shifts the autonomic nervous system. Med Hypotheses. 2006; 67(3):566-71. DOI: 10.1016/j.mehy.2006.02.042. View

12.

Acker K . Do critical care nurses face burnout, PTSD, or is it something else?: getting help for the helpers. AACN Clin Issues Crit Care Nurs. 1993; 4(3):558-65. View

13.

Pitman R, Orr S . Twenty-four hour urinary cortisol and catecholamine excretion in combat-related posttraumatic stress disorder. Biol Psychiatry. 1990; 27(2):245-7. DOI: 10.1016/0006-3223(90)90654-k. View

14.

Grodin M, Piwowarczyk L, Fulker D, Bazazi A, Saper R . Treating survivors of torture and refugee trauma: a preliminary case series using qigong and t'ai chi. J Altern Complement Med. 2008; 14(7):801-6. PMC: 2745908. DOI: 10.1089/acm.2007.0736. View

15.

Lemieux A, Coe C . Abuse-related posttraumatic stress disorder: evidence for chronic neuroendocrine activation in women. Psychosom Med. 1995; 57(2):105-15. DOI: 10.1097/00006842-199503000-00002. View

16.

Smith M, Davidson J, Ritchie J, Kudler H, Lipper S, Chappell P . The corticotropin-releasing hormone test in patients with posttraumatic stress disorder. Biol Psychiatry. 1989; 26(4):349-55. DOI: 10.1016/0006-3223(89)90050-4. View

17.

Brandenberger G, Follenius M . Influence of timing and intensity of musclar exercise on temporal patterns of plasma cortisol levels. J Clin Endocrinol Metab. 1975; 40(5):845-9. DOI: 10.1210/jcem-40-5-845. View

18.

Kessler R, Chiu W, Demler O, Merikangas K, Walters E . Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62(6):617-27. PMC: 2847357. DOI: 10.1001/archpsyc.62.6.617. View

19.

Gates D, Gillespie G . Secondary traumatic stress in nurses who care for traumatized women. J Obstet Gynecol Neonatal Nurs. 2008; 37(2):243-9. DOI: 10.1111/j.1552-6909.2008.00228.x. View

20.

Potter P, Deshields T, Divanbeigi J, Berger J, Cipriano D, Norris L . Compassion fatigue and burnout: prevalence among oncology nurses. Clin J Oncol Nurs. 2010; 14(5):E56-62. DOI: 10.1188/10.CJON.E56-E62. View