A Pilot Study of Big Mind for Veterans With PTSD

In recent years, interventions involving mindfulness have become increasingly popular as complementary mind-body therapeutic strategies for a variety of medical and psychiatric conditions.

Mindfulness has been described as a practice of focusing attention on moment-by-moment experience with an attitude of curiosity, openness and acceptance. In other words, practicing mindfulness is simply experiencing the present moment. During mindfulness, awareness is focused on external sensory inputs, internal sensations, such as proprioception and pain, as well as awareness of the internal workings of the mind.

Mindfulness originated in Buddhist spiritual practices. One of these is Zen, a traditional Buddhist approach that primarily involves the practice of developing mindfulness by way of seated meditation. Two secular mindfulness-based interventions that have been extensively studied are Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT). MBSR was developed by Dr. Jon Kabat-Zinn at the University of Massachusetts Medical Center as secular method to utilize Buddhist mindfulness in mainstream psychology and medicine. MBSR includes education about stress as well as training on coping strategies and assertiveness in addition to mindfulness. MBCT was developed by Zindel Segal, Mark Williams and John Teasdale. MBCT is based upon MBSR and combines the principles of cognitive therapy with those of mindfulness to prevent relapse of depression. MBCT, like MBSR, utilizes secular mindfulness techniques including seated meditation.

A very large literature now supports the effectiveness of MBSR for social anxiety disorder, generalized anxiety disorder, improved psychological functioning among individuals with medical disorders and pain. Evidence indicates that MBCT is beneficial for unipolar depression relapse prevention, generalized anxiety disorder, panic disorder, hypochondriasis and social phobia. The strongest evidence is for relapse prevention in unipolar illness. Finally, a recent review and meta-analysis specifically addressed the effectiveness of MBSR and MBCT (and similar interventions) for reducing symptoms of anxiety and depression. The authors concluded that mindfulness based therapy improves symptoms of anxiety and depression across a wide range of severity and even when these symptoms are associated with other disorders.

The mechanisms underlying the effectiveness of mindfulness interventions are incompletely understood. However, considerable evidence suggests these approaches decrease depression and anxiety, at least in part, by altering self-referential thinking. For example, increased self-focused thinking is associated with affective symptoms. Furthermore, there is strong evidence that a particular type of thinking about self contributes to dysphoria in general and unipolar depression. Specifically, analytical self-focused rumination (thinking analytically about self and symptoms) is maladaptive. This cognitive style is associated with overgeneral autobiographical memory, global negative self-judgments, greater negative future thinking and dysphoria. Furthermore, there is compelling evidence that ruminative self-focus is associated with both the severity and duration of depressive symptoms as well as relapse of illness. In contrast to analytic self-focus, mindfulness (or experiential self-focus) is adaptive. Therefore, interventions that increase mindfulness and/or decrease analytical self-referential ruminations may be effective for depressive and anxiety symptoms. In fact, studies indicate that mindfulness approaches do in fact exert benefit as a result of both increasing mindfulness and decreasing self-focused rumination. These interventions also promote additional cognitive changes that may help ameliorate symptoms. One of these is enhancing compassion specifically including patience and kindness directed toward the self. Self-compassion is a predictor of psychological health and increases in caring for one's self appear to contribute to the effectiveness of these interventions.