Overview of included treatment studies and their main findings
| Study | Sample | Assigned therapy | Assessments | Study type | Attrition | Main findings |
|---|---|---|---|---|---|---|
| Bergen-Cico et al. (135) | 40 veterans (90% male) with PTSD | BMP based on MBSR (4 weekly 90-min sessions) plus TAU or to TAU alone (typical primary care for veterans) | Salivary cortisol PCL, PHQ-9 (measure of depression) | RCT, pre/post measures | 20% drop-out rate | BMP completers showed significant reduction in CAR (0.2 μg/dL) TAU and noncompleters did not show a significant decrease in CAR Significant correlation between changes in cortisol levels and PTSD and depression scores |
| Bormann et al. (146) | 146 veterans (142 male) with PTSD | MRP (6 weekly 90-min classes) or TAU alone (case management and consultation as needed) | CAPS, PCL-C, BSI-18 (depressive symptom subscale), SF-12 (mental health component), MAAS | RCT, pre/post measures | 95% of MRP+TAU completed treatment | Significantly greater reduction in PCL-C, CAPS hyperarousal and numbing symptoms, depression, and mental HRQOL in MRP+TAU group Significantly greater improvement on MAAS in MRP+TAU group Mindful attention mediated effect of MRP on PTSD, depression and psychological well-being measures Daily mantrum practice mediated effect of MRP on mindful attention |
| Catani et al. (145) | 31 children (17 male) exposed to tsunami with working diagnosis of PTSD | Meditation–relaxation (individual psychoeducation and meditation relaxation strategies) or KIDNET (individual narrative exposure therapy adapted for children) | UPID (5 items to assess problems in functioning, 5 items to assess presence of somatic complaints) | RCT, pre/post measures; 6-mo follow-up | 100% completed full treatment | No significant difference between groups on PTSD symptoms Significant reduction in PTSD scores within meditation–relaxation group immediately posttreatment (d = 1.83) and at follow-up (d = 2.20) 71% of meditation–relaxation children did not meet criteria for PTSD at 6-mo follow-up and 81% did not meet criteria in KIDNET group (no significant difference) Significant improvement on functional scores in both treatment groups (no significant difference) |
| Cole et al. (129) | 10 veterans with history of mTBI and PTSD | MBSR (1 introductory 2-hr class, 8 weekly 2.5-hr sessions, 1 7-hr retreat) | PCL-C, Cogstate computerized assessment to measure attention | Single arm, uncontrolled study, pre/post measures; 3-mo follow-up | 90% completed treatment | Significant reductions in PCL-C scores immediately posttreatment (d = 1.56) and at follow-up (d = 0.93) Significant improvement on attention measures immediately posttreatment (d = 0.57), not maintained at follow-up |
| Earley et al. (130) | 19 women survivors of CSA with general severity index BSI score > 0.50 | MBSR (8 weekly 2.5–4 hr classes and 1 5-hr retreat (augmented for CSA) with concurrent psychotherapy | BDI-II, PCL, BSI-18, MAAS | Single arm, uncontrolled study; 2.5-yr follow-up of previous study (133) | NA | Improvements at 1 mo posttreatment maintained at 2.5-yr follow-up for depression (d = 1.10), anxiety (d = 0.90), and PTSD symptoms (d = 0.80) PCL subscales significantly lower from baseline at 2.5-yr follow-up: avoidance/numbing (d = 0.70), re-experiencing (d = 0.50), hyperarousal (d = 0.90) |
| Gallegos et al. (139) | 42 women with history of interpersonal violence and high perceived stress | MBSR (8 weekly 2.5-hr sessions, 1 day-long retreat) | TLEQ, STAI, DERS, CDES, MPSS, FFMQ, IL-6, TNF-α, CRP | Single arm, uncontrolled study, pre/mid/post measures; 1-mo follow-up | 57% completed more than 50% of classes | Significant reductions in depressive symptoms at all time points Significant reductions in PTSD symptoms, state and trait anxiety immediately posttreatment and at follow-up Significant improvement in DERS scores immediately posttreatment and at follow-up Significant effect of attendance on IL-6 levels (reduced IL-6 with increased attendance) |
| Goldsmith et al. (131) | 10 individuals with exposure to lifetime trauma or childhood abuse (9 female) with primary diagnosis of PTSD or MDD | MBSR (8 weekly 2.5-hr sessions with 1 day-long retreat) | PHQ-9, BDI-II, PCL, CTQ, LEC, AAQ-II (measure of experiential avoidance), TAQ | Single arm, uncontrolled study, pre/mid/post measures | 90% retention | Significant reduction at mid-treatment and post-treatment in PTSD symptoms (d = 0.70, d = 0.73), depression (d = 0.30, d = 0.54) and TAQ shame-based appraisals (d = 0.30, d = 0.70) Significant improvement in AAQ scores mid-treatment and post-treatment (d = 0.77, d = 1.11) |
| Kearney et al. (132) | 92 veterans with PTSD | MBSR (8 weekly 2.5-hr sessions and 1 7-hr retreat) | PCL-C, PHQ-9, BADS, SF-8 (mental and physical HRQOL), AAQ-II, FFMQ | Single arm uncontrolled study, pre/post measures; 4-mo follow-up | 74% met minimum compliance (4 of 8 classes) | Significant improvement at baseline and follow-up on PCL total (d = 0.55; d = 0.65), PCL re-experiencing (d = 0.40; d = 0.56), avoidance (d = 0.36; d = 0.35), emotional numbing (d = 0.46; d = 0.54), and hyperarousal (d = 0.64; d = 0.67) Significant improvement at baseline and follow-up on depression score (PHQ-9; d = 0.53; d = 0.70), BADS (d = 0.47; d = 0.62), mental HRQOL (d = 0.62, d = 0.73), and AAQ (d = 0.65; d = 0.68) Clinically significant reductions in PCL scores in 47.7% of participants Changes in FFMQ scores from baseline to post-treatment significantly predicted PCL, PHQ-9, mental HRQOL immediately post-treatment and at follow-up |
| Kearney et al. (133) | 47 veterans (37 men) with chronic PTSD | MBSR (8 weekly 2.5-hr sessions and 1 7-hr retreat) plus TAU or TAU (usual care for PTSD within veterans health administration clinics) | PCL-C, LEC, PHQ-9, SF-8, FFMQ, BADS | RCT, pre/post measures; 4-mo follow-up | 84% met minimum compliance in MBSR group (4 of 8 sessions) | No significant difference between MBSR and TAU groups on PTSD, depression or behavioural activation immediately post-intervention or at follow-up Significantly greater improvement in mental HRQOL in MBSR group post-treatment (d = 0.69), but this was not maintained at follow-up Significant within-group improvement in the MBSR group on PTSD (d = 0.64), depression (d = 0.65), and mental HRQOL (d = 0.77) post-treatment (maintained only for mental HRQOL at follow-up) Significant improvement in mindfulness scores immediately post-treatment (d = 0.65) and at follow-up (d = 0.67) in the MBSR group |
| King et al. (142) | 37 veterans with long-term (> 10 yr) PTSD or PTSD in partial remission | MBCT adapted for PTSD (8 weekly 8-hr group sessions) or TAU (psychoeducation and skills training, 8 weekly 1-hr sessions) or imagery research therapy (6 weekly 1.5-hr sessions) | CAPS (all groups), PDS (MBSR group only), PTCI (MBSR group only) | Nonrandomized controlled study, pre/post measures | Dropout 25% in MBCT and 23.4% in TAU groups | Significant reduction in CAPS score (d = 2.20) within MBCT group (ITT) Significantly greater improvement on CAPS score in MBCT than in TAU group (d = 1.14; ITT) Improvements on CAPS score in MBCT group explained by significant reduction in avoidant subscale (d = 2.11; ITT) Significant reductions in CAPS intrusive (d = 0.64) and hyperarousal (d = 0.78) symptoms also seen in MBCT group (ITT) 73% in MBCT group attained clinically significant reductions in CAPS score (33% in TAU group; completer analysis) Significant reduction in PDS numbing subscale (d = 0.57) and PTCI self-blame cognitions (d = 1.80) in MBCT group (completer analysis) |
| King et al. (35) | 43 veterans with PTSD | MBET (16-wk nontrauma focused intervention; mindfulness, psychoeducation, self-compassion training; in-vivo exposure to avoided situations [no trauma exposure]) or PCGT (16-wk intervention identifying current stressors contributing to PTSD) | CAPS | RCT, pre/post measures | Not reported | MBET participants attended an average of 13.5 of 16 sessions; PCGT group attended an average of 7.5 of 16 sessions No significant differences between groups on PTSD symptom severity differences between pre- and post-treatment assessments MBET group showed significant reduction in total CAPS (d = 0.96), CAPS intrusion (d = 0.72) and CAPS avoidance (d = 0.97) symptoms PCGT group showed significant reduction in CAPS hyperarousal symptoms only (d = 0.79) |
| Kim et al. (143) | 22 nurses with PTSD, 7 healthy control nurses | MBX (16 semi-weekly 60-min sessions) or control condition | PCL-C, serum cortisol, plasma ACTH, DHEAS | RCT, pre/post measures; 2-mo follow-up | Not reported | Significantly greater decrease in PTSD symptoms and cortisol levels in MBX group than in controls No significant differences between groups in ACTH and DHEAS levels MBX group showed significant reductions in PTSD symptoms (including re-experiencing, avoidance, and hyperarousal) at 2-mo follow-up Significant association between cortisol levels and PTSD symptoms |
| Kimbrough et al. (134) | 27 survivors of CSA (24 women) with general severity index BSI score > 0.50 | MBSR (8 weekly 2.5–4 hr classes and 1 5-hr retreat augmented for CSA) with concurrent psychotherapy | BDI-II, PCL, BSI, MAAS, practice logs and attendance monitoring | Single arm uncontrolled study, pre/mid/post measures; 4-mo follow-up | 85% retention | Significant reduction immediately post-treatment and at follow-up on depression scores (d = 1.8; d = 1.0), anxiety (BSI; d = 1.1; d = 0.90), PTSD symptoms (d = 1.2; d = 1.0) Significant reductions immediately post-treatment and at follow-up on PTSD avoidance/numbing (d = 1.4; d = 0.90), re-experiencing (d = 0.70 both time points), and hyperarousal (d = 1.2; d = 0.60) Significant reduction in individuals meeting criteria for PTSD post-treatment but not at follow-up |
| Niles et al. (137) | 33 veterans with current PTSD | MBSR-based telehealth group (2 45-min in-person sessions and 6 20-min weekly phone calls with weekly individual practice) or telehealth psychoeducation with same contact | CAPS, PCL-M, PSQ | RCT, pre/post measures; 6-wk follow-up | 76% completed MBSR treatment | MBSR group showed significant decrease in PCL score (d = 0.84) and decrease in CAPS score (d = 0.70) At 6-wk follow-up, changes in PTSD in MBSR group were not sustained (d = 0.16) Significantly greater improvement in MBSR group at posttreatment on PCL (d = 1.95) and CAPS scores (d = 1.27) |
| Polusny et al. (138) | 116 veterans with PTSD or subthreshold PTSD | MBSR (8 weekly 2.5-hr sessions and 1 day-long retreat) or PCT (9 weekly 1.5-hr sessions) | PCL, CAPS, PHQ-9, FFMQ, WHOQOL | RCT, pre/post measures; 2-mo follow-up | Dropout 22.4% in MBSR and 6.9% in PCT | Significantly greater reductions in PCL (d = 0.40), CAPS (d = 0.41), WHOQOL (d = 0.41) scores in MBSR group between baseline and 2-mo follow-up Nonsignificant differences between groups on depressive scores (similar improvement in both groups) Improvements of FFMQ scores significantly correlated with PTSD (PCL), depression and WHOQOL scores |
| Possemato et al. (136) | 62 veterans with PTSD or subthreshold PTSD | BMP (based on MBSR, 4 weekly 90-min sessions) plus TAU or TAU alone (typical primary care for veterans) | CAPS, PCL, PHQ-9, FFMQ, MAAS | RCT, pre/post measures; 1-mo follow-up | 20% dropout rate | No significant difference between BMP+TAU and TAU groups using ITT analysis for CAPS and PCL scores Significantly greater improvement in BMP+TAU group on depression scores (d = 0.86) BMP+TAU completers showed significantly larger decreases in PTSD severity (CAPS; d = 0.72) and depression scores (PHQ-9; d = 0.99) FFMQ describing, nonjudgment and acting with awareness and MAAS scores accounted for 30% of total effect of BMP completion on PTSD severity |
| Rosenthal et al. (144) | 7 veterans with PTSD (all men) | TM (taught in 2 information lectures, brief personal interview, individual instruction and 3 follow-up sessions on 3 consecutive days; participants asked to meditate at home for 20 min twice daily for 12 wk) | CAPS, PCL-M, Q-LES-Q, BDI, CGI-S, CGI-I, CES | Single arm uncontrolled trial, pre-treatment measures; 8-wk follow-up | 71% completed | Significant improvement on CAPS, Q-LES-Q, PCL-M, CGI-I at week 8 |
AAQ-II = Acceptance and Action Questionnaire-II; ACTH = adrenocorticotropic hormone; BADS = Behavioural Activation for Depression Scale; BDI-II = Beck Depression Inventory-II; BMP = Brief Mindfulness Program; BSI-18 = 18-item Brief Symptom Inventory; CAPS = Clinician-Administered PTSD scale; CAR = cortisol-awakening response; CDES = Center for Epidemiological Studies Depression Scale; CES = Combat Exposure Scale; CGI-I = Clinical Global Impression Improvement; CGI-S = Clinical Global Impression Severity; CRP = C-reactive protein; CSA = childhood sexual abuse; CTQ = Childhood Trauma Questionnaire; DERS = Difficulties in Emotion Regulation Scale; DHEAS = dehydroepiandrosterone sulfate; FFMQ = Five Factor Mindfulness Questionnaire; HRQOL = health-related quality of life; IL-6 = interleukin-6; ITT = intention to treat; MAAS = Meditation Attention and Awareness Scale; MBSR = mindfulness-based stress reduction; MBX = mindfulness-based stretching and deep breathing exercises; MDD = major depressive disorder; MPSS = Modified PTSD Symptom Scale; LEC = Life Events Checklist; MBET = mindfulness-based exposure therapy: MRP = mantram repetition practice; mTBI = mild traumatic brain injury; NA = not applicable; PCGT = present-centred group therapy; PCL = PTSD Check List; PCL-C = PTSD Check List–Civilian; PCL-M = PTSD Check List–Military; PDS = PTSD Diagnostic Scale; PHQ-9 = Patient Health Questionnaire-9; PSQ = Patient Satisfaction Questionnaire; PTCI = Post-traumatic cognitions inventory; PTSD = posttraumatic stress disorder; Q-LES-Q = quality of life enjoyment and satisfaction questionnaire; RCT = randomized controlled trial; SF-8/SF-12 = 8-item/12-item Short-Form Health Survey; STAI = Spielberger State-Trait Anxiety Inventory; TAQ = Trauma Appraisals Questionnaire; TAU = treatment as usual; TLEQ = Traumatic Life Events Questionnaire; TM = transcendental meditation; TNF-α; tumour-necrosis factor-α; UPID = University of California, Los Angeles PTSD index for DSM-IV; WHOQOL = World Health Organization Quality of Life.