Randomised clinical non-inferiority trial of breathing-based meditation and cognitive processing therapy for symptoms of posttraumatic stress disorder in military veterans

Bayley, P.J., Schulz-Heik, R.J., Tang, J.S., Mathersul, D.C., Avery, T., Wong, M., Zeitzer, J.M., Rosen, C.S., Burn, A.S., Hernandez, B., Lazzeroni, L.C., & Seppälä, E.M. (2022). Randomised clinical non-inferiority trial of breathing-based meditation and cognitive processing therapy for symptoms of posttraumatic stress disorder in military veterans. BMJ Open. doi:10.1136/bmjopen-2021-056609

Post-traumatic stress disorder (PTSD) is a debilitating condition that can develop after exposure to a traumatic event. Symptoms include re-experiencing, avoidance, negative alterations in cognition and mood, and increased arousal and reactivity. The lifetime prevalence of PTSD is estimated at 24.5% in veteran populations. Veterans Affairs (VA)/Department of Defense (DoD) clinical practice guidelines recommend evidence-based, trauma-focused therapies including prolonged exposure therapy, cognitive processing therapy (CPT) and eye movement desensitisation and reprocessing as first-line treatments for PTSD. These therapies typically show large effect sizes (>1.0). However, up to two-thirds of individuals retain a PTSD diagnosis post treatment and dropout is a significant problem. Other treatments are urgently needed, and there are compelling reasons for considering complementary and integrative health (CIH) modalities such as yoga and meditation.

CIH interventions can be effective, less stigmatising and are popular. However, a review of the literature reveals several limitations: small–medium effect sizes and methodological concerns regarding controls, small sample sizes, randomisation, blinding and reporting. More high-quality, well-controlled studies are needed.