Targeting hyperarousal: Mantram Repetition Program for PTSD in US veterans

Abstract

Background: Hyperarousal appears to play an important role in the development and maintenance of posttraumatic stress disorder (PTSD) symptoms, but current evidencebased treatments appear to address this symptom type less effectively than the other symptom clusters. The Mantram Repetition Program (MRP) is a meditation-based intervention that has previously been shown to improve symptoms of posttraumatic stress disorder (PTSD) and may be especially helpful for hyperarousal. If MRP is an effective tool for decreasing this often treatment-resistant symptom cluster, it may become an important clinical tool. Objective: The goal of this secondary analysis was to examine the effect of the MRP on hyperarousal and other PTSD symptom clusters and to examine hyperarousal as a mediator of treatment response. Method: Secondary analyses were conducted on data from a randomized controlled trial in which Veterans with PTSD (n = 173) were assigned to the MRP or a non-specific psychotherapy control and assessed pre-treatment, post-treatment and 8 weeks after treatment completion. The impact of the interventions on PTSD symptom clusters was examined, and time-lagged hierarchical linear modelling was applied to examine alternative mediation models. Results: All PTSD symptom clusters improved in both treatments. MRP led to greater reductions in hyperarousal at post-treatment (Hedge's g = 0.57) and follow-up (Hedge's g = 0.52), and in numbing at post-treatment (Hedge's g = 0.47). Hyperarousal mediated reductions in the composite of the other PTSD symptom clusters. Although the reverse model was significant as well, the effect was weaker in this direction. Conclusion: Interventions focused on the management of hyperarousal may play an important role in recovery from PTSD. The MRP appears efficacious in reducing hyperarousal, and thereby impacting other PTSD symptom clusters, as one pathway to facilitating recovery.

Mantram Repetition as a Portable Mindfulness Practice: Applications During the COVID-19 Pandemic

“…RCTs of the MRP have also documented reduced PTSD diagnostic prevalence, reduced PTSD symptom severity, and improved self-efficacy for managing PTSD symptoms (Bormann et al 2008 , 2013b , 2018 ; Oman and Bormann 2015 ). RCTs of the MRP have furthermore documented significant and favorable treatment effects on stress-related mental health outcomes that include hyperarousal, insomnia, burnout, quality of life, and depression (Barger et al 2015 ; Beck et al 2017 ; Bormann et al 2008 , 2013b , 2018 ; Crawford et al 2019 ; Yong et al 2011 ). In non-randomized studies, the MRP has been linked to reduced stress in VA staff, family caregivers in the USA, and nursing students in Korea (Bormann et al 2006c , 2009 ; Kang and Yong 2019 ).…”

“…In such longer time periods, the accumulated benefits of engaging in MRP practices and integrating adherence to them into daily routines can foster additional attentional and psychosocial factors that causally mediate outcomes of interest. Thus, statistical mediation analyses of evidence from randomized trials of the MRP, investigating changes over 5 to 8 weeks and sometimes longer, have supported mediation of benefits by at least five factors: increased trait mindfulness, strengthened self-efficacy, improved coping, reduced hyperarousal, and enhanced psychospiritual well-being (Bormann and Carrico 2009 ; Bormann et al 2012 , 2014a ; Crawford et al 2019 ; Oman and Bormann 2015 ). Evidence from RCTs also indicates that gains in mindful awareness from the MRP intervention are mediated by frequency of mantram repetition (Bormann et al 2014a ).…”

Stellate ganglion block treats posttraumatic stress: An example of precision mental health

“…Hyperarousal symptoms can be specifically addressed in a variety of ways (e.g., meditation) (Crawford, Talkovsky, Bormann, & Lang, 2019). Some treatments targeting an overstimulated sympathetic nervous system may have undesirable side effects.…”

An integrated model of chronic trauma‐induced insomnia

“…Empirical evidence for such an approach is provided by observed improvements in brain regions associated with cognitive processing and arousal in patients with PTSD, social anxiety disorder, and major depressive disorder who received cognitive behaviour therapy (Aupperle et al, 2013; Månsson et al, 2013; Ritchey, Dolcos, Eddington, Strauman, & Cabeza, 2011). Additionally, targeted reduction of physiological hyperarousal is also likely indicated and may be treated with pharmaceutical methods, relaxation strategies, mindfulness (Crawford, Talkovsky, Bormann, & Lang, 2019), exercise (Babson et al, 2015), and/or cognitive restructuring. Interestingly, mindfulness‐based stress reduction (MBSR) has demonstrated significant reductions in self‐reported PTSD symptoms, attention, depression, emotion regulation, and general hyperarousal symptoms in various PTSD patient populations (Boyd, Lanius, & McKinnon, 2018); however, no trials of MBSR in patients with PTSD have reported on the effects on sleep disturbance.…”