A recent study published in Medical Care (Serpa, Taylor, Tillisch, 2014) showed that veterans who participated in a nine-week mindfulness-based stress reduction (MBSR) program experienced significant reductions in anxiety, depression, and suicidal ideation from baseline to completion of the nine weeks. The research specifically suggested that increases in mindfulness were related to improvements in anxiety, depression, and mental health functionality, which suggests that MBSR has the potential to improve multiple health outcomes for veterans, including a significant effect on suicidal ideations.
The researchers collected data among 79 patients at an urban Veterans Health Administration (VA) medical facility. It may be the first naturalistic MBSR study to include veterans with active psychosis, active substance use disorders, and severe personality disorders. Additionally, about one quarter of the veterans in the group expressed active suicidal ideation.
The MBSR course consisted of nine weekly sessions that included seated and walking meditations, gentle yoga, body scans, and discussions of pain, stress, and mindfulness.
Suicide prevention is considered a central target of VA clinical care, but the improvement of suicidal ideation has not been addressed in previous studies of MBSR in veterans; thus, these findings are particularly relevant. Although this study could not tease out the individual role of mindfulness in the decreasing suicidal ideation, the results suggest that MBSR may have added value when used in conjunction with standard clinical care.
Anxiety, depression, and pain are also common concerns among the veteran population. The VA provides patients with a wide range of standard treatment options for these conditions (e.g. pharmacotherapy and psychotherapy), but pharmacotherapy is often only modestly efficacious, and ongoing negative perceptions of antidepressants and opiates among veterans may be a barrier to optimal treatment of pain and psychological symptoms in some.
In veterans with chronic pain, up to 76% of those not currently using complementary and alternative or integrative medicine modalities report wanting to do so if such options were readily available at their VA facility.
As a manualized treatment regimen with documented teacher training requirements, MBSR is well suited for distribution throughout a large health care system like the VA, wherein patient care is provided at multiple sites with multiple practitioners. It also meets the veterans’ demand for nonpharmacological interventions and can be delivered on a time-limited, large group format.
The implications of the results are that MBSR has the potential to be an adjunctive treatment for anxiety, depression, and general mental health functionality, and may have the potential to reduce the need for antidepressants, thereby serving both the goals of many patients as well as potential reductions in long-term health care utilization.
Further work is needed in this population to better understand the role of MBSR in veterans with pain, and to determine whether the benefits of MBSR allow for decreased health care utilization and better long-term outcomes.
The full article was originally published in Medical Care, Volume 52 in December 2014, and is accessible here.
J. Greg Serpa, PhD, is a clinical psychologist for the US Department of Veterans Affairs at the VA Greater Los Angeles Healthcare System and the co-author of A Clinician's Guide to Teaching Mindfulness: The Comprehensive, Session-by-Session Program for Mental Health Professionals and Healthcare Providers. He is honored to teach mindfulness to America's veterans and is the first full-time mindfulness teacher and trainer in the federal system. Serpa is an associate clinical professor in the psychology department at the University of California, Los Angeles, and an associate visiting clinical scientist at the David Geffen School of Medicine at UCLA. He teaches intensive mindfulness-based stress reduction (MBSR), mindful self-compassion (MSC), and introductory level mindfulness classes at four area hospitals, and serves as a trainer, supervisor, and consultant to clinicians at the VA and UCLA. He is currently the director of interprofessional mental health education at the West Los Angeles VA, where he trains psychology postdoctoral fellows, psychiatry residents, social work interns, and nurses in mindfulness and integrative modalities of health and well-being. Serpa is a national mindfulness content expert for the VA's Office of Patient Centered Care and Cultural Transformation, where he and Christiane Wolf are preparing mindfulness toolkits for national dissemination. He is also an active researcher with a number of projects expanding on the evidence basis of mindfulness interventions. This includes a National Institutes of Health-funded biomarker study examining the impact of meditation on brain structure in combat veterans from Iraq and Afghanistan who have traumatic brain injury and post-traumatic headache.