Mental Health

Mind-Body Program Effective, Durable, in Treatment of Children With PTSD

Mind-Body Program Effective, Durable, in Treatment of Children With PTSD

August 21, 2008 — Children who suffer from posttraumatic stress disorder (PTSD) can be effectively treated with a nondrug model that employs a combination of mind-body techniques and can be delivered by nonmedical personnel.

In the first randomized controlled trial of any intervention with war-traumatized adolescents, investigators at the Center for Mind-Body Medicine, in Washington, DC, found the 12-session program produced significant and lasting reductions in PTSD symptoms, including stress levels; avoidance, numbing, and flashbacks; and nightmares, in a group of highly traumatized children who experienced the war in Kosovo.

Furthermore, investigators say that this study marks the first randomized controlled trial of a successful, comprehensive mind-body approach with any traumatized population.

Caroline Cassels

August 21, 2008 — Children who suffer from posttraumatic stress disorder (PTSD) can be effectively treated with a nondrug model that employs a combination of mind-body techniques and can be delivered by nonmedical personnel.

In the first randomized controlled trial of any intervention with war-traumatized adolescents, investigators at the Center for Mind-Body Medicine, in Washington, DC, found the 12-session program produced significant and lasting reductions in PTSD symptoms, including stress levels; avoidance, numbing, and flashbacks; and nightmares, in a group of highly traumatized children who experienced the war in Kosovo.

Furthermore, investigators say that this study marks the first randomized controlled trial of a successful, comprehensive mind-body approach with any traumatized population.

“We’ve shown this approach produces statistically significant reductions in symptoms of PTSD in a severely traumatized population. Importantly, we’ve also shown that it can be effectively delivered by trained individuals who don’t necessarily have to have a psychiatric or medical background,” principal investigator James Gordon, MD, told Medscape Psychiatry.

This latter point, said Dr. Gordon, is particularly significant, because it enlarges the potential pool of trainers in populations or societies where healthcare professionals are in short supply.

“It’s very important to be able to train teachers, community leaders, religious leaders, and others to do this work, so that we can disseminate this program to large numbers of people who have experienced war, epidemics, or other types of disasters,” he added.

The study is published online August 12 in the Journal of Clinical Psychiatry.

Severely Traumatized Population

While previous studies have used individual mind-body techniques, including deep breathing, progressive muscle relaxation, and positive imagery, to treat PTSD symptoms, Dr. Gordon said the current approach is more comprehensive and combines a much wider range of modalities in a small group setting.

The program’s philosophy of self-expression and self-care also teaches individuals to understand and take care of themselves, rather than relying on a therapist in an ongoing way.

Positive results from of an earlier pilot project using the same intervention in the same high school in southern Kosovo prompted the investigators to initiate the current trial to determine whether the results could be replicated in a larger, more rigorous study.

The study included 82 high school students diagnosed with PTSD who lived in Suhareka, an area of Kosovo where, in 1999, 90% of the homes were burned or bombed and 20% of the children lost 1 or both parents.

It is estimated that in June 2000, 1 year after the war ended, 25% of Kosovar Albanians aged 15 years or older reported PTSD symptoms. Further, a 2005 unpublished survey of 226 high school students in the Suhareka region revealed a PTSD prevalence of 45.1%.

Sustained Effect

The study was conducted from September 2004 to May 2005. Children were randomly assigned to a 12-session mind-body group program or a wait-list control group. High school teachers who had received 10 days of brief but intensive training from the Center for Mind-Body Medicine and who worked in consultation with similarly trained psychiatrists and psychologists delivered the program.

The program included meditation; guided imagery; breathing techniques; self-expression through words, drawings, and movement; autogenic training and biofeedback; and genograms.

The primary outcome was changes in PTSD symptoms between the 2 study groups as measured by the Harvard Trauma Questionnaire (HTQ). In addition, investigators examined HTQ scores in the treatment group pre- and postintervention and at 3-month follow-up.

According to investigators, students in the immediate-intervention group had significantly lower PTSD symptom scores following treatment than those in the wait-list control group.

They also found that the effect was durable, with PTSD scores not significantly different at 3-month follow-up from those immediately following the program and remaining significantly lower than baseline scores.

Strength in Diversity

Investigators also found children in the wait-listed control group experienced a reduction in PTSD symptoms after participating in the program. Interestingly, they observed that these wait-listed children experienced a significant reduction in symptoms of anxiety and agitation even before starting the program.

“The best explanation for this is that these children knew they were going to be in the program, which has a very good reputation, and that this led to a certain degree of hopeful anticipation that, in turn, led to a reduction in these particular symptoms,” said Dr. Gordon.

One of the program’s strengths lies in its diversity, he said. Teaching a variety of techniques allows students to individualize the program and practice those that they find most effective. It also offers individuals who are resistant to medication or traditional psychotherapy an alternative treatment option.

Dr. Gordon said that this treatment model, developed over a period of 35 years, has been used successfully in a variety of populations that extend beyond PTSD, including illnesses such as cancer, HIV, and chronic pain, as well as to help children in inner-city schools in the United States who have been exposed to violence and to enable medical students to deal with stress.

So far, he said, the program has been taught to almost 3000 health and mental-health professionals worldwide. Currently, he added, the US military has expressed interest in the program as a way of helping returning veterans and service members who are awaiting deployment to the current wars in Iraq and Afghanistan.

Dr. Gordon has also recently released a book, Unstuck: Your Guide to the Seven-Stage Journey Out of Depression, which describes the program in detail.

“We believe this program really helps people mobilize their capacity to help themselves, a highly valued part of the psychiatric tradition that is often underutilized,” said Dr. Gordon.

The authors have no financial disclosures.

J Clin Psychiatry. Published online August 12, 2008.

   

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Caroline Cassels is News Editor for Medscape Psychiatry. A medical and health journalist for 20 years, she has written extensively for both physician and consumer audiences. She is the recipient of the 2008 American Academy of Neurology Journalism Fellowship Award. She can be contacted at [email protected]

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