Skip to main content

Advertisement

Log in

Feasibility and Acceptability of a Brief Mindfulness Program for Veterans in Primary Care with Posttraumatic Stress Disorder

  • ORIGINAL PAPER
  • Published:
Mindfulness Aims and scope Submit manuscript

Abstract

Mindfulness-based stress reduction programs have improved psychological health for clinical populations including veterans with posttraumatic stress disorder (PTSD). Veterans with PTSD who seek services in Department of Veterans Affairs primary care are especially in need of brief treatments that can alleviate PTSD symptoms. A clinical demonstration project was carried out to assess the feasibility and acceptability of a brief mindfulness program consisting of four weekly 1.5-h class sessions. Veterans enrolled in primary care with diagnostic or subthreshold PTSD were recruited. The brief mindfulness intervention was feasible to deliver, and veterans were generally satisfied with the program. Despite good retention once a class session was attended, a large number of veterans provided a variety of reasons for not attending the program at all. Veteran feedback that can be addressed to improve the brief mindfulness program is discussed, including enhancing initial attendance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Andersen, J., Wade, M., Possemato, K., & Ouimette, P. (2010). Association between posttraumatic stress disorder and provider-diagnosed disease among Iraq and Afghanistan veterans. Psychosomatic Medicine, 72(5), 498–504. doi:10.1097/PSY.0b013e3181d969a1.

    Article  PubMed  Google Scholar 

  • Attkisson, C. C., & Greenfield, T. K. (2004). The UCSF Client Satisfaction Scales: I. The Client Satisfaction Questionnaire-8. In M. Maruish (Ed.), The use of psychological testing for treatment planning and outcome assessment (3rd ed.). Mahwah: Lawrence Erlbaum Associates.

    Google Scholar 

  • Baer, R. A. (2003). Mindfulness training as clinical intervention. A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125–143. doi:10.1093/clipsy/bpg015.

    Google Scholar 

  • Becker, C. B., Zayfert, C., & Anderson, E. (2004). A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD. Behaviour Research and Therapy, 42, 277–292. doi:10.1016/S0005-7967(03)00138-4.

    Article  PubMed  Google Scholar 

  • Bédard, M., Felteau, M., Mazmanian, D., Fedyk, K., Klein, R., Richardson, J., Parkinson, W., & Minthorn-Biggs, M. B. (2003). Pilot evaluation of a mindfulness-based intervention to improve quality of life among individuals who sustained traumatic brain injuries. Disability and Rehabilitation, 25, 722–731. doi:10.1080/0963828031000090489.

    Article  PubMed  Google Scholar 

  • Bergen-Cico, D., & Cheon, S. (2013). The mediating effects of mindfulness and self-compassion on trait anxiety. Mindfulness. doi:10.1007/s12671-013-0205-y.

    Google Scholar 

  • Bergen-Cico, D., Possemato, K., & Cheon, S. (2013). Examining the efficacy of a brief mindfulness based stress reduction (brief MBSR) program on psychological health. Journal of American College Health, 61(6), 348–360.

    Article  PubMed  Google Scholar 

  • Blake, D. D., Weathers, F. W., Nagy, L. M., & Kaloupek, D. G. (1995). The development of a Clinician-Administered PTSD Scale. Journal of Traumatic Stress, 8(1), 75–90.

    Article  PubMed  Google Scholar 

  • Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D., Klauminzer, G., Charney, D. S., Keane, T. M., & Buckley, T. C. (2000). Clinician-Administered PTSD Scale (CAPS) Instruction Manual. Boston: National Center for PTSD.

    Google Scholar 

  • Boscarino, J. A. (2008). A prospective study of PTSD and early-age heart disease mortality among Vietnam veterans: implication for surveillance and prevention. Psychosomatic Medicine, 70, 668–676. doi:10.1097/PSY.0b013e31817bccaf.

    Article  PubMed Central  PubMed  Google Scholar 

  • Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822–848. doi:10.1037/0022-3514.84.4.822.

    Article  PubMed  Google Scholar 

  • Carmody, J., & Baer, R. A. (2009). How long does a mindfulness-based stress reduction program need to be? A review of class contact hours and effect sizes for psychological distress. Journal of Clinical Psychology, 65(6), 627–638. doi:10.1002/jclp.20555.

    Article  PubMed  Google Scholar 

  • Desai, R. A., Stefanovics, E. A., & Rosenheck, R. A. (2005). The role of psychiatric diagnosis in satisfaction with primary care: data from the Department of Veterans Affairs. Medical Care, 43(12), 1208–1216. doi:10.1097/01.mlr.0000185747.79104.90.

    Article  PubMed  Google Scholar 

  • Ehring, T., Frank, S., & Ehlers, A. (2008). The role of rumination and reduced concreteness in the maintenance of posttraumatic stress disorder and depression following trauma. Cognitive Therapy and Research, 32(4), 488–506.

    Article  PubMed Central  PubMed  Google Scholar 

  • Follette, V. A., & Vijay, A. (2009). Mindfulness for trauma and posttraumatic stress disorder. In D. Fabrizio (Ed.), Clinical handbook for mindfulness (pp. 299–317). New York: Springer.

    Chapter  Google Scholar 

  • Foy, D. W., Kagan, B., McDermott, C., Leskin, G., Sipprelle, R., & Paz, G. (1996). Practical parameters in the use of flooding for treating chronic PTSD. Clinical Psychology & Psychotherapy, 3, 169–175.

    Article  Google Scholar 

  • Frueh, B. C., Cusack, K. J., & Wells, C. (2006). Clinicians’ perspectives on cognitive-behavioral treatment for PTSD among persons with severe mental illness. Psychiatric Services, 57(7), 1027–1031. doi:10.1176/appi.ps.57.7.1027.

    Article  PubMed  Google Scholar 

  • Garcia, H. A., Kelley, L. P., Rentz, T. O., & Lee, S. (2011). Pretreatment predictors of dropout from cognitive behavioral therapy for PTSD in Iraq and Afghanistan war veterans. Psychological Services, 8(1), 1–11. doi:10.1037/a0022705.

    Article  Google Scholar 

  • Gillock, K. L., Zayfert, C., Hegel, M. T., & Ferguson, R. J. (2005). Posttraumatic stress disorder in primary care: prevalence and relationships with physical symptoms and medical utilization. General Hospital Psychiatry, 27(6), 392–399. doi:10.1016/j.genhosppsych.2005.06.004.

    Article  PubMed  Google Scholar 

  • Grubaugh, A. L., Magruder, K. M., Waldrop, A. E., Elhai, J. D., Knapp, R. G., & Frueh, B. C. (2005). Subthreshold PTSD in primary care: prevalence, psychiatric disorders, healthcare use, and functional status. Journal of Nervous and Mental Disease, 193(10), 658–664. doi:10.1097/01.nmd.0000180740.02644.ab.

    Article  PubMed  Google Scholar 

  • Gunn, W. B., & Blount, A. (2009). Primary care mental health: a new frontier for psychology. Journal of Clinical Psychology, 65(3), 235–252. doi:10.1002/jclp.20499.

    Article  PubMed  Google Scholar 

  • Hankin, C. S., Spiro, A., III, Miller, D. R., & Kazis, L. (1999). Mental disorders and mental health treatment among U.S. Department of Veterans Affairs outpatients: the veterans health study. The American Journal of Psychiatry, 156(12), 1924–1930.

    PubMed  Google Scholar 

  • Hoge, C. W., Castro, C. A., Messer, S. C., & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. The New England Journal of Medicine, 351(1), 13–22. doi:10.1056/NEJMoa040603.

    Article  PubMed  Google Scholar 

  • Jacobs, B., & Nagel, L. (2003). The impact of a brief mindfulness-based stress reduction program on perceived quality of life. International Journal of Self Help and Self Care, 2(2), 155–168.

    Article  Google Scholar 

  • Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156. doi:10.1093/clipsy/bpg016.

    Google Scholar 

  • Kabat-Zinn, J. (2009). Full catastrophe living: using the wisdom of your body and mind to face stress, pain and illness. New York: Delacorte.

    Google Scholar 

  • Kabat-Zinn, J., Massion, A. O., Kristeller, J., Peterson, L. G., Fletcher, K. E., Pbert, L., & Santorelli, S. F. (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. American Journal of Psychiatry, 149(7), 936–943.

    Article  PubMed  Google Scholar 

  • Katzman, R., Brown, T., Fuld, P., Peck, A., Schechter, R., & Schimmel, H. (1983). Validation of a short orientation-memory-concentration test of cognitive impairment. The American Journal of Psychiatry, 140(6), 734–739.

    Article  PubMed  Google Scholar 

  • Kearney, D. J., McDermott, K., Malte, C., Martinez, M., & Simpson, C. L. (2012). Association of participation in a mindfulness program with measures of PTSD, depression, and quality of life in a veteran sample. Journal of Clinical Psychology, 68(1), 101–116. doi:10.1002/jclp.20853.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048–1060.

    Article  PubMed  Google Scholar 

  • Kimerling, R., Ouimette, P., Prins, A., Nisco, P., Lawler, C., Cronkite, R., & Moos, R. H. (2006). Utility of a short screening scale for DSM-IV PTSD in primary care. Journal of General Internal Medicine, 21(1), 65–67. doi:10.1111/j.1525-1497.2005.00292.x.

    Article  PubMed Central  PubMed  Google Scholar 

  • King, A. P., Erickson, T. M., Giardino, N. D., Favorite, T., Rauch, S. A. M., Robinson, E., Kulkarni, M., & Liberzon, I. (2013). A pilot study of group mindfulness-based cognitive therapy (mbct) for combat veterans with posttraumatic stress disorder (ptsd). Depress. Anxiety, 30, 638–645. doi:10.1002/da.22104.

    Article  PubMed Central  PubMed  Google Scholar 

  • Klatt, M. D., Buckworth, J., & Malarkey, W. B. (2009). Effects of low-dose mindfulness-based stress reduction (MBSR-ld) on working adults. Health Education & Behavior, 36(3), 601–614. doi:10.1177/1090198108317627.

    Article  Google Scholar 

  • Koszycki, D., Benger, M., Shlik, J., & Bradwejn, J. (2007). Randomized trial of a meditation-based stress reduction program and cognitive behaviour therapy in generalized social anxiety disorder. Behaviour Research and Therapy, 45, 2518–2526. doi:10.1016/j.brat.2007.04.011.

    Article  PubMed  Google Scholar 

  • Mackenzie, C. S., Poulin, P. A., & Seidman-Carlson, R. (2006). A brief mindfulness based stress reduction intervention for nurses and nurses aides. Applied Nursing Research, 19(2), 105–109. doi:10.1016/j.apnr.2005.08.002 pp. 105-9.

    Article  PubMed  Google Scholar 

  • Magruder, K. M., Frueh, B. C., Knapp, R. G., Davis, L., Hamner, M.B., Martin, R.H…. Arana, G.W. (2005). Prevalence of posttraumatic stress disorder in Veterans Affairs primary care clinics. General Hospital Psychiatry, 27(3), 167–179. doi:10.1016/j.genhosppsych.2004.11.001

  • McDaniel, S. H., & LeRoux, P. (2007). An overview of primary care family psychology. Journal of Clinical Psychology in Medical Settings, 14(1), 23–32. doi:10.1007/s10880-006-9050-7.

    Article  Google Scholar 

  • Niles, B. L., Klunk-Gillis, J., Ryngala, D. J., Silberbogen, A. K., Paysnick, A., & Wolf, E. J. (2012). Comparing mindfulness and psychoeducation treatments for combat-related PTSD using a telehealth approach. Psychological Trauma: Theory, Research, Practice and Policy, 4(5), 538–547. doi:10.1037/a0026161.

    Article  Google Scholar 

  • Ouimette, P., Cronkite, R., Henson, B. R., Prins, A., Gima, K., & Moos, R. H. (2004). PTSD and health status among female and male medical patients. Journal of Traumatic Stress, 17(1), 1–9. doi:10.1023/B:JOTS.0000014670.68240.38.

    Article  PubMed  Google Scholar 

  • Posner, K., Brent, D., Lucas, C., Gould, M., Stanley, B., Brown, G….Mann, J. (2006). Columbia-suicide severity rating scale (C-SSRS). New York: Columbia University/New York State Psychiatric Institute.

  • Possemato, K. (2011). The current state of intervention research for posttraumatic stress disorder within the primary care setting. Journal of Clinical Psychology in Medical Settings. doi:10.1007/s10880-011-9237-4.

    PubMed  Google Scholar 

  • Prins, A., Ouimette, P., Kimerling, R., Cameron, R.P., Hugelshofer, D.S., Shaw-Hegwer, J. … Sheikh, J.I. (2003). The primary care PTSD screen (PC-PTSD): Development and operating characteristics. Primary Care Psychiatry, 9(1), 9–14. doi:10.1185/135525703125002360

  • Ramel, W., Goldin, P. R., Carmona, P. E., & McQuaid, J. R. (2004). The effects of mindfulness meditation on cognitive processes and affect in patients with past depression. Cognitive Therapy and Research, 28(4), 433–455. doi:10.1023/B:COTR.0000045557.15923.96.

    Article  Google Scholar 

  • Schnurr, P. P., & Spiro, A., III. (1999). Combat disorder, posttraumatic stress disorder symptoms, and health behaviors as predictors of self-reported physical health in older veterans. Journal of Nervous and Mental Disease, 187(6), 353–359. doi:10.1097/00005053-199906000-00004.

    Article  PubMed  Google Scholar 

  • Schottenbauer, M. A., Glass, C. R., Arnkoff, D. B., Tendick, V., & Gray, S. H. (2008). Nonresponse and dropout rates in outcome studies on PTSD: review and methodological considerations. Psychiatry, 71(2), 134–168. doi:10.1521/psyc.2008.71.2.134.

    Article  PubMed  Google Scholar 

  • Seal, K. H., Maguen, S., Cohen, B., Gima, K. S., Metzler, T. J., Ren, L….Marmar, C.R. (2010). VA mental health services utilization in Iraq and Afghanistan veterans in the first year of receiving new mental health diagnoses. Journal of Traumatic Stress, 23(1), 5–16. doi:10.1002/jts.20493

  • Sederer, L. I., Dickey, B., & Hermann, R. C. (1996). The imperative of outcomes assessment in psychiatry. In L. I. Sederer & B. Dickey (Eds.), Outcomes assessment in clinical practice (pp. 1–7). Baltimore: Williams & Wilkins.

    Google Scholar 

  • Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62(3), 373–386. doi:10.1002/jclp.20237.

    Article  PubMed  Google Scholar 

  • Spoont, M., Murdoch, M., Hodges, J., & Nugent, S. (2010). Treatment receipt by veterans after a PTSD diagnosis in PTSD, mental health, or general medical clinics. Psychiatric Services, 61(1), 58–63. doi:10.1176/appi.ps.61.1.58.

    Article  PubMed  Google Scholar 

  • Stein, M. B., McQuaid, J. R., Pedrelli, P., Lenox, R., & McCahill, M. E. (2000). Posttraumatic stress disorder in the primary care medical setting. General Hospital Psychiatry, 22(4), 261–269. doi:10.1016/S0163-8343(00)00080-3.

    Article  PubMed  Google Scholar 

  • Tacon, A. M., McComb, J., Caldera, Y., & Randolph, P. (2003). Mindfulness meditation, anxiety reduction, and heart disease: a pilot study. Family and Community Health, 26(1), 25–33.

    Article  PubMed  Google Scholar 

  • Tang, Y. Y., Ma, Y., Wang, J., Fan, Y., Feng, S., Lu, Q., Yu, Q., Sui, D., Rothbart, M. K., Fan, M., & Posner, M. I. (2007). Short-term meditation training improves attention and self-regulation. Proceedings of the National Academy of Sciences, 104(43), 17153–17156.

    Article  Google Scholar 

  • The Management of Post-Traumatic Stress Working Group. (2010). VA/DoD Clinical Practice Guideline for Management of Post-Traumatic Stress. Washington: Veterans Health Administration, Department of Defense.

    Google Scholar 

  • Vujanovic, A. A., Youngwirth, N. E., Johnson, K. A., & Zvolensky, M. J. (2009). Mindfulness-based acceptance and posttraumatic stress symptoms among trauma-exposed adults without Axis I psychopathology. Journal of Anxiety Disorders, 23(2), 297–303. doi:10.1016/j.janxdis.2008.08.005.

    Article  PubMed Central  PubMed  Google Scholar 

  • Zayfert, C., & DeViva, J. C. (2004). Residual insomnia following cognitive behavioral therapy for PTSD. Journal of Traumatic Stress, 17(1), 69–73. doi:10.1023/B:JOTS.0000014679.31799.e7.

    Article  PubMed  Google Scholar 

  • Zeidan, F., Johnson, S. K., Gordon, N. S., & Goolkasian, P. (2010). Effects of brief and sham mindfulness meditation on mood and cardiovascular variables. Journal of Alternative and Complementary Medicine, 16, 867–873. doi:10.1089/acm.2009.0321.

    Article  PubMed  Google Scholar 

  • Zlotnick, C., Rodriguez, B. F., Weisberg, R. B., Bruce, S. E., Spencer, M. A., Culpepper, L., & Keller, M. B. (2004). Chronicity in posttraumatic stress disorder and predictors of the course of posttraumatic stress disorder among primary care patients. The Journal of Nervous and Mental Disease, 192(2), 153–159.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by clinical demonstration funds from the VA Office of Mental Health Services. The authors’ views or opinions do not necessarily represent those of the Department of Veterans Affairs or the United States Government.

Conflict of Interest

The authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Wilfred Pigeon.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pigeon, W., Allen, C., Possemato, K. et al. Feasibility and Acceptability of a Brief Mindfulness Program for Veterans in Primary Care with Posttraumatic Stress Disorder. Mindfulness 6, 986–995 (2015). https://doi.org/10.1007/s12671-014-0340-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12671-014-0340-0

Keywords

Navigation