Mantram Repetition to Manage PTSD in Veterans

• SF-12 Health Quality of Life and Functional Assessment of Chronic Illness Therapy-Spiritual Wellbeing (FACIT-Sp) [ Time Frame: Baseline, Post-Intervention ] [ Designated as safety issue: No ]

  SF-12 measures health-related quality of life changes in mental, physical health from SF-36 scales:

  • physical functioning
  • role limitations- physical problems
  • bodily pain
  • general health perceptions
  • energy
  • vitality
  • social functioning
  • role limitations- emotional problems
  • mental health Summary scores explain 90% variance of SF-36 component scores. FACIT-SWB assesses spiritual components using 23 items rated on a 5-point Likert scale; high scores reflect greater spiritual well-being. Validity of Pearson correlations measures quality of life, mood, religious growth.
• Brief Symptom Inventory-18 (BSI-18) for anxiety and depression [ Time Frame: Baseline, Post-Intervention ] [ Designated as safety issue: No ]
  Brief Symptom 18 Item Inventory (BSI-18) is a highly sensitive self-report symptom inventory that screens for psychological distress and psychiatric disorders. It contains 18 items scored on a 5-point Likert scale and has three subscales of depression, anxiety and somatization.
• Mindfulness Attention Awareness Scale (MAAS) [ Time Frame: Baseline, Post-Intervention ] [ Designated as safety issue: No ]
  The Mindfulness Attention Awareness Scale (MAAS) is a 15-item questionnaire scored from 1 (almost always) to 6 (almost never) assessing individual differences in frequency of mindful states over time. Mindfulness has been linked to well-being and quality of life. This questionnaire has documented content validity using factor analysis, evidence of convergent and discriminant validity, and test-retest reliability.
• Quality of Life Enjoyment & Satisfaction Questionnaire (Q-LES-Q) [ Time Frame: Pre- & Post-Intervention ] [ Designated as safety issue: No ]
  Q-LES-Q general scale measures quality of life and satisfaction of 14 domains.
• Spiritual well-being [Functional Assessment of Chronic Illness Therapy (FACIT-Sp)] [ Time Frame: Pre- & Post-Intervention ] [ Designated as safety issue: No ]
  This is a measure of existential spiritual well-being that has subscales measuring peace/meaning and faith/assurance.
• Spiritual well-being (Functional Assessment of Chronic Illness Therapy (FACIT-Sp) [ Time Frame: Pre- & Post-Intervention ] [ Designated as safety issue: No ]
  This is a measure of existential spiritual well-being that has subscales measuring peace/meaning and faith/assurance.

With ongoing war in Iraq, the incidence of posttraumatic stress disorder (PTSD) in combat veterans is increasing. Creation, implementation, and testing of new and innovative interventions are needed to provide additional options for enhancing the mental health of those with PTSD. Surveys indicate that veterans are interested in complementary approaches to health care. The purpose of this study is to determine the efficacy of the Mantram Repetition Program (MRP) delivered as a brief, 6-week, complementary and portable intervention. It includes frequent, silent repetitions of a mantram (mantra), a word or phrase with spiritual associations, to manage PTSD symptoms and improve quality of life military veterans with trauma.

The Mantram Repetition Program (MRP) is an innovative, portable meditation-based group intervention. In this study, the MRP was delivered in addition to usual care (defined as case management and medication) in a 6-week (90 minutes/week) group setting. The MRP was compared to usual care only.

This 4-year study employed a mixed-methods, prospective, randomized controlled trial with qualitative phone interviews at 3 months post-intervention to explore ways that the intervention was used. Outpatient Veterans (N=146) with military-related PTSD were recruited from a single VA site and randomly assigned to the experimental arm (n=71) which consisted of usual care and the mantram program versus usual care only control group (n=76). Outcome measures included the PTSD Checklist (PCL), Clinician Administered PTSD Scale (CAPS), Brief Symptom Inventory-18, SF-12 Health Survey, Functional Assessment of Chronic Illness Existential Spirituality Scale (FACIT-Sp) and the Mindfulness Attention Awareness Scale (MAAS).

• Stress Disorders, Post Traumatic
• Veterans

• Behavioral: Mantram Repetition Program (MRP)
  The MRP includes three strategies for training attention and managing symptoms: Mantram Repetition, Slowing Down and One-Pointed Attention. In this study, it was delivered in a 6-week (90 minutes/week) group setting that consists of information, experiential learning and homework. A "mantram" is a self-selected, sacred word or phrase that is meaningful to the participant. Slowing down refers to setting priorities and doing things carefully so one is not rushed or does not make mistakes. One-pointed attention refers to concentrating on one thing at a time (similar to mindfulness). These three tools are presented to work together synergistically and cumulatively to interrupt negative thoughts and emotional states such as anger, rage, irritability and hyper-arousal. The unique focus on spiritual words is linked to what one might call inner spiritual resources.
  Other Name: Mantram Repetition Program (MRP)
• Other: Usual care consisting of medication and case management
  Case management consists of meeting with Veterans at least once per month and monitoring medications, if prescribed.
  Other Name: Usual Care

• Experimental: Arm 1
  Mantram Repetition Program for PTSD delivered in this study as 6-week, 90-minute per week that targeted PTSD symptoms. It was offered as an adjunct to usual care consisting of medication and case-management.
  Intervention: Behavioral: Mantram Repetition Program (MRP)
• Arm 2
  Usual care consisting of medication and case-management.
  Intervention: Other: Usual care consisting of medication and case management

• Bormann JE, Thorp S, Wetherell JL, Golshan S. A spiritually based group intervention for combat veterans with posttraumatic stress disorder: feasibility study. J Holist Nurs. 2008 Jun;26(2):109-16. Epub 2008 Mar 20.
• Bormann JE, Smith TL, Shively M, Dellefield ME, Gifford AL. Self-monitoring of a stress reduction technique using wrist-worn counters. J Healthc Qual. 2007 Jan-Feb;29(1):45-52.
• Bormann JE, Smith TL, Becker S, Gershwin M, Pada L, Grudzinski AH, Nurmi EA. Efficacy of frequent mantram repetition on stress, quality of life, and spiritual well-being in veterans: a pilot study. J Holist Nurs. 2005 Dec;23(4):395-414.

Inclusion Criteria:

• Primary diagnosis of PTSD, military related
• Read and write English
• Score of > 50 on PTSD Checklist
• Has a telephone with answering machine or voice mail to receive study messages
• Has a Case Manager assigned for usual care
• Willingness to track medications, relaxation techniques and number of case manager visit

Exclusion Criteria:

• Cognitive impairment including active psychosis, untreated bipolar disorder, dementia or personality disorder that interferes with group participation
• Presence of active, serious suicidal ideation