BACKGROUND/RATIONALE:
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.
OBJECTIVE(S):
This is a 4-year plan that began in July 2005 to study the efficacy of a 6-week, complementary and portable intervention of frequent, silent repetition of a mantram (mantra), a word or phrase with spiritual associations, to manage severity of PTSD symptoms and improve quality of life in military veterans.
METHODS:
A randomized, controlled clinical trial (N=140) is being conducted to compare a mantram group intervention (n = 70) to a delayed treatment control group (n = 70) on outcomes of self-reported PTSD symptoms, psychological distress, and quality of life. Outpatient veterans with military-related PTSD will be recruited and randomized to either intervention or delayed treatment control group. The intervention will be given over 6-weeks, 90-minutes per week in small groups. Mantram repetition will be measured using a wrist-watch counter and tracking logs. Outcomes of PTSD symptom severity, psychological distress, and quality of life will be assessed using Clinician Administered PTSD Scale (CAPS), PTSD Checklist (PCL), Spielberger State-Trait Anxiety Inventory-2, Brief Symptom Inventory-18, SF-12 Health Survey, and Functional Assessment of Chronic Illness Existential Spirituality Scale at pre-intervention, post-intervention, and 6 week follow-up. Intervention efficacy will be assessed using 2 (group) by 2 (time) repeated measure design. Within intervention group comparisons will be examined at pre-intervention and week 12. Qualitative tape-recorded phone interviews will be conducted at week 24 to assess situations where the intervention was either helpful or not helpful. Qualitative interviews will be analyzed using critical incident technique.
FINDINGS/RESULTS:
Recruitment and enrollment is on going. Of particpants enrolled, there are a total of 138 (134 males and 4 females). Of these, 67% are white, 24% are African-American, 5% are Native Hawaiian or other Pacific Islander, 3% are American Indian or Alaskan Native, 0.5% Asian and 0.5% unknown. Of these, 12 participants withdrew from the study due to hospitalization (n=1), incarceration (n=2), medical problems (n=2), schedule conflicts (n=2), moved (n=1), noncompliant (n=1), not interested (n=1), refused to continue (n=1), had wrong diagnosis (n=1). Retention rate is estimated at 91.3%. Ninety-five have completed the study and 31 are currently active for a total of 126 participants. The study target for participants is 140. No further findings to report at this timepoint.
IMPACT:
This continuing study is an effort to simplify military-related PTSD interventions using frequent, silent mantram repetition as a complementary, nonpharmacological therapy. Mantram is a spiritually-based word or phrase self-selected and repeated silently throughout the day to focus attention for stress reduction. It has the potential to significantly and cost-effectively improve mental health and quality of life in emotionally traumatized patients.
PUBLICATIONS:
Journal Articles
- Bormann JE, Smith TL, Shively M, Dellefield ME, Gifford AL. Self-monitoring of a stress reduction technique using wrist-worn counters. Journal For Healthcare Quality. 2007; 29(1): 45-52.
- Bormann JE, Oman D, Kemppainen JK, Becker S, Gershwin M, Kelly A. Mantram repetition for stress management in veterans and employees: a critical incident study. Journal of Advanced Nursing. 2006; 53(5): 502-12.
- 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. Journal of Holistic Nursing. 2005; 23(4): 395-414.
