Description of the Meditation Programs Evaluated in the Demonstration Project

Supplemental APPENDIX

Description of the Meditation Programs Evaluated in the Demonstration Project

Mantram Repetition (Bormann, et al., 2013)

The Mantram Repetition Program (MRP) is a group-based program that emphasizes three strategies for training attention and managing symptoms: (1) Mantram Repetition, (2) Slowing Down and (3) One-Pointed Attention. A "mantram" is a self-selected, sacred word or phrase that is meaningful to the participant and used to focus one’s attention internally. One-pointed attention refers to concentrating on doing one thing at a time and bringing full attention into the present moment. These three tools are used to interrupt negative thoughts and emotional reactivity. The unique focus of the MRP is upon spiritually-based words believed to link attention to inner spiritual resources and help to calm the mind, body, and spirit.

In the demonstration project at both the California sites, MRP was delivered in an 8-week (90 minutes/week) group setting that included information about posttraumatic stress disorder (PTSD) symptoms, experiential learning exercises and weekly homework. The session topics included: (1) Introduction to Mantram Repetition; (2) Choosing and Using a Mantram; (3) Mantram and the Stress Response; (4) Slowing Down versus Automatic Pilot; (5) One-pointed Attention versus Multi-tasking; (6) Slowing Down and One-pointed Attention; (7) Making Mantram Repetition a Part of Your Life; and (8) Putting it All Together. Participants were also given a small counter worn on one finger to track the frequency of “mantram sessions” practiced each week. They were also provided a small notebook to write the mantram as an additional strategy to slow down and practice one-pointed attention.

Transcendental Meditation® (Wallace, 1970)

The Transcendental Meditation (or TM)® technique is a mantra-based meditation program developed by Maharishi Mahesh Yogi. The TM® organization describes the technique as, “an effortless technique for automatic self-transcending. It allows your mind to settle inward beyond thought to experience the source of thought — pure awareness. This is the most silent and peaceful level of consciousness — your innermost Self.” (www.tm.org). After formal instruction in TM®, the technique is to be practiced twice a day for 15-20 minutes while sitting comfortably with the eyes closed.

Standardized training in TM® consists of a 7-step instructional program, including introduction and preparation sessions for learning the technique, a standardized instructional session with a certified TM® teacher, and then 3 follow-up sessions to verify or correct individual TM practice.

The TM® program training schedule for the demonstration project was modified to include an introduction and preparation (interview) session on day 1, individual training on day 2, and group training on days 3, 4 and 5. Approximately 1 week later, patients were scheduled to meet with the instructor for an initial follow-up to verify or correct individual TM practice. This was followed by 2 more weekly follow-ups and 2 bi-weekly follow-ups. Thus, it was possible for patients to have contact with the instructor up to 10 times across 7-8 weeks.

Inner Resources (Waelde, 1999)

Inner Resources for Veterans (IRV) is a manualized meditation program that has been specifically adapted for use with Veterans with PTSD.

The IRV protocol comprised an 8-week, 8-session group-based program. Sessions were 60 minutes long, with the first third of each session spent learning and practicing meditation techniques, the middle third on didactic material and group discussion, and the last third of each session practicing and debriefing meditation. The between-session practice target was 30 minutes a day for 6 days per week. Participants were given a 60-page manual and four 30-minute audio-recordings of guided meditation to facilitate between-session practice. The sessions included instruction and group practice in mindfulness meditation techniques, including breath-focused awareness and imagery, and mantra repetition; IRV therapists were trained to assess the usefulness of these different meditation techniques for individual Veterans and encourage the use of the most effective techniques. There was also a booster session offered 4 weeks after the program (this was not evaluated in the demonstration project).

Primary Care brief Mindfulness Program (PCbMP; Bergen-Cico et al., 2014)

PCbMP utilizes techniques and practices taught in Mindfulness Based Stress Reduction (MBSR), (Kabat-Zinn, 2003).

For the demonstration project, the PCbMP entailed weekly, in-person 1.5 hour sessions for 4 consecutive weeks in group sessions led by an experienced MBSR facilitator. In addition to the weekly in person group sessions, each group participant was given a copy of the book Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness (Kabat-Zinn, 1990) and three audio CDs containing the facilitator’s renditions of several pre-recorded guided meditations such as: “Two-minute chill out,” “Breath Awareness,” “Loving Kindness,” “Body Scan,” “Sitting Meditation,” and “Mindful Yoga.” Audio CD selections were assigned weekly to be listened to outside of the didactic sessions, and home practice was a core component of the program, particularly given the brevity of the intervention.

Adapted Mantra Meditation

The Adapted Mantra Meditation program is delivered as a standardized group-based program, similar to Transcendental Meditation® in its technique and goals, but all members use the same non-spiritual, generic mantra during their instruction and daily practice. This meditation training program was designed and implemented (and later evaluated in the demonstrated project) specifically for Veterans at the Michigan site, for whom spiritual-based meditation had been unappealing, based on the staff’s experience with past program offerings.

Participants met as a group for 8 weekly sessions lasting 1.5 hours each, with no more than 8-10 participants per group. Sessions consisted of an introductory meeting, a group meditation instruction meeting, and 6 follow-up meetings. Each meeting consisted of review of homework and exploring side effects or successes; motivational interventions to aid in the participants developing a consistent daily meditation practice; personalized assistance in removing any blocks to successful meditation sessions; and then group practice of the meditation. All group sessions included guided practice in meditation and problem-solving side effects and obstacles to effective meditation. Participants completed daily homework and logs of their meditation experiences. Daily homework consisted of a titrated schedule of meditation culminating at two daily 15-20 minute meditation sessions.

Mindfulness Based PTSD Treatment

Mindfulness based PTSD treatment (MBPT) program was designed specifically for Veterans at the South Carolina site (and later evaluated in the demonstration project). MBPT incorporates elements from the Mindfulness Based Stress Reduction (MBSR, Kabat-Zinn, 2003) program, as well as from Mindfulness Based Cognitive Therapy (Segal et al, 2002), and other mindfulness training programs.

MBPT comprised 10, 1 hour-sessions, and was an individual-based program. It consisted of one-on-one, guided training in how to focus attention and tolerate emotional states. Emphasis was placed on non-avoidance and non-judgment. Veterans were guided through various mindfulness practices, included eating, walking, and sitting while keeping their attention focused on a various objects and sensations.

References

Bergen-Cico, D., Possemato, K., & Pigeon, W. (2014). Reductions in cortisol associated with primary are brief mindfulness program for veterans with PTSD. Medical Care, 52, S25-S31.

Bormann, J. E., Thorp, S., Wetherell, J., Golshan, S., & Lang, A. J. (2013). Meditation-based mantram intervention for Veterans with post-traumatic stress disorder: A randomized trial. Psychological Trauma: Theory, Research, Practice, and Policy, 5, 259-267.

Kabat-Zinn, J. Mindfulness-based stress reduction (MBSR) (2003). Constructivism in the Human Sciences, 8, 73-107.

Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York, NY: Guilford Press; US.

Waelde L. C. (2005). Inner resources for stress. Palo Alto, CA: Palo Alto University.

Wallace, R. K. (1970). Physiological effects of transcendental meditation. Science, 167, 1751-1754.