Transcendental Meditation may reduce PTSD symptoms, medication use in active-duty personnel

The study looked at 74 active-duty service members with PTSD or anxiety disorder, often resulting from multiple deployments over multiple years, who were seeking treatment at Dwight David Eisenhower Army Medical Center's Traumatic Brain Injury Clinic at Fort Gordon, Georgia.

Half the service members voluntarily practiced Transcendental Meditation regularly in addition to their other therapy; half did not. At one month, 83.7 percent of the meditators had stabilized, reduced or stopped their use of psychotropic drugs to treat their conditions while 10.9 percent had increased their medication dosage.

Of those who did not meditate, 59.4 percent had stabilized, reduced or stopped taking psychotropic drugs while 40.5 percent were taking more medication. Similar percentages held up in the following months and by six months, non-meditators had experienced about a 20 percent increase in their symptoms compared with those using the meditation practice.

Headaches, memory, sleep and mood issues are the big four symptoms following a concussion, and these patients had multiple concussions that occurred in the heat of war, said Dr. John L. Rigg, physiatrist at Eisenhower and the study's senior author. Rigg is program director of the military hospital's TBI Clinic, one of the largest of its kind in the nation, which offers an intensive outpatient approach where service members with mild brain injuries learn skills to help with their PTSD.

"Concussions heal, but this is a unique concussion because it happened when somebody was trying to kill them," Rigg said. "It's not like you or I were riding bikes on the weekend and fell down and hit our head. There is significant emotional trauma, hyperarousal of basic instincts of survival. They are having a normal reaction to an abnormal situation, which is being in an environment where somebody is trying to kill them on a daily basis."

"Regular practice of Transcendental Meditation provides a habit of calming down and healing the brain," said Dr. Vernon A. Barnes, physiologist at the Georgia Prevention Institute at the Medical College of Georgia at Augusta University. Barnes, the study's lead author, teaches Eisenhower's TBI Clinic patients the practice, which he recommends be done twice daily for 20 minutes.

Transcendental Meditation takes users from a level of active thinking to a state of inner quietness that reduces levels of stress hormones and activation of the sympathetic nervous system, which drives the so-called fight-or-flight response by increasing heart rate and blood pressure, Barnes said.

When soldiers come home, that hyperactive state can come with them, leaving them on edge, irritable, anxious, prone to overreacting, and more. Memory problems can continue because they have trouble concentrating on anything beyond potential dangers.

"Even going to a crowded restaurant for dinner can be problematic," said Rigg with the echo of the 24-hour warzone mantra "strangers are dangers" replaying in their head. In this hypervigilant state of mind, a soldier might be inclined to get a table where he can sit with his back to the wall and monitor other patrons' comings and goings rather than the conversation his partner is trying to have with him.

Eisenhower Army Medical Center is among the first to use Transcendental Meditation in active duty personnel, although the practice has been more widely used with veterans. Rigg, who has worked at Eisenhower since 2008, quickly realized that medication, such as antidepressants and anti-anxiety drugs, often are not sufficient to help active duty personnel struggling with PTSD. In the pursuit of non-pharmacologic options, his friend, former Kansas City Royals shortstop Buddy Biancalana, told him about the work of the David Lynch Foundation's Operation Warrior Wellness, which teaches Transcendental Meditation to veterans. David Lynch Foundation Director of Research Dr. Sarina Grosswald put Rigg in touch with Barnes, whose years of work with Transcendental Meditation includes demonstrating its ability to lower blood pressure in black adolescents with above-normal blood pressures.

In addition to using evidence-based therapies, such as cognitive processing therapy, where service members learn ways to better handle their distressing thoughts, the Eisenhower clinic staff wanted better ways to help restore a more regular state of awareness in these hyperaroused individuals, said Jennifer J. Williams, social worker and primary behavioral health therapist at the TBI Clinic. After regularly practicing Transcendental Meditation, soldiers began to report that they felt less irritable, slept better, and their relationships were improving, said Williams, a study co-author.

While there was some skepticism among service members when they added Transcendental Meditation to the skill list in early 2012, the clinic now has a waiting list for the course where Barnes first introduces the technique's origin and benefits before teaching the technique. Other mind-body techniques used in the clinic, such as yoga, helped pave the way for Transcendental Meditation, which is still not considered a frontline treatment, Rigg said.

The researchers note that health care providers may be hesitant to reduce medication dosage in these patients because they are not certain whether the stabilization is due to meditation or medication. Previous studies, including a 1985 study in Vietnam Veterans, showed that soldiers who practiced Transcendental Meditation instead of taking medication experienced significantly reduced PTSD symptoms.

Response rates to psychotropic medication -- such as the selective serotonin reuptake inhibitors also used for depression -- for PTSD and anxiety disorders is only about 30 percent, the researchers report. Treatment success can be further complicated by brain injury, drug abuse, and sleep and mood disorders. PTSD medications have a host of potential side effects including exacerbating memory loss and depression. Transcendental Meditation has no known adverse side effects.

PTSD affects about 13 percent of service members deployed to Operations Enduring and Iraqi Freedom. Finding the optimal therapy remains in debate as these prolonged wars have large numbers of active duty and veteran personnel struggling with the emotional aftershock, the researchers write.