Mindfulness and the Military: Does Self-Acceptance Help Veterans?

“The seed of suffering in you may be strong, but don’t wait until you have no more suffering before allowing yourself to be happy.” 
~Thich Nhat Hanh

 “You have to make the mind run the body.”
~General George S. Patton Jr.

A recently published article in the Journal of Clinical Psychology by Kearney, McDermott, Malte, Martinez, and Simpson (2012) may have broad implications for veterans suffering with symptoms of Post-traumatic Stress Disorder (PTSD).

These researchers demonstrated that engagement in mindfulness-based stress reduction (MBSR) showed significant improvements after six months in reducing soldiers’ symptoms of PTSD, depression, behavioral activation (the ability to engage in activities to achieve a goal in spite of aversive symptoms), and self-acceptance.

Forty-seven percent of the veterans in the study showed clinically significant improvements in their PTSD symptoms. This highlights the fact that sustainable symptom reduction may be possible by employing a mindfulness technique. MBSR and other mindfulness-based meditation practices may provide broad-based ancillary interventions in the treatment of PTSD that can complement the current psychotherapeutic and pharmacological practices.

PTSD is a particularly nasty collection of symptoms.  Some of the more difficult indications include hyperarousal, rumination about the event, depression and anxiety. In addition to the study noted above, other researchers (Vujanovic, Niles, Pietrefesa, Schmertz, & Potter, 2011) have also found a link between mindfulness meditation and reduced PTSD symptoms in veterans.  In both studies it appears that accepting one’s emotional pain appears to actually help alleviate that pain.

This is good news for the toolbox needed to treat PTSD — because there is also evidence that being unable to accept and adequately regulate trauma-activated emotional responses may cause poor interpersonal relationships (Roth, Newman, Pelcovitz, ver der Kolk, & Mandel, 1997). In turn, poor relationships may make using the more traditional exposure-based treatments (such as desensitization) a risk for exacerbating symptoms (Cloitre, Koenen, Cohen, & Han, 2002).  What is valuable about mindfulness techniques is that they can be practiced independently after training.

Mindfulness meditation has largely been derived from Buddhist practices known as the eight-fold path.  Of the eight, mindfulness is specifically devoted to enhancing the ability to focus our attention. Developed to cope with human suffering, it involves a cultivation of private experiences with the aim of nurturing calmness.  The primary goal is to help achieve self-acceptance.  According to Pema Chodron (2001), an American Tibetan Buddhist nun (or Ani), there are four components of this self-acceptance: commitment; awareness; willingness to experience emotional distress; and attention to the present moment.

Over the years, a number of researchers have shown that meditation practices — including cultivating self — acceptance and the tolerance for emotionally distressing experiences — both reduce stress and increase well-being (Kabat-Zinn, 1990, 1994; Simpson, et al., 2007; Thompson, & Waltz, 2008; Smith, et al., 2011).  But the question has always been if these changes are sustainable.  At least one study has indicated that they are.

Researchers Michael A. Cohna and Barbara L. Fredrickson (2010) demonstrated that, after an initial meditation practice was introduced, subjects sustained positive experiences for fifteen months. Although veterans were not part of the investigation, this was one of the first studies to show a link between meditation and sustainable positive experiences.

Acceptance-based therapies such as mindfulness provide an alternative to traditional Western approaches for dealing with pain (Folette, Palm and Pearson, 2006).  As Ekman, Davidson, Ricard and Wallace (2005) have pointed out, mindfulness is used to tolerate emotional distress rather than to try to control or overcome negative feelings. In other words, trying to control or avoid negative emotions may not be the most effective way to manage them.

It also appears that mindfulness may facilitate resilience.  In another study, Jha, Stanley, Kiyonaga, Wong and Gelfand (2010) found that providing military personnel mindfulness training (MT) might help to guard against functional impairments in stressful contexts.

The more mindfulness meditation is researched, the more it appears to be able both to prevent and correct trauma, particularly for military veterans.

In the past few years the Army has invested in training soldiers to be psychologically as well as physically fit. The Master Resilience Training (MAT) program (Reivich, Seligman, & McBride, 2011) has a series of modules designed to help soldiers maximize their potential and cope with combat stressors.  Meditation is specifically identified as a technique to be taught as part of the larger resilience effort and part of Comprehensive Soldier Fitness program.

Self-acceptance through mindfulness meditation is an ancient tool that is needed now more than ever, but it is no easy task. In the words of Pema Chodron: “The most fundamental aggression to ourselves, the most fundamental harm we can do to ourselves, is to remain ignorant by not having the courage and the respect to look at ourselves honestly and gently.”

References
Chodron, P. (2001). The places that scare you: A guide to fearlessness in difficult times. Boston: Shambhala.

Ekman, P, Davidson, R. J., Ricard, M., & Wallace, B. A. (2005). Buddhist and psychological perspectives on emotional well-being. Current Directions in Psychological Science, 14(2), 59 — 63.

Follette, V., Palm, K. M., & Pearson, A. N. (2006). Mindfulness and trauma: Implications for treatment. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 24(1), 45-61.

Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life (1st ed.). New York: Hyperion.

Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York: Dell Publishing.

Kearney, D. J., McDermott, K., Malte, C., Martinez, M., & Simpson, T. 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,

Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, D. (1997). Complex PTSD in victims exposed to physical and sexual abuse: Results from the DSM-IV field trial for posttraumatic stress disorder. Journal of Traumatic Stress, 10(4), 539 — 555.

Simpson, T., Kaysen, D., Bowen, S., MacPherson, L., Chawla, N., Blume, A., . . . Larimer, M. (2007). PTSD symptoms, substance use, and vipassana meditation among incarcerated individuals. Journal of Traumatic Stress, 20(3), 239-249.

Smith, B. W., Ortiz, J. A., Steffen, L. E., Tooley, E. M., Wiggins, K. T., Yeater, E. A., . . . Bernard, M. L. (2011). Mindfulness is associated with fewer PTSD symptoms, depressive symptoms, physical symptoms, and alcohol problems in urban firefighters.Journal of Consulting and Clinical Psychology, 79(5), 613.

Thompson, B. L., & Waltz, J. (2008). Self‐compassion and PTSD symptom severity.Journal of Traumatic Stress, 21(6), 556-558.

Vujanovic, A. A., Niles, B., Pietrefesa, A., Schmertz, S. K., & Potter, C. M. (2011). Mindfulness in the treatment of posttraumatic stress disorder among military veterans. Professional Psychology: Research and Practice, 42(1), 24.