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التأمل لعلاج اضطرابات توتر ما بعد الصدمة

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Research Question

  1. What are the effects of meditation interventions on posttraumatic stress disorder symptoms, depression, anxiety, health-related quality of life, functional status, and adverse events compared with treatment as usual, waitlists, no treatment, or other active treatments, in adults with posttraumatic stress disorder?

RAND researchers conducted a systematic review and meta-analysis that synthesized evidence from randomized controlled trials of meditation interventions to provide estimates of their efficacy and safety in treating adults diagnosed with posttraumatic stress disorder (PTSD).

Outcomes of interest included PSTD symptoms, depression symptoms, anxiety, health-related quality of life, functional status, and adverse events. Meta-analyses were conducted using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Quality of evidence was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (or GRADE) approach.

In total, ten trials on meditation interventions for PTSD with 643 participants met inclusion criteria. Across interventions, adjunctive meditation interventions of mindfulness-based stress reduction, yoga, and the mantram repetition program improve PTSD symptoms and depression compared with control groups based on low to moderate quality of evidence. Effects were positive but not statistically significant for quality of life and anxiety, and no studies addressed functional status. The variety of meditation intervention types, the short follow-up times, and the quality of studies limited analyses. There were no adverse events in the included studies, but only half of the studies reported on safety. In order to increase confidence in these findings, researchers should conduct more high-quality studies on meditation as adjunctive treatment with PTSD-diagnosed participant samples large enough to detect statistical differences in outcomes.

Key Findings

Meditation Is Associated with Improved PTSD and Depression Symptoms, but the Evidence Is Limited

  • Ten randomized controlled trials (RCTs) on meditation interventions for PTSD met inclusion criteria. Intervention approach, intensity, and study quality varied considerably. Six RCTs focused exclusively on patients exposed to combat-associated trauma.
  • Meditation interventions — including mindfulness-based stress therapy, yoga, and mantram repetition program offered as adjunctive therapy — reduced PTSD symptoms statistically significantly compared with all comparators across all sources of trauma; the quality of evidence was rated as low.
  • Adjunctive meditation interventions were also efficacious in reducing depression symptoms; the quality of evidence was rated as moderate.
  • Effects were positive but not statistically significantly different for quality of life or anxiety symptoms, and no study addressed functional status. Only five RCTs assessed safety. None of these five studies identified any adverse events as a result of meditation interventions.
  • No head-to-head trials compared different meditation approaches, and indirect comparisons did not systematically favor one type of meditation over another. Treatment effect estimates did not vary systematically by comparator. It was not possible to determine the differential effect of offering meditation as adjunctive or monotherapy, and meta-regressions did not identify a systematic effect of the intervention intensity or trauma type.

Recommendations

  • Further research examining the effect of meditation on PTSD symptoms may focus on analyzing treatment adherence to identify the minimum frequency or duration of meditation practice required for maximum efficacy. Reporting on adherence may also help compare the acceptability of complementary and alternative treatments when compared with current first-line treatments.
  • The fact that something has been shown to be efficacious does not mean it has been shown to be more effective. Therapies with equal efficacy may have different levels of effectiveness, and a therapy with a lesser rate of efficacy may have higher rates of effectiveness if the adherence rate is higher. This may be an important policy issue to guide whether resources should be placed on more trials for efficacy or more studies of comparative effectiveness and to find approaches with greater likelihood of adherence.
  • More well-designed, rigorous, and large RCTs are needed in order to develop an evidence base that can more decisively provide estimates of the efficacy of the many types of meditation interventions for PTSD, depression, anxiety, quality of life, functional status, and adverse events.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Methods

  • Chapter Three

    Results

  • Chapter Four

    Discussion

  • Appendix A

    Search Strategies

  • Appendix B

    Excluded Full-Text Articles

  • Appendix C

    Evidence Table

This research was sponsored by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

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