Higher frequency of mantram repetition practice is associated with enhanced clinical benefits among United States Veterans with posttraumatic stress disorder

Anne Malaktaris, Caitlin L McLean, Sheetal Mallavarapu, Matthew S Herbert, Skylar Kelsven, Jill E Bormann, Ariel J Lang, Anne Malaktaris, Caitlin L McLean, Sheetal Mallavarapu, Matthew S Herbert, Skylar Kelsven, Jill E Bormann, Ariel J Lang

Abstract

Background: There is increasing support for the use of meditation-based treatments for US military Veterans with posttraumatic stress disorder (PTSD). The Mantram Repetition Program (MRP), which is a portable meditative practice that features mindful repetition of a sacred phrase, is associated with significant reductions in PTSD symptom severity. Although regular practice is emphasized in meditation-based interventions, associations between frequency of practice and clinical outcomes are often not reported.

Objectives: This study will examine whether the frequency of mantram repetition is associated with greater improvements in clinical outcomes.

Methods: Veterans with PTSD participating in MRP (N = 160; combined experimental groups from two randomized controlled trials). Participants completed pre- and post-treatment self-report measures of anger and well-being and a clinician-administered interview of PTSD severity (CAPS-IV-TR). Veterans also reported average daily mantram repetition practice at post-treatment. We conducted a series of hierarchal multiple regression analyses.

Results: When controlling for race/ethnicity and pre-treatment severity, higher frequency of mantram repetition practice was associated with significantly greater improvements (small effect sizes) in PTSD symptom severity (F(3,128) = 6.60, p < .001, β = .21, p = .007), trait anger (F(3,128) = 31.23, p <.001, β = .25, p < .001), state anger (F(3,110) = 17.62, p < .001, β = .16, p = .04), mental health well-being (F(3,128) = 28.38, p < .001, β = .14, p = .04), and spiritual well-being (F(3,127) = 13.15, p < .001, β = .23, p = .003), but not physical health well-being.

Conclusions: Higher frequency of mantram repetition practice appears to have beneficial effects on clinical outcomes for Veterans with PTSD. Strategies that promote skills practice may be an important target for improving clinical outcomes for meditation-based interventions.

Highlights: Higher frequency of meditation practice during Mantram Repetition Program was associated with greater reductions in PTSD symptoms and anger as well as improvements in well-being.Strategies to promote at-home meditation practice may optimize the benefits of MRP.

Trial registration: ClinicalTrials.gov NCT01506323.

Keywords: Complementary and integrative treatments; US military Veterans; anger; meditation; posttraumatic stress disorder; well-being.

Conflict of interest statement

No potential conflict of interest was reported by the author(s).

© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

References

    1. Avina, C. (2008). The use of self-monitoring as a treatment intervention. In O’Donohue W. T. & Cummings N. A. (Eds.), Evidence-based adjunctive treatments (pp. 207–219). Elsevier Academic Press. 10.1016/B978-012088520-6.50011-1
    1. Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45. 10.1177/1073191105283504
    1. Barger, M. K., Weinrich, S., Bormann, J. E., Bouvier, M., & Brosz Hardin, S. (2015). Mantram repetition program decreases insomnia among homeless women: A pilot study. Journal of Psychosocial Nursing and Mental Health Services, 53(6), 44–49. 10.3928/02793695-20150526-03
    1. Berkovich-Ohana, A., Wilf, M., Kahana, R., Arieli, A., & Malach, R. (2015). Repetitive speech elicits widespread deactivation in the human cortex: The ‘Mantra’ effect? Brain and Behavior, 5(7), e00346. 10.1002/brb3.346
    1. Bormann, J. E., Becker, S., Gershwin, M., Kelly, A., Pada, L., Smith, T., & Gifford, A. L. (2006). Relationship of frequent mantram repetition to emotional and spiritual well-being in healthcare workers. The Journal of Continuing Education in Nursing, 37(5), 218–224. 10.3928/00220124-20060901-02
    1. Bormann, J. E., Gifford, A. L., Shively, M., Smith, T. L., Redwine, L., Kelly, A., Becker, S., Gershwin, M., Bone, P., & Belding, W. (2006). Effects of spiritual mantram repetition on HIV outcomes: A randomized controlled trial. Journal of Behavioral Medicine, 29(4), 359–376. 10.1007/s10865-006-9063-6
    1. Bormann, J. E., Oman, D., Walter, K. H., & Johnson, B. D. (2014). Mindful attention increases and mediates outcomes following mantram repetition practice in veterans with posttraumatic stress disorder. Medical Care, 52(12 Suppl 5), S13–S18. 10.1097/MLR.0000000000000200
    1. Bormann, J. E., Smith, T. L., Becker, S., Gershwin, M., Pada, L., Grudzinski, A. H., & Nurmi, E. A. (2005). Efficacy of frequent mantram repetition on stress, quality of life, and spiritual well-being in veterans. Journal of Holistic Nursing, 23, 395–414. 10.1177/0898010105278929
    1. Bormann, J. E., Smith, T. L., Shively, M., Dellefield, M. E., & Gifford, A. L. (2007). Self-monitoring of a stress reduction technique using wrist-worn counters. Journal of Healthcare Quality, 29(1), 45–52. 10.1111/j.1945-1474.2007.tb00175.x
    1. Bormann, J. E., Thorp, S. R., Smith, E., Glickman, M., Beck, D., Plumb, D., Zhao, S., Ackland, P. E., Rodgers, C. S., Heppner, P., Herz, L. R., & Elwy, A. R. (2018). Individual treatment of posttraumtic stress disorder using mantram repetition: A randomized trial. The American Journal of Psychiatry, 175(10), 979–988. 10.1176/appi.ajp.2018.17060611
    1. Bormann, J. E., Thorp, S. R., Wetherell, J. L., Golshan, S., & Lang, A. J. (2013). Meditation-based mantram intervention for veterans with posttraumatic stress disorder: A randomized trial. Psychological Trauma: Theory, Research, Practice, and Policy, 5(3), 259–267. 10.1080/20008198.2019.1665768
    1. Bormann, J. E., Walter, K. H., Leary, S., & Glaser, D. (2017). An internet-delivered Mantram Repetition Program for spiritual well-being and mindfulness for health care workers. Spirituality in Clinical Practice, 4(1), 64–73. 10.1037/scp0000118
    1. Bormann, J. E., Warren, K. A., Regalbuto, L., Glaser, D., Kelly, A., Schnack, J., & Hinton, L. (2009). A spiritually-based caregiver intervention with telephone delivery for family caregivers of Veterans with dementia. Journal of Family and Community Health, 32(4), 345–353. 10.1097/FCH.0b013e3181b91fd6
    1. Brady, M. J., Peterman, A. H., Fitchett, G., Mo, M., & Cella, D. (1999). A case for including spirituality in quality of life measurement in oncology. Psycho-Oncology, 8(5), 417–428. 10.1002/(SICI)1099-1611(199909/10)8:5_417::;2-4
    1. Carmody, J., & Baer, R. A. (2008). Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. Journal of Behavioral Medicine, 31(1), 23–33. 10.10.07/s10865-007-9130-7
    1. Crawford, J. N., Talkovsky, A. M., Bormann, J. E., & Lang, A. J. (2019). Targeting hyperarousal: Mantram repetition program for PTSD in US veterans. European Journal of Psychotraumatology, 10(1), 1665768. 10.1080/20008198.2019.1665768
    1. Edenfield, T. M., & Saeed, S. A. (2012). An update on mindfulness meditation as a self-help treatment for anxiety and depression. Psychology Research and Behavior Management, 5, 131–141. 10.2147/PRBM.S34937
    1. Fredrickson, B. L., Boulton, A. J., Firestine, A. M., Van Cappellen, P., Algoe, S. B., Brantley, M. M., Kim, S. L., Brantley, J., & Salzberg, S. (2017). Positive emotion correlates of meditation practice: A comparison of mindfulness meditation and loving-kindness meditation. Mindfulness, 8(6), 1623–1633. 10.1007/s12671-017-0735-9
    1. Gallegos, A. M., Crean, H. F., Pigeon, W. R., & Heffner, K. L. (2017). Meditation and yoga for posttraumatic stress disorder: A meta-analytic review of randomized controlled trials. Clinical Psychology Review, 58, 115–124. 10.1016/j.cpr.2017.10.004
    1. Goldberg, S. B., Knoeppel, C., Davidson, R. J., & Flook, L. (2020). Does practice quality mediate the relationship between practice time and outcome in mindfulness-based stress reduction? Journal of Counseling Psychology, 67(1), 115–122. 10.1037/cou0000369
    1. Harris, J. I., Chamberlin, E. S., Engdahl, B., Ayre, A., Usset, T., & Mendez, D. (2021). Spiritually integrated interventions for PTSD and moral injury: A review. Current Treatment Options in Psychiatry, 8(4), 196–212. 10.1007/s40501-021-00248-w
    1. Jazaieri, H., Lee, I. A., McGonigal, K., Jinpa, T., Doty, J. R., Gross, J. J., & Goldin, P. R. (2016). A wandering mind is a less caring mind: Daily experience sampling during compassion meditation training. The Journal of Positive Psychology, 11(1), 37–50. 10.1080/17439760.2015.1025418
    1. King, A. P., Erickson, T. M., Giardino, N. D., Favorite, T., Rauch, S. A., Robinson, E., Kulkarni, M., & Liberzon, I. (2013). A pilot study of group mindfulness-based cognitive therapy (MBCT) for combat veterans with posttraumatic stress disorder (PTSD). Depression and Anxiety, 30(7), 638–645. 10.1002/da.22104
    1. Kostovich, C. T., Bormann, J. E., Gonzalez, B., Hansbrough, W., Kelly, B., & Collins, E. G. (2021). Being present: Examining the efficacy of an internet mantram program on RN-delivered patient-centered care. Nursing Outlook, 69(2), 136–146. 10.1016/j.outlook.2021.01.001
    1. Lloyd, A., White, R., Eames, C., & Crane, R. (2018). The utility of home-practice in mindfulness-based group interventions: A systematic review. Mindfulness, 9(3), 673–692. 10.1007/s12671-017-0813-z
    1. Montero-Marin, J., Pérez-Yus, M. C., Cebolla, A., Soler, J., Demarzo, M., & Garcia-Campayo, J. (2019). Religiosity and meditation practice: Exploring their explanatory power on psychological adjustment. Frontiers in Psychology, 10, 630. 10.3389/fpsyg.2019.00630
    1. Mrazek, A. J., Mrazek, M. D., Calcagnotto, L. A., Cloughesy, J. N., Holman, A. M., Masters-Waage, T. C., & Schooler, J. W. (2020). Familiarity, attitudes, and self-regulatory challenges related to mindfulness. Mindfulness, 11, 1218–1225. 10.1007/s12671-020-01332-7
    1. Oman, D., Bormann, J. E., & Kane, J. J. (2020). Mantram repetition as a portable mindfulness practice: Applications during the COVID-19 pandemic. Mindfulness, 11(8), 2031–2033. 10.1007/s12671-020-01440-4
    1. Parsons, C. E., Crane, C., Parsons, L. J., Fjorback, L. O., & Kuyken, W. (2017). Home practice in mindfulness-based cognitive therapy and mindfulness-based stress reduction: A systematic review and meta-analysis of participants’ mindfulness practice and its association with outcomes. Behaviour Research and Therapy, 95, 29–41. 10.1016/j.brat.2017.05.004
    1. Peterman, A. H., Fitchett, G., Brady, M. J., Hernandez, L., & Cella, D. (2002). Measuring spiritual well-being in people with cancer: The functional assessment of chronic illness therapy-spiritual well-being scale (FACIT-Sp). Annals of Behavioral Medicine, 24(1), 49–58. 10.1207/S15324796ABM2401_06
    1. Schoormans, D., & Nyklíček, I. (2011). Mindfulness and psychologic well-being: Are they related to type of meditation technique practiced? The Journal of Alternative and Complementary Medicine, 17(7), 629–634. 10.1089/acm.2010.0332
    1. Spielberger, C. D. (1999). State-Trait Anger Expression Inventory-2: Professional manual. Lutz, FL: Psychological Assessment Resources.
    1. Spielberger, C. D., Jacobs, G., Russell, S., & Crane, R. S. (1983). Assessment of anger: The state-trait anger scale. In Butcher J. N. & Spielberger C. D. (Eds.), Advances in personality assessment (Vol. 2, pp. 159–187). Hillsdale, NJ: Lawrence Erlbaum Associates.
    1. Tang, Y. Y., Rothbart, M. K., & Posner, M. I. (2012). Neural correlates of establishing, maintaining, and switching brain states. Trends in Cognitive Sciences, 16(6), 330–337. 10.1016/j.tics.2012.05.001
    1. Vannini, M. B. N., McLean, C. L., Bormann, J. E., & Lang, A. J. (2021). The feasibility of an internet-delivered Mantram Repetition program with undergraduate students. Poster presented at the Western Psychological Association Annual Meeting, Virtual.
    1. Wadlinger, H. A., & Isaacowitz, D. M. (2011). Fixing our focus: Training attention to regulate emotion. Personality and Social Psychology Review, 15(1), 75–102. 10.1177/1088868310365565
    1. Ware, J. E., & Gandek, B. (1998). Overview of the SF-36 health survey and the international quality of life assessment (IQOLA) project. Journal of Clinical Epidemiology, 51(11), 903–912. 10.1016/S0895-4356(98)00081-X
    1. Ware, J. E., Kosinski, M. A., & Keller, S. D. (1995). SF-12: How to score the SF-12 physical and mental health summary scales (2nd Ed.). Boston, MA: Health Institute, New England Medical Center.
    1. Ware, J. E., Kosinski, M., Turner-Bowker, D. M., & Gandek, B. (2002). User’s manual for the SF-12v2 health survey with a supplement documenting SF-12 health survey. QualityMetric.
    1. Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36): Conceptual framework and item selection. Medical Care, 30(6), 473–483.
    1. Weathers, F. W., Keane, T. M., & Davidson, J. R. (2001). Clinician administered PTSD scale: A review of the first ten years of research. Depression and Anxiety, 13(3), 132–156. 10.1002/da.1029
    1. Zeng, X., Chio, F. H. N., Oei, T. P. S., Leung, F. Y. K., & Liu, X. (2017). A systematic review of associations between amount of meditation practice and outcomes in interventions using the four immeasurables meditations. Frontiers in Psychology, 8, Article 141. 10.3389/fpsyg.2017.00141

Source: PubMed

3
Subscribe