Biomarker Response to Mindfulness Intervention in Veterans Diagnosed with Post-traumatic Stress Disorder

• Authors: Itamar Shapira, UAB Heersink School of Medicine; Joshua Richman, UAB Heersink School of Medicine; Thaddeus Pace, Emory University; Kelvin O Lim, University of Minnesota, Minneapolis; Melissa A Polusny, University of Minnesota, Minneapolis; Mark B Hamner, Ralph H. Johnson VA Medical Center; James Bremner, Emory University; Mercy N Mumba, Tuscaloosa VA Medical Center; Lindsey M Jacobs, Tuscaloosa VA Medical Center; Patricia Pilkinton, Tuscaloosa VA Medical Center; Lori L Davis, Tuscaloosa VA Medical Center
• Journal Title: MINDFULNESS
• Volume: Volume 13, Number 10
• Publisher: SPRINGER | 2022-09-12, Pages 2448-2460
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1007/s12671-022-01969-6
• Subjects: Health Sciences, Medicine and Surgery; Psychology, Behavioral; Health Sciences, Mental Health; Health Sciences, Nursing
• Keywords: Social Sciences; Science & Technology; Life Sciences & Biomedicine; Psychology, Clinical; Psychiatry; Psychology; Post-traumatic stress disorder; Mindfulness; Meditation; Cortisol; Inflammatory markers; Mindfulness-based stress reduction; Veterans; RANDOMIZED-TRIAL; CORTISOL; PTSD; EXPOSURE; DEPRESSION; REACTIVITY; REDUCTION; VALIDITY; THERAPY; RISK

Abstract

Objectives: This study evaluates the effects of treatment with mindfulness-based stress reduction (MBSR) compared to the active control, present-centered group therapy (PCGT), on morning plasma cortisol, interleukin-6 (IL-6), and C-reactive protein (CRP) in veterans diagnosed with post-traumatic stress disorder (PTSD). Methods: In a post hoc exploratory analysis, we pooled biomarkers and clinical outcomes of mindfulness, PTSD, and depression from two randomized controlled trials comparing MBSR (n = 104) to PCGT (n = 106) in U.S. military veterans diagnosed with PTSD. Linear mixed-effects modeling was used to evaluate associations between changes in biomarkers and clinical outcomes from baseline to 9-week primary endpoint and 16-week follow-up endpoint. Results: Cortisol levels were inversely related to self-reported PTSD symptoms at baseline (p = 0.02). Cortisol increased from baseline to 9-week endpoint for both groups, but significantly less so in the MBSR group compared to PCGT group (mean difference 1.69 ± 0.8 SE; p = 0.035). Changes in IL-6 and CRP did not differ between groups at either baseline or week 9. From baseline to week 9, increased mindfulness was significantly associated with increased cortisol (p = 0.02) and decreased PTSD and depression severity (p < 0.01). Increased IL-6 and CRP were significantly associated with decreased PTSD severity (p < 0.05), but not depression. Pooled analysis corroborated earlier findings that MBSR is significantly better than PCGT in improving clinical outcomes. Increased mindfulness was strongly associated with improved symptoms. Conclusions: Increased mindfulness is associated with a recalibration of cortisol levels which may be indicative of therapeutic response, especially in patients with lower baseline cortisol. Furthermore, mindfulness-based practices improve symptoms of PTSD and depression in a significant correlation with self-reported levels of mindfulness. Clinical Trial Registration (clinicaltrials.gov): NCT01532999 and NCT01548742.