Clinical Practice Guidelines on the Use of Integrative Body-Mind-Spirit (I-BMS) Treatment for People with Post-Traumatic Stress Disorder (PTSD)

Background: Post-Traumatic Stress Disorder (PTSD) is a psychological injury that can develop in response to exposure to an extreme traumatic event, and may include symptoms such as re-experiencing, avoidance, hyper arousal, and negative cognitions or mood. In the United States, approximately 10% of females and 4% of males will develop PTSD in their lifetime, and about 8 million adults have PTSD in any given year. However, traditional treatments have limited effects because of the high risk of re-exposure and high dropout rate. A growing interest in integrative body-mind-spirit (I-BMS) approaches to treatments of PTSD has resulted in a significant increase in related research. This study conducted a systematic review of randomized clinical trials of I-BMS treatments for PTSD to provide a practical guide to evidence-based complementary or alternative therapeutic modalities for post-traumatic stress.

Method: A systematic review of randomized controlled trial I-BMS treatments for PTSD was conducted. Recommendations were based on studies identified through electronic databases including EBSCO-host, PubMed, Cochrane systematic review, Campbell Systematic Review, and SSCI from January 2004 through December 2015. After the title and abstract review, there were 26 articles located. A subsequent full review resulted in 11 eligible articles. I-BMS treatments include: mindfulness and meditation (5), yoga (3), spiritually-related intervention (2), and relaxation training (1). Articles were rated by quality scoring systems - a Modified Delphi List Scale (score 0-7) to assess methodological rigor. The California evidence-based clearinghouse (CEBC) for child welfare scientific rating scale was also used for each intervention category to evaluate the level of research support. Scores were rated by two independent reviewers.

Results: None of the I-BMS interventions demonstrated negative outcomes, although inconclusive results were found in yoga and mindfulness/ meditation; and no effect was found for relaxation. The mean quality scores based on the Modified Delphi List were 6.2 for meditation and mindfulness-based intervention, 5.3 for yoga, 3.5 for spiritually-related intervention, and 4.0 for relaxation training. Spiritually-related interventions are recommended as practices with Supported by Research Evidence (Level 2) for PTSD; meditation and mindfulness-based intervention, yoga are all recommended as practices with Promising Research Evidence (Level 3), while relaxation cannot be rated based on the CEBC scale.

Implications: This study demonstrated that spiritually-related interventions, meditation and mindfulness-based interventions, and yoga are rated as high quality practices for PTSD, while there is not enough evidence to evaluate the level of relaxation training. The majority of treatments are considered to be promising practice, but not well supported based on CEBC scale. The primary reason for this lower ranking is a lack of long-term (6-12 month after termination) estimation of the effects. Only one study has a 2-year follow-up, and average follow-up length is 1.9 months for the other studies. Overall, there is support for I-BMS practices for PTSD as effective and safe approaches to treatment. Future studies should assess long-term effects in order to further elevate the level of research support.