Mindfulness Treatment for Anger in Veterans With PTSD
Condition: Anger; Aggression
MeSH terms: Aggression
Study type: Interventional

Summary: 
      Research has consistently shown that Veterans with PTSD are more likely to experience higher
      levels of anger and commit aggressive acts compared to Veterans without PTSD. Given the
      significant negative impact that anger and aggression can have on the lives of Veterans,
      their families, and society at large, there is a great need to examine novel interventions
      that could decrease anger and aggression risk with this population. Mindfulness may be one
      such technique, given its effectiveness in assisting individuals in regulating difficult
      emotions and in decreasing physiological reactivity, which have both been implicated in PTSD
      and aggression perpetration. Findings showing that a mindfulness intervention is effective in
      reducing anger and aggressive behavior would be relevant for Veterans with PTSD experiencing
      such difficulties and would help prevent the detrimental consequences that can come from
      anger and aggression among these individuals.
    

Detailed description: 
      Military Veterans suffering from posttraumatic stress disorder (PTSD) have been shown to
      exhibit increases in aggressive urges, difficulties managing anger, and difficulties
      controlling violent behavior. Dysregulated anger and aggression can create fear and distress
      in spouses, family members, and friends resulting in strained and deteriorated relationships,
      and can have a detrimental impact on Veterans' social, occupational and other important areas
      of functioning. In addition, more severe forms of aggression and violent behavior (i.e.,
      homicide) in the community have been observed among Veterans with PTSD, as recently reported
      in several news media outlets. The seriousness of this problem is underscored by the high
      rates of alcohol use observed among Veterans with PTSD which further increases anger and the
      risk of aggressive behavior.

      Current therapeutic interventions may not be effective in reducing anger and aggressive
      behavior among Veterans with PTSD due to the lack of techniques that directly target symptoms
      most strongly associated with aggression, particularly hyperarousal and physiological
      reactivity. Furthermore, existing interventions may not be effective in assisting individuals
      achieve awareness and insight into their anger states, necessary for the effective management
      of anger and aggression. Mindfulness is rooted in Eastern meditation practices and has been
      successfully used to decrease stress, pain, anxiety, and depression. In civilian samples,
      mindfulness interventions have been found to be effective in reducing anger and aggression.
      To date, mindfulness for anger and aggression has not been examined in Veterans with PTSD.

      The primary objective of the proposed investigation is to conduct a pilot randomized control
      trial to examine the initial efficacy of an established mindfulness intervention, Mindfulness
      Based Stress Reduction (MBSR) in decreasing anger and aggression in Veterans with PTSD. The
      proposed investigation also seeks to examine potential mechanisms of action that account for
      its effects. Sixty Veterans with PTSD experiencing problems with anger and aggression will be
      recruited. These individuals will complete a baseline assessment to assess self-reported
      levels of anger and aggression. They will then be randomly assigned to participate in an
      online (i.e., virtual) PTSD psychoeducational course or MBSR. After completing treatment, all
      participants will complete a post-treatment assessment to assess changes in anger and
      aggression.

      At a later date and time, participants will also be asked to attend an in-person laboratory
      session where they will engage in a trauma-imagery procedure followed by a task designed to
      assess provoked aggression. In addition to examining whether participation in MBSR decreases
      self-reported levels of anger and aggression, this study will examine whether MBSR decreases
      aggression in participants after being exposed to trauma reminders in vivo. Potential
      mechanisms of action of MBSR and its effects on additional outcomes also will be explored.
    

Intervention name(s): Mindfulness Based Stress Reduction; Trauma Recovery Education Class
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Mindfulness Based Stress Reduction (MBSR) is a group-based intervention in which participants are taught different mindfulness meditation practices, including body scan (focusing attention to different areas of the body in sequence), sitting meditation (focusing attention to one's breathing), and Hatha yoga postures (focusing attention to different body sensations during gentle stretching). Participants also are taught how to practice mindfulness while engaging in ordinary activities including walking, standing, and eating. MBSR consists of 8, two-hour weekly sessions and will be delivered in group format. MBSR groups will be delivered virtually.; Trauma Recovery Education Class (TREC): TREC is a group based treatment that focuses on providing information on PTSD and traumatic reactions. TREC provides psycho-education to Veterans on PTSD, including common reactions to trauma and the role of avoidance, common problems associated with PTSD, as well as common barriers to care (e.g., stigma, maladaptive beliefs, fear). Additional content focuses on problem identification and goal setting, discussion of current problems and life issues, and treatment planning. TREC consists of 8, one-hour weekly sessions. TREC groups will be delivered virtually.
Other intervention name(s): MBSR; TREC
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: anger; aggression