Meditation as Trauma Therapy: A Cognitive Neuroscience ...

Meditation as Trauma Therapy: A Cognitive Neuroscience Perspective

Peter J. Bayley, Ph.D.

War Related Illness and Injury Study Center (WRIISC)

VA Palo Alto Health Care System

Clinical Assistant Professor (Affiliated)

Department of Psychiatry and Behavioral Sciences, Stanford University

&

Ram Chelakara, PhD.

Faculty: International Association for Human Values

28th Annual Trauma Conference, Boston, MA 2017

Workshop Outline

Subtle Yoga

Meditation as a treatment for PTSD

Pilot study – Sudharshan Kriya Yoga (SKY) as a

treatment for PTSD

Effects of SKY on cognition and sleep

Bhastrika Break

Sleep to forget and sleep to remember (SFSR)

model of emotional memory processing

Current study – SKY vs. Cognitive Processing

Therapy for treating PTSD

Experience a taste of SKY

Project Welcome Home Troops

Sukshma Yoga- Subtle Yoga

Risk For Suicide is Higher Among Veterans When Compared With U.S. Civilian Adults

In 2014, an average of 20 Veterans died by suicide each day. Six of

the 20 were users of VHA services

In 2014, Veterans accounted for 18 percent of all deaths by suicide

among U.S. adults and constituted 8.5 percent of the U.S. adult

population

In 2014, rates of suicide were highest among younger Veterans

(ages 18–29) and lowest among older Veterans (ages 60+).

Suicide rate among recent Veterans is 50 % higher than non-

military civilians.

US Dept. of Veterans Affairs (2016), Office of Suicide Prevention

Current Treatments for PTSD

Pharmaceutical

Therapeutic: Exposure/Cognitive Behavioral

Problems

Overall: High dropout

Pharmaceutics: aversive side effects, results mixed

Therapy: difficulty revisiting trauma; substantial residual effects

Stigma

Unwillingness to be a victim/dependent & rely on drugs/therapist

Post-Traumatic Stress Disorder (PTSD) Diagnostic Criteria – DSM-5

Anxiety disorder that develops after exposure to trauma:

A. Exposure to actual or threatened death/injury

B. Intrusion Symptoms (thoughts, distressing dreams, dissociative reactions)

C. Avoidance Symptoms (memories, thoughts, feelings)

D. Negative cognitive and mood symptoms (amnesia for event, detachment

from others)

E. Arousal and reactivity (hyper-vigilance, Startle, Anxiety, Insomnia)

Meditation is effective for treating PTSD: Systematic Review and Meta-Analysis

10 trials (N=643)

Cohen’s d = 0.41; CI [0.81, 0.01]

PTSD symptoms for adjunctive meditation interventions were statistically

significantly different compared with all comparators in favor of meditation

Substantial heterogeneity in study quality

Hilton et al., (2016) Psychol Trauma

Sudarshan Kriya Yogic (SKY) Breathing

Prana – translates to “life force” or “energy”

Pranayama- “control of energy” and “expansion of energy”

Breathing techniques have potential to relieve stress-related illness including

-anxiety

-depression

-PTSD

Breathing under both voluntary and involuntary control via complex feedback

loops involving

- autonomic visceral networks

-brains stem nuclei

- limbic system

- cortical areas

- neuroendocrine system

By voluntarily controlling breathing it is possible to influence these networks

and hence mood and cognition.

Sudarshan Kriya Yogic (SKY) Breathing Developed by Sri Sri Ravi Shankar, cofounder of the

International Association for Human Values

International Association of Human Values holds special

consultative status with the United National Economic

and Social Council (ECOSOC).

Widely used across many cultures

Follows a reproducible sequence

Research and clinical experience demonstrates it

significantly alleviates

Stress

Anxiety

Depression

SKY has 4 breath components

1. Three-stage pranayam using ujjayi – 2-4 breaths per minute. Subjective

experience of mental and physical calmness with alertness

2. Bhastrika – (Bellows Breath) – air is rapidly inhaled and forcefully exhaled at 30

breaths per minute. It engenders excitation followed by calmness

3. Chanting of “om” chanted 3 times with very prolonged expiration.

4. Sudarshan Kriya (cyclical breathing) –an advanced form of cyclical breathing at

various rates.

SKY courses also include: Yoga-based stretching

Guided relaxation after the practice

Aspects of CBT and psychoeducation

Group exercises to teach self-awareness, connectedness and create a sense of

community

Effects Of A Yoga Breath Intervention Alone And In Combination With An Exposure Therapy For PTSD In Survivors Of The 2004 South-east Asia Tsunami

Group Mean PCL-17 Test Scores Changes in Mean Test

Scores ± SD

Base

1

week

6

weeks

12

weeks

24

weeks 0-6 weeks 0-24 weeks

Yoga

breath66.5 27.5 23.9 26.7 20.6 42.5 ± 10.0 45.5 ± 9.6

Yoga

breath+

trauma

reduction

therapy

64.1 _ 24.6 27.0 19.6 39.2 ±17.2 44.6 ± 11.3

Wait list

control67.9 _ 63.3 _ _ 4.6 ± 13.2 _

• N=183: Initial PCL moderate/severe (> 50)

• Yoga breath:8-hrs given in 2-h sessions over four consecutive days

• Traumatic Reduction Therapy: 3-5 individual sessions lasting 1–3 hrs per

session, addressing trauma

Descilo et al., (2010) Acta Psychiatr Scand

Is Meditation Effective for Post-Traumatic Stress Disorder (PTSD)?

Design21 Male Participants

• Inclusion criteria: OEF/OIF veteran

• Exclusion criteria: substance dependence, psychosis, alpha/beta blockers, severe TBI/

cognitive impairment

• 2 Groups (Active Group N = 11, Wait-List Control Group N = 10)

• Groups matched for ethnicity, education, marital status, combat exposure and PTSD

symptoms

• Average Age = 28 (range = 22 to 45)

• Ethnicity (90% European-American, 10% Asian-American)

Longitudinal Design

TIME 1: Pre Questionnaires, Psychophysiology, Neuropsych Testing (SKY N=11,

CNTRL N=10)

TIME 2: Post Questionnaires, Psychophysiology, Neuropsych Testing (SKY N=10,

CNTRL N=10)

TIME 3: 1 month post Questionnaires (SKY N=8, CNTRL N=8)

TIME 4: 1 year post Questionnaires (SKY N=9, CNTRL N=8)

Seppala et al. (2014) J. Traumatic Stress

- SKY Breathing

- Gentle yoga

- Meditation

- Group processes

- Discussion

Seppala et al. (2014)

J. Traumatic Stress

Intervention: 7-day, 24-hour Breath-Based Meditation Intervention SKY

PTSD and Anxiety were Reduced in the SKY group

Control SKY Control SKY

PTSD Anxiety

0

5

10

15

Time 1 Time 2 Time 3 Time 4

Hyp

erar

ou

sal (

PC

L-D

)

PCL, F(2.03, 57) = 4.46, p < .02, ηp2 = .19

PCL-D F(2.21, 57) = 6.51, p < .003, ηp2 = .26

Seppälä et al. (2014) J. Traumatic Stress

Startle was reduced in theSKY group

0

5

10

15


Hyp

erar

ou

sal (

PC

L-D

)

PCL, F(2.03, 57) = 4.46, p < .02, ηp2 = .19

PCL-D F(2.21, 57) = 6.51, p < .003, ηp2 = .26

-15

-10

-5

0

5

-300 -200 -100 0 100

Ch

ange

inH

yper

aro

usa

l (P

CL-

D)

Change in Startle (µv)

r = .90, p < .001

Fisher’s z = 2.93, p < .004


Startle was reduced in theSKY group

Respiration was reduced in the SKY group

0

4

8

12

Time 1 Time 2

Res

pir

atio

n C

ou

nt

F(1, 19) = 7.83, p < .02, ηp2 = .29


Sleep quality was improved in the SKY group

0

5

10


Slee

p P

rob

lem

s (P

SQ)

PSQ, F(3.00, 57) = 2.77, p < .05, ηp2 = .13


10000

10500

11000

11500

12000

12500

13000

13500

Time 1 Time 2

SKY

WLC

Tim

e to F

inis

h (

ms)

F(1, 19) = 4.45, p < .05, ηp2 = .19

Spatial Working Memory (CANTAB) was improved in the SKY group

Follow-up Study Based on Mechanism of Action

Mechanisms of SKY meditation are currently

unclear

Mechanism is important to define in order to

refine treatment

From the perspective of cognitive neuroscience,

potential mechanisms may relate to changes in

sleep and memory processing

Post-Traumatic Stress Disorder (PTSD) Diagnostic Criteria – DSM-5

Anxiety disorder that develops after exposure to trauma:

A. Exposure to actual or threatened death/injury

B. Intrusion Symptoms (thoughts, distressing dreams, dissociative reactions)

C. Avoidance Symptoms (memories, thoughts, feelings)

D. Negative cognitive and mood symptoms (amnesia for event, detachment

from others)

E. Arousal and reactivity (hyper-vigilance, Startle, Anxiety, Insomnia)

Sleep problems represent two of the diagnostic criteria for PTSD in DSM-5

B2: recurrent distressing dreams in which

the content and/or affect of the dream are

related to the traumatic event.

E6: sleep disturbance (e.g., difficulty falling

or staying asleep or restless sleep).

Treatment Groups

CPT-C

Manualized VA treatment

for PTSD

Revising maladaptive

cognition;

-responsibility

-trust

-intimacy

6 weeks

2 x 1 hour sessions per

week

Licensed Clinical

Psychologist

SKY

6 weeks

5-day intensive group

class (2.5 hours/day)

2 x 1 hour sessions per

week for five weeks

Assessments

Bhastrika Break(Bellows Breath)

The Paradox of Traumatic Memory

Emotionally salient memories are more

persistent and vivid than non-emotional

memories, but normally there is a gradual

reduction in emotional salience over time

Why don’t traumatic memories fade over time?

Semantic Non-personal Memory Fades With Time: Performance On A Test Of News Events That Occurred From 1951 To 2005

Bayley, P. J., Hopkins, R. O., & Squire, L. R. (2006). J Neurosci

N=13

age = 51.6 y

Autobiographical memory is more enduring: performance on the Autobiographical Interview

0

3

6

9

Recent Early adult Childhood

Sc

ore

Time Period

Bayley, P. J., Hopkins, R. O., & Squire, L. R. (2006). J Neurosci

The Affect Associated With Unpleasant Events Fades Faster Than The Affect Associated With Pleasant Events

Mean C

hange in I

nte

nsity R

atings

Pleasant Unpleasant

Pleasantness

Walker, Vogl & Thompson (1997), Applied Cognitive Psychology

Memory Consolidation

Memory consolidation during sleep allows

memories to be integrated with existing

memories

Memory consolidation may involve

decoupling of emotion and memory during

REM sleep (Walker).

REM sleep may be chronically impaired,

or defragmened (Melman) in PTSD so

emotional “tag” is not removed from the

trauma memory

Sleep To Forget And Sleep To Remember (SFSR) Model Of Emotional Memory Processing

van der Helm & Walker, 2009, Psychol Bull

Indoor or Outdoor?

Study

Same, Similar, or New?

same

Test


Test

new


Test

similar


same

Test

Study Test (“similar”)

Similar Items Test For Pattern Separation: Distinct, Minimally Overlapping Memory Representation – DG and CA3 Region of Hippocampus

Study Test (“same)

Same Items Test For Pattern Completion: Stored Memory Representations Reactivated From Degraded Or Noisy Cues In A Process Of Generalization-CA1 region of hippocampus

4:00 PM 10:00 AM

Overnight Delay

Consolidation

Study and

Immediate

Test

Delayed Test

Sleep Has A Beneficial Effect On Pattern Separation

Patt

ern

Separa

tion S

core

Immediate 12hr

Study-Test Delay

Pattern separation score =p(sim | lure) – p(sim | novel)

Doxey and Kirwan (submitted)

Immediate 12hr

Study-Test Delay

Recognitio

n M

em

ory

Score

Sleep Has No Effect On Recognition Memory

Recognition memory score =p(old | repeat) – p(old | novel)

PTSD and Cognition

Relationship between PTSD and cognitive functioning is not clear

Typically effects memory, attention, and executive functioning.

Memory problems could be accounted for by attentional difficulties –

e.g., internal distraction due to hyperarousal, hypervigilance, re-

experiencing.

Some anatomical studies show reduced hippocampal volume. This

may be cause or effect.

Possible that standard neuropsychological tests are not sufficiently

sensitive to PTSD, which would be revealed by computerized

cognitive battery.

Summary

Tests of cognition function and sleep are not usually

included in meditation studies.

Tests of cognitive function and sleep provide objective

measures for studies of PTSD and complement self-

reported measures.

Mechanisms of meditation-based therapies are currently

unclear.

Mechanism important to refine and optimally implement

meditation-based approaches.

More research needed on alternative and complimentary

treatments

State-of-the-art relaxation!

Experience

Acknowledgements

Adam Burn

Rachael Cho

Marcelle Friedman

Liya Habte

Stephan Kim

Laura Lazzeroni

Denise Marcus

Danielle Mathersul

Leslye Moore

Denise Richardson

Craig Rosen

Jay Schulz-Heik

Emma Seppala

Julia Tang

Melinda Wong

Steve Woodward

VA RR&D Merit Review Grant

1 I01 RX001485-01

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