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Home > Public Resources > Trauma Blog > 2015 - October > Mindfulness and Self-compassion in Returning War Veterans: Relationships with PTSD Symptom Severity

Mindfulness and Self-compassion in Returning War Veterans: Relationships with PTSD Symptom Severity and Functional Disability

October 9, 2015


Since the start of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OEF), and Operation New Dawn (OND), posttraumatic stress disorder has received immense empirical attention and is identified as one of the “signature injuries” of these wars. Prevalence rates for clinically significant levels of PTSD are as high as 23% in returning service members (e.g., Fulton et al., 2015). Extensive literature documents a strong association between PTSD and functional impairment across multiple domains (see Rodriguez, Holowka, & Marx, 2012 for a review). While there are several efficacious treatments for PTSD, these treatments are often less effective in veteran samples (Steenkamp & Litz, 2013). Therefore, greater understanding of modifiable factors that influence PTSD and functional impairment is needed to enhance treatment efforts and aid in the readjustment of war veterans. Two such modifiable traits are mindfulness and self-compassion.

Broadly defined, mindfulness entails being aware of present moment experiences in a clear and balanced manner (Brown & Ryan, 2003). It is a metacognitive skill that involves self-regulation of attention and relating to one’s experience with a stance of acceptance and curiosity (Bishop et al., 2004). Both mindfulness and self-compassion are notions drawn from Buddhist psychology, and mindfulness is a core component of self-compassion (Neff & Dahm, in press). Recently pioneered in the research by Kristin Neff (2003a), self-compassion is a powerful and relevant construct that directly targets the avoidance and negative emotional states typically found in posttraumatic stress reactions.  Self-compassion is comprised of three interacting components: mindful awareness of suffering, self-kindness, and a sense of common humanity. It involves acknowledging the difficulty of the experience, responding inward with kindness and support, and remembering that suffering is part of the common, shared human experience.  Conversely, a lack of self-compassion includes self-judgment in response to experiencing emotional distress, over-identification with or clinging to negative thoughts and feelings, and isolation. Self-compassion is positively associated with well-being in multiple life domains (Neff, 2012) and negatively associated with a range of psychopathology (MacBeth & Grumley, 2012), including PTSD symptom severity in war veterans (Hiraoka et al., 2015).

In this study, we examined the associations of mindfulness and self-compassion with PTSD symptom severity and functional disability in trauma-exposed Iraq-Afghanistan combat veterans. As expected, we found that mindfulness and self-compassion were each uniquely, negatively associated with PTSD symptom severity. In addition, after accounting for mindfulness, self-compassion accounted for unique variance in PTSD symptom severity. When examining associations with functional disability, we found that mindfulness and self-compassion were each uniquely associated with disability even after accounting for PTSD symptom severity. In addition, after accounting for mindfulness, self-compassion accounted for unique variance in disability.

These findings suggest that mindfulness and self-compassion may impact how veterans relate to trauma-related distress.  Specifically, greater levels of mindfulness and self-compassion may help to minimize the effects of traumatic experiences on veterans’ overall functioning.  Cultivating mindfulness and self-compassion may provide skills to help veterans approach their trauma-related symptoms from a more balanced perspective, so that symptoms are neither avoided nor exacerbated. Our results also found that self-compassion was associated with functional disability above and beyond PTSD symptoms and mindfulness. This may be because self-compassion provides an additional component of turning kindness and support inwards during moments of distress. It is a powerful form of emotional intelligence that teaches how to be aware of and cope with negative emotions without being hijacked by them (Neff, 2011). Due to these factors, it may be particularly important to target the unique aspects of self-compassion along with mindfulness to minimize the impact of trauma-related distress on functioning. One recently developed group intervention that explicitly teaches mindfulness and self-compassion skills is Mindful Self-Compassion (MSC: Neff & Germer, 2013). MSC not only targets avoidance by focusing on acceptance of present moment experiences but also includes self-soothing skills to help individuals better tolerate negative thoughts and emotions.

More research is warranted to determine whether compassion-focused treatments are efficacious in a veteran population and how they impact symptoms of PTSD and disability.  As an intervention, self-compassion provides encouraging ways of relating to negative experiences and identifying with others in times of suffering. It is an inspiring treatment component that teaches the skills to be an inner ally – rather than an inner enemy – and may assist in the complex adjustment and mental health concerns of our returning veterans.
 

Discussion Questions

  • Could mindfulness and self-compassion help facilitate recovery from trauma in combat veterans?
  • In what ways can mindfulness and self-compassion exercises be incorporated with evidenced-based treatments for PTSD?
  • Could teaching mindfulness and self-compassion to service members prior to deployment promote resilience and emotional intelligence in combat?
 

Reference Article: 

Dahm, K., Meyer, E.C., Neff, K., Kimbrel, N.A., Gulliver, S.B., & Morissette, S.B. (2015). Mindfulness, self-compassion, posttraumatic stress disorder symptoms, and functional disability in U.S. Iraq and Afghanistan war veteransJournal of Traumatic Stress, 28, 460-464. DOI: 10.1002/jts.22045
 

Author Bio

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Katherine Dahm, Ph.D.
is a clinical psychologist at Jesse Brown VA Medical Center in Chicago, IL. She focuses her work in the PTSD Clinic and also serves as Military Sexual Trauma Coordinator for the hospital.
 

References

Bishop, S., Lau, M., Shapiro, S., Carlson, A., Segal, Z., & Carmody, A., et al. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230-250. doi:10.1093/clipsy/bph077

Brown, K., & Ryan, R. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822 - 848. doi:org/10.1037/0022-3514.84.4.822

Fulton, J. J., Calhoun, P. S., Wagner, H. R., Schry, A. R., Hair, L. P., Feeling, N., ... & Beckham, J. C. (2015). The prevalence of posttraumatic stress disorder in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans: A meta-analysis. Journal of anxiety disorders, 31, 98-107. doi:10.1016/j.janxdis.2015.02.003

Hiraoka, R., Meyer, E.C., Kimbrel, N.A., DeBeer, B.B., Gulliver, S.B., & Morissette, S.B. (2015). Self-compassion as a prospective predictor of PTSD symptom severity among trauma-exposed U.S. Iraq and Afghanistan war veterans. Journal of Traumatic Stress, 28, 1-7. doi: 10.1002/jts.21995

MacBeth, A., & Gumley, A. (2012). Exploring compassion: A meta-analysis of the association between self-compassion and psychopathology. Clinical Psychology Review, 32, 545-552. doi:10.1016/j.cpr.2012.06.003
Neff, K. D. (2003a). Self-compassion: An alternative conceptualization of healthy attitude towards oneself. Self and Identity, 2, 85-102. doi: 10.1080/15298860309032

Neff, K. D. (2003b). Development and validation of a scale to measure self-compassion. Self and Identity, 2, 223-250. doi: 10.1080/15298860309027

Neff, K.D. (2011). Self compassion: The proven power of being kind to yourself. New York,       NY: Harper Collins.

Neff, K. D. (2012). The science of self-compassion. In C. Germer & R. Siegel (Eds.), Compassion and wisdom in psychotherapy (pp. 79–92). New York, NY: Guilford Press.

Neff, K.D. & Dahm, K.A. (in press). Self-compassion: What it is, what it does, and how it relates to mindfulness. To appear in M. Robinson, B. Meier, & B. Ostafin (Eds.). Mindfulness and Self-Regulation. New York: Springer.

Neff, K. D., & Germer, C. K. (2013). A Pilot Study and Randomized Controlled Trial of the Mindful Self-Compassion Program. Journal of Clinical Psychology, 69(1), 28-44. doi: 10.1002/jclp.21923

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Rodriguez, P., Holowka, D. W., & Marx, B. P. (2012). Assessment of posttraumatic stress disorder–related functional impairment: A review. Journal of Rehabilitation Research and Development, 49(5), 649-666. doi:10.1682/JRRD.2011.09.0162

Steenkamp, M. M., & Litz, B. T. (2013). Psychotherapy for military-related posttraumatic stress disorder: Review of the evidence. Clinical Psychology Review, 33(1), 45-53. doi:10.1016/j.cpr.2012.10.002