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Can Mindfulness Tease Apart PTSD and Comorbid Depression?

January 31, 2023

Josh Kaplan, PhD
Reposted from IONS

It is important to note that mindfulness-based interventions

should not be used as a substitute for professional treatment,

and individuals with comorbid depression should always seek

the guidance of a mental health professional. - LTC

Depression often comes along with trauma

Traumatic stress can result from many different experiences, including those that are dangerous or shocking, and can cause people to feel and think differently about the world around them. For example, someone who survived a car crash might start to feel anxious whenever they hear a car screech to a stop, or may start noticing themselves believing the world is a basically unsafe place. People that experience traumatic stress – and the mental health diagnosis it causes, posttraumatic stress disorder (PTSD) – are also more likely to develop other conditions, including depression. We examined this connection in a recent study.

So what exactly is comorbid PTSD and depression?

Even though this is a common phenomenon, we don’t understand why it occurs so frequently. Some researchers believe that PTSD and depression might actually represent a new, unclassified disorder, while others have suggested that the categories we’ve created to describe these disorders have too much overlap – in other words, how we define depression is just too similar to how we define PTSD. Some other research studies have found that PTSD might actually be a risk factor for depression, causing individuals with PTSD to be more likely to develop depression in the future. Regardless, we do know that individuals who suffer from both PTSD and depression experience a huge amount of distress, and show increased suicide attempts and decreased quality of life. Treatments for comorbid PTSD and depression are also quite tricky, and are much more complicated when these disorders occur together versus treating either one alone.

Mindfulness may be helpful

Although a small number of research studies have suggested that mindfulness might help to address the problem of comorbid PTSD and depression, we don’t have a good sense of the specific aspects of mindfulness that might be the most helpful. For example, nonjudging of inner experience may help people who suffer from these conditions be more accepting of their uncomfortable internal experiences, such as a depressed mood or trauma-related thoughts, as opposed to feeling compelled to fight against those experiences every step of the way. Other elements of mindfulness, including acting with awareness (i.e., engaging fully in the present moment) or nonreactivity to inner experience (i.e., allowing internal experiences to pass out of our awareness without attachment) may have a similar effect on comorbid depression and PTSD. The truth is that these questions need to be answered if we hope to improve the effectiveness of mindfulness for PTSD and depression.

We recently sought to address some of these unknowns by examining whether veterans with PTSD with higher dispositional (or pre-existing) levels of mindfulness might show a weaker relationship between PTSD and depression. That is, would these individuals higher in mindfulness perhaps be less likely to develop depression in the future? Our analyses revealed that of the three specific elements of mindfulness we tested (nonjudging of inner experience, acting with awareness, and nonreactivity of inner experience), nonreactivity appeared to be the most meaningful in separating PTSD from depression. While this area of research is still very much underdeveloped, we have a few thoughts regarding why we observed these findings.

Why might nonreactivity be particularly helpful

First, individuals high in nonreactivity think about their stress differently, and it’s likely that this extends to stress caused by PTSD. As we mentioned earlier, nonreactivity to inner experience allows people to avoid getting attached or too tangled up in uncomfortable thoughts or feelings. Since depression is often characterized by rumination – or repetitive negative thoughts – nonreactivity may help these people allow these thoughts to come and go more easily, thus reducing the likelihood of depression developing. Nonreactivity also encourages cognitive reappraisal, or the ability to reframe a bad situation so it doesn’t seem quite as bad. This skill is highly related to reducing activation of the amygdala, a key brain region related to stress and one that is related to both PTSD and depression.

Although we’re excited by these findings and the implications they may have for the future of this area of study, we are still woefully short on high-quality studies investigating mindfulness for PTSD, let alone common secondary complications related to trauma. We hope that this study might represent the next step in getting more detailed and specific in our research in this area.

Getting there together...

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