Direct Practice Improvement (DPI) Project
Post-traumatic stress disorder (PTSD) has disabling impacts on trauma patients that can sometimes become chronic. Therefore, there is a need to prevent these outcomes through both pharmacological and nonpharmacological needs. This paper aims to describe a direct practice improvement topic concerning treatments for post-traumatic stress disorder that will inform the best modalities through research and scientific evidence.
Trauma is an emotional threat that impacts the victim’s general well-being. Stress resulting from trauma and other related consequences also impacts the patient’s emotional well-being. There are various ways of managing stress and anxiety. Mindfulness-based stress reduction is a treatment strategy that was developed in 1979 by Dr. Jon Kabat-Zinn for stress management (Janssen et al., 2018).
Over the years, it has evolved, and now this treatment strategy has become a treatment program that encompasses treatment for depression, anxiety, and physical diseases such as diabetes, hypertension, and immune disorders. PTSD is a stress disorder that can present with anxiety states and other mood changes, as well as changes in cognitive problems. Antidepressants with selective serotonin reuptake inhibitors are also currently used to manage PTSD symptoms.
Background of the Problem
Inadequate response to emotional and physical threats to an individual’s well-being causes stress. In post-traumatic stress disorder, this stress is characterized by an inappropriate response to reencounter or memory of a stressful or traumatic event (Miao et al., 2018).
In the DMS-5 criteria, intrusion symptoms, negative alterations in mood and cognition, altercations in arousal and reactivity, and most importantly, an actual or threatened trauma from death, injury, or sexual violation (American Psychiatric Association, 2013).
Stress reduction, cognitive behavioral interventions, and exposure-based interventions are some of the key nonpharmacological strategies for PTD symptom reduction. Cognitive behavioral and stress reduction can be based on mindfulness.
According to Janssen et al. (2018), mindfulness-based interventions, even though not related to meditation, improves psychological functioning in stressful environments such as stressful workplace environments. Mindfulness-based interventions focus on attention and conscious awareness of specific traumatic experiences to promote self-regulation of immediate experience.
Theoretical Foundations or Conceptual Framework
The theory of self-efficacy by Albert Bandura focuses on the capacity of an individual to execute actions to achieve intended health outcomes. According to this theoretical model, Bandura postulated that emotional and somatic states contribute to beliefs of self-efficacy (Peterson & Bredow, 2020). These emotional states include anxiety, arousal, mood, and stress.
These are the same emotional states that present in PTSD. To achieve self-efficacy and patient outcomes, modulation of these emotional states can be altered through mindfulness-based interactions. These emotional states also determine the individual’s confidence level in achieving the best positive emotional states (Schunk & DiBenedetto, 2021). Bandura also postulated that generative use of knowledge and self-reflection could determine how a person will think, behave, and respond to threats.
Outline of Review of Literature
Various literature sources have described studies testing the effectiveness of mindfulness-based interventions with mixed results. When used among healthcare professionals to reduce stress, Micklitz et al. (2021) found that mindfulness-based stress reduction is still insufficient. A systematic review by Janssen et al. (2018) found that this intervention is effective in stress reduction among employees.
An older systematic review study by Niazi & Niazi (2011) among patients with chronic illnesses, this nonpharmacological intervention initially designed for stress management is an effective coping strategy that improves the general patient condition. According to (Dubey, 2019), there has been a recent increase in anxiety and related disorders, but the frontline strategies remain ineffective in treatments.
MBSR provides promising potential despite its limited use. Improvements in attention span have been reported. Key themes arising from this literature review are limited documented evidence regarding the effectiveness of MBSR, the rising need to treat anxiety and related disorders, and mixed findings from the existing current literature items.
PTSD is an anxiety-related disorder presenting with mood, anxiety, and stress in the trauma victim. These emotional states impact the individual’s self-efficiency. According to the self-efficacy theory by Bandura in 1977, self-efficacy relies on the individual’s self-confidence in their capacity to achieve the best functioning, including emotional health.
Mindfulness-based interventions that include mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy focus on the individual conscious awareness and attention to current experiences to impact their behavior, thinking, and cognition. Current literature items emphasize the need to establish effective strategies to improve patient outcomes owing to the rising prevalence of anxiety-related disorders such as PTSD.
The current burden of anxiety and anxiety-related states have impacted the quality of health that the patients receive. PTSD is one of the anxiety-related disorders where mindfulness-based stress reduction strategies can improve the outcomes. However, the current literature is limited regarding MBSR effectiveness is contradictory and limited. Mindfulness-based stress reduction (MBSR) was initially developed for chronic pain but has proved effective in other conditions.
Antidepressant and antipsychotic medications are also effective in PTSD symptom improvement. The comparisons of efficiencies and effectiveness of these interventions require scientific evidence-based underpinnings. The use of MBSR is relatively safe, considering the risk of adverse events or effects compared with medications.
Quality interventions need to balance the safety, effectiveness, efficacy, and patient-centeredness of the specific treatments. This study will address the benefits that MBSR has over the current frontline strategies, such as antidepressants.
Sample and Location
The participants of this study will be older adults admitted to the psychiatric primary care setting. They will include mental health patients with significant trauma in the past and who have been diagnosed with PTSD. These patients will be sampled from this primary care setting through convenience sampling. The study targets fifty PTSD patients.
The research question for this study is in a PICOT format. The research question states: “For older adults admitted to the psychiatric primary care setting, will mindfulness-based stress reduction compared to antidepressant medication approaches decrease the prevalence of Post-Traumatic Stress Disorder (PTSD) symptoms in eight weeks?”
This study hypothesizes that mindfulness-based stress reduction can reduce PTSD symptoms. Therefore, the key intervention, MBSR, is expected to impact outcome variables, and the incidence of PTSD symptoms among PTSD patients. Baseline stress levels and other PTSD symptoms will be assessed, and the outcome variable also assessed at the end of eight weeks.
Methodology and Design
This will be a quantitative research study using a quasi-experimental study design. Patients diagnosed with PTSD and those with significant traumatic past will be sampled into two groups, with one group receiving the MBSR intervention while the other group receiving antidepressants without MBSR.
This study aims to compare mindfulness-based stress reduction and antidepressants medication approaches in decreasing the prevalence of Post-Traumatic Stress Disorder (PTSD) symptoms among older adults admitted to the psychiatric primary care setting.
Data on PTSD symptoms will be assessed using the PTSD checklist for DSM-5 by the National Center for PTSD (U.S. Department of Veterans Affairs, n.d.). This is a 5-pointer scale that assesses reexperiencing, avoidance, hyper-arousal, and negative alterations in cognition and mood.
Descriptive statistics and use of T-tests will be used to analyze and compare outcomes between the two groups. Null hypothesis significance testing will be used to assess the significance of the differences between the outcomes in the two groups.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5 (R)) (5th ed.). American Psychiatric Association Publishing.
Dubey, G. (2019, November 15). Benefits & Limitations of Mindfulness Meditation For Anxiety & Depression, According to Science — Critical Thinking. Critical Thinking | Intelligent Speculation. https://www.intelligentspeculation.com/blog/benefits-amp-limitations-of-mindfulness-meditation-for-anxiety-amp-depression-according-to-science
Janssen, M., Heerkens, Y., Kuijer, W., van der Heijden, B., & Engels, J. (2018). Effects of Mindfulness-Based Stress Reduction on employees’ mental health: A systematic review. PloS One, 13(1), e0191332. https://doi.org/10.1371/journal.pone.0191332
Miao, X.-R., Chen, Q.-B., Wei, K., Tao, K.-M., & Lu, Z.-J. (2018). Posttraumatic stress disorder: from diagnosis to prevention. Military Medical Research, 5(1), 32. https://doi.org/10.1186/s40779-018-0179-0
Micklitz, K., Wong, G., & Howick, J. (2021). Mindfulness-based programs to reduce stress and enhance well-being at work: a realist review. BMJ Open, 11(3), e043525. https://doi.org/10.1136/bmjopen-2020-043525
Niazi, A. K., & Niazi, S. K. (2011). Mindfulness-based stress reduction: a non-pharmacological approach for chronic illnesses. North American Journal of Medical Sciences, 3(1), 20–23. https://doi.org/10.4297/najms.2011.320
Peterson, S., & Bredow, T. S. (2020). Middle range theories: Application to nursing research and practice. Wolters Kluwer Health.
Schunk, D. H., & DiBenedetto, M. K. (2021). Self-efficacy and human motivation. In Advances in Motivation Science (pp. 153–179). Elsevier.
U.S. Department of Veterans Affairs. (n.d.). PTSD: National Center for PTSD. Ptsd.va.gov. Retrieved September 1, 2022, from https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp