How Gentle Eastern Mindfulness Can Reform Western Traditional PTSD Treatment

Let’s take a closer look at John’s story. He is a veteran who returned home after a long deployment in a combat zone. Since then, he has been haunted by flashbacks full of details and nightmares that are too vivid. His PTSD symptoms force him to avoid everyday environments that remind him of the war, such as loud noises or crowded places. John also unintentionally isolates himself from others and finds it difficult to trust people or feel safe in daily life. He avoids talking about his experiences and is often on edge, even in the safety of his own home, constantly on alert for danger.

John has tried traditional PTSD treatments, such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). This therapy requires him to directly confront and process trauma memories. The therapist asks him to talk in detail about his combat experiences and re-experience painful memories through a technique called imaginal exposure, then change his views about those experiences, primarily focusing on guilt or self-blame. At times, he is required to watch news reports related to war or go into places resembling combat zones. John finds the emotional pressure overwhelming when revisiting traumatic memories, and he is not ready to confront them, so he resists the treatment, finding it too painful and intense. Over time, this treatment becomes an ineffective process that only increases his suffering and disappointment.

In desperation, John tried CoMET (Compassion-Oriented and Mindfulness-Based Exposure Therapy) upon a friend's recommendation. CoMET is different from directly confronting the trauma; it focuses more on helping John learn to approach painful memories and emotions in a gentler, more accepting way. CoMET first helps John develop mindfulness awareness of his thoughts, emotions, and bodily sensations without judgment. John learns how to observe his emotions through mindfulness when he encounters trauma-related flashbacks or thoughts, attempting to prevent being overwhelmed by them. Furthermore, self-compassion is a key component of the treatment, primarily guiding John to offer himself care during difficult times, rather than self-blame. John does not directly confront the most painful trauma memories. CoMET uses a graduated exposure approach, where he gradually re-engages with situations he has been avoiding, like entering crowded places, but starting with lower-pressure situations. This might begin with sitting in a quiet public place and gradually progressing to more challenging situations. The first half of the therapy focuses only on developing mindfulness and self-compassion skills. Only after John has mastered these skills does he apply them to more challenging situations. This phased treatment approach ensures that John has the necessary tools to manage emotions before facing difficult situations.

Aspect	Traditional PTSD Treatment (TF-CBT)	CoMET
Focus of Therapy	Directly process trauma memories, including imaginal exposure	Develop mindfulness and self-compassion first, then use graduated exposure
Exposure Method	Directly face trauma memories	Gradually expose to avoided situations, starting with low-pressure scenarios
Emotion Regulation	Cognitive restructuring and emotional processing	Develop mindfulness to regulate emotions and self-compassion skills
Treatment Progress	Address trauma-related content immediately	Build skills first, then begin exposure
Treatment Adaptability	May be challenging for individuals with severe avoidance behaviors	More suitable for individuals with high avoidance or those unwilling to directly confront trauma
Neurophysiological Effects	Less focus on neurophysiological impact	Mindfulness and self-compassion combination affects brain activity (e.g., increases in alpha waves)

For John, CoMET offered a gentler, more supportive approach to therapy, especially considering his intense avoidance behavior and emotional numbness due to trauma. Compared to traditional PTSD treatment, CoMET first helped him build mindfulness and self-compassion skills, enabling him to gradually face painful emotions and situations. This approach may make the therapeutic process feel more manageable and compassionate, helping John regulate his emotions when confronting trauma, thus allowing him to gradually cope with his traumatic experiences in a more bearable way.

This is exactly what the researchers in today’s article, An 8-week Compassion and Mindfulness-Based Exposure Therapy Program Improves Posttraumatic Stress Symptoms, by Kumar et al. (2023), explored in their study. Unlike many treatments that focus on full PTSD, this program targets individuals who have post-traumatic stress symptoms but do not meet the full criteria for PTSD.

The coolest part is that the researchers compared the CoMET intervention group with a waitlist control group, which reflects the non-treatment that people with PTSS are more likely to experience. Additionally, they measured brain changes through EEG (electroencephalogram)!

First, Post-Traumatic Stress Symptoms (PTSS) and Post-Traumatic Stress Disorder (PTSD) are both reactions to traumatic events, but there are some key differences between them:

• PTSS, also known as Acute Stress Disorder (ASD), typically develops within 30 days of the trauma. PTSS includes intense and disruptive symptoms like intrusive thoughts, nightmares, avoidance behaviors, and hyperarousal. These symptoms can be severe but often improve over time.

• PTSD is a more persistent and debilitating condition with symptoms similar to PTSS, but these symptoms last longer than one month and significantly impact daily life.

• PTSS is not a formal diagnosis, but it is often considered a precursor to PTSD.

A range of symptoms of PTSD includes:

• Intrusive memories of the traumatic event, such as flashbacks or nightmares.

• Avoidance of places, people, or situations that remind them of the trauma.

• Negative thoughts and feelings, such as guilt, shame, or emotional detachment.

• Hyperarousal, such as being easily startled, having difficulty sleeping, or feeling on edge.

CoMET is an 8-week program combining mindfulness, compassion, and exposure therapy. Imagine learning how to remain kind to yourself and handle emotions better as you gradually face things you have been avoiding.

Mindfulness involves cultivating non-judgmental awareness of thoughts, emotions, and bodily sensations, helping individuals maintain psychological distance from their experiences and respond in a non-reactive manner. Self-compassion focuses on treating oneself with warmth, care, and validation during difficult times.

The program is divided into two parts:

• The first four weeks focus on practicing mindfulness and compassion skills to help individuals coexist better with their emotions and thoughts.

• The next four weeks integrate these skills with graduated exposure, gradually facing the individual's avoided situations.

• Homework: Participants are encouraged to continue practicing mindfulness and self-compassion between sessions. This is key to making real progress.

The study involved 28 participants, primarily women (27 women, 1 man), aged 18 to 39, all of whom had post-traumatic stress symptoms but did not meet PTSD diagnostic criteria. These participants had experienced trauma (e.g., sexual assault or physical harm) but were still able to maintain a certain level of daily life, social, and professional functioning. Those with other mental disorders, substance abuse issues, or heavy smoking habits were excluded.

They found that CoMET participants showed a significant reduction in PTSS symptoms (from clinical to non-clinical levels), with significant improvements in emotional dysregulation and experiential avoidance. Their mindfulness, self-compassion, and quality of life also significantly improved. At the same time, brain connectivity was enhanced: EEG analysis revealed that the CoMET group had increased alpha-band connectivity, which involved the amygdala (the brain’s fear center). Moreover, the brain connectivity changes, especially the increase in alpha-band waves, suggest that CoMET may help improve emotional regulation on a neurophysiological level. This could explain why participants experienced significant improvements in emotional regulation. CoMET led to significant increases in mindfulness skills and self-compassion, measured by the Five-Facet Mindfulness Questionnaire (FFMQ) and the Self-Compassion Scale (SCS). These alpha-band connectivity changes occurred from mid- to post-intervention, indicating that mindfulness and self-compassion techniques during graded exposure may directly affect brain activity. Given the amygdala’s central role in fear and trauma responses, the increased connectivity within the network involving the amygdala suggests that CoMET may promote emotional regulation on a neurological level, aiding in processing and regulating emotional responses.

In summary, the study tells us that combining mindfulness and self-compassion helps you process emotions in a healthier way, rather than criticizing yourself. By enhancing mindfulness and self-love, we retrain the brain to process emotions in a more positive way, especially when facing fear.