THE RELAXATION RESPONSE — SUPERIOR TO TM FOR TREATING PTSD
Home Base, a program that provides comprehensive care to veterans and their families, is a joint venture between the Boston Red Sox Foundation and Massachusetts General Hospital. Home Base’s Resilient Warrior and Resilient Family programs incorporate mind-body activities developed by the Benson-Henry Institute for Mind Body Medicine (BHI). Clinical treatment priorities of the program include PTSD and traumatic brain injury.
In working to help individuals manage their response to stress and, in turn, improve their ability to adapt more effectively (i.e., build resilience), Home Base uses the relaxation response as one of their treatment modalities, which usually incorporates physical and recreational activities, and medication, and surgery, if indicated.
In June 2018, in recognition of the extremely high success rate of these programs, Home Base and Massachusetts General Hospital received a $67 million grant from the Wounded Warrior Project, the second largest gift in the hospital’s history. Recently, Home Base and BHI have collaborated to develop a certification program to train instructors to deliver relaxation response training and other program services to veterans and their families.
Since its inception, Home Base, according to the program’s website, has provided support to over 21,000 veterans and their family members, and has trained more than 73,000 clinicians, educators, first responders and community members — all at no cost.
Also, learning the relaxation response is far less expensive than TM instruction. As of September 2014, the number of veterans in the US with a diagnosis of PTSD was estimated at 750,000, making the cost of service delivery a critical factor in choosing any treatment. (1)
TM AND PTSD
In a pilot study, TM is not proven worse, but it is also not proven better than one of the standard treatment options for PTSD.
The Lancet Psychiatry reported on a $2.4 million, three-month-long pilot study funded by the US Department of Defense that concluded Transcendental Meditation (TM) is not inferior to the Cognitive Behavioral Therapy Prolonged-Exposure (CBT-PE) approach, one of the Veterans Administration’s treatments for post-traumatic stress disorder (PTSD).(2)
Based on the findings of the pilot study, which did not include a provision for follow-up, the TM organization and the David Lynch Foundation began promoting TM as a viable option for the treatment of PTSD and are seeking government and private funding to teach TM to veterans with PTSD. In an Enjoy TM News article, Bob Roth states:
“This new study. . . will help to open doors for many thousands of veterans to learn TM.” (3)
Notably, the study was categorized as a “non-inferiority” design, meaning that its purpose was to determine whether TM worked “as well as” CBT-PE, one of the standard behavioral therapies used by the VA to treat PTSD. Both TM and CBT-PE produced significantly better results compared to health-education classes which served as a control group. (4)
Nevertheless, in an Agence France-Presse story, the study’s lead author, Sanford Nidich, EdD, Director of the Center for Social-Emotional Health at TM’s Maharishi University of Management, states:
“Due to the increasing need to address the PTSD public health care problem in the US, UK and worldwide, there is a compelling need to implement government policy to include alternative therapies such as transcendental meditation as an option for treating veterans with PTSD.” (5)
In another quote for an article in Enjoy TM News, Nidich states, “This trial provides evidence that Transcendental Meditation®, a non-trauma-focused therapy, is a viable option for decreasing PTSD symptoms in veterans.” (6)
The Pilot Study
67 veterans received TM training, but only 50 were still available when the three-month treatment phase of the study concluded. The study lacked a provision for follow-up beyond the active treatment period, which means there is no information on how many veterans continued TM post study. There were not enough women to include in the analysis, so nothing can be said with certainty about the effects of TM training on women with PTSD.
The Cost of TM to the VA
Dr. Thomas Rutledge, one of the study’s on-site researchers, stated in a phone conversation (and confirmed via email) with Aryeh Siegel that TM charged the VA $1,450 for each veteran who received TM training, which amounts to nearly $100,000 for the 67 veterans instructed. Rutledge also noted that some potential study candidates selected for the TM intervention refused instruction because of TM’s “religious overtones.”
TM’s flagship website, TM.org, has a category headed “More evidence-based benefits,” which presents four studies that all, according to the TM organization, demonstrate TM’s effectiveness in treating PTSD. The following summarizes the “evidence”:
The first study attempts to determine whether three soldiers with PTSD can learn TM. (7)
The second study reports the effect of TM on PTSD in Congolese refugees. In addition to questions about the relevance of this population to US military personnel or veterans, the investigation was compromised. Of 102 study participants (refugees in Kampala, Uganda) who were randomly assigned either to the TM group or a non-matched, wait-list control group, 30 of the 51 participants (59%) assigned to the TM group were not available at the end of the study. Therefore, they were dropped from the study, and only 21 participants remained in the TM group. (8)
The third study, funded by the David Lynch Foundation, is of 11 remaining Congolese refugees who reportedly were still doing TM at follow up. About 80% of the study participants had either stopped TM or could not be located at follow up. (9)
The fourth study is an uncontrolled pilot study in which researchers taught TM to five veterans with PTSD. Again, the study arrives at no valid conclusions on TM as a useful treatment option for PTSD. (10)
NOTES
[1] 2015, September 20. Veterans statistics: PTSD, Depression, TBI, Suicide. Retrieved from http://veteransandptsd.com/PTSD-statistics.html
[2] 2018, December 1. Non-trauma-focused meditation versus exposure therapy in veterans with post-traumatic stress disorder: a randomized controlled trial. Retrieved from https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30384-5/fulltext
[3] Hodder, Harbour Fraser. 2018, December 18. Retrieved from https://enjoytmnews.org/new-study-department-of-defense-funded-study-shows-tm-technique-significantly-reduces-ptsd-symptoms-in-veterans/#.XI3p1RNKi1s
[4] 2018, December 1. Non-trauma-focused meditation versus exposure therapy in veterans with post-traumatic stress disorder: a randomised controlled trial. Retrieved from https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30384-5/fulltext
[5] Galey, Patrick. 2018, November 16. Retrieved from https://www.yahoo.com/news/meditation-helps-conflict-veterans-ptsd-study-104425200.html
[6] Hodder, Harbour Fraser. 2018, December 18. Retrieved from https://enjoytmnews.org/new-study-department-of-defense-funded-study-shows-tm-technique-significantly-reduces-ptsd-symptoms-in-veterans/#.XI3p1RNKi1s
[7] Vernon A. Barnes, PhD; John L. Rigg, MD & Jennifer J. Williams, LCSW. “Clinical Case Series: Treatment of PTSD With Transcendental Meditation in Active Duty Military Personnel,” Military Medicine (2013), 178(7), pp. e836–840. Retrieved from https://academic.oup.com/milmed/article/178/7/3836/4243566
[8] Brian Rees, Fred Travis, David Shapiro, & Ruth Chant. “Reduction in Posttraumatic Stress Symptoms in Congolese Refugees Practicing Transcendental Meditation,” Journal of Traumatic Stress (2013), 26(2), pp. 295–298. Retrieved from https://pdfs.semanticscholar.org/51b1/608a58fd545e9b45b49c547a96e71c77d945.pdf
[9] Brian Rees, Fred Travis, David Shapiro, & Ruth Chant, “Significant Reductions in Posttraumatic Stress Symptoms in Congolese Refugees Within 10 days of Transcendental Meditation Practice,” Journal of Traumatic Stress (February 2014), 27(1), pp. 112–115. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1002/jts.21883
[10] See Joshua Z. Rosenthal, MD, Sarina Grosswald, EdD, Richard Ross, MD, PhD, & Norman Rosenthal, MD. “Effects of Transcendental Meditation in Veterans of Operation Enduring Freedom and Operation Iraqi Freedom with Posttraumatic Stress Disorder: A Pilot Study,” Military Medicine (2011), 176(6), pp. 626–630. Available at https://pdfs.semanticscholar.org/3906/cef2ca4270ffb755a55164d1aa392a113dad.pdf
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Aryeh Siegel is the author of TRANSCENDENTAL DECEPTION: Behind the TM curtain — bogus science, hidden agendas, and David Lynch’s campaign to push a million public school kids into Transcendental Meditation while falsely claiming it is not a religion. He lives in Los Angeles with his wife and family.
Blog 17
