Comment
Transcendental Meditation and treatment for post-traumatic
stress disorder
A key challenge in military medicine has been the
treatment of the mental health of military service
members who have been deployed in operations in recent
years. The most effective course of treatment for post-
traumatic stress disorder (PTSD) has been highly debated
and is a central focus in the military community because
of the large number of service members returning from
deployment with PTSD.1 More than a third of patients with
PTSD do not recover even after many years, showing PTSD
to be a chronic and costly illness to service members, their
families, and society as a whole.2 Traditional treatment
of PTSD has not been uniformly successful because of
comorbidities, side-effects of drug therapy, and time and
energy needed for psychotherapy.3 Pharmacotherapy
has shown insufficient benefit in the treatment of PTSD,4
while adherence and the treatment success of various
psychotherapies has been disappointing. When patients
with PTSD do not respond to traditional treatment, new
approaches should be considered.5
The study by Sanford Nidich and colleagues6 in
The Lancet Psychiatry advances the field by reporting the
benefit of Transcendental Meditation (TM) in reducing
PTSD in veterans. TM offers a gentle approach requiring
minimal effort to practice, a factor that might contribute
to adherence, which is key to gaining maximum benefit.
TM does not involve concentration or control of the
mind as is required with other meditation or mindfulness
practice—factors that can be difficult for those with
intrusive thoughts and hyperarousal experienced in PTSD.
TM also does not involve trauma exposure, which can be
difficult for those with PTSD.
Increased activation of the sympathetic nervous system,
characterised by complex neuroendocrine changes, are
associated with the stress response. PTSD is characterised
by persistent symptoms of increased arousal and an
exaggerated sympathetic response to stimuli. High
plasma concentrations of the stress hormone cortisol
have also been associated with PTSD, which implies that
patients with chronic stress conditions such as PTSD will
benefit from reducing these stress hormones. During
TM practice, lowering sympathetic tone and increas­
ing parasympathetic tone might contribute to reducing
PTSD symptoms.7
www.thelancet.com/psychiatry Published online November 15, 2018 http://dx.doi.org/10.1016/ S2215-0366(18)30423-1 1
TM provides a deep level of rest, facilitating stress
relief, which is important for the promotion of healing.8
Consistent with military culture, TM is self-administered,
self-empowering, completely transportable, and in­
conspicuous.9 The technique can be practiced anywhere at
Cordelia Molloy/Science Photo Library
any time, without specialised equipment or the need for
personnel support. The US military has already included
TM as an adjunct to the PTSD recovery programme in
some facilities.10,11
The findings by Nidich and colleagues suggest that TM
is one of a few interventions for which benefits could be Lancet Psychiatry 2018
immediately translated into improved care in military Published Online
November 15, 2018
medicine and could have a substantial effect on health http://dx.doi.org/10.1016/
if widely disseminated. Future research will be needed S2215-0366(18)30423-1
See Online/Articles
to answer questions about the efficacy of TM for active
http://dx.doi.org/10.1016/
duty soldiers with PTSD and whether the results apply to S2215-0366(18)30384-5
the many PTSD sufferers who have multiple conditions,
and also to examine the long-term effects of TM. Head-
to-head studies assessing the effect of TM compared
with Cognitive Processing Therapy and Eye Movement
Desensitisation reprocessing therapy are also needed.
This study is one of a few high quality random­
ised controlled trials to provide evidence for non-
pharmacological treatment of PTSD. The study addresses
previous study design problems, with a randomisation
procedure that is well done, has a low dropout rate, and
an appropriate statistical approach to the data analysis,
all of which give confidence in the results.
We do not know how much money would be saved
in the US Department of Veterans Affairs and the
Department of Defense if TM were to be introduced as an
adjunctive treatment for PTSD. A study found a reduction
in medication use in active duty service members with
PTSD that was associated with TM.10,11 A future study is
needed to assess the economic effect of TM on PTSD and
related medical expenses. Health-care use and costs have
been shown to decrease with TM practice.12 Since patients
with PTSD have lifelong high medical costs, especially
with multiple chronic conditions, one could infer at least a
cumulative savings in costs.
Development of treatment and prevention inter­
ventions for PTSD is a high priority at military medical
facilities. The implementation of TM training at military
 Comment
medical facilities in the USA has shown remarkable
acceptance, excellent retention rates, attendance, and
compliance.10,11 TM training could have a substantial
effect on health as an adjunct to the standard of care and
might have considerable value to improve the quality of
life for military service members. These findings suggest
that TM might have a substantial effect on patient care,
providing an efficacious supplementary modality for the
treatment of PTSD.
Vernon Anthony Barnes
Pediatrics, Augusta University, Augusta, GA 30912, USA
vbarnes@augusta.edu
I declare no competing interests.
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2 www.thelancet.com/psychiatry Published online November 15, 2018 http://dx.doi.org/10.1016/ S2215-0366(18)30423-1
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