Meditation-Based Mantram Intervention for Veterans With Posttraumatic Stress Disorder: A Randomized Trial
Abstract: Few complementary therapies for posttraumatic stress disorder (PTSD) have been empirically tested. This study explored the efficacy of a portable, private meditation-based mantram (sacred word) intervention for veterans with chronic posttraumatic stress disorder. A prospective, single-blind randomized clinical trial was conducted with 146 outpatient veterans diagnosed with military-related PTSD. Subjects were randomly assigned to either (a) medication and case management alone (i.e., treatment-as-usual [TAU]), or (b) TAU augmented by a 6-week group mantram repetition program (MRP + TAU). A total of 136 veterans (66 in MRP + TAU; 70 in TAU) completed posttreatment assessments. An intent-to-treat analysis indicated significantly greater symptom reductions in self-reported and clinician-rated PTSD symptoms in the MRP + TAU compared with TAU alone. At posttreatment, 24% of MRP + TAU subjects, compared with 12% TAU subjects, had clinically meaningful improvements in PTSD symptom severity. MRP + TAU subjects also reported significant improvements in depression, mental health status, and existential spiritual well-being compared with TAU subjects. There was a 7% dropout rate in both treatment conditions. A meditation-based mantram repetition intervention shows potential when used as an adjunct to TAU for mitigating chronic PTSD symptoms in veterans. Veterans may seek this type of treatment because it is nonpharmacological and does not focus on trauma. It also has potential as a facilitator of exposure-based therapy or to enhance spiritual well-being. More research is needed using a longitudinal effectiveness design with an active comparison control group.
Abstract: Novel and automated means of opioid use and relapse risk detection are needed. Unstructured electronic medical record data, including written progress notes, can be mined for clinically relevant information, including the presence of substance use and relapse-critical markers of risk and recovery from opioid use disorder (OUD). In this study, we used natural language processing (NLP) to automate the extraction of opioid relapses, and the timing of these occurrences, from veteran patients' electronic medical record. We then demonstrated the utility of our NLP tool via analysis of pre-/post-COVID-19 opioid relapse trends among veterans with OUD. For this demonstration, we analyzed data from 107,606 veterans OUD enrolled in Veterans Health Administration, comparing a pandemic-exposed cohort (n = 53,803; January 2019-March 2021) to a matched prepandemic cohort (n = 53,803; October 2017-December 2019). The recall of our NLP tool was 75% and our precision was 94%, demonstrating moderate sensitivity and excellent specificity. Using the NLP tool, we found that the odds of opioid relapse postpandemic onset were proportionally higher compared to prepandemic trends, despite patients having fewer mental health encounters from which to derive instances of relapse postpandemic onset. In this research application of the tool, and as hypothesized, we found that opioid relapse risk was elevated postpandemic. The application of NLP Methods: to identify and monitor relapse risk holds promise for future surveillance, risk prevention, and clinical outcome research.