Skip to main content
SpringerLink
Log in

Mindful Awareness and Non-judging in Relation to Posttraumatic Stress Disorder Symptoms

  • ORIGINAL PAPER
  • Published:
Mindfulness Aims and scope Submit manuscript

Abstract

The objective of this cross-sectional study was to assess group differences between veterans with and without posttraumatic stress disorder (PTSD) in mindful awareness and mindful non-judging. The relationships between mindfulness and PTSD symptom clusters were also evaluated. Three age and gender-matched groups, (1) 15 combat veterans with PTSD, (2) 15 combat veterans without PTSD, and (3) 15 non-combat veterans without PTSD, completed the Mindful Attention Awareness Scale and the Accept without Judgment Scale. PTSD status was determined with the Clinician Administered PTSD Scale and excluded disorders screened with the Structured Clinical Interview for DSM-IV. Mindfulness scale group differences were assessed with analysis of variance. Mindfulness and the PTSD symptom clusters relationships were assessed with hierarchical regression analysis. There were group differences on mindful non-judging (F(2,44) = 7.22, p = .002) but not mindful awareness (p > .05). Combat exposure accounted for significant variation in PTSD symptoms (hyper-arousal 47%; numbing-avoiding 32%; re-experiencing 23%). Mindfulness accounted for a significant percentage variance of PTSD symptoms (re-experiencing 32%; numbing-avoiding 19%, hyper-arousal 16%), beyond combat exposure effects, although only mindful non-judging was significant in the model. This study confirms in a clinical sample that mindful non-judging is associated with PTSD symptoms and could represent a meaningful focus for treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Allen, N. B., Chambers, R., & Knight, W. (2006). Mindfulness-based psychotherapies: a review of conceptual foundations, empirical evidence and practical considerations. The Australian and New Zealand Journal of Psychiatry, 40(4), 285–294.

    PubMed  Google Scholar 

  • Baer, R. A., Smith, G. T., & Allen, K. B. (2004). Assessment of mindfulness by self-report: the Kentucky inventory of mindfulness skills. Assessment, 11(3), 191–206.

    Article  PubMed  Google Scholar 

  • Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., et al. (2008). Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment, 15(3), 329–342.

    Article  PubMed  Google Scholar 

  • Baum, C., Kuyken, W., Bohus, M., Heidenreich, T., Michalak, J., & Steil, R. (2009). The psychometric properties of the Kentucky inventory of mindfulness skills in clinical populations. Assessment, 17, 220–229.

    Article  PubMed  Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck depression inventory—second edition manual. San Antonio: Harcourt Brace.

    Google Scholar 

  • Bishop, S. R., Lau, M. A., Shapiro, S., Carlson, L., Anderson, N. D., & Carmody, J. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11, 230–241.

    Article  Google Scholar 

  • Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., et al. (1995). The development of a Clinician-Administered PTSD Scale. Journal of Traumatic Stress, 8(1), 75–90.

    Article  PubMed  Google Scholar 

  • Bowen, S., Chawla, N., Collins, S. E., Witkiewitz, K., Hsu, S., Grow, J., et al. (2009). Mindfulness-based relapse prevention for substance use disorders: a pilot efficacy trial. Substance Abuse, 30(4), 295–305.

    Article  PubMed  Google Scholar 

  • Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822–848.

    Article  PubMed  Google Scholar 

  • Brunello, N., Davidson, J. R., Deahl, M., Kessler, R. C., Mendlewicz, J., Racagni, G., et al. (2001). Posttraumatic stress disorder: diagnosis and epidemiology, comorbidity and social consequences, biology and treatment. Neuropsychobiology, 43(3), 150–162.

    Article  PubMed  Google Scholar 

  • Buckley, T. C., Holohan, D., Greif, J. L., Bedard, M., & Suvak, M. (2004). Twenty-four-hour ambulatory assessment of heart rate and blood pressure in chronic PTSD and non-PTSD veterans. Journal of Traumatic Stress, 17(2), 163–171.

    Article  PubMed  Google Scholar 

  • Cahn, B. R., & Polich, J. (2006). Meditation states and traits: EEG, ERP, and neuroimaging studies. Psychological Bulletin, 132(2), 180–211.

    Article  PubMed  Google Scholar 

  • Cardaciotto, L., Herbert, J. D., Forman, E. M., Moitra, E., & Farrow, V. (2008). The assessment of present-moment awareness and acceptance: the Philadelphia Mindfulness Scale. [Validation Study]. Assessment, 15(2), 204–223.

    Article  PubMed  Google Scholar 

  • Carlson, L. E., & Brown, K. W. (2005). Validation of the mindful attention awareness scale in a cancer population. Journal of Psychosomatic Research, 58(1), 29–33.

    Article  PubMed  Google Scholar 

  • Carlson, L. E., & Garland, S. N. (2005). Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients. International Journal of Behavioral Medicine, 12(4), 278–285.

    Article  PubMed  Google Scholar 

  • Chiesa, A., & Serretti, A. (2009). A systematic review of neurobiological and clinical features of mindfulness meditations. Psychological Medicine, 40(8), 1239–1252.

    Article  PubMed  Google Scholar 

  • Cohen, H., Kotler, M., Matar, M. A., Kaplan, Z., Loewenthal, U., Miodownik, H., et al. (1998). Analysis of heart rate variability in posttraumatic stress disorder patients in response to a trauma-related reminder. Biological Psychiatry, 44(10), 1054–1059.

    Article  PubMed  Google Scholar 

  • Duncan, L. G., & Bardacke, N. (2010). Mindfulness-based childbirth and parenting education: Promoting family mindfulness during the perinatal period. Journal of Child and Family Studies, 19(2), 190–202.

    Article  PubMed  Google Scholar 

  • Etkin, A., & Wager, T. D. (2007). Functional neuroimaging of anxiety: a meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. The American Journal of Psychiatry, 164(10), 1476–1488.

    Article  PubMed  Google Scholar 

  • Fassbender, C., Murphy, K., Foxe, J. J., Wylie, G. R., Javitt, D. C., Robertson, I. H., et al. (2004). A topography of executive functions and their interactions revealed by functional magnetic resonance imaging. Cognitive Brain Research, 20(2), 132–143.

    Article  PubMed  Google Scholar 

  • Finucane, A., & Mercer, S. W. (2006). An exploratory mixed methods study of the acceptability and effectiveness of Mindfulness-Based Cognitive Therapy for patients with active depression and anxiety in primary care. Biomedcentral Psychiatry, 6, 14.

    Article  Google Scholar 

  • First, M., Spitzer, R., Gibbon, M., & Williams, J. (2002). Structured clinical interview for DSM-IV-TR Axis 1 Disorders-Patient Edition (SCID-I/P, 11/2002 revision). New York: Biometrics Research Department.

    Google Scholar 

  • Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits. A meta-analysis. Journal of Psychosomatic Research, 57(1), 35–43.

    Article  PubMed  Google Scholar 

  • Hansen, E., Lundh, L. G., Homman, A., & Wangby-Lundh, M. (2009). Measuring mindfulness: pilot studies with the Swedish versions of the mindful attention awareness scale and the Kentucky inventory of mindfulness skills. Cognitive Behaviour Therapy, 38(1), 2–15.

    Article  PubMed  Google Scholar 

  • Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experimental avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment. A Journal of Consulting and Clinical Psychology, 64(6), 1152–1168.

    Article  Google Scholar 

  • Herwig, U., Kaffenberger, T., Jancke, L., & Bruhl, A. B. (2010). Self-related awareness and emotion regulation. NeuroImage, 50(2), 734–741.

    Article  PubMed  Google Scholar 

  • Hoge, C. W., Terhakopian, A., Castro, C. A., Messer, S. C., & Engel, C. C. (2007). Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans. The American Journal of Psychiatry, 164(1), 150–153.

    Article  PubMed  Google Scholar 

  • Holm, S. (1979). A simple sequentially rejective multiple test procedure. Scandinavian Journal of Statistics, 6, 65–70.

    Google Scholar 

  • Holzel, B. K., Ott, U., Hempel, H., Hackl, A., Wolf, K., Stark, R., et al. (2007). Differential engagement of anterior cingulate and adjacent medial frontal cortex in adept meditators and non-meditators. Neuroscience Letters, 421(1), 16–21.

    Article  PubMed  Google Scholar 

  • Jermann, F., Billieux, J., Laroi, F., d’Argembeau, A., Bondolfi, G., Zermatten, A., et al. (2009). Mindful Attention Awareness Scale (MAAS): Psychometric properties of the French translation and exploration of its relations with emotion regulation strategies. Psychological Assessment, 21(4), 506–514.

    Article  PubMed  Google Scholar 

  • Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. General Hospital Psychiatry, 4(1), 33–47.

    Article  PubMed  Google Scholar 

  • Kabat-Zinn, J., Massion, A. O., Kristeller, J., Peterson, L. G., Fletcher, K. E., Pbert, L., et al. (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. The American Journal of Psychiatry, 149(7), 936–943.

    PubMed  Google Scholar 

  • Kabat-Zinn, J., & Santorelli, S. F. (2007). MBSR Curriculum Guide and Supporting Materials. Worcester: Center for Mindfulness in Medicine, Health Care and Society.

    Google Scholar 

  • Keane, T., Fairbank, J. A., Caddell, J., Zimering, R., Taylor, K., & Mora, C. (1989). Clinical evaluation of a measure to assess combat exposure. A Journal of Consulting and Clinical Psychology, 1(1), 53–55.

    Article  Google Scholar 

  • Kenny, M. A., & Williams, J. M. (2007). Treatment-resistant depressed patients show a good response to Mindfulness-based Cognitive Therapy. Behaviour Research and Therapy, 45(3), 617–625.

    Article  PubMed  Google Scholar 

  • Koenigs, M., & Grafman, J. (2009). Posttraumatic stress disorder: the role of medial prefrontal cortex and amygdala. The Neuroscientist, 15(5), 540–548.

    Article  PubMed  Google Scholar 

  • Kristeller, J. L., & Wolever, R. Q. (2011). Mindfulness-based eating awareness training for treating binge eating disorder: The conceptual foundation. Eating Disorders, 19(1), 49–61.

    Article  PubMed  Google Scholar 

  • Kulka, R., Schlenger, W., Fairbank, J., Hough, R., Jordan, B., Marmar, C., et al. (1990). Trauma and the Vietnam war generation: Report of findings from the National Vietnam veterans readjustment study. New York: Routledge.

    Google Scholar 

  • Lakusic, N., Fuckar, K., Mahovic, D., Cerovec, D., Majsec, M., & Stancin, N. (2007). Characteristics of heart rate variability in war veterans with post-traumatic stress disorder after myocardial infarction. Military Medicine, 172(11), 1190–1193.

    PubMed  Google Scholar 

  • Langley, R. (1979). Practical statistics simply explained. London: Pan Books.

    Google Scholar 

  • Lieberman, M. D., Eisenberger, N. I., Crockett, M. J., Tom, S. M., Pfeifer, J. H., & Way, B. M. (2007). Putting feelings into words: Affect labeling disrupts amygdala activity in response to affective stimuli. Psychological Science, 18(5), 421–428.

    Article  PubMed  Google Scholar 

  • Linehan, M. M., Heard, H. L., & Armstrong, H. E. (1993). Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Archives of General Psychiatry, 50(12), 971–974.

    PubMed  Google Scholar 

  • Ma, S. H., & Teasdale, J. D. (2004). Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. A Journal of Consulting and Clinical Psychology, 72(1), 31–40.

    Article  Google Scholar 

  • Marciniak, M. D., Lage, M. J., Dunayevich, E., Russell, J. M., Bowman, L., Landbloom, R. P., et al. (2005). The cost of treating anxiety: the medical and demographic correlates that impact total medical costs. Depression and Anxiety, 21(4), 178–184.

    Article  PubMed  Google Scholar 

  • Mason, O., & Hargreaves, I. (2001). A qualitative study of mindfulness-based cognitive therapy for depression. British Journal of Medical Psychology, 74(2), 197–212.

    Article  Google Scholar 

  • McKee, L., Zvolensky, M. J., Solomon, S. E., Bernstein, A., & Leen-Feldner, E. (2007). Emotional-vulnerability and mindfulness: a preliminary test of associations among negative affectivity, anxiety sensitivity, and mindfulness skills. Cognitive Behaviour Therapy, 36(2), 91–101.

    Article  PubMed  Google Scholar 

  • Mellman, T. A., Knorr, B. R., Pigeon, W. R., Leiter, J. C., & Akay, M. (2004). Heart rate variability during sleep and the early development of posttraumatic stress disorder. Biological Psychiatry, 55(9), 953–956.

    Article  PubMed  Google Scholar 

  • Miller, J. J., Fletcher, K., & Kabat-Zinn, J. (1995). Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. General Hospital Psychiatry, 17(3), 192–200.

    Article  PubMed  Google Scholar 

  • Muraoka, M. Y., Carlson, J. G., & Chemtob, C. M. (1998). Twenty-four-hour ambulatory blood pressure and heart rate monitoring in combat-related posttraumatic stress disorder. Journal of Traumatic Stress, 11(3), 473–484.

    Article  PubMed  Google Scholar 

  • Nicastro, R., Jermann, F., Bondolfi, G., & McQuillan, A. (2010). Assessment of mindfulness with the French version of the Kentucky inventory of mindfulness skills in community and borderline personality disorder samples. Assessment, 17, 197–205.

    Article  PubMed  Google Scholar 

  • Oken, B. S., Salinsky, M. C., & Elsas, S. M. (2006). Vigilance, alertness, or sustained attention: physiological basis and measurement. Clinical Neurophysiology, 117(9), 1885–1901.

    Article  PubMed  Google Scholar 

  • Pan, X., Hu, Y., Li, L., & Li, J. (2009). Evaluative-feedback stimuli selectively activate the self-related brain area: An fMRI study. Neuroscience Letters, 465(1), 90–94.

    Article  PubMed  Google Scholar 

  • Pole, N. (2006). Moderators of PTSD-related psychophysiological effect sizes: results from a meta-analysis. Annals of the New York Academy of Sciences, 1071, 422–424.

    Article  PubMed  Google Scholar 

  • Pole, N. (2007). The psychophysiology of posttraumatic stress disorder: A meta-analysis. Psychological Bulletin, 133(5), 725–746.

    Article  PubMed  Google Scholar 

  • Price, C. J., McBride, B., Hyerle, L., & Kivlahan, D. R. (2007). Mindful awareness in body-oriented therapy for female veterans with post-traumatic stress disorder taking prescription analgesics for chronic pain: a feasibility study. Alternative Therapies in Health and Medicine, 13(6), 32–40.

    PubMed  Google Scholar 

  • Rubia, K. (2009). The neurobiology of Meditation and its clinical effectiveness in psychiatric disorders. Biological Psychology, 82(1), 1–11.

    Article  PubMed  Google Scholar 

  • Schell, T. L., Marshall, G. N., & Jaycox, L. H. (2004). All symptoms are not created equal: the prominent role of hyperarousal in the natural course of posttraumatic psychological distress. Journal of Abnormal Psychology, 113(2), 189–197.

    Article  PubMed  Google Scholar 

  • Schindel-Allon, I., Aderka, I. M., Shahar, G., Stein, M., & Gilboa-Schechtman, E. (2010). Longitudinal associations between post-traumatic distress and depressive symptoms following a traumatic event: a test of three models. Psychological Medicine, 40, 1–10.

    Article  Google Scholar 

  • Segal, Z. V., Williams, M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford.

    Google Scholar 

  • Sephton, S. E., Salmon, P., Weissbecker, I., Ulmer, C., Floyd, A., Hoover, K., et al. (2007). Mindfulness meditation alleviates depressive symptoms in women with fibromyalgia: results of a randomized clinical trial. Arthritis and Rheumatism, 57(1), 77–85.

    Article  PubMed  Google Scholar 

  • Shapiro, S. L., Bootzin, R. R., Figueredo, A. J., Lopez, A. M., & Schwartz, G. E. (2003). The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer: An exploratory study. Journal of Psychosomatic Research, 54(1), 85–91.

    Article  PubMed  Google Scholar 

  • Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62(3), 373–386.

    Article  PubMed  Google Scholar 

  • Shin, L. M., Rauch, S. L., & Pitman, R. K. (2006). Amygdala, medial prefrontal cortex, and hippocampal function in PTSD. Annals of the New York Academy of Sciences, 1071, 67–79.

    Article  PubMed  Google Scholar 

  • Solomon, S. D., & Davidson, J. R. (1997). Trauma: prevalence, impairment, service use, and cost. The Journal of Clinical Psychiatry, 58(Suppl 9), 5–11.

    PubMed  Google Scholar 

  • Solomon, Z., Horesh, D., & Ein-Dor, T. (2009). The longitudinal course of posttraumatic stress disorder symptom clusters among war veterans. The Journal of Clinical Psychiatry, 70(6), 837–843.

    Article  PubMed  Google Scholar 

  • Tacon, A. M., McComb, J., Caldera, Y., & Randolph, P. (2003). Mindfulness meditation, anxiety reduction, and heart disease: A pilot study. Family & Community Health, 26(1), 25–33.

    Google Scholar 

  • Tanielian, T., & Jaycox, L. H. (Eds.). (2008). Invisibile wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica: RAND.

    Google Scholar 

  • Teasdale, J. D., Segal, Z. V., Williams, J. M., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. A Journal of Consulting and Clinical Psychology, 68(4), 615–623.

    Article  Google Scholar 

  • Thompson, B. L., & Waltz, J. (2010). Mindfulness and experiential avoidance as predictors of posttraumatic stress disorder avoidance symptom severity. Journal of Anxiety Disorders, 24(4), 409–415.

    Article  PubMed  Google Scholar 

  • Travis, F., & Arenander, A. (2004). EEG asymmetry and mindfulness meditation.[comment]. Psychosomatic Medicine, 66(1), 147–148. author reply 147–148.

    PubMed  Google Scholar 

  • Vujanovic, A. A., Bonn-Miller, M. O., & Marlatt, G. A. (2011). Posttraumatic stress and alcohol use coping motives among a trauma-exposed community sample: The mediating role of non-judgmental acceptance. Addictive Behaviours, 36(7), 707–712.

    Article  Google Scholar 

  • Vujanovic, A. A., Youngwirth, N. E., Johnson, K. A., & Zvolensky, M. J. (2009). Mindfulness-based acceptance and posttraumatic stress symptoms among trauma-exposed adults without axis I psychopathology. Journal of Anxiety Disorders, 23(2), 297–303.

    Article  PubMed  Google Scholar 

  • Williams, J. M., Duggan, D. S., Crane, C., & Fennell, M. J. (2006). Mindfulness-Based cognitive therapy for prevention of recurrence of suicidal behavior. A Journal of Consulting and Clinical Psychology, 62(2), 201–210.

    Google Scholar 

  • Witkiewitz, K., & Bowen, S. (2010). Depression, craving, and substance use following a randomized trial of mindfulness-based relapse prevention. A Journal of Consulting and Clinical Psychology, 78(3), 362–374.

    Article  Google Scholar 

  • Wyland, C. L., Kelley, W. M., Macrae, C. N., Gordon, H. L., & Heatherton, T. F. (2003). Neural correlates of thought suppression. Neuropsychologia, 41(14), 1863–1867.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported in part by National Institute of Health grants T32 AT002688, K01 AT004951, U19 AT002656, UL1 RR024140, K24AT005121, and a Tartar Trust Grant. Special thanks to Roger Ellingson, Dan Zajdel, Aisha Kudura, Alex Amen, and Irina Fonareva.

Author information

Authors and Affiliations

  1. Department of Neurology, Oregon Health & Science University, Portland, OR, USA

    Helané Wahbeh & Barry Oken

  2. Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA

    Mary Lu

  3. Mental Health & Neuroscience Division, Portland Veterans Administration Medical Center, Portland, OR, USA

    Mary Lu

Authors
  1. Helané Wahbeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mary Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Barry Oken
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Helané Wahbeh.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wahbeh, H., Lu, M. & Oken, B. Mindful Awareness and Non-judging in Relation to Posttraumatic Stress Disorder Symptoms. Mindfulness 2, 219–227 (2011). https://doi.org/10.1007/s12671-011-0064-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12671-011-0064-3

Keywords

Search

Navigation