Mindfulness Treatment for Anger in Veterans With PTSD

Military Veterans suffering from posttraumatic stress disorder (PTSD) have been shown to
exhibit increases in aggressive urges, difficulties managing anger, and difficulties
controlling violent behavior. Dysregulated anger and aggression can create fear and distress
in spouses, family members, and friends resulting in strained and deteriorated relationships,
and can have a detrimental impact on Veterans' social, occupational and other important areas
of functioning. In addition, more severe forms of aggression and violent behavior (i.e.,
homicide) in the community have been observed among Veterans with PTSD, as recently reported
in several news media outlets. The seriousness of this problem is underscored by the high
rates of alcohol use observed among Veterans with PTSD which further increases anger and the
risk of aggressive behavior.

Current therapeutic interventions may not be effective in reducing anger and aggressive
behavior among Veterans with PTSD due to the lack of techniques that directly target symptoms
most strongly associated with aggression, particularly hyperarousal and physiological
reactivity. Furthermore, existing interventions may not be effective in assisting individuals
achieve awareness and insight into their anger states, necessary for the effective management
of anger and aggression. Mindfulness is rooted in Eastern meditation practices and has been
successfully used to decrease stress, pain, anxiety, and depression. In civilian samples,
mindfulness interventions have been found to be effective in reducing anger and aggression.
To date, mindfulness for anger and aggression has not been examined in Veterans with PTSD.

The primary objective of the proposed investigation is to conduct a pilot randomized control
trial to examine the initial efficacy of an established mindfulness intervention, Mindfulness
Based Stress Reduction (MBSR) in decreasing anger and aggression in Veterans with PTSD. The
proposed investigation also seeks to examine potential mechanisms of action that account for
its effects. Sixty Veterans with PTSD experiencing problems with anger and aggression will be
recruited. These individuals will attend a baseline session to assess self-reported levels of
anger and aggression. They will then be randomly assigned to participate in a PTSD
psychoeducational course or MBSR. After completing treatment, all participants will attend a
post-treatment session to assess changes in anger and aggression. At this session,
participants will also engage in a trauma-imagery procedure using trauma narratives developed
at the baseline session. Then, all participants will complete a laboratory paradigm designed
to assess provoked aggression. In addition to examining whether participation in MBSR
decreases self-reported levels of anger and aggression, this study will examine whether MBSR
decreases aggression in participants after being exposed to trauma reminders in vivo.
Potential mechanisms of action of MBSR and its effects on additional outcomes also will be
explored.

Inclusion Criteria:

- Participants must meet current DSM-V diagnostic criteria for PTSD (participants with
sub-syndromal levels of PTSD will also be allowed to participate).

- Participants must also indicate current difficulties with anger and aggression.

Exclusion Criteria:

- Participants with a current diagnosis of bipolar disorder, psychotic disorder, or
current substance use disorder with severe symptoms.

- Participants also must not have a seizure disorder and must not be taking any
medications that would affect cognition or behavior on the aggression task, including
pain medication.

- Finally, participants must not currently be receiving concurrent individual therapy or
group therapy focused on anger and aggression, must not be currently receiving any
evidence-based treatment for PTSD, and must not currently be participating in the
modified TREC group offered at the WHVA.