Mindfulness physical therapy, pain management, rehabilitation

MBSR for Veterans with Gulf War Syndrome

Of the approximately 700,000 military personnel deployed to the Persian Gulf in 1991 and 1992, at least ¼ have reported negative health consequences, including musculoskeletal pain, fatigue and cognitive impairment.1 This constellation of symptoms, termed “Gulf War Syndrome,” can be comorbid with PTSD, however many veterans with Gulf War Syndrome do not have concurrent mental health disorders.2 In a pilot study of Mindfulness-Based Stress Reduction (MBSR) for veterans with Gulf War Syndrome, Kearney and colleagues randomized 55 veterans to treatment as usual or treatment as usual and MBSR.3 Pain, fatigue and cognitive impairment was assessed at baseline, post-MBSR and at 6-month follow-up. Secondary outcomes included PTSD and depression.

At 6-month follow-up, compared to those in treatment as usual group, veterans randomized to the treatment as usual plus MBSR reported greater reductions in pain, fatigue and cognitive failure. In addition, depressive symptoms showed a greater decline in the MBSR group at 6 months. Veterans with PTSD experienced greater reductions in symptoms of PTSD immediately after MBSR but not at 6-month follow up.

Kearney and colleagues are following this small trial with a larger trial, randomizing veterans with chronic multisymptom illness (chronic pain, fatigue and/or cognitive failure) to MBSR or a Chronic Illness Education intervention. As an MBSR instructor in this trial and other non-research, clinical classes, I find it both informative and inspiring to witness the applications and insights veterans make as they experiment with the principles and practices of mindfulness.

One veteran attributed improvements he observed in his cognitive function to his dedicated practice of mindful driving. When he drives, rather than listen to the radio or think about random topics, he deliberately attends to what he sees as he drives, moment to moment. He concluded that his increasing ability to be in the present moment when driving was building concentration that carried over to other activities.

Another veteran had the insight that when he had a traumatic memory, rather than identify with it, he could take a breath and say to himself “I am having a memory. This is a memory.” By focusing on breathing and labeling his experience “memory” he commented, “The memory no longer controls me. I am in control of my response to the memory.”

A third veteran stunned the whole group when he walked into the last class without his cane. He said that by breathing, staying more calm and learning to be a more mindful listener in conversations, he was much less tense and his pain had decreased to the point that he did not need his cane.

Our veterans need and deserve all the resources we can offer to support their well-being and help them achieve their goals and potential. Although additional studies are needed, preliminary research suggests mindful awareness training may present a plausible intervention to help meet this need.

1 Research Advisory Committee on Gulf War Veterans’ Illnesses. Gulf War Illness and the Health of Gulf War Veterans: Scientific Findings and Recommendations. Washington DC: US Government Printing Office;2008.

2Fukuda K, Nisenbaum R, Stewart G, et al. Chronic multisymptom illness affecting Air Force veterans of the Gulf War. JAMA. 1998:280(11);981-8.

3Kearney DJ, Simpson TL, Malte CA, et al. Mindfulness-based stress reduction in addition to usual care is associated with improvements in pain, fatigue and cognitive failures among veterans with Gulf War Illness. 2016;129(2):204-14.