Thank you for having me. Indeed, I did share the website, and my presentation will pertain directly to it.
Thanks very much. I'm going to share my screen now. You can see it in a moment.
What I'm going to be describing to you is a therapy that we've developed that combines an Internet-based approach with making use of mindfulness meditation and other types of meditation that I feel would be a good intervention for post-traumatic stress in first responders as well as other populations.
I was able to hear some of the earlier presentations which had to do not only with treatment but also preparation for an individual who can be expected to witness and respond to traumatic life events. I heard the terms “preparation” and “self-training”. I feel this type of approach, which is Internet-based and very much an intervention in which people are training themselves, would fit very well with that interest. As such, it should be a feasible intervention to provide in a large capacity.
We should think about the treatment of trauma and stressor-related disorders as involving two primary objectives.
The first is to work through the trauma. This typically involves some dialogue with a therapist in which a person is reviewing what has happened to him or her in different formats, essentially trying to understand what happened to them. It could be verbally or through writing or art, etc. That reflection leads to an increased capacity to not become distressed, for example, by being reminded of what has happened to them.
The other component, which may be talked about less, is the component of self-regulation, which essentially is helping a person cope better with the difficult emotions that come with diagnoses such as PTSD. I think you've certainly heard of the current evidence-based treatments. We have some effective treatments, typically cognitive behavioural approaches to psychotherapy, but there are certainly limitations to the current approaches. Indeed, not so many participants get fully well. For example, only about half show a response rate that leads to a loss of the diagnosis of PTSD in randomized controlled trials, and there's also a lot of dropout.
The literature is starting to turn to both Internet-based treatments and alternative approaches to cognitive behavioural therapy, such as mindfulness-based therapy. Indeed, at the University of Western Ontario, we've been the first to essentially put these two together with an Internet-based approach to mindfulness-based therapy.
Very briefly, assessment of the web-based interventions have been published, especially in the areas of treatments for depression and anxiety disorders, and more recently PTSD as well, and the findings are quite striking. Relative to the same types of treatments administered in the typical way—in face-to-face psychotherapy, for example—the effect sizes, the outcomes for the Internet-based approach are often just as strong and just as good as those obtained in the face-to-face approach. That surprised many, but it has actually been documented extensively now.
This is also the case in PTSD trials, for example, in college student samples, community samples, and combat veteran samples. To my knowledge, we don't have a study yet on an Internet-based approach for first responder groups, but based on the literature, similar kinds of outcomes can be expected.
Mindfulness-based interventions so far have not been delivered in an Internet-based approach, but there are several reasons that we would think mindfulness-based practices should be helpful in the treatment of post-traumatic stress disorder and dissociative disorders.
For one, they tend to improve attention and concentration, can improve the ability to focus on the present and away from ruminations around past trauma as well as future-based anxiety, and can alter cognitive style and help a person become less judgmental and more compassionate towards themselves. They can directly reduce physiological arousal and associated emotions of anxiety, irritability, and anger. They can lower anhedonia—the emotional numbing, the inability to experience positive emotions such as joy—and so increase positive emotions, increase a person's experience of social connectedness, and restore existential concerns towards improved well-being.
There are good ideas. There have been several research projects that have also shown persons with post-traumatic stress disorder are lower on what are called mindfulness traits. For example, they are less likely to notice changes in the body, such as whether their breathing slows down or speeds up. They are less able to put feelings to words and less able to find words to describe their feelings. They are less able to stay in the present. Their minds wander. They are easily distracted. Further, they are less able to accept their feelings without judgment.
These are areas that a PTSD treatment should target, and a mindfulness-based treatment targets such things.
We have recently shown that the relationship between trauma exposure and PTSD symptoms is significantly mediated with these types of mindfulness-based personality traits. If we can affect these traits, then we can affect the PTSD symptoms.
Improvements in attention and improvements in emotion are expected outcomes for mindfulness-based therapy, and there have been several studies that have shown positive results for mindfulness-based therapy, including our own study.
If I have a moment, I'll be able to describe a bit more about the specific treatment using mindfulness and metta-based trauma therapy, which is an Internet-based approach. It involves teaching meditation as well as various mindfulness-based principles and ethics.