An Integrative, Mindfulness, Compassion, and Somatic Approach to Treatment of Chronic Pain and Post-traumatic Stress Disorder Among Military Populations with Brain Injury: A Case Series

Research Objectives: Military service populations with traumatic brain injury (TBI) report high levels of chronic pain (CP) and posttraumatic stress disorder (PTSD). These comorbid conditions severely impact physical and social functioning, identity, cognition, mood, and performance. Evidence supports the inclusion of mindfulness and compassion in cognitive treatment of co-occurring CP and PTSD, and has also shown positive outcomes from somatosensory approaches targeting this relationship (e.g., greater nervous system regulation and embodiment, decreased symptomology). Mental skills training and sport enhancement may enhance these models by promoting enhanced resilience, performance, and strategies for managing the challenges inherent to these conditions. To date, there are no body-centered treatment frameworks that integrate these modalities to target comorbidity among rehabilitation populations. This is the first investigation to examine an integrated clinical model for military service members with TBI and co-occurring CP and PTSD.

Design: A case series featuring mixed methods with pre-post intervention measures and qualitative responses.

Setting: An intensive post-acute brain injury inpatient rehabilitation program within a veterans affairs hospital that provides service to active duty military members.

Participants: Male special operations forces service members (N = 3) with TBI, CP, PTSD, other comorbid psychiatric disorders, and neurobehavioral symptoms.

Interventions: Treatment consisted of 3 weeks of 1-hour, 2x a week acceptance-and commitment as well as cognitive behavioral psychotherapy sessions, mindfulness and meditation, self-compassion practices, sport psychology psychoeducation, performance coaching, somatic exercises, mindful movement, experiential practices, and homework.

Main Outcome Measures: Participants completed the GAD-7, PHQ-9, PCL-5, Headache Management and Self-Efficacy Scale, Migraine Disability Assessment, and Neurobehavioral Symptom Inventory. Acceptability and usability were also assessed via open-ended questions.

Results: Participants reported significant decreases in anxiety, depression, PTSD, and neurobehavioral symptoms. They also reported increased, significant ability to manage pain and greater self-efficacy. Results on migraine disability were mixed. Positive changes such as relating more adaptively to self and symptoms, increased self-mastery, and sense of competency in the face of stress were reported.

Conclusions: To our awareness, this is the first evidence to support initial efficacy and acceptability of an individualized, integrative treatment framework for co-occurring PTSD and CP among active-duty service members with TBI. Results are an innovative contribution to the literature, highlighting the possible impactful change in individuals’ ability to effectively manage PTSD symptoms and pain after injury via contemplative, mental performance-based approaches. Recommendations for future investigations, interdisciplinary team consultation and collaboration, as well as trauma-sensitive adaptions are provided.

Author(s) Disclosures: The named authors have no conflict of interest, financial or otherwise.