Mindful self-compassion for veteran women with a history of military sexual trauma: feasibility, acceptability, potential benefits, and considerations

ABSTRACT

Background: Military sexual trauma (MST) is reported by up to 74% of women veterans in the United States and is a driver of poor behavioural and physical health. Self-compassion is a transdiagnostic, protective factor linked with improved posttraumatic stress disorder (PTSD), depression, and health behaviours. Thus, Mindful Self-Compassion training (MSC) may help ameliorate MST-related impacts. However, MSC can also temporarily increase distress (i.e. backdraft). Delivering it with elective trauma-informed yoga (TIY), which regulates acute distress, may help address this issue.

Objective: This VA quality improvement project examined feasibility, acceptability, and reported benefits and challenges of a manualized 8-week MSC including within non-randomized subgroups: MSC (n = 4) and MSC+ elective TIY classes (MSC+; n = 4).

Methods: Nine women veterans with a history of MST at a Vet Center in the Northeastern U.S.A. enrolled; eight completed, excluding one MSC+ participant. Measures included attrition (n = 9), attendance (n = 8), weekly (n = 8) and posttreatment acceptability (n = 6), validated symptom severity assessments (n = 7), and an exit interview (n = 8).

Results: Among completers, MSC attendance was excellent (89%) and higher among in MSC+ vs. MSC (94% vs. 84% sessions completed). On average across the two groups, depressive and PTSD symptom severity decreased by 21% and 30%, respectively. In exit interviews, participants across groups described improved coping with distress and psychiatric symptoms, reduced stress, and improved self-care and health behaviours. Although women in both groups reported backdraft during the programme, MSC+ also reported healthier coping and improved emotional processing.

Conclusion: The results of this programme evaluation infer MSC may be feasible, acceptable, and beneficial for women survivors of MST in one Vet Center in the Northeastern USA. Further, temporary elevations in MSC-related distress may be ameliorated with adjunctive TIY. Given requests of women veterans in the USA. for additional complementary and integrative health treatment options, formal research on these approaches is warranted.

HIGHLIGHTS

• This programme evaluation with women veterans with a history of military sexual trauma (MST) explored the preliminary feasibility, acceptability, and reported benefits and challenges of a Mindful Self-Compassion (MSC) programme, with or without trauma-informed yoga.

• Women across groups reported improved psychiatric symptoms, self-care, and health behaviours, although those in MSC+ yoga reported healthier coping and improved emotional processing.

• Results suggest MSC training may be feasible, acceptable, and potentially beneficial for women veterans with MST in one clinical setting in the Northeastern USA, with potential synergistic effects of adjunctive yoga.

Antecedentes: Hasta el 74% de las mujeres veteranas de los Estados Unidos han sufrido traumas sexuales en el ejército (MST, en sus siglas en inglés), lo que provoca una mala salud física y conductual. La autocompasión es un factor protector transdiagnóstico relacionado con la mejora del trastorno de estrés postraumático (TEPT), la depresión y los comportamientos saludables. Así pues, el entrenamiento en Mindful Self-Compassion (MSC, en sus siglas en inglés) puede ayudar a mejorar los efectos relacionados con el MST. Sin embargo, el MSC también puede aumentar temporalmente la perturbación (es decir, el retroceso). Si se combina con el yoga informada en trauma (TIY, en sus siglas en inglés), que regula la angustia aguda, puede ayudar a resolver este problema.

Objetivo: Este proyecto de mejora de la calidad de VA examinó la viabilidad, la aceptabilidad y los beneficios y desafíos reportados de un MSC manualizado de 8 semanas incluyendo dentro de subgrupos no aleatorizados: MSC (n = 4) y MSC+ clases selectivas de TIY (MSC+; n = 4).

Métodos: Se inscribieron nueve mujeres veteranas con antecedentes de MST en un centro de veteranos del noreste de EE.UU.; ocho completaron el programa, excluida una participante MSC+. Las medidas incluyeron deserción (n = 9), asistencia (n = 8), aceptabilidad semanal (n = 8) y posterior al tratamiento (n = 6), evaluaciones validadas de la gravedad de los síntomas (n = 7) y una entrevista de salida (n = 8).

Resultados: Entre los participantes, la asistencia al MSC fue excelente (89%) y mayor en el MSC+ que en el MSC (94% frente a 84% de sesiones completadas). En promedio, en los dos grupos, la gravedad de los síntomas depresivos y de TEPT disminuyó un 21% y un 30%, respectivamente. En las entrevistas de salida, las participantes de todos los grupos describieron una mejora en el afrontamiento de la perturbación y los síntomas psiquiátricos, una reducción del estrés y una mejora en las conductas de autocuidado y salud. Aunque las mujeres de ambos grupos informaron de un retroceso durante el programa, MSC+ también informó de un afrontamiento más saludable y una mejora en el procesamiento emocional.

Conclusiones: Los resultados de esta evaluación del programa infieren que el MSC puede ser factible, aceptable y beneficioso para las mujeres sobrevivientes de MST en un Centro de Veteranos en el noreste de EE.UU. Además, las elevaciones temporales en la angustia relacionada con el MSC pueden mejorarse con TIY complementario. Dadas las necesidades de las mujeres veteranas en EE.UU. de opciones adicionales de tratamiento complementario e integrador de la salud, se justifica la investigación formal de estos enfoques.

KEYWORDS:

• Self-compassion
• yoga
• PTSD
• MST
• mental health

PALABRAS CLAVE:

• Autocompasión
• yoga
• TEPT
• TMS
• salud mental

Acknowledgements

The authors acknowledge with gratitude the honourable service of USA military service members and the women veterans who participated in this quality improvement project. The authors would like to thank VACWM and Vet Center providers for their Veteran referrals to the project. Additionally, they appreciatively acknowledge the Vet Center where this project took place for their generous allocation of space and other resources to support this project, and Dr. Rochelle Rosen for her early consultation on qualitative methodology. These contents do not represent the views of the US Department of Veterans Affairs or the United States Government.

Disclosure statement

Dr Braun receives occasional payments for courses, workshops, and presentations related to her roles as a certified yoga therapist, Mindful Self-Compassion teacher, and teacher of Mindfulness-Based Stress Reduction. All other authors report no conflicts of interest.

Additional information

Funding

The project described was supported by the National Center for Complementary and Integrative Health (NCCIH) under grants K23 AT011917 and L30 AT011637, as well as Institutional Development Award Number U54GM115677 from the National Institute of General Medical Sciences of the National Institutes of Health, which funds Advance Clinical and Translational Research (Advance RI-CTR). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.