Targeting hyperarousal: Mantram Repetition Program for PTSD in US veterans

Figures & data

Figure 1. Proposed mediation model. a = effect of predictor on proposed mediator; b = effect of proposed mediator on outcome when controlling for predictor; c’ = direct effect of predictor when controlling for proposed mediator. The indirect path of the predictor on the outcome via the proposed mediator occurs via the product of paths a and b.

Table 1. Descriptive statistics for PTSD symptoms.

		Mantram Repetition Program						Present-Centred Therapy
		BL CAPS (n = 89) PCL (n = 85)		Post CAPS (n = 69) PCL (n = 68)		8WFU CAPS (n = 65) PCL (n = 61)		BL CAPS (n = 84) PCL (n = 79)		Post CAPS (n = 72) PCL (n = 70)		8WFU CAPS (n = 71) PCL (n = 66)
		M	SD	M	SD	M	SD	M	SD	M	SD	M	SD
CAPS	Re-experiencing	21.90	7.65	14.58	8.74	13.27	8.89	21.36	6.90	16.46	9.10	15.26	10.35
	Avoidance	10.66	3.74	7.19	4.22	6.76	4.36	10.05	3.40	8.22	4.69	6.61	5.47
	Numbing	19.68	6.92	12.82	7.73	12.17	8.49	18.95	7.58	16.52	7.77	15.70	8.96
	Hyperarousal	25.51	5.58	17.75	8.75	16.80	8.89	24.38	6.02	22.16	6.65	21.12	7.48
PCL	Re-experiencing	16.56	4.43	12.69	4.91	12.77	4.90	15.80	4.34	13.67	4.51	13.14	5.24
	Avoidance	7.59	2.07	5.72	2.43	5.77	2.43	7.15	2.12	6.59	2.60	5.97	2.68
	Numbing	16.55	4.48	12.60	5.05	12.15	4.71	15.84	4.30	13.90	4.81	13.52	5.13
	Hyperarousal	18.56	4.13	14.38	5.26	14.01	5.05	18.78	3.55	16.19	4.50	15.80	4.67

CAPS = Clinician-Administered PTSD Scale; PCL = Posttraumatic Checklist – Military Version; BL = Baseline; Post = Post-treatment; 8WFU = 8-week Follow-up.

Table 2. Linear mixed-effects models.

Predictor	B	SE	df	t	p	LLCI	ULCI
Outcome: CAPS–Re-experiencing
Time	−0.48	0.06	118.22	−8.6	<0.001	−0.59	−0.37
Group	−0.32	1.06	169.07	−0.31	0.761	−2.41	1.76
Time x Group	−0.11	0.11	118.22	−1.01	0.316	−0.34	0.11
Outcome: CAPS–Avoidance
Time	−0.25	0.03	124.22	−7.93	<0.001	−0.31	−0.19
Group	−0.03	0.5	173.43	−0.05	0.958	−1.01	0.96
Time x Group	−0.06	0.06	124.22	−1.02	0.312	−0.19	0.06
Outcome: CAPS–Numbing
Time	−0.42	0.05	118.45	−9.10	<0.001	−0.51	−0.33
Group	−1.36	1.04	168.08	−1.31	0.192	−3.4	0.69
Time x Group	−0.29	0.09	118.45	−3.15	0.002	−0.46	−0.11
Outcome: CAPS–Hyperarousal
Time	−0.42	0.05	88.53	−8.22	<0.001	−0.52	−0.32
Group	−1.64	0.89	161.29	−1.84	0.067	−3.41	0.12
Time x Group	−0.41	0.1	88.53	−4.03	<0.001	−0.61	−0.21

LLCI = lower limit of the 95% confidence interval; ULCI = upper limit of the 95% confidence interval. CAPS = Clinician-Administered PTSD Scale.

Table 3. Between-groups effect sizes.

	Pre-treatment	Post-treatment	8-week follow-up
CAPS–Re-experiencing	−0.07 (−0.38, 0.23)	0.24 (−0.09, 0.58)	0.20 (−0.22, 0.63)
CAPS–Avoidance	−0.71 (−0.47, 0.13)	0.23 (−0.11, 0.57)	−0.02 (−0.46, 0.40)
CAPS–Numbing	−0.10 (−0.40, 0.20)	0.47* (0.14, 0.82)	0.40 (−0.02, 0.84)
CAPS–Hyperarousal	−0.19 (−0.50, 0.11)	0.57* (0.22, 0.91)	0.52* (0.09, 0.96)

*p ≤ 0.05 as demonstrated by the absence of 0 from the 95% confidence interval. Effect sizes are Hedge’s g. CAPS = Clinician-Administered PTSD Scale.

Table 4. Multilevel mediation.

Path	Predictor	Outcome	Estimate	SE	df	t	p
Present-Centred Therapy
c	Time	PCL-RAN	−0.40**	0.08	68.24	−4.90	<0.001
a	Time	PCL-H	−0.19**	0.03	53.44	−5.51	<0.001
b	PCL-H	PCL-RAN	1.53**	0.15	27.37	9.98	<0.001
c’	Time	PCL-RAN	−0.12	0.13	49.52	−0.90	0.375
Mantram Repetition Program
c	Time	PCL-RAN	−0.60**	0.08	64.66	−7.29	<0.001
a	Time	PCL-H	−0.29**	0.04	64.40	−7.15	<0.001
b	PCL-H	PCL-RAN	1.43**	0.16	55.76	9.14	<0.001
c’	Time	PCL-RAN	−0.40	0.11	80.41	−3.70	<0.001

*p ≤ 0.05, **p ≤ 0.05. PCL-RAN = Posttraumatic Checklist–Military Version (PCL-M) composite of re-experiencing, avoidance, and numbing factors; PCL-H = PCL, Hyperarousal Subscale.

Table 5. Reverse multilevel mediation.

Path	Predictor	Outcome	Estimate	SE	df	t	p
Mantram Repetition Program
c	Time	PCL-H	−0.60	0.04	64.40	−7.15	<0.001
a	Time	PCL-RAN	−0.60	0.08	64.66	−7.29	<0.001
b	PCL-H	PCL-H	0.29	0.03	142.65	10.54	<0.001
c’	Time	PCL-H	−0.17	0.06	46.08	−2.84	0.007
Present-Centred Therapy
c	Time	PCL-H	−0.19	0.03	53.44	−5.51	<0.001
a	Time	PCL-RAN	−0.40	0.08	68.24	−4.90	<0.001
b	PCL-H	PCL-H	0.28	0.05	107.44	5.10	<0.001
c’	Time	PCL-H	−0.12	0.07	21.56	−1.70	0.105

PCL-RAN = Posttraumatic Checklist–Military Version (PCL-M), composite of re-experiencing, avoidance, and numbing factors; PCL-H = PCL, Hyperarousal Subscale.