Mindfulness-Based Therapy Aids PTSD in Cardiac Arrest Survivors

A recent pilot study exploring a combination of mindfulness and exposure therapy demonstrates potential in alleviating post-traumatic stress symptoms among sudden cardiac arrest (SCA) survivors, a major cause of mortality in the United States.

According to the study, published in The Journal of Clinical Psychiatry, more than 356,000 Americans experience out-of-hospital cardiac arrest, 90 percent of which are fatal. Among those who do survive, an estimated one in three patients report symptoms that meet the criteria for post-traumatic stress disorder (PTSD) following hospital discharge.

“Beyond emotional suffering, elevated PTSD symptoms are associated with increased mortality and cardiovascular risk, yet no psychotherapeutic treatment has been developed and tested for this population,” said Maja Bergman, PhD, lead study author and a postdoctoral clinician with the PTSD Research and Treatment Program at Columbia University Irving Medical Center in New York City.

For this investigation, Dr. Bergman and his colleagues sought to explore the benefits of mindfulness paired with exposure therapy for PTSD in cardiac arrest survivors. To do so, they designed an open feasibility pilot study, recruiting a small group of 11 cardiac arrest survivors diagnosed with PTSD. The intervention, termed Acceptance and Mindfulness-Based Exposure Therapy (AMBET), aimed to reduce PTSD symptoms through an eight-week treatment program.

Conducted remotely due to COVID-19 restrictions, the AMBET protocol consisted of weekly sessions, each lasting 90 minutes. These sessions combined exposure and mindfulness interventions with cardiovascular psychoeducation. For the exposure therapy aspect, patients were encouraged to revisit their traumatic cardiac event through various techniques, such as discussion and guided imagery, to help process the associated memories. Meanwhile, the mindfulness component focused on experiencing internal body stimuli, aiming to normalize physiological stress responses linked to both PTSD and cardiovascular risk to foster adaptive behaviors.

After the eight-week trial period, all but two of the 11 patients no longer met the criteria for PTSD. According to the researchers, the trial had low dropout rates, high participant satisfaction, and no adverse effects. Moreover, the study reported improvements in cardiovascular health behaviors. Participants exhibited enhanced sleep quality and increased physical activity, as evidenced by data from Fitbit devices tracking steps and sedentary behavior.

To Dr. Bergman, the study addresses a crucial treatment gap for a high-risk patient group and demonstrates AMBET's potential in improving coping strategies and reducing cardiac-related anxiety. However, the researchers acknowledged the need for further investigation to understand the distinct contributions of exposure and mindfulness techniques in treating SCA survivors.

“We believe that the strong findings of this small trial provide an excellent opportunity to continue to partner with our colleagues at the Center for Behavioral Cardiovascular Health and move to a larger randomized controlled trial,” said Yuval Neria, PhD, senior author of the study and Director of the Columbia PTSD Research and Treatment program.