Can Meditation Help TBI?
Is it possible for those affected with TBI to meditate, and will it help?
From the Field
How does TBI affect one's ability to meditate? If it is possible for those affected with TBI to meditate, what does meditation do for their mental/emotional state, cognition, etc.?
Meditation may hold some benefits for those with TBI, but currently there is not enough research on the ability of those affected by TBI to meditate or the impact of meditation on those with TBI, and the few published studies report different results, so its effectiveness remains to be proven.
The Defense Centers of Excellence has recognized that meditation and other mindfulness techniques can help reduce anxiety and depression and may be effective for panic disorders, binge eating disorders, and substance abuse. However, little research has been done with regard to these methods’ effectiveness with TBI. There is very little literature on the topic, mostly with small groups of individuals, but there are some promising findings.
Traumatic Brain Injury, according to DCoE, is “a blow or jolt to the head that disrupts the normal function of the brain.” TBI can range from mild to severe. Common symptoms of TBI include:
Some believe that meditation is not a helpful practice for those individuals with TBI due to the nature of the injury; others believe that meditation may be an effective rehabilitation strategy.
There is some evidence that meditation may benefit individuals with TBI, especially when a tradition mindfulness-based stress reduction (MBSR) program is specially modified. Individuals with mild TBI have experienced improvements in quality of life, memory, depression, and regulation of attention after 10 to 12 weeks of training and practice. These modified programs focused on things such as meditation, breathing exercises, guided visualization, and reframing the TBI through acceptance. Practicing acceptance (which is at the heart of mindfulness based work) also could be an important factor for individuals with a TBI in particular to deal with negative self-image. One study revisited its participants a year later, and they reported continued improvement in mental health, including reduced symptoms of depression.
There was one relatively large study on brief mindfulness training for TBI-related attention problems that found no significant differences in associated symptoms over a one-year follow-up period. Although that study led to the conclusion not to recommend such training, its researchers also said that further research was needed and that their therapist contact had been low, possibly affecting the impact of the training.
While it is unclear how meditation as a whole affects TBI symptoms, there is other research showing that meditation has a positive impact on TBI-like symptoms:
- Meditation can positively impact one’s ability to sustain focused attention and cognitive efficiency.
- One study found that mindfulness practice can significantly lower fatigue and anxiety, and improve working memory and ability to manage time, including organizing tasks, making decisions, and solving problems.
- Both guided meditation and loving kindness (also called “metta”) meditation practices may help with some aspects of depression.
- Long-term practice of meditation has been found to improve overall mood, including greater emotional stability, ability to accept emotional states, and awareness in the moment, as well as ability to deal with negative emotions that could decrease the development of depressive symptoms.
For more in-depth information on all these research studies, see HPRC’s Research Summary on “Potential of Meditation for Treatment of TBI.”
The ability of someone with TBI to meditate and/or benefit from meditation may depend on the type and severity of the TBI. The location and extent of the injury also could impact one’s ability to meditate. It is also important to keep in mind that the successful studies mentioned above adapted the MBSR program specially for TBI patients by focusing on attention skills, awareness, and adopting a nonjudgmental attitude. Other typical meditation practices might not be as successful. In general, caution must be practiced in interpreting research to date because there just isn’t enough evidence.
Summary for Military Relevance
TBI is a significant issue for military personnel, notably those who have been deployed to combat zones, but there is no research to date on Warfighters with TBI. Some research suggests that meditation may help some TBI-related symptoms. Moreover, researchers in TBI emphasize that treatment methods integrating awareness, self-concept, self-efficacy, and emotional issues—which theoretically could be accomplished through mindfulness/meditative practices—are crucial to rehabilitation and reintegration of TBI patients. However, the few published studies to date report mixed results and further research clearly is needed.
* Bottom Line Up Front
- There is not enough research on meditation and TBI; very few studies have examined the impact of meditation on those with TBI, and more research is needed to gain a better understanding of its impact, if any.
- As of now, the few studies that are published report mixed results, and caution should be exerted in interpreting these findings until further research has been published.
- Some research suggests that meditation may hold some benefits for attention, memory, executive functioning, depression, mood changes, and emotional reactivity in non-TBI populations.
Meditation and mindfulness techniques have been found to be effective for reducing anxiety and depression; may be effective for panic disorders, binge eating disorders, and substance abuse; and have been deemed promising practices by the Defense Centers of Excellence.1 However, little research has been done with regard to its effectiveness with TBI. The few studies that have examined this question tend to be pilot studies with small sample sizes, so results are difficult to generalize. However, there are some notable findings from these studies.
The Defense Centers of Excellence describes Traumatic Brain Injury as “a blow or jolt to the head that disrupts the normal function of the brain. The severity of the TBI is determined at the time of the injury and may be classified as mild, moderate or severe.” Mild TBIs are the most common, and 80 – 90% of all TBIs are classified as mild. Of note is that the course of recovery, symptoms, and evidence-based treatments are different for mild versus moderate-severe TBI.
Common symptoms associated with a TBI are:
Physical: headache, sleep disturbances, dizziness, balance problems, nausea/vomiting, fatigue, visual disturbances, sensitivity to light, ringing in ears
Cognitive: slowed thinking, poor concentration, memory problems, difficulty finding words
Emotional: anxiety, depression, irritability, mood swings
Some within the meditation community believe that the central concepts of mindfulness practices would fit well with the symptoms and needs of individuals with TBI and their recovery/rehabilitation. On the other hand, some think that the nature of an injury to the brain may prove too great an obstacle for traditional practices that require sustained attention and focused cognitive activity due to locations of the injury. Additionally, there are some who think that it may be a little of both viewpoints, depending on the nature and severity of the TBI, the time since the injury, and where the individual currently resides in the rehabilitation process.
Facts and Evidence
Three studies that altogether examined 32 individuals found positive effects of meditation on individuals with TBI. One study examined the effects of a mindfulness-based stress reduction (MBSR) program (adapted from Kabat-Zinn’s MBSR program) for a group of 22 individuals with persisting post-concussion symptoms with mild TBI who were concurrently participating in a TBI rehab program, had relatively intact memory, and were at least three months post-injury. They found improvements in perceived quality of life, perceived self-efficacy, working memory, and regulation of attention after 10 weeks of group-meditation-based stress reduction modified to specifically meet cognitive challenges using a standardized curriculum (i.e., a manual). However, there were no effects of treatment on neurobehavioral symptoms. They noted that practicing acceptance (which is at the heart of mindfulness based work) could be an important factor for individuals with TBI in particular to help mitigate negative perceptions of self that may be associated with chronic symptoms.2 A pilot study with 10 participants (with a comparison group of three patients who did not complete the treatment) examined the impact of a 12-week MBSR group intervention, also standardized and with a manual, that focused on insight meditation, breathing exercises, guided visualization, and an emphasis on psychological well being through awareness and acceptance.3 This patient population had mild to moderate TBI, had completed rehabilitation, had good insight, and was without co-occurring psychological health conditions (70% were women). Participants reported improved quality of life and improved aspects of depression (specifically in the cognitive-affective area). In a follow-up study, seven of the participants were evaluated one year post-intervention.4 These participants reported improved mental health as well as continued reduction in depressive symptoms.
On the other hand, a larger, randomized controlled trial (145 individuals with various severities of TBI who exhibited problems with attention on neuropsychological testing or who reported problems with attention in daily life who were three months to one year post-injury) examined the impact of brief mindfulness training for attention problems after TBI. The brief mindfulness training consisted of group treatment in five 45-minute sessions over four weeks and practice between sessions with audiotapes. This was followed up 12 months after the intervention. They collected data on the amount of mindfulness practice the participants did in the 12 months following the training, and although the published article did not report the amount of practice, it did report no significant differences within these variables through any of the groups. But most importantly, they found no significant differences in cognitive functioning, mood, or symptoms, leading to the conclusion that brief exposure to mindfulness meditation “could not be recommended as a treatment technique for traumatic brain injury cases” (p117).5 However, they noted that further research was needed and highlighted that their therapist contact was low, possibly diluting the impact of the training.
While there is an absence of evidence on the effectiveness of meditation in the treatment of TBI, there is other research showing that meditation has a positive impact on some common symptoms of TBI. Although these studies excluded individuals with psychological or neurological disorders, their findings suggest that meditation may have positive effects on cognitive and emotional functioning:
- Attention: Studies have found that meditation positively impacts one’s ability to sustain focused attention and cognitive efficiency.6 For example, one study examined intensive meditation training (for 10-12 hours daily for three months) and found that it improved one’s ability to sustain attention over time.7
- Memory & Executive Functions: Even brief mindfulness practices have been found to have positive effects. One study found that novices in mindfulness practice who spent twenty minutes daily for four days in meditation training had significantly lower scores of fatique, anxiety, and improved working memory, visuo-spatial processing, and executive functioning as compared to a control group whose members instead listened to a recorded book.8
- Depression: In a sample of participants who had a history of at least one previous episode of major depression and had been in recovery for at least eight weeks, both guided meditation and loving kindness (also called “metta”) meditation practices were associated with aspects of depression. For example, those who tend to brood about things responded well to deep breathing, whereas those who do not often brood responded better to loving kindness meditation.9 Additionally, mindfulness has been linked to greater ability to deal with negative emotions, which could decrease the development of depressive symptoms.10
- Mood: Long-term practice of meditation has been associated with greater emotional stability and a greater ability to accept emotional states and be aware in the moment.11
- Pain: Mindfulness practice has been found to attenuate pain, regardless of how or what form of mindfulness is practiced.12 Mindfulness practice reduced the unpleasantness of pain by 22% through decreasing cognitive control and increasing sensory processing in the brain.
Subject matter experts suggest that the ability of someone with TBI to learn to meditate and/or benefit from meditation might depend on the severity of the TBI and the presence of specific neurocognitive and neurobehavioral deficits. The location and extent of the injury, as well as time since injury and level of recovery, theoretically also could impact one’s ability to meditate.
It is important to realize that the studies mentioned above used modifications to typical MBSR programs to help those with TBI perform meditation successfully.2-5 For example, one study adapted the MBSR program by focusing on increasing attention skills, increasing awareness of internal and external experiences, and adopting a nonjudgmental, accepting attitude throughout the practice.
Military Relevance and Summary
There is to date no research on meditation and military personnel with TBI, and very few studies have examined the impact of meditation on any TBI patients, so there is not enough research to conclude that meditation is beneficial—or even possible—for those who have sustained a TBI. More research is needed to gain a better understanding of its impact, if any, as well as what patient and injury characteristics predict a positive response to meditation. Some preliminary research suggests that meditation may hold some benefits for attention, memory, depression, mood changes, pain, and emotional reactivity. However, researchers in TBI highlight that “holistic approaches integrating awareness, self-concept, self-efficacy, and emotional issues are crucial to rehabilitation and reintegration of individuals with TBI” (p723), therefore meditation may prove a beneficial adjunct to multidisciplinary holistic rehabilitation of service members with TBI.3 For now, however, caution should be exerted in interpreting these early findings until further research has been carried out.
- Moore M, Brown D, Money N, Bates M. Mind-Body Skills for Regulating the Autonomic Nervous System. Version 2 ed. Arlington, VA: Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury 2011:57.
- Azulay J, Smart CM, Mott T, Cicerone KD. A Pilot Study Examining the Effect of Mindfulness-Based Stress Reduction on Symptoms of Chronic Mild Traumatic Brain Injury/Postconcussive Syndrome. J Head Trauma Rehabil. 2012.
- Bedard M, Felteau M, Mazmanian D, Fedyk K, et al. Pilot evaluation of a mindfulness-based intervention to improve quality of life among individuals who sustained traumatic brain injuries. Disabil Rehabil. 2003;25(13):722-31.
- Bedard M, Mazmanian D, Felteau M, Fedyk K, et al. A Mindfulness-Based Intervention to Improve Quality of Life Among Individuals Who Sustained Traumatic Brain Injuries: One-Year Follow-Up. The Journal of Cognitive Rehabilitation. 2005;23(1):8-13.
- McMillan T, Robertson IH, Brock D, Chorlton L. Brief mindfulness training for attentional problems after traumatic brain injury: A randomised control treatment trial. Neuropsychological rehabilitation. 2002;12(2):117-25.
- Kozasa EH, Sato JR, Lacerda SS, Barreiros MAM, et al. Meditation training increases brain efficiency in an attention task. NeuroImage. 2012;59(1):745-9.
- Lutz A, Slagter HA, Rawlings NB, Francis AD, et al. Mental training enhances attentional stability: Neural and behavioral evidence. Journal of Neuroscience. 2009;29(42):13418-27.
- Zeidan F, Johnson SK, Diamond BJ, David Z, et al. Mindfulness meditation improves cognition: Evidence of brief mental training. Consciousness and Cognition. 2010;19(2):597-605.
- Barnhofer T, Chittka T, Nightingale H, Visser C, et al. State Effects of Two Forms of Meditation on Prefrontal EEG Asymmetry in Previously Depressed Individuals. Mindfulness. 2010;1(1):21-7.
- Barnhofer T, Duggan DS, Griffith JW. Dispositional mindfulness moderates the relation between neuroticism and depressive symptoms. Personality and Individual Differences. 2011;51(8):958-62.
- Taylor VA, Grant J, Daneault V, Scavone G, et al. Impact of mindfulness on the neural responses to emotional pictures in experienced and beginner meditators. NeuroImage. 2011;57:1524-33.
- Gard T, Hölzel BK, Sack AT, Hempel H, et al. Pain Attenuation through Mindfulness is Associated with Decreased Cognitive Control and Increased Sensory Processing in the Brain. Cerebral Cortex. 2011;15 Dec 2011 [Epub ahead of print].