Effect of Web-Based MBSR for Service Members with Post-mTBI Symptoms

This study represents the first attempt to evaluate the impact of a nurse-facilitated web-based mindfulness-based stress reduction (MBSR) on service members (SMs) with post-mTBI symptoms and possible PTSD comorbidity. Specific aims of this study are to evaluate: 1) the preliminary effectiveness, and 2) the feasibility of nurse-facilitated compared to self-directed and in-class MBSR programs in reducing post-mTBI symptoms for SMs. This is a prospective randomized study and the intervention will consist of a once a week, 2.5 hour, nurse-facilitated web-class compared to a self-directed web-class and in-class MBSR interventions. Web-based MBSR will incorporate a wide range of learning styles with frequent examples, brief video clips, and reading materials. In-class MBSR will include guided-MBSR and group discussion. All three groups will focus on learning, attention control, moment-to-moment awareness of thoughts, and bodily sensations. All of this will be accomplished via a meditation relaxation-response technique (e.g., body scan meditation) and mindful movement (e.g., yoga stretching).
The intervention will begin with a 2-hour in-person introductory class that will include an overview of MBSR, followed by once a week 2.5 hour sessions over an 8-week period. Basic demographic data such as age, gender, years in service, deployment history, marital status, education, and medication will be collected. Six types of outcome measures will be analyzed to ascertain significant changes in variables: 1) Hospital Anxiety and Depression Scale (HADS); 2) General Self-Efficacy (GSE) Scale; 3) Mindfulness Attention Awareness Scale (MAAS); 4) Neurobehavioral Symptom Inventory (NSI); 5) Posttraumatic Stress Disorder Checklist (PCL-5); and 6) Satisfaction With Life Scale (SWLS). Homework and daily logs also will be analyzed. The
outcome measures will be collected at three assessment time points: pre- (0 week); post-(8th week); and 4 weekpost-(12th week). The end result will be a determination of whether nurse-facilitated web-based MBSR can be easily communicated, delivered, and effective in mitigating post-mTBI symptoms compared to self-directed and in-class programs. Therefore, if found effective, the immediate use of findings from this study would be the first step in providing a DoD-wide web-based MBSR intervention for post-mTBI SMs. In addition, web-based MBSR may be used as part of pre-deployment training for all SMs to improve overall resilience and readiness.
Given the prevalence of SMs and Veterans with a history of mTBI who suffer from postmTBI/concussion symptoms and the shortage of qualified mental health providers, the results of this study
could have a profound effect on how we treat SMs and Veterans. This research may provide a foundation for nurses to leverage emerging technology (e.g., telemedicine, smartphone application, and remote monitoring) for developing potentially cost-effective rehabilitation and prevention education programs that are aimed at improving psychological health and building resilience for SMs and Veterans. This study will contribute to nursing science as the evidence-based alternative therapeutic approach that improves individuals’ own health outcomes and well-being.