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Posttraumatic Stress Disorder: Approaches and Symptoms

Why the Article was Chosen

The study conducted by Müller-Engelmann et al. (2019) contains plenty of significant elements within the scope of research design. The authors seem to adhere to the best practices of the multiple baseline approach and apply it to the relevant issue. This is the primary reason why the mentioned study was chosen. What is more, there is a number of notable aspects that draw attention to the article besides the research design. The commonness of posttraumatic stress disorder (PTSD) might be perceived as considerably high among individuals who faced interpersonal violence. This disorder implies communication issues, negative self-perception, and affective dysregulation.

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The scholars state that meta-analyses reaffirm the efficiency of a trauma-focused intervention, for instance, an exposure-based treatment with better effects in the framework of individual treatment regimes in comparison with group regimes. The mentioned interventions tend to demonstrate more significant results than other therapies, for example, supportive treatment. It should also be noted that group treatment is associated with amplified dropout and treatments with solid exposure elements and lead to a higher dropout rate if to compare with an integrative approach involving, for instance, mindfulness.

Recently, mindfulness-founded interventions have been proved to be an expedient new treatment of PTSD. Mindfulness can be determined as a nonjudgmental, nonreactive, and frank understanding of the present moments. The authors report that a number of investigations indicate a negative relationship between mindfulness-based approaches and PTSD symptoms acuteness. Some assumptions maintain the idea that mindfulness can be useful within the scope of reducing PTSD consequences. The scholars accept the claim that PTSD is supported by the perception of trauma as an actual menace. Such an impression of risk may be reduced by developing present-moment awareness, which contributes to the distinguishing of the present and past. Given the fact that mindfulness-based interventions seem to become quite popular nowadays and that PTSD is a serious disease that requires significant and appropriate treatment, it might be assumed that the described above scholars’ position is relevant and noteworthy.

It seems reasonable to state that the research contributes to the field of ABA as well. The mentioned field aims to improve social and learning abilities through positive reinforcement. The crucial point here is that mindfulness and loving-kindness meditation has become quite a popular approach that should be learned and applied through such a lens. Inner psychological harmony is the foundation that serves to significant results in the framework of social and learning skills. The scholars implement the evidence-based methodology in order to prove that mindfulness and loving-kindness might be an essential element to cure severe disease. Their multiple-baseline approach provides the audience with the opportunity to realize the critical benefits of mindfulness and loving-kindness in this regard.

The Details of the Research

In their multiple-baseline research, the authors investigated the efficiency of an eight-session intervention that mixes psychological education and mindfulness-founded exercises in order to overcome PTSD consequences, applying the formal practice from MBSR and loving-kindness meditations. The participants were as follows; patients were involved from the waiting lists of the particular PTSD center. Those who were able to take part in the research were contacted via phone. If they expressed interest, the patients were assessed in order to verify whether they fall either under inclusion or exclusion criteria. The ones who fell under the former were asked to come to two evaluation sessions to check if their mental state allows them to participate. A total number of fourteen patients took part in the study.

Intake evaluations were held by six competent therapists who took part in the research. After these evaluations, the patients had to “fill out a set of self-report measures” (Engelmann et al., 2019, p. 1108). Then, according to Müller-Engelmann et al. (2019), “they were randomly assigned to a 2-, 3-, or 4-week baseline period, during which they were asked to fill out the Davidson Trauma Scale… and the WHO-Five Well-Being Index… on a weekly basis” (p. 1108). The mutual understanding was achieved, given the fact that the therapist who was responsible for the participants’ intake evaluations was the one with whom they started the treatment process. During the interventions and for the eight-week period after, the patients filled the same questionnaires mentioned above each week and indicated the length they had implemented exercises during the previous week. Right after these interventions and one more time at a six-week follow-up, the patients filed the same self-reports.

These interventions involved eight 90-min sessions that were implemented in individual treatment settings. The interventions adhered to the particular needs of the participants who had PTSD after they had faced interpersonal violence. The target of the procedures was to develop mindfulness and loving-kindness skills by various exercises, as well as to tell the participants how to apply them in the framework of their psychological situation. The main outcomes of the research were PTSD symptoms, as well as well-being. The secondary ones were “depressive symptoms and psychological distress as well as mindfulness skills and self-compassion” (Engelmann et al., 2019, p. 1110).

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The scholars applied “a nonconcurrent multiple-baseline across individual design” (Engelmann et al., 2019, p. 1112). A baseline of different duration was assigned to the patients on a random basis. All baselines were followed by the interventions and the postintervention phases; symptom severity, as well as well-being, were assessed weekly. The authors utilized Tau-U analysis rather than visual inspections of the graphically provided information in order to evaluate changes that are taking place. This approach was developed for a single-case study, and it mixes the non-overlap between phases, for instance, between baselines and intervention phases. Engelmann et al. (2019) also used t-tests and repeated-measures MANOVAs, which, again, stays in line with the best practices of the baseline method.

The major part of the participants demonstrated a substantial decrease in self-reported PTSD manifestations (75%), as well as a notable improvement in well-being (50%). After the interventions, nine out of twelve completers no longer fell under the diagnostic measure according to the interviews, which should be considered significant because there were participants with impressive trauma exposure. In the framework of the secondary outcomes, there was a noticeable impact on depression, as well as psychological distress. What is more, the scholars identified a number of improvements within the scope of mindfulness skills. The study reported that the above achievements were associated with the reduction of PTSD symptoms.

The authors claim that the interventions were beneficial in reducing PTSD symptoms; this aligns with previous findings in this field. The notable impact on avoidance symptoms in the investigation reveals the fact that the interventions were successful in modifying essential pathological processes that serve as a foundation for PTSD severity. “An increase in mindfulness skills and a reduction in self-criticism had strong, significant relationships with the reduction of PTSD symptoms, depressive symptoms, and psychological distress” (Engelmann et al., 2019, p. 1116). However, there is still a number of limitations present in the study. The most crucial one is the small sample size and the non-inclusion of individuals who have life-threatening problematical behaviors – such a restriction negatively affects the generalizability of the study’s outcomes. Then, the individual approach to the patients could have contributed to their aspiration to please a therapist and report an improved state. A promising direction for future studies might be to investigate which aspects of mindfulness reduce these symptoms to the greatest extent and to elaborate on the related exercises.

Why Such a Design was Chosen

The researchers chose the multiple-baseline method as it provided them with the opportunity to draw conclusions on the efficiency of the treatment, even given the fact the sample size was small. Then, this design eliminates “the effect of history” (Engelmann et al., 2019, p. 1112), which is a notable danger to validity. Finally, there was no necessity for control groups as the baseline phase was the control for each patient.

Article Critique

It might be assumed that the scholars chose the best possible design for their study, given such a small sample size. The primary foundation for this argument is that the baseline phase was the control, and there was no need for a control group. The researchers could focus on the observation, obtaining of the results, and interpretation of the latter. The multiple-baseline approach made the investigation process smooth and coherent, which allowed the authors to demonstrate a solid train of thought and significant outcomes. The only change in procedures that could have been implemented is expanding the extent of participants’ inclusion so that the generalizability of results would be more convincing


Müller-Engelmann, M., Schreiber, C., Kümmerle, S., Heidenreich, T., Stangier, U., & Steil, R. (2019). A trauma-adapted mindfulness and loving-kindness intervention for patients with PTSD after interpersonal violence: a multiple-baseline study. Mindfulness, 10, 1105–1123. Web.

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