Comparative Effectiveness Trial of Transcendental Meditation,
Prolonged Exposure, and Health Education in Veterans with PTSD:
A Randomized Controlled Study

Sanford Nidich, Ed.D.


Best estimates indicate that posttraumatic stress disorder (PTSD) occurs in 11–20% of Iraq and Afghanistan veterans, 10% of Gulf War veterans, and over 25% of Vietnam veterans. Preliminary studies with veterans and military personnel and other civilian populations show positive effects of TM in decreasing trauma symptom severity and depression.  This comparative effectiveness clinical trial directly compares meditation to the gold-standard Cognitive Behavior Therapy—Prolonged Exposure (PE) in veterans.

Intention-to-treat analysis indicated that both TM and PE groups showed significant decreases in trauma symptom severity and depression compared to HE at three-month posttest. The TM group further exhibited significant reductions compared to PE in both trauma symptoms and depression. The TM group showed significant reductions compared to HE on hyperarousal, intrusions, and avoidance (p < .005). Decreased hyperarousal was also found in the TM group compared to PE (p = .097).

The results of the trial showed that the TM program compares favorably to the gold-standard Prolonged Exposure therapy. Significantly decreased trauma symptoms and depression were observed over multiple time periods. Effects of the TM program were observed starting within the first month of practice and continuing over the three-month intervention period. One possible mechanism for how the TM program works, compared to exposure therapy, is in significantly reducing a veteran’s state of hyperarousal.

The TM program may be preferred to other existing treatments for PTSD such as exposure therapy that involve repeated, deliberate contact with anxiety-provoking stimuli. The availability of an alternative, evidence-based PTSD therapy could benefit patients by offering a greater range of primary treatment options, and by serving as a secondary modality for those not responding to prior therapy.

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