Trauma Interventions using Mindfulness Based Extinction and Reconsolidation (TIMBER©) as Monotherapy for Chronic PTSD: A Pilot Study

Objective: Despite recent advancements in treatments, prognosis for PTSD is still poor and there are limited therapeutic options. Because of feasibility and acceptability issues with many existing treatment options, this challenge is even more pronounced in adolescents with PTSD. The extinction-only based treatments including prolonged exposure therapy (PE) have significant limitations in terms of tolerability and efficacy. Method: This paper presents an overview of Trauma Interventions using Mindfulness Based Extinction/Reconsolidation (TIMBER), a translational mindfulness based psychotherapy for PTSD, which was developed by the first author, and preliminary results of this treatment in four adolescent patients. The methodology of TIMBER integrates principles of mindfulness based graded exposure therapy with neurobiological understanding of trauma memories including the interplay between the memory extinction and memory reconsolidation mechanisms that lead to formation and maintenance of the trauma memories in a dynamic way. TIMBER uses combined extinction and reconsolidation approaches, whereby reappraisal and modification of the trauma experiences are done via cognitive-emotive restructuring. The technique employs cognitive-behavioral and standardized Yoga and meditation interventions to induce new learning. This combined and targeted approach prevents restoration or re-expression of the trauma memories and the associated reactivity that lie at the core of the dysfunctions in PTSD. TIMBER has been tested in adults, either alone or in combination with medications. Results: All four patients remitted with respect to the symptoms of PTSD and associated dysfunction as measured clinically as well as based on their scores on PTSD specific rating scale. This improvement was maintained during follow-up of up to 8 months. Conclusion: Efficacy of TIMBER is currently being evaluated in a double blind randomized controlled trial in adult patients with PTSD. In this paper, we present the version of the TIMBER applicable to adolescents suffering from PTSD. Although further replication in future studies is necessary before drawing definite conclusions, preliminary data on efficacy of TIMBER for treatment of PTSD are encouraging. Further study in larger samples is necessary to confirm its usefulness in adolescent patients with PTSD.