[Impact of physical activity and meditation on the clinical improvement of military personnel suffering from post-traumatic stress disorder: Focus on the role of attachment style and professional reintegration].

内容摘要

Military personnel are frequently exposed to traumatic situations that can lead to chronic post-traumatic stress disorder (PTSD). PTSD complicates their reintegration due to the high risk of retraumatization. To support the reintegration of injured servicemen and women, the army has developed the Omega program which includes courses at the Centre des Bless&#xe9;s de l'Arm&#xe9;e de Terre (CReBAT). These courses combine physical activity and reintegration workshops to which mindfulness meditation exercises have been integrated, notably through diving. The voluntary involvement of participants in this program relies on good adherence to the various workshops for post-course follow-up, which implies attachment abilities. The aim of this study was to compare the effects of mindfulness diving (MD) with those of a multisport program (MS), mainly carried out in groups, on the clinical improvement of PTSD symptoms in military personnel with PTSD. The primary objective was to measure the impact of these two physical activities on specific PTSD symptoms. The secondary objective was to explore the role of attachment style on clinical impact and professional reintegration at one year after the course. A controlled clinical trial was conducted with 60 military personnel suffering from PTSD, divided into two groups: CReBAT-MD and CReBAT-MS. Participants were included as they enrolled in the Omega program. Symptom severity (PCL5) was assessed at the beginning, at the end and at one to two months after the courses. Reintegration at one year was examined. Attachment style was also assessed at the start of the course to characterize all participants in two categories according to their Internal Operating Model (IOM): positive self-IOM or negative self-IOM. The results showed a slight improvement in PTSD symptoms in both groups (CReBAT-MD and CReBAT-MS) with no significant difference between them. Regarding reintegration at one year, no significant differences were found between the groups. However, positive effects were observed at one-two months after the course for the MS group, notably a reduction in intrusions (P<0.05) and avoidance symptoms (P<0.05). No difference was observed between subjects with positive and negative self-IOM in terms of overall clinical course, except for a trend towards improvement in negative cognitions and effects (P=0.08) for the negative self-IOM group. Nor was there any difference in terms of reintegration. The lack of marked clinical improvement may be explained by the chronic nature of PTSD in military personnel and certain methodological limitations of the study. However, in addition to physical activity, social support and group interactions could play a role in the improvement process. Individuals with a negative IOM of self appeared to benefit more from MS internships, suggesting that group physical activity could enhance self-image and social skills. Further research is needed to better understand the role of physical activity in the management of PTSD, particularly regarding its impact on social cognition and long-term reintegration.