1. Mindfulness Interventions for PTSD and Comorbid Substance Use Disorders
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Bridgette Cool, MSW Candidate
GRC MSW Program
Abstract
Many studies have found that Posttraumatic Stress Disorder (PTSD) and Substance Use Disorders (SUDs) are frequently co-occurring, yet majority of interventions treat each disorder separately. With a high prevalence of comorbid PTSD and SUDs there is a serious need for a treatment modality that simultaneously targets symptoms of both disorders. Mindfulness based interventions have been found to reduce stress, increase awareness and promote self-regulatory skills that are essential to the recovery process of PTSD as well as SUDs. This thesis will examine PTSD and comorbid SUDs with application of mindfulness based interventions such as mindfulness meditation, yoga, Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), and Mindfulness Based Stress Reduction (MBSR) and their effectiveness in treating comorbid PTSD and SUDs.
PTSD
Mindfulness
Comorbid PTSD & SUDs
Post-traumatic Stress Disorder (PTSD) occurs after exposure to a traumatic event that results in a variety of behavioral, physiological, and emotional responses; the prominent symptoms are different for each individual (American Psychiatric Asociation, 2013).
Risk Factors; Pretraumatic (must exist before the trauma) low socioeconomic status, limited education, low cognitive functioning, female gender; Peritraumatic (taking place around the traumatic event) serverity of trauma, percieved threat, injuries sustained ; Posttraumatic poor/inappropriate coping mechanisms, negative appraisals, repeated exposure, lacking support.
Symptoms: mood disturbances, dissociative symptoms, impulsive behaviors, hyperarousal, loss of self-regulation skills (Rhodes, Spinazzola, & van der Kolk, 2016)
Mindfulness practices seek to maintain awareness of the mind and body in the present moment using a non-judgemental lens (Cacciatore, et al., 2014); the use of mindfulness can bring one’s awareness to the present therefore taking away the attention from ruminating thoughts (Im & Follette, 2016) which is helpful in developing better response patterns to unwanted thoughts or emotions. The bi-directional cycle of PTSD and SUDs may be interrupted through the use of mindfulness by reducing automatic reactions and dysregulation in the mind and body (Bowen, et. al, 2017). A willingness to learn and integrate mindfulness based interventions into one’s life promotes and supports mental health recovery (Khusid & Vythilingham, 2016).
Implications with Trauma The practice of mindfulness with trauma survivors can alter avoidance patterns and the development of succeeding symptoms (Bowen, et. al, 2017). In order to re-establish safety one must begin with gaining control of their body, which for many survivors involves developing ways to be calm, focused and maintaining that feeling of calm when reminded of the past, learning to be honest with oneself, and being alive in the present moment (van der Kolk, 2014). Through the key component mindfulness practice, awareness, a person can reduce their responses to unpleasant experiences by creating a sense of safety and control.
Implications with Substance Use Replacing substance use with mindfulness practices can reduce the cravings of substances such as drugs and alcohol; the idea behind this is that mindfulness promotes awareness which is the opposite of avoidance (Vrana, et al., 2017). The use of mindfulness with SUDs can also decrease emotional reactivity, and increase awareness and acceptance which in turn allows an individual to use self-regulatory skills rather than avoiding or numbing.
Of persons meeting the criteria for PTSD 46.6% had a comorbid SUD (Bowen, et al., 2017).
Comorbid PTSD and SUDs are linked to poorer outcomes in treatment and recovery (Zambrano-Vasquez, et al., 2017)
PTSD and SUDs function in a bidirectional cycle (Bowen, et. al, 2017)
Studies have indicated a connection with PTSD and SUDs through the use of similar pathways in the brain (Jaques, 2017).
Substance Use Disorders
Substance Use Disorders (SUDs) are characterized by a variety of cognitive, physiological, and behavioral symptoms which results in repeated substance use regargless of major problems and consequences related to the substance use (American Psychiatric Association, 2013).
Symptoms: Impaired control, social impairment, risky use, and withdrawal symptoms, increased tolerance, health issues related to substance use (Jones, Gill, & Ray, 2012).
Often it is suggested that substance abuse may be a maladaptice coping mechanism for people suffering from PTSD symptoms.
Recent studies indicate that addiction is a chronic illness affecting the brain, thus it should be treated as such; the release of stress hormones adrenaline and cortisol is activated by the bodies sympathetic nervous system in response to stress; significant amounts of these stress hormones are related to addiction (Jaques,2017).
Recommendations
Currently there are very few treatments that target comorbid PTSD and SUDs rather many treatments more commonly focus on each disorder separately (Zambrano-Vasquez, et al, 2017). Emotion dysregulation is a common conceptualization among PTST and SUDs (Vrana, et al., 2017), therefore it may be beneficial to consider an integrated approach to the treatment of comorbid PTSD and SUDs. Mindfulness based interventions improve emotion regulation skills, decrease avoidance patterns, and reduce states of hyperarousal which consequently reduce symptoms of PTSD and SUDs.
References
*May be found on a separate handout*