An Adapted Intervention for Minoritized and Other Women Facing Co-Occurring Disorders Including Post-Traumatic-Stress Disorder

Overview: Limited research exists to guide social work clinical practice for individuals with PTSD and co-occurring disorders; further gaps exist for BIPOC women. Addressing these gaps is critical to ensuring the right to mental health. We present results from a pilot study of Seeking Safety alongside a culturally inclusive art-therapy curriculumProposal text:

Purpose: According to SAMHSA’s National Survey on Drug Use and Health (2018), almost 9.2 million adults in the U.S. have a co-occurring disorder – that is, at least one mental health diagnosis in the presence of a substance use disorder. There is a significant sub-group that suffers with complex concurrent disorders (CCD). CCD populations experience additional co-occurring issues such as poly-substance use, serious mental illnesses, brain injury, severe trauma, and physical health problems (BCMOH, 2013). Limited research exists to guide social work education and clinical practice for individuals with CCD (Hakobyan et al., 2020). Individuals with CCD often have significant history and/or ongoing experiences of severe trauma, including historical trauma, with women and BIPOC groups being at special risk for PTSD (Najavits et al., 2009; NCPTSD, 2020; SAMHSA, 2020). While research supports the use of Seeking Safety (SS) for the treatment of co-occurring PTSD and SUD, there is limited evidence for the efficacy of this treatment with BIPOC individuals and others that experience CCD. A pilot study was conducted to evaluate the feasibility, safety, and outcomes of an adapted SS intervention that included non-verbal, sensory, and culturally inclusive elements.

Methods: The study intervention consisted of two SS group sessions each week: one contained conventional SS material alone, the second contained an SS focused art therapy curriculum. There were 26 participants in the sample; characteristics were: 73% female, 65% White, 23% Indigenous Canadian, 11% Black. All participants had a history of trauma and complex concurrent mental health and substance use disorders. Measures targeted PTSD symptoms (PCL-5; Blevins et al., 2015, TSC-40; Elliot & Briere, 1992); substance use (BAM; Cacciola et al., 2013); cognitive function (MoCa; Nasreddine et al., 2005); and participant rated session helpfulness with an open response section.

Outcomes: T-tests examined differences between baseline and post-test scores. Two sub-scales of the TSC-40 were significant: disassociation (M=1.73, p=0.024, d=0.80) and anxiety (M=2.82, p=0.014, d=0.89). The PCL-5 total score was significant (M=12.54, p=0.007, d=1.0) and the largest differences were seen in two sub-scales: negative cognitions and emotions (M=5.27, p=0.015, d=0.80) and arousal and reactivity (M=3.36, p=0.004, d=1.13). The End of Session Helpfulness questionnaires demonstrated high scores in both the manual and art sessions with no statistically significant differences. Qualitative data indicated that art therapy was a value-added component of treatment.

Conclusion: Findings from this study demonstrate that culturally inclusive and non-verbal, sensory interventions may help to engage clients experiencing PTSD as part of a CCD symptom profile. The implications suggest that the education of clinically focused MSW students should include interventions with minimal exclusion criteria and flexibility to adapt to a wide range of complex clients (Najavits et al., 2009; Roberts et al., 2020). Of particular importance is the evidence-based tailoring of treatment to support those from diverse cultural and ethnic backgrounds, and those that have experienced violations of human rights and traumatic histories Furthermore, social work students should be educated on the limitations of the current science and provided with strategies for how to engage and help those with CCD.