Adaptation of a mindfulness-based intervention for trauma-exposed, unhoused women with substance use disorder.
Dana Rose Garfin, Alexandra Amador, Jessica Osorio, Krista Sadiwa Ruivivar, April Torres, Adeline M Nyamathi
Psychological trauma : theory, research, practice and policy December 1, 2024 DOI: 10.1037/tra0001486
Summary
Nearly all women experiencing homelessness (WEH) reported that mindfulness-based stress reduction (MBSR) activities would be at least "somewhat helpful," with 71% to 89% deeming them "a great deal helpful." In a study involving 28 trauma-exposed WEH at a drug treatment site, focus groups revealed themes around MBSR's feasibility, recruitment strategies, and trainer characteristics. These insights can enhance program design and retention in community settings, ultimately supporting better mental health outcomes for WEH dealing with trauma and substance use disorders.
Abstract
Women experiencing homelessness (WEH) report exceedingly high rates of trauma exposure, posttraumatic stress disorder (PTSD), and substance use disorder (SUD). Mindfulness-based interventions including Mindfulness-based Stress Reduction (MBSR) may help lower traumatic stress-related symptoms and reduce SUD, but have been underexplored in community-based settings serving WEH with symptoms of PTSD and SUD. We used a mixed-method, community-engaged approach that implemented a Community Advisory Board and the ADAPT-ITT (assessment, decision, adaptation, production, topical experts, integration, training, testing) framework, including intervention demonstrations, to adapt and refine MBSR for WEH experiencing symptoms of PTSD/SUD. Trauma-exposed WEH (N = 28) living at a drug treatment site provided perspectives and feedback on an MBSR demonstration via quantitative questionnaires and four focus groups. Quantitative measures indicated high perceived acceptability and feasibility: Nearly all WEH reported MBSR activities (including yoga, meditation, body scans, class discussion, and home practice) would be at least "somewhat helpful"; between 71.43% to 89.29% reported each activity would be "a great deal helpful." Most reported the focus group sessions were useful for providing feedback relevant for improving program design and administration. Qualitative findings revealed four themes aligning with quantitative findings that provided useful suggestions to guide MBSR implementation with trauma-exposed WEH: (a) perception of feasibility and effectiveness of MBSR, (b) strategies for successful recruitment, (c) strategies for successful retention, and (d) characteristics of the MBSR trainer. Focus group recommendations could bolster intervention compliance, engagement, and completion for MBSR and community-based programs for WEH more generally. Results provide suggestions for implementing a trauma-sensitive approach when administering MBSR to trauma-exposed WEH. (PsycInfo Database Record (c) 2024 APA, all rights reserved).