Seeking Safety Therapy for Co-occurring PTSD and Substance Use - - PowerPoint PPT Presentation

Seeking Safety Therapy for Co-occurring PTSD and Substance Use Disorder in HIV-positive Transgender Women: A Feasibility Study

• S. Empson1, J. Cocohoba2,3, K. Davis3, E.L. Machtinger1,3

1University of California, San Francisco (UCSF), School of Medicine, 2UCSF School of Pharmacy, 3Women’s HIV Program (WHP) at UCSF

Background

• Post-traumatic stress disorder (PTSD) and

substance use disorder (SUD) disproportionately affect HIV-positive male-to-female transgender women.

• PTSD and SUD are associated with poor HIV-

related health outcomes and increased transmission-risk behaviors.

Methods

Participants

• HIV-positive transgender women
• Recent substance use
• Recent or past trauma
• Receiving care at either SFGH Ward 86 or Women’s

HIV Program (WHP) at UCSF Content

• 12 of 25 Seeking Safety modules selected
• Modules selected by social worker/physician team

based on appropriateness for HIV-positive transgender women

• Sessions lasted 2 hours, food provided

Incentives

• $180 for completion of 12 sessions

Outcome Measures

• Demographic, health, and behavioral characteristics
• PTSD symptoms (PCL-C 17)
• HIV stigma (HIV Stigma Scale)
• Drug and alcohol use (DAST-20, MAST-22)
• Focus groups conducted post-intervention with

facilitators and participants.

What is Seeking Safety?

• A flexible, manualized cognitive-behavioral

therapy to treat co-occurring PTSD and SUD

• 25 individual modules
• Emphasis on cognitive, behavioral, and

interpersonal content areas

• Allows for flexibility in:
• Number of sessions/modules included
• Length of sessions
• Order of sessions
• Individual vs. group format
• Choice of pre-approved materials
• Materials are all pre-approved and un-alterable
• Each session follows the same structured format

Study Design

Table 1: PTSD, Stigma, and Substance Use Mean Score (95% CI) Pre-Seeking Safety Post-Seeking Safety PCL-C 55.4 (41.1-69.8) 45.7 (31.6-59.9) HIV Stigma 115.3 (94.5-136.1) 111.3 (86.8-135.8) DAST 20 6.4 (0.1-12.8) 2.0 (-0.7-4.7) MAST 22 7.1 (2.6-11.7) 5.4 (1.2-9.6) Table 2: Seeking Safety Impact on PTSD and SUD Pre-Seeking Safety (n=7) Post-Seeking Safety (n=7) PTSD Diagnosis (PCL-C) 5 (71.4%) 4 (57.1%) Drug Problem (DAST) 5 (71.4%) 4 (57.1%) Drinking Problem (MAST) 7 (100.0%) 4 (57.1%)

Participant Characteristics (n=7)

• African-American (71.4%)
• Aged 42.3 years (SD=10.1)
• On HAART (85.7%)
• Sexually active (57.1%)
• Earning < $1000/month (85.7%)
• Receiving government-provided health

insurance (100%) Six participants (85.7%) completed > 7 sessions

Outcome Measures

PTSD, HIV stigma, drug and alcohol use mean scores decreased post-intervention (Table 1). At baseline (Table 2):

• 71.4% met criteria for PTSD diagnosis
• 71.4% had a self-identified drug problem
• 100% had a self-identified drinking problem

Post-Seeking Safety (Table 2):

• 57.1% met criteria for PTSD diagnosis
• 57.1% had a self-identified drug problem
• 57.1% had a self-identified drinking problem

Results

Conclusions

Seeking Safety is feasible to conduct with HIV- positive transgender women and may reduce PTSD symptoms and substance use. Larger studies should fully explore the potential for Seeking Safety to benefit HIV-positive transgender and non-transgender women.

Limitations

• Small sample size (limited about of data)
• Neither the sessions nor the focus groups were

recorded

• Participant focus groups were conducted by the

Seeking Safety facilitators

Future Considerations

Focus groups identified important areas of consideration for future Seeking Safety Interventions:

• Appropriate module selection
• Amount and content of material included in each

session

• Session structure
• Role of incentives
• Long-term impact

Module Domain Description PTSD Taking Back Your Power Cognitive Causes and behaviors associated with PTSD Grounding Behavioral Skills to reduce emotional distress When Substances Control You Cognitive Definition of substance abuse and dependence Healing from Anger Interpersona l Role of anger in PTSD and SUD Taking Good Care of Yourself Behavioral Self-care and neglect Honesty Interpersona l Role of honesty in trauma and SUD recovery Compassion Cognitive Promotion of non-judgmental thinking Setting Boundaries Interpersona l Setting healthy boundaries in relationships Commitment Behavioral Strategies to improve follow-through Respecting Your Time Behavioral Time management skills Healthy Relationships Interpersona l Identification of (un)healthy relationships

Conclusions