A multi‐method exploration of mindfulness as a coping tool: Perspectives from trauma‐exposed, unhoused women residing at a drug treatment facility

Abstract

This multi-method study examined perspectives on mindfulness and coping strategies used by trauma-exposed women experiencing homelessness (WEH), residing in a state-funded residential drug treatment site in Southern California (United States). Questionnaires and in-depth focus group interviews were utilised to examine traumatic experiences over the lifespan, probable-posttraumatic stress disorder (PTSD), and coping strategies. Mindfulness was explored as a potential way to improve coping; potential benefits and challenges associated with implementing a mindfulness-based intervention (MBI) with trauma-exposed WEH were also investigated. A Community Advisory Board (CAB) was formed to identify key issues experienced by WEH and to develop a semi structured interview guide (SSIG). Using the SSIG, women participated in one of four focus groups (total N = 28; n = 7 per group). Quantitative data on demographic indicators, probable-PTSD, and trauma exposure were collected. Almost 90% of women met criteria for probable-PTSD; trauma exposure was exceedingly high; most women had experienced multiple traumas throughout their lives. Four main themes emerged from qualitative analyses, which drew from Grounded Theory and used open, selective, and axial coding:(1) ways of coping with trauma; (2) perspectives on mindfulness; (3) prior experiences with mindfulness; and (4) challenges for conducting a mindfulness programme. Overall, WEH used a variety of coping techniques to deal with their trauma, had some familiarity with mindfulness, and were optimistic an MBI would be helpful, despite identifying several challenges to implementation. MBIs may be helpful adjuncts to traditional care for trauma-exposed, WEH, recovering from substance use disorder. Population-specific considerations may improve implementation and participation.

Adaptation of a mindfulness-based intervention for trauma-exposed, unhoused women with substance use disorder.

“…All 28 WEH had been diagnosed with an SUD as a criterion for living at the drug treatment site and had been involved with the criminal justice system; 22 (78.6%) reported an additional clinician-based diagnosed mental health condition. Nearly all women met screening criteria for probable PTSD (89%, n = 25), as presented in a related report (Garfin et al, 2023). Reports of symptoms were high: 81.48% (n = 22) reported nightmares; 92.86% (n = 26) reported avoidance symptoms; 82.14% (n = 23) felt numb/detached from others; 75% (n = 21) felt guilty or unable to stop blaming themselves or others for the events; and 85.71% (n = 24) reported been constantly on guard, watchful, or easily startled.…”

“…Reports of symptoms were high: 81.48% ( n = 22) reported nightmares; 92.86% ( n = 26) reported avoidance symptoms; 82.14% ( n = 23) felt numb/detached from others; 75% ( n = 21) felt guilty or unable to stop blaming themselves or others for the events; and 85.71% ( n = 24) reported been constantly on guard, watchful, or easily startled. Additional descriptive demographic statistics are provided in a related report (Garfin et al, 2023).…”

Lived Experiences of Intimate Partner Violence and Help-seeking among Wives of Persons with Alcohol Dependence: A Thematic Analysis

“…Few studies reported similar findings which revealed that silence helps them to know what situations and circumstances to avoid. [ 45 ] employing a problem-focused approach, [ 46 ] engaging in assertive communication, [ 47 ] preparing safety plans, [ 48 ] striving for financial independence, [ 49 ] utilizing emotional-focused techniques, [ 31 ] relying on religious/spiritual strategies, [ 50 ] practising relaxation techniques, [ 51 ] employing social coping mechanisms, [ 7 ] seeking assistance from others, [ 52 ] supporting the husband’s treatment, and accessing peer support groups. [ 53 ]…”

Pilot randomized controlled trial of biofeedback on reducing psychological and physiological stress among persons experiencing homelessness

“…PEH report high levels of stress and elevated symptoms of anxiety (Garfin et al, 2020), depression (Garfin et al, 2020;Gutwinski et al, 2021), and PTSD (Armstrong et al, 2020;Duncan et al, 2019;Garfin et al, 2022) most likely due to exposure to cumulative traumatic life events (Buhrich et al, 2000;Edalati et al, 2017), including recurrent adverse childhood experiences (Paat et al, 2019;Sundin & Baguley, 2015), adult traumatic events (Buhrich et al, 2000;Edalati et al, 2017), and unstable housing (Karadzhov et al, 2020). Indeed findings estimate the prevalence of anxiety and depression at 40% and 48%, respectively (Garfin et al, 2020); PTSD has ranged from 19% to 79% (Ayano et al, 2020;Garfin et al, 2022;Landefeld et al, 2017). PEH also experience significant disparities in chronic physical diseases (CPD) (Brown et al, 2017;Drum, 2014;Fong, 2019), including hypertension (Salem et al, 2014), arthritis (Brown et al, 2013), and diabetes, 16% (Brown et al, 2013;Cezaretto et al, 2016;Markle-Reid et al, 2018).…”