A multisite randomized controlled trial of Seeking Safety vs. Relapse Prevention Training for women with co-occurring posttraumatic stress disorder and substance use disorders

Abstract

Background : Co-occurring posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are associated with a more severe course and worse outcome than either disorder alone. In Europe, few treatments have been evaluated for PTSD and SUD. Seeking Safety, a manualized, integrated, cognitive-behavioural treatment, has been shown to be effective in studies in the USA. Objective : To test the efficacy of Seeking Safety plus treatment as usual (TAU) in female outpatients with PTSD and SUD compared to Relapse Prevention Training (RPT) plus TAU and TAU alone. Method : In five German study centres a total of N = 343 women were randomized into one of the three study conditions. PTSD severity (primary outcome), substance use, depression and emotion dysregulation (secondary outcomes) were assessed at baseline, post-treatment, as well as at three months and six months post-treatment. Results : Treatment participants attended M = 6.6 sessions (Seeking Safety) and M = 6.1 sessions (RPT). In an intent-to-treat analysis, Seeking Safety plus TAU, RPT plus TAU and TAU alone showed comparable decreases in PTSD severity over the course of the study. Seeking Safety plus TAU showed superior efficacy to TAU alone on depression and emotion regulation and RPT plus TAU was more effective than TAU alone on number of substance-free days and alcohol severity. Minimum-dose analyses suggest additional effects of both programmes among participants who attended at least eight group sessions. Conclusions : With respect to PTSD symptoms, a brief dose of Seeking Safety and RPT in addition to TAU was not superior to TAU alone in women with PTSD and SUD. However, Seeking Safety and RPT showed greater reductions than TAU alone in other domains of psychopathology and substance use outcomes respectively. Future studies should investigate further variables, such as what aspects of each treatment appeal to particular patients and how best to disseminate them.

Residual Symptoms of Posttraumatic Stress Disorder and Alcohol Use Disorder Following Integrated Exposure Treatment Versus Coping Skills Treatment

“…Seeking Safety (Najavits, 2002) is a present‐focused integrated PTSD/SUD treatment that emphasizes establishing safety and coping skills as the primary clinical need for individuals with this comorbidity. Studies have shown that SS is comparable to SUD treatments such as relapse prevention or health education in reducing PTSD and SUD symptoms (Boden et al., 2012; Hien et al., 2009; Schäfer et al., 2019). The results of one direct comparison demonstrated that both COPE and SS reduced PTSD symptoms, with COPE showing larger reductions in PTSD compared to SS (Norman et al., 2019).…”

Profiles of mothers who seek treatment for substance use disorders in a clinical centre

“…Accurate assessments of these mothers should be developed and tailored interventions according to the trauma-informed care perspective should be provided (Covington, 2008). There is a large literature on posttraumatic stress disorder (PTSD) and substance use in women (Melchior et al , 2019), and treatments like Seeking Safety have been developed as a specific and integrated psychotherapy for PTSD and substance use disorder, showing promising results (Lenz et al , 2016; Schaefer et al , 2019).…”

Profiles of Childhood Trauma in Women With Substance Use Disorders and Comorbid Posttraumatic Stress Disorders

“…The data of this study are derived from the baseline data of a larger intervention trial among patients with SUD and PTSD (27) (DRKS00004288).…”