Program Profile: Meditation for Female Trauma IPV Survivors with Co-Occurring Disorders

This is a therapeutic program that used meditation to improve mental health outcomes for female survivors of interpersonal violence with co-occurring disorders. The program is rated Promising. Women in the treatment group who participated in the meditation curriculum had a statistically significant fewer number of mental health and trauma symptoms, and a higher level of reliable change in mental health and trauma symptoms, compared with women in the control group who received services as usual.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals/Target Population

This program was developed to use meditation as a therapeutic treatment for female survivors of interpersonal violence (IPV) with co-occurring disorders (CODs) such as depression or substance abuse. Meditation practice typically has two intentions: 1) to cultivate the ability to create a mindful existence, and 2) to expand attention and awareness of a moment-to-moment existence. The goal of this program was to curate a meditation curriculum for treating the problems associated with both trauma and CODs in female IPV survivors (Lee et al. 2011) by reducing mental health symptoms and trauma symptoms.

Program Components

The program consisted of a 6-week meditation curriculum guided by Tibetan meditation tradition. The first 2 weeks of the curriculum were devoted to breathing meditation, which focused on training for mindfulness and calmness. The next 2 weeks were devoted to Nying-je (loving kindness), which centered on empathy skills regarding one’s own affect and sensitivity to others’ affects. The final 2 weeks were devoted to Tonglen (compassion), which focused on the development of compassion for oneself and others.

The class met for 1 hour, twice a day, 5 days a week for a total of 60 hours of meditation. Each session usually began with 5 to 10 minutes of instruction, followed by 20 to 40 minutes of silent meditation. The instructor took questions at the end of each session (Lee et al. 2017).

Program Theory

The impact of meditation can be described according to the following four processes:

• Physiological. Studies have found that mindfulness-based meditation is a stress-reducing phenomenon that brings “the relaxation response” by provoking more left-sided electroencephalographic (EEG) activity and lowering the physiological byproducts of stress, leading to decreased heart, respiration, and blood pressure rates and cortisol levels (Kim 2012; Lazar et al. 2000).
• Neurological. Meditation practice is associated with positively activating brain regions that are correlated with attention, concentration, sensory processing, emotional memories, drives, inhibition, and motivation (Lazar et al. 2000).
• Psychological. Self-determination theory proposes that self-awareness is essential in facilitating the choice of behaviors that are consistent with one’s needs, values, and interests, and that mindfulness-based meditation can foster behavioral regulation (Deci and Ryan 2008).
• Emotional. Brain-imaging studies have shown that loving kindness and compassion meditation have been associated with enhanced positive affective processing and stronger functional connectivity from the frontal regions to the brain’s emotional regions (Brefczynski-Lewis et al. 2007).

Study

Lee and colleagues (2017) conducted a randomized controlled trial to determine the effects that meditation had on mental health and trauma symptoms of female survivors of interpersonal violence (IPV) with co-occurring disorders (CODs). This study took place in a midwestern metropolitan area. Participants were recruited from a substance abuse treatment and housing program for homeless women, and clients were considered eligible for the study if they had experienced interpersonal abuse and had CODs. Clients with schizophrenia, severe depression, or who were actively suicidal were excluded from the study.

Of the 63 total clients recruited, 32 were randomly assigned to the treatment group, and 31 were assigned to the control group. Of these participants, 31 women in the treatment group and 25 women in the control group completed the study. Participants in both groups received regular services provided by the agency, including group therapy, individual counseling, and substance abuse treatment, but the treatment group received the additional meditation classes, whereas the control group did not. The age of participants ranged from 22 to 56 years, with an average age of 38.6. Of the participants, 58.6 percent were white, and 41.4 percent were nonwhite. Of this group, 53.4 percent were single, 24.1 percent were divorced, 15.5 percent were separated, 6.9 percent were widowed, and 0 percent were married. Regarding education, 10.3 percent of the participants had graduated from college, 53.5 percent had some college education, 20.7 percent had graduated high school, and 15.5 percent did not finish high school. All participants had DSM-IV diagnoses in substance-related disorders: 39.7 percent for cocaine dependence, 32.8 percent for alcohol dependence, 15.5 percent for opioid dependence, 6.9 percent for polysubstance dependence, 3.4 for cannabis dependence, and 1.7 percent for amphetamine dependence. In addition to substance-related disorders, 32.8 percent of participants had been diagnosed with depression disorders, 27.6 percent with bipolar disorders, 12.1 percent with anxiety disorders, and 12.1 percent with posttraumatic stress disorder (PTSD). All participants also had experienced trauma: 82.5 percent through physical abuse, 82.5 percent through emotional abuse, and 78.9 percent through sexual abuse. The two groups only varied in race/ethnicity: 71.9 percent of the treatment group was white, compared with 42.3 percent of the control group. No adjustments were made.

Outcomes of interest included mental health and trauma symptoms, and a reliable change in mental health and trauma symptoms between the pre- and posttest. Mental health symptoms were measured by the Symptom Distress Scale (SDS) of the Ohio Department of Mental Health Adult Consumer Form. The SDS is a self-report instrument consisting of 15 items, which asks participants to rate their own mental health symptoms on a 5-point Likert scale. The score of the SDS can range from 15 to 75, with a higher score indicating a greater level of symptom distress. The Reliable Change score is calculated at 11; therefore, a difference of at least 11 points from pre- to posttest indicates a reliable change that is not the result of chance. Trauma symptoms were measured by the Modified PTSD Symptom Scale (MPSS), a 17-item instrument to measure the frequency and severity of PTSD symptoms within the past 2 weeks. The MPSS has three subscales: 1) Re-experiencing, 2) Avoidance/Numbing, and 3) Arousal. The score of the MPSS can range from 0 to 119, with higher scores indicating more severe PTSD symptoms. The Reliable Change score is calculated at 10; therefore, a difference of at least 10 points from pre- to posttest indicates a reliable change that is not the result of chance. Paired-sample t tests were used to examine changes in scores from pretest to posttest, and an analysis of covariance (ANCOVA) was used to compare treatment and control groups. The study authors did not conduct subgroup analyses.

The meditation classes were developed and instructed by Geshe Kalsang Damdul, the assistant director of the Institute of Buddhist Dialectics in Dharamasala, India (Lee et al. 2017).

These sources were used in the development of the program profile:

These sources were used in the development of the program profile: