Treating Co-occurring Adolescent PTSD and Addiction: Mindfulness-Based Cognitive Therapy for Adolescents with Trauma and Substance-Abuse Disorders PDF
Preview Treating Co-occurring Adolescent PTSD and Addiction: Mindfulness-Based Cognitive Therapy for Adolescents with Trauma and Substance-Abuse Disorders
“This outstanding, state- of- the- art treatment program is an essential resource for all clinicians helping all adolescents reclaim and rebuild their lives after the devas- tating effects of trauma and addiction.” — Kim T. Mueser, PhD, director of the Center for Psychiatric Rehabilitation and professor of occupational therapy, psychology, and psychiatry at Boston University “The world is witnessing an explosion of mindfulness possibilities, but mindfulness is not a generic, one- size- fits- all fix. The process and delivery of a mindfulness- based program demands subtle adjustments in dosage and approach, including knowledge about how mindfulness practice may impact specific populations. Fortuna and Vallejo bring mature experience and deep wisdom to the task. By blending mindfulness with therapeutic interventions, such as cognitive restructur- ing and motivational interviewing (among others), this guide is a trustworthy com- panion in meeting your adolescent clients in skillful, responsive, and life- affirming ways.” — Lynn Koerbel, MPH, associate director of the Oasis Institute for Mindfulness- Based Professional Education and Training at the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School, coauthor of A Mindfulness- Based Stress Reduction Workbook for Anxiety, and teacher of MBSR since 2005 “Adolescents with complex trauma lack a basic sense of safety in the world and an understanding of others as responsive and trustworthy. It is through relationship that we develop the capacity to be seen and to be known. This wonderful guide helps teens restore safety and predictability within their bodies, a sense of agency in the world, and an understanding of themselves as worthy of care.” — David Schouela, staff yoga teacher at the Trauma Center at Justice Resource Institute (JRI), Brookline, MA “As a father, it is very comforting to know that two very dedicated, wise, and loving clinicians have written a hands- on treatment manual for adolescents living with PTSD and addiction. The practices of mindfulness have the power to transform and heal the wounded heart. Thank you, Lisa and Zayda, for loving and caring for our children.” — Bob Stahl, PhD, coauthor of A Mindfulness- Based Stress Reduction Workbook, Living with Your Heart Wide Open, Calming the Rush of Panic, A Mindfulness- Based Stress Reduction Workbook for Anxiety, and MBSR Every Day “This book is just what I was looking for to assist me in my work with adolescents struggling with PTSD and substance abuse. What I really appreciated was that the authors offer clear and useful solutions for working with teens that may never have practiced any type of self- soothing techniques. Not only does the book provide concrete explanations of strategies such as mindfulness and meditations, but it also gives step- by- step guidelines as to how to implement them into my practice. As a social worker in an urban middle school, this book has given me intervention tech- niques that will assist the students so that they can calm down to the point that they are able to identify the underlying feelings that are causing them to act out in school.” — Stacy L. Homan, LICSW, School Adjustment Counselor, Worcester East Middle School, Worcester, MA Treating Co-occurring Adolescent PTSD Addiction and Mindfulness-Based Cognitive Therapy for Adolescents with Trauma and Substance-Abuse Disorders Lisa R. Fortuna, MD | Zayda Vallejo, MLitt C P ontext ress An Imprint of New Harbinger Publications, Inc. Publisher’s Note This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other professional services. If expert assistance or counseling is needed, the services of a competent professional should be sought. Nine dots exercise and “The Monkey Story: Illustrating Letting Go” are adapted from FULL CATASTRO PHE LIVING by Jon KabatZinn, copyright © 1990 by Jon KabatZinn. Used by permission of Dell Publishing, an imprint of Random House, a division of Penguin Random House LLC. All rights reserved. Material from Gregory Kramer’s INSIGHT DIALOGUE: THE INTERPERSONAL PATH TO FREEDOM copyright © 2007 by Gregory Kramer. Used by arrangement with The Permissions Company, Inc., on behalf of Shambhala Publications, Inc., Boston, MA. http://www.shambhala.com. “Autobiography in Five Chapters” reprinted from There’s a Hole in My Sidewalk: The Romance of Self Discovery by Portia Nelson. Copyright © 1993 by Portia Nelson; reprinted with permission of Beyond Words/Atria, a division of Simon & Schuster, Inc. All rights reserved. Distributed in Canada by Raincoast Books Copyright © 2015 by L isa R. Fortuna and Zayda Vallejo Context Press An Imprint of New Harbinger Publications, Inc. 5674 Shattuck Avenue Oakland, CA 94609 www.newharbinger.com Cover design by Amy Shoup; Acquired by Jess O’Brien; Edited by Rona Bernstein; Indexed by James Minkin All Rights Reserved Library of Congress CataloginginPublication Data Fortuna, Lisa R. Treating cooccurring adolescent PTSD and addiction : mindfulnessbased cognitive therapy for adolescents with trauma and substanceabuse disorders / Lisa R. Fortuna, MD, MPH, MDiv, and Zayda Vallejo, MLitt ; foreword by Florence MeleoMeyer, MS, MA. pages cm Includes bibliographical references and index. ISBN 9781626251335 (paperback) ISBN 9781626251342 (pdf ebook) ISBN 978162625 1359 (epub) 1. Posttraumatic stress disorder in adolescenceTreatment. 2. Substance abuseTreat ment. 3. Cognitive therapy for teenagers. I. Vallejo, Zayda. II. Title. RJ506.P55F67 2015 616.85’2100835dc23 2015018136 To H. E. Choegyal Rinpoche, VIII, who embodies unconditional love —Zayda To my grandmother “Bolito” —Lisa Contents Foreword vii Acknowledgments xi Introduction 1 Part 1 Understanding Mindfulness- Based Cognitive Therapy for Adolescents with Trauma and Substance- Abuse Disorders 1 An Integrated Approach to the Treatment of Trauma and Addictions in Adolescents 7 2 Theory and Practice of Mindfulness- Based Cognitive Therapy– Dual 21 3 Engaging, Motivating, and Working with Adolescents in Therapy 41 4 Mindfulness- Based Cognitive Therapy for Other Co- occurring Adolescent Mental Health Conditions 59 5 Mindful Communication 81 Part 2 Conducting MBCT- Dual Sessions 6 General Considerations for Conducting MBCT- Dual Sessions 97 7 MBCT- Dual Therapy Session Guide 103 Meeting 1: Introduction, Feedback, and Safety 103 Meeting 2: Introduction to Mindfulness 112 Meeting 3: Psychoeducation Part I—PTSD 122 Meeting 4: Psychoeducation Part II—Risk Behaviors and Drug and Alcohol Triggers 130 Meeting 5: Managing Triggers, Cravings, and Urges 137 Meeting 6: Common Styles of Thinking 144 Meeting 7: Cognitive Restructuring—Observing Our Thoughts 153 Meetings 8– 11: Mindfulness- Based CR and Recovery 161 Meeting 12 (Or Final Meeting): Generalization Training and Termination 163 Treating Co-occurring Adolescent PTSD and Addiction Appendix A: Guided Mindfulness Scripts 169 Appendix B: Selected MBCT- Dual Tools 191 Appendix C: Guidelines for Behavior Rehearsal Role- Play 197 Appendix D: Poetry in Mindfulness 201 References 203 Index 213 vi Foreword The guiding intention and focus of this book is essentially compassion in action. The authors, Lisa Fortuna, MD, and Zayda Vallejo, MLitt (Oxon), have defined a potential pathway for adolescents to achieve greater health through mindfulness- based cognitive therapy for adolescents with trauma and substance- abuse disorders (MBCT- Dual). The book offers the therapist and caregiver a host of tools to deliver a program that has the potential to skillfully alleviate the suffering of adolescents who have been hurt multiple times in their lives. Numbing is one way an adoles- cent may attempt to cope with the anguish of intrusive thoughts and emotions following the shock of trespassing encounters of physical, emotional, and sexual abuse. Commonly, drugs and alcohol are the means teens employ to find relief, and in turn become another source of suffering as addiction. These methods, of course, make teens more susceptible to deeper trauma, expose them to dangerous situa- tions, and complicate a lifelong trap of avoidance. The information and skillful guidance in this book offer a pathway to greater ease and health that focuses on recovery from trauma and addiction while also establishing the groundwork for greater self- esteem and constructive life skills. Through psychoeducation, mindfulness practices, and cognitive strategies, the adolescent is offered a program that is much more than a technique. Through the strong and ongoing practice of mindfulness, the adolescent is introduced to a way of living. Mindfulness is not just a practice of meditation but an intrinsic human awareness in all human beings. Through mindfulness meditation, one discovers presence— a presence which can never be diminished, no matter how terribly one has been hurt. The practice engages the adolescent in the discovery of this essen- tial human capacity that is most often overlooked— innate wholeness. Mindfulness honors and strengthens what is most deep, wise, and kind within one’s own being. The practice of mindfulness allows this innate capacity to be known. Through this, the adolescent has the potential to directly experience the statement by Jon Kabat- Zinn, PhD, founder of the Mindfulness- Based Stress Reduction (MBSR) program at the University of Massachusetts over 35 years ago: “there is more right with you than there is wrong, no matter how ill or how hopeless you may feel” (Kabat- Zinn, 2013, p. 2).
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