Treating Co-occurring Adolescent PTSD and Addiction: Mindfulness-Based Cognitive Therapy for Adolescents with Trauma and Substance-Abuse Disorders

241 Pages·2015·4.89 MB·English

by  Lisa R. Fortuna

“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).