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Free ebooks ==> www.Ebook777.com www.Ebook777.com Free ebooks ==> www.Ebook777.com “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 devastating 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 restructuring and motivational interviewing (among others), this guide is a trustworthy companion 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 www.Ebook777.com “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 techniques 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 and Addiction Mindfulness-Based Cognitive Therapy for Adolescents with Trauma and Substance-Abuse Disorders Lisa R Fortuna, MD | Zayda Vallejo, MLitt Context Press An Imprint of New Harbinger Publications, Inc Free ebooks ==> www.Ebook777.com 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 Kabat-Zinn, copyright © 1990 by Jon Kabat-Zinn 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 SelfDiscovery 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 Cataloging-in-Publication Data Fortuna, Lisa R Treating co-occurring adolescent PTSD and addiction : mindfulness-based cognitive therapy for adolescents with trauma and substance-abuse disorders / Lisa R Fortuna, MD, MPH, MDiv, and Zayda Vallejo, MLitt ; foreword by Florence Meleo-Meyer, MS, MA pages cm Includes bibliographical references and index ISBN 978-1-62625-133-5 (paperback) ISBN 978-1-62625-134-2 (pdf e-book) ISBN 978-1-62625135-9 (epub) Post-traumatic stress disorder in adolescence Treatment Substance abuse Treat ment Cognitive therapy for teenagers I Vallejo, Zayda II Title RJ506.P55F67 2015 616.85’2100835 dc23 2015018136 www.Ebook777.com To H E Choegyal Rinpoche, VIII, who embodies unconditional love —Zayda To my grandmother “Bolito” —Lisa Contents Forewordvii Acknowledgmentsxi Introduction1 Part nderstanding Mindfulness-Based Cognitive Therapy for U Adolescents with Trauma and Substance-Abuse Disorders n Integrated Approach to the Treatment of Trauma and A Addictions in Adolescents7 heory and Practice of Mindfulness-Based Cognitive T Therapy–Dual21 Engaging, Motivating, and Working with Adolescents in Therapy41 indfulness-Based Cognitive Therapy for Other Co-occurring M Adolescent Mental Health Conditions59 Mindful Communication81 Part Conducting MBCT-Dual Sessions General Considerations for Conducting MBCT-Dual Sessions97 MBCT-Dual Therapy Session Guide103 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 Meeting 6: Common Styles of Thinking Meeting 7: Cognitive Restructuring—Observing Our Thoughts Meetings 8–11: Mindfulness-Based CR and Recovery Meeting 12 (Or Final Meeting): Generalization Training and Termination 137 144 153 161 163 Treating Co-occurring Adolescent PTSD and Addiction Appendix A: Guided Mindfulness Scripts169 Appendix B: Selected MBCT-Dual Tools191 Appendix C: Guidelines for Behavior Rehearsal Role-Play197 Appendix D: Poetry in Mindfulness201 References203 Index213 vi Free ebooks ==> www.Ebook777.com 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 adolescent 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 situations, 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 essential 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) www.Ebook777.com Index A about this book, 2–3 abstinence: therapeutic goal of, 53–54; urine screening to measure, 55–57 acceptance, 10, 64, 121 action plans, 31, 160 actions: examples of unhealthy, 158; thoughts and feelings connected to, 151–152 addictions: cognitive therapy and, 13; MBCT-Dual treatment for, 67 ADHD See attention deficit/ hyperactivity disorder adolescent clients: importance of practice for, 101; introducing mindfulness to, 98–101, 118; relating mindfully with, 86–87; teaching mindful communication to, 89–93; therapeutic alliance with, 41–43 affectionate curiosity, 34, 82, 142 again-and-again thinking, 149 agoraphobia, 62 alcohol abuse See substance abuse all-or-nothing thinking, 149 ambivalence about change, 45–46 analytical mode, 29 anger, PTSD-related, 126 anxiety disorders, 61–62; MBCT-Dual treatment for, 66; mindfulness practice and, 74–79 approach behavior, 36 argumentation avoidance, 50–51 assessment process, 13–14 attention deficit/hyperactivity disorder (ADHD), 62–63; MBCT- Dual treatment for, 66; mindfulness and, 70–74 attention regulation, 69, 70 “Autobiography in Five Chapters” (Nelson), 132–133 automatic pilot, 28, 85 automatic thoughts, 13 avoidance: mindfulness and, 11; polyvagal theory and, 36–37; related to trauma, 125 awareness: body, 11, 37–38, 69, 79; of choices, 132–133; nonjudgmental, 10, 82, 120; practices for building, 1–2, 28–29 See also mindfulness Awareness of Breath exercise, 114–115 B Beck, Aaron T., 21 beginner’s mind, 47, 120 behavior rehearsal role-play, 197–199 being mode, 11–12, 27–29 bipolar disorder, 61 Treating Co-occurring Adolescent PTSD and Addiction blaming yourself, 150 body scan, 34; Brief Body Scan exercise, 119–121; explaining and guiding, 123–124; Seated Body Scan exercise, 176–177; Seated Body Scan with Mindful Movement, 178–180 body sensations: awareness of, 11, 37–38, 69, 79; examples of unhealthy, 157 body-mind functioning, 69 breathing: awareness exercise, 114– 115; guided meditation focused on, 170; mindful, 28, 110–111; three- minute awareness of, 117 Brief Body Scan exercise, 119–121 Brief Mindful Breathing Practice, 111 C change: ambivalence about, 45–46; handout on measuring, 110; motivation for, 49, 53 Child PTSD Symptom Scale, 14 childhood trauma, 37–38, 59 choices: awareness of, 132–133; importance of, 37 Client Workbook, 3, 102 clinicians: importance of practice for, 101; interpersonal mindfulness for, 82–89; therapeutic alliance and, 41–43 closed-ended questions, 48 cognitive functioning, 69 cognitive model, 21 cognitive restructuring (CR), 13, 15; cultivation of, 25–27; explaining to clients, 106; exposure treatments vs., 9–10; five steps of, 15, 29–31, 158–160 cognitive strategies, 214 cognitive therapy (CT), 12–13; addiction recovery and, 13; compared to mindfulness and MBCT, 23; development and central aim of, 21; mindfulness with, 17, 21–22 Common Styles of Thinking handout, 148–150 communication practice See mindful communication compassion: employing self-care and, 29; evidence-based studies of, 22; meditation based on, 79 conduct disorder (CD), 63 confidentiality, limits of, 16, 43 contextual factors, 43–45 co-occurring psychiatric disorders, 60–63; anxiety disorders, 61–62; attention deficit/hyperactivity disorder, 62–63; bipolar disorder, 61; conduct disorder, 63; depressive disorders, 60; MBCT-Dual treatment and, 66–67; obsessive- compulsive disorder, 62; oppositional defiant disorder, 63 Coping with Stress handout, 126 counseling, weighing pros and cons of, 108 cravings and urges: affectionate curiosity toward, 34; benefits of mindfulness for, 65; riding the roller coaster of, 142–143 cultural factors, 43–45 D depression: disorders related to, 60; efficacy of MBCT for, 22; MBCT- Dual treatment for, 66; mindfulness practice and, 74–79; PTSD-related, 126 Free ebooks ==> www.Ebook777.com Index Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 60 discrepancy development, 49–50 disembodied listening, 86 doing mode, 11 double-sided reflections, 47, 51 downside thinking, 150 drug abuse See substance abuse dual-diagnosis approach, 8–9 dyadic practices: Insight Dialogue, 89–91, 94; mindful listening, 91–93 dysthymia, 60 E eating meditation, 118–119, 182 Einstein, Albert, 41 embodied presence, 47–48 emotions/feelings: connection of actions and thoughts to, 151–152; differences between thoughts and, 156–157; examples of unhealthy, 157; guided meditation on observing, 171–172; helping adolescents express, 99–100; identifying and naming, 30, 159; PTSD-related, 126; reflection of, 46; regulation of, 64, 69; riding the roller coaster of, 33–34, 183–185; thinking with, 150 empathy, 49, 121 end-of-the-world thinking, 149 exercises: Awareness of Breath, 114–115; Brief Body Scan, 119–121; Brief Mindful Breathing Practice, 111; Five Steps of Cognitive Restructuring, 158–160; Guided Eating Meditation, 118–119; Insight Dialogue, 89–91, 94; Loving- Kindness Meditation, 146–147; Mindful Standing Stretches, 117, 123; Nine Dots Exercise, 26–27; Riding the Roller Coaster of Cravings and Urges, 142–143; Riding the Roller Coaster of Emotions, 33–34, 183–185; Three- Minute Awareness of Breath, 117 See also guided mindfulness scripts exposure: cognitive restructuring vs., 9–10; mindfulness related to, 68 external risk, 36 F family involvement: MBCT-Dual treatment and, 16–17, 101–102, 163; therapeutic alliance and, 42–43 fear, 126 feelings See emotions/feelings fight-or-f light reaction, 36, 79 Five Facet Mindfulness Questionnaire, 65 five steps of cognitive restructuring, 15, 29–31, 158–160 “fixing” clients, 85 flipchart, 102 follow-up services, 165–166 forgiveness meditation, 173–175 formal mindfulness practice: interpersonal mindfulness and, 89; introducing to clients, 118–121 See also mindfulness Fortuna, Lisa, viii fourfold approach, 113 freeze response, 38, 79 G generalized anxiety disorder, 61 generosity, 121 gentleness, 121 215 www.Ebook777.com Treating Co-occurring Adolescent PTSD and Addiction Gilbert, Daniel, 85 goals: abstinence-related, 53–54; MBCT-Dual intentions and, 25 gratitude, 121 “Guest House, The” (Rumi), 103, 201 Guided Eating Meditation, 118–119 guided mindfulness scripts, 102, 169–189; breath awareness meditation, 170; eating meditation (with raisin), 182; loving-kindness and forgiveness meditation, 173– 175; mindful standing stretching practice, 186–189; riding the roller coaster of emotions, 183–185; seated body scan (stationary), 176–177; seated body scan with mindful movement, 178–180; sound awareness sitting meditation, 169; thoughts and feelings awareness meditation, 171–172; walking meditation, 181 See also exercises Guillemets, Terri, 59 guilt and shame, 126 Gunaratana, Henepola, 97 H handouts, 102; About the Program, 106; “Autobiography in Five Chapters” poem, 132–133; Avoidance, 125; Breathing and Mindfulness, 117; Common Styles of Thinking, 148–150; Coping with Stress, 126; Emotions Associated with PTSD, 126; Five Steps of Cognitive Restructuring, 158; Measuring Change, 110; Mindfulness Practices, 121; My Signs of Stress, 125; Pleasant Events Calendar, 127, 128; PTSD, 216 Drugs, Alcohol, and the Brain, 106; Reexperiencing the Event, 125; Rethinking Your Thoughts About Using Substances, 143; Risk Behaviors and Drug and Alcohol Triggers, 134; STOP Technique and Stop Light Metaphor, 141, 196; Substance Use and Safety Plan, 110; Summing Up, 166–167; Thoughts, Feelings, and Actions Triangle, 151–152, 157; Triggering Thoughts, Feelings, and Experiences, 143; Trouble Getting Along with Others, 134; Unpleasant Events Calendar, 127, 129; Weekly Rating Sheet, 115, 124, 192–195; Weighing My Options, 108 “Holy Longing, The” (Goethe), 201 I impulse-control disorders, 63, 66 informal practice, 89, 93, 116–118 insight, process of, 68 Insight Dialogue practice, 89–91, 94 Insight Dialogue: The Interpersonal Path to Freedom (Kramer), 89 integrated functioning, 69 intention to serve, 84–85 intergenerational trauma, 16 internal risk, 36 interpersonal mindfulness, 82–89; basic steps to practicing, 82; clinicians’ stories about, 86–87; foundational principles of, 83–86; hints and tips for clinicians on, 87–89; Insight Dialogue practice for, 89–91, 94; intentionality and commitment to, 93–94; mindful listening practice for, 91–93; Index teaching the practice of, 89–93; ways of listening antithetical to, 85–86 “Invitation, The” (Oriah Mountain Dreamer), 201 J “Journey, The” (Oliver), 103 judging, observing vs., 120 K Kabat-Zinn, Jon, vii, 10, 18, 139 Killingsworth, Matthew A., 85 “Kindness” (Nye), 201 Kobasa, Suzanne, 38 Kramer, Gregory, 89 L letting be, 121 listening: mindful, 81, 83, 84, 91–93; partial, 85–86; reflective, 46–47 long-term plans, 166–167 “Love After Love” (Walcott), 201 loving-kindness: ending sessions with, 100–101; evidence-based studies of, 22; guided meditation on, 173–175; practice of, 121, 146–147 Loving-Kindness Meditation exercise, 146–147 M major depressive disorder, 60 MBCT-Dual: assessment process in, 13–14; cognitive restructuring in, 15, 25–27, 29–31, 158–160; co- occurring problems and, 65, 66–67; dual-diagnosis approach in, 8–9; family involvement in, 16–17, 101–102; importance of practice in, 101–102; intentions and goals of, 25; mindfulness practice in, 16, 17–18, 27–29, 98–101; motivational interviewing in, 14–15, 49–52; original development of, 7; overview of strategies in, 1–2; psychoeducation in, 15, 106, 124–126; resiliency in, 38–39; structuring sessions for, 97–98; theory and practice of, 21–39; therapeutic alliance in, 41–43; therapy session guide, 103–167; treatment components in, 13–17 MBCT-Dual meeting (Introduction, Feedback, and Safety), 103–112; daily practice assignment, 112; detailed guide, 104–112; feedback on assessments, 105; inspirational reading, 111; materials, 104; mindful breathing exercise, 110– 111; outline, 104; poems, 103; preparation process, 104; program introduction, 105–108; rapport building, 104; safety plan, 110; weighing options, 108–110 MBCT-Dual meeting (Introduction to Mindfulness), 112–121; Awareness of Breath exercise, 114–115; Brief Body Scan exercise, 119–121; daily practice assignment, 121; detailed guide, 114–121; formal mindfulness practice, 118–121; Guided Eating Meditation, 118– 119; informal mindfulness practice, 116–118; materials, 113; Mindful Standing Stretches exercise, 117; Mindful Walking exercise, 117–118; one-word check-in, 115; outline, 113–114; preparation process, 113; 217 Treating Co-occurring Adolescent PTSD and Addiction review of intentions, 115; Three- Minute Awareness of Breath exercise, 117; weekly ratings, 115–116 MBCT-Dual meeting (Psychoeducation Part I–PTSD), 122–130; daily practice assignment, 127–130; detailed guide, 123–130; impact of stressful events and trauma, 124–126; materials, 122; mindful stretching or body scan, 123–124; one-word check-in, 124; outline, 122–123; preparation process, 122; review of intentions, 124; weekly ratings, 124 MBCT-Dual meeting (Psychoeducation Part II–Risk Behaviors and Drug and Alcohol Triggers), 130–136; awareness of choices, 132–133; daily practice assignment, 136; detailed guide, 131–136; formal mindfulness practice, 131; materials, 130–131; one-word check-in, 131; outline, 131; preparation process, 130; problems linked to PTSD, 134– 136; review of intentions, 131–132; weekly ratings, 132 MBCT-Dual meeting (Managing Triggers, Cravings, and Urges), 137–144; daily practice assignment, 144; detailed guide, 138–144; formal mindfulness practice, 138; materials, 137; Monkey Story discussion, 139–140; one-word check-in, 138; outline, 138; preparation process, 137; review of intentions, 138–139; Riding the Roller Coaster exercise, 142–143; 218 STOP and Stop Light techniques, 141; weekly ratings, 139 MBCT-Dual meeting (Common Styles of Thinking), 144–152; daily practice assignment, 152; detailed guide, 145–152; discussion on thinking styles, 148–151; formal mindfulness practice, 145–146; Loving-Kindness Meditation, 146–147; materials, 145; one-word check-in, 147; outline, 145; preparation process, 144; review of intentions, 147; weekly ratings, 147–148 MBCT-Dual meeting (Cognitive Restructuring–Observing Our Thoughts), 153–161; daily practice assignment, 160–161; detailed guide, 154–161; five steps of cognitive restructuring, 158–160; formal mindfulness practice, 154; learning to watch what you think, 156–158; materials, 153; one-word check-in, 154; outline, 154; preparation process, 153; review of intentions, 154–155; weekly ratings, 155 MBCT-Dual meetings 8–11 (Mindfulness-Based CR and Recovery), 161–163; intentions, purposes and methods for, 161–162; parent-child session during, 163 MBCT-Dual meeting 12 (Or Final Meeting), 163–167; commemorating accomplishments, 167; detailed guide, 164–167; long-term plan development, 166–167; materials, 164; outline, 164; practice encouragement, 165; preparation process, 163–164; Index progress and skills review, 165; referral for follow-up services, 165–166; treatment/termination thoughts, 164–165 meaning, reflection of, 46 meditation bells, 102 Meleo-Meyer, Florence, ix mental health conditions See co- occurring psychiatric disorders Mindful Attention Awareness Scale for Adolescents, 14 mindful breathing, 110–111 mindful communication, 81–94; clinicians’ stories about, 86–87; foundational principles of, 83–86; hints and tips for clinicians on, 87–89; Insight Dialogue practice for, 89–91, 94; intentionality and commitment to, 93–94; mindful listening practice for, 91–93; practiced by clinicians, 82–89; teaching the practice of, 89–93; ways of listening antithetical to, 85–86 mindful eating, 118–119, 182 mindful listening, 81, 83, 84, 91–93 Mindful Standing Stretching practice, 117, 123, 186–189 Mindful Walking exercise, 117–118, 181 mindfulness, 1–2, 10–12; ADHD and, 70–74; anxiety and, 74–79; awareness related to, 28–29; being mode and, 11–12, 27–29; benefits of, 64–69; Buddhist vs secular, 21–22; case examples, 12, 18–19; cognitive therapy with, 17, 21–22; compared to CT and MBCT, 23; definitions of, 10, 16; depression and, 74–79; dual-diagnosis subjects and, 10; formal practice of, 118– 121; guided scripts for, 169–189; informal practice of, 93, 116–118; interpersonal, 82–89; introducing to clients, 98–101, 106–107, 112– 121; mental health problems and, 65, 66–67; poetry in, 102, 103, 201; practice of, 16, 17–18, 38, 101–102; underlying processes of, 68–69 mindfulness-based cognitive therapy (MBCT): compared to CT and mindfulness, 23; efficacy of depression treatment with, 22 See also MBCT-Dual Mindfulness-Based Relapse Prevention for Addictive Behaviors (Bowen, Chawla, and Marlatt), 33 Monkey Story, The (Kabat-Zinn), 139 mood shifts, 28 motivation: importance of internally driven, 14; open-ended questions for enhancing, 48; reinforcing for PTSD treatment, 52–53 motivational enhancement, 14 Motivational Enhancement Therapy for Marijuana Use with Adolescents (Sampl & Kadden), 49 motivational interviewing (MI), 14–15, 49–52; avoiding argumentation in, 50–51; developing discrepancy in, 49–50; expressing empathy in, 49; rolling with resistance in, 51; supporting self-efficacy in, 52; therapeutic alliance and, 45 Motivational Interviewing: Helping People Change (Miller & Rollnick), 49 “must”, “should”, or “never” thinking, 149 219 Treating Co-occurring Adolescent PTSD and Addiction N Nelson, Portia, 132 nervousness, 126 neuroception, 36 Nhat Hanh, Thich, Nine Dots Exercise, 26–27 nonattachment, 68–69 nonjudgmental awareness, 10, 82, 120 nonstriving, 120 nonverbal cues, 47 Nye, Naomi Shihab, 201 O observing thoughts/feelings, 171–172 obsessive-compulsive disorder (OCD), 62 Oliver, Mary, 103, 201 one-word check-ins, 115, 124 open-ended questions, 48 oppositional defiant disorder (ODD), 63 P panic disorder, 62 parasympathetic nervous system, 36, 38 parental participation: MBCT-Dual treatment and, 16–17, 101–102, 163; therapeutic alliance and, 42–43 patience, 120 Penman, Danny, 11 Perceived Self-Compassion Scale, 14 persistent depressive disorder, 60 phobias, 62 physical abuse, 16, 37 Pleasant Events Calendar, 127, 128 poetry, 102, 103, 201 polyvagal theory, 36–38 220 positive reappraisal, 68 positive reinforcement, 55 post-traumatic stress disorder See PTSD practice: encouraging continued, 165; importance of, 101–102 present-moment awareness, 28 program introduction, 105–108 progress and skills review, 165 psychiatric disorders See co-occurring psychiatric disorders psychoeducation, 1, 15, 106 psychological hardiness, 38 PTSD (post-traumatic stress disorder): disorders co-occurring with, 60–63; emotions associated with, 126; mindfulness-based approach to, 24–25; problems linked to, 134–136; psychoeducation about, 106, 124–126; substance abuse co-occurring with, 8–9 See also trauma PTSD, Drugs, Alcohol, and the Brain handout, 106 Q questions, open-vs closed-ended, 48 quotes, inspiring, 102 R reappraisal process, 68 Reexperiencing the Event handout, 125 referral for follow-up services, 165–166 reflective listening, 46–47 reframing: case examples of, 31–33; cultivating, 25–27; explaining to clients, 106; mindfulness related to, 11 See also cognitive restructuring Index relapses: learning from, 54–55; urine screening and, 55–57 resiliency, 7, 38–39 resistance, rolling with, 51 Riding the Roller Coaster of Cravings and Urges exercise, 142–143 Riding the Roller Coaster of Emotions exercise, 33–34, 183–185 risk assessment, 36, 150 role-playing, 197–199 role reversal, 198 Rumi, 103, 201 S sadness, 126 safety plan, 110 Satichidananda, Swami, 18 scripts See guided mindfulness scripts Seated Body Scan exercise, 176–177 Seated Body Scan with Mindful Movement, 178–180 self-acceptance, 64 self-care, 29 self-efficacy, 52 self-monitoring, 15 self-observation, 65 self-regulation, 69 sessions/meetings (MBCT-Dual): guide to conducting, 103–167; importance of practice for, 101–102; introducing mindfulness in, 98– 101; materials used in, 102; structuring, 97–98 See also specific meetings sexual abuse, 16, 37, 59 shame and guilt, 126 sitting meditation: with awareness of breath, 170; with awareness of sounds, 169; with awareness of thoughts and feelings, 171–172 skills and progress review, 165 slips, learning from, 54–55 social anxiety disorder, 62 sounds, mindfulness of, 28, 169 specific phobias, 62 Stop Light metaphor, 141, 196 STOP technique, 28, 92, 113, 141, 196 stress: body reactions to, 126; mindfulness for reducing, 64; resilience under, 38–39 stretching practice, 117, 123, 186–189 striving mind, 85 substance abuse: goal of abstaining from, 53–54; handouts related to, 110, 143; learning from slips or relapses in, 54–55; PTSD co- occurring with, 8–9; research on mindfulness for, 65; thoughts/ behaviors related to, 106; tracking triggers for, 35, 134–135; urine screening for, 55–57; weighing pros and cons of, 109 Substance Use and Safety Plan handout, 110 substance-use disorders (SUDs), 8–9 sympathetic nervous system, 36 systems perspective, 27 T Teen Addiction Severity Index, 14 termination process, 164–167 therapeutic alliance, 41–43, 82–89 therapists See clinicians Thoreau, Henry David, 81 thoughts: automatic, 13; case examples of working with, 31–33; differences between feelings and, 156–157; examples of unhealthy, 157; feelings and actions connected 221 Treating Co-occurring Adolescent PTSD and Addiction to, 151–152; guided meditation on observing, 171–172; identifying and exploring, 30–31, 159–160; learning to watch, 156–158; mindful awareness of, 29; styles of thinking and, 148–151; treatment- and termination-related, 164–165 Thoughts, Feelings, and Actions Triangle, 151–152, 157 Three-Minute Awareness of Breath exercise, 117 Tolle, Eckhart, 21, 103 trauma: childhood, 37–38, 59; disorders co-occurring with, 60–63; impact of stressful events and, 124–126; intergenerational, 16; MBCT-Dual treatment for, 67; polyvagal theory and, 36–38 See also PTSD triggers, substance use, 35, 134–135 trust, 90, 91, 120 “Two Kinds of Intelligence” (Rumi), 103, 201 222 U Unpleasant Events Calendar, 127, 129 Urge Surfing exercise, 33–34, 183 urges See cravings and urges urine screening, 55–57 V vagus nerve, 36–37 Vallejo, Zayda, viii–ix W Walcott, Derek, 201 walking meditation, 117–118, 181 wandering mind, 85 Weekly Rating Sheet, 14, 115–116, 192–195 weighing options, 108–110 “Wild Geese” (Oliver), 201 Williams, Mark, 11 mor e book s from Ne W Ha r bi Nger publicaTioNs the thriving aDoLesCent Parenting Your DeLinquent, Defiant, or out-of-ControL teen using acceptance & commitment Therapy & positive psychology to Help Teens manage emotions, achieve goals & build connection ISBN: 978-1608828029 / US $54.95 Don’t Let Your emotions run Your Life for teens How to Help Your Teen stay in school Dialectical behavior Therapy skills & out of Trouble using an innovative for Helping You manage mood multisystemic approach swings, control angry outbursts & get along with others ISBN: 978-1626250833 / US $16.95 ISBN: 978-1572248830 / US $16.95 An Imprint of New Harbinger Publications the PtsD Workbook for teens the anger Workbook for teens simple, effective skills for Healing Trauma activities to Help You Deal with anger & 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Sign up for newharbinger.com/bookalerts Sign up to receive Quick Tips for Therapists— fast and free solutions to common client situations mental health professionals encounter Written by New Harbinger authors, some of the most prominent names in psychology today, Quick Tips for Therapists are short, helpful emails that will help enhance your client sessions Sign up online at newharbinger.com/quicktips new harbinger new harbinger • • • Free ebooks ==> www.Ebook777.com www.Ebook777.com ... www.Ebook777.com Treating Co- occurring Adolescent PTSD and Addiction As the adolescent recognizes and practices the potential ability to know a sensation as a sensation, a thought as a thought, and an... Treating Co- occurring Adolescent PTSD and Addiction Instead it acknowledges your fear and your sadness, your fatigue and exhaustion, and encourages you to “turn toward” these feelings and whatever... therapy and obtain the adolescent s and parents’ (or guardians’) agreement to participate We recommend that treatment 13 Treating Co- occurring Adolescent PTSD and Addiction begin with a comprehensive
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