A mixed-methods study to evaluate the feasibility and acceptability of delivering an intervention to support women with experiences of interpersonal abuse, post-traumatic stress disorder symptoms, and substance use, within an English substance use service.

Student thesis: Doctoral ThesisDoctor of Philosophy


Background and aims: Women with interpersonal abuse (IPA) histories experience high levels of post-traumatic stress disorder (PTSD) and substance use. UK substance use treatment services lack integrated responses and trauma-informed practice (TIP). This thesis determined the feasibility of delivering and evaluating an integrated trauma-specific group intervention within routine substance use treatment in England. 
Methods: Mixed methods were employed: a narrative systematic review of 20 international controlled trials examined the evidence base (Phase 1); thematic analysis of 25 semi-structured interviews with UK and US stakeholders explored delivery of trauma-specific interventions (Phase 2); Seeking Safety was adapted, using Behaviour Change Theory (Phase 3). The feasibility of delivering the adapted Seeking Safety intervention was evaluated with participants (n=19) and facilitators (Phase 4). Qualitative interviews, analysed using ‘Framework’, elicited their intervention experiences. Mental health, coping skills and substance use outcomes were measured post-intervention (T2) and 3-months post-intervention (T3). 
Results: Phase 1) Present-focused interventions, concentrating on extensive safety and stabilisation copings skills, may be best suited to women with more severe PTSD and substance use, and those experiencing ongoing victimisation; Phase 2) UK stakeholders warned against tokenistic approaches to TIP. US stakeholders found Seeking Safety compatible with communitybased substance use services; Phase 3) Seeking Safety adaptions included 12-sessions and additional mind-body activities; Phase 4) Seeking Safety was feasible and acceptable to participants (64% received the minimum-dose and 84% were followed-up at T3); concerns centred on group cohesion. Participants reported decreased PTSD symptoms and alcohol use, but not drug use. Service closure and ongoing victimisation negatively impacted on recovery. 
Conclusions: Substance use services should respond to IPA. Present-focused integrated traumaspecific interventions, which include mind-body strategies, hold promise. Services require support to develop TIP in the face of funding cuts. Future Seeking Safety delivery should consider increasing session quantity, ensuring support for facilitators to adhere to intervention fidelity.
Date of Award1 Jul 2019
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorGail Gilchrist (Supervisor) & Kylee Trevillion (Supervisor)

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