Advertisement

Mindfulness and Meditation in the Conceptualization and Treatment of Posttraumatic Stress Disorder

  • Anka A. VujanovicEmail author
  • Barbara L. Niles
  • Jocelyn L. Abrams
Part of the Advances in Mental Health and Addiction book series (AMHA)

Abstract

In recent years, mindfulness and meditation-based processes and interventions have received increasing clinical and scholarly attention in the trauma field due to their theoretical and clinical relevance to the etiology, maintenance, and treatment of posttraumatic stress disorder (PTSD). Indeed, there has been a proliferation of literature documenting associations between mindfulness as well as meditation and PTSD symptomatology and supporting the efficacy of such interventions for the treatment of PTSD. Mounting empirical evidence indicates that mindfulness- or meditation-based skills and/or intervention programs may serve as effective stand-alone or adjunctive interventions for PTSD. For populations with a high probability of exposure to intense or chronic potentially traumatizing events, such as police or military personnel, mindfulness- or meditation-based interventions may prevent the development of persistent PTSD. The goal of this chapter is to elucidate the construct of mindfulness in terms of the potential utility in the conceptualization and treatment of PTSD so as to stimulate further scholarly and clinical thought in this domain. Notably, distinct, though related, practices such as meditation are included so as to provide a broad-based picture of relevant clinical and empirical landscapes. The most salient research associated with posttraumatic stress/PTSD, mindfulness, and meditation is reviewed, and the clinical implications of mindfulness and meditation for the treatment of PTSD are discussed. Finally, future research directions that may inform both clinical and research efforts are suggested.

Keywords

Mindfulness Meditation Acceptance Trauma Posttraumatic stress disorder PTSD 

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American Psychiatric Association.CrossRefGoogle Scholar
  2. Baer, R. A., Smith, G. T., & Allen, K. B. (2004). Assessment of mindfulness by self-report: The Kentucky inventory of mindfulness skills. Assessment, 11, 191–203.CrossRefPubMedGoogle Scholar
  3. Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13, 27–45.CrossRefPubMedGoogle Scholar
  4. Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., et al. (2008). Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment, 15, 329–342.CrossRefPubMedGoogle Scholar
  5. Batten, S. V., Orsillo, S. M., & Walser, R. D. (2005). Acceptance and mindfulness-based approaches to the treatment of posttraumatic stress disorder. In S. M. Orsillo & L. Roemer (Eds.), Acceptance and mindfulness-based approaches to anxiety: Conceptualization and treatment (pp. 241–269). New York: Springer Science + Business Media.CrossRefGoogle Scholar
  6. Bernstein, A., Tanay, G., & Vujanovic, A. A. (2011). Concurrent relations between mindful attention and awareness and psychopathology among trauma-exposed adults: Preliminary evidence of transdiagnostic resilience. Journal of Cognitive Psychotherapy, 25, 99–113.CrossRefGoogle Scholar
  7. Birnie, K., Speca, M., & Carlson, L. E. (2010). Exploring self-compassion and empathy in the context of mindfulness-based stress reduction (MBSR). Stress and Health, 26, 359–371.CrossRefGoogle Scholar
  8. Bishop, S. R., Lau, M. A., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., et al. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11, 230–241.Google Scholar
  9. Boden, M. T., Bernstein, A., Walser, R. D., Bui, L., Alvarez, J., & Bonn-Miller, M. O. (2012). Changes in facets of mindfulness and posttraumatic stress disorder treatment outcome. Psychiatry Research, 200, 609–613.CrossRefGoogle Scholar
  10. Bonn-Miller, M. O., Vujanovic, A. A., Twohig, M. P., Medina, J. L., & Huggins, J. L. (2010). Posttraumatic stress symptom severity and marijuana use coping motives: A test of the mediating role of non-judgmental acceptance within a trauma-exposed community sample. Mindfulness, 1, 98–106.CrossRefGoogle Scholar
  11. Bormann, J. E., Thorp, S., Wetherell, J. L., & Golshan, S. (2008). A spiritually based group intervention for combat veterans with posttraumatic stress disorder: Feasibility study. Journal of Holistic Nursing, 26, 109–116.PubMedCentralCrossRefPubMedGoogle Scholar
  12. Bormann, J. E., Thorp, S. R., Wetherell, J. L., Golshan, S., & Lang, A. J. (2013). Meditation-based mantram intervention for veterans with posttraumatic stress disorder: A randomized trial. Psychological Trauma: Theory, Research, Practice, and Policy, 5, 259–267.CrossRefGoogle Scholar
  13. Bowen, S., & Marlatt, G. A. (2009). Surfing the urge: Brief mindfulness-based intervention for college student smokers. Psychology of Addictive Behaviors, 23, 666–671.CrossRefPubMedGoogle Scholar
  14. Bowen, S., Witkiewitz, K., Clifasefi, S. L., Grow, J., Chawla, N., Hsu, S. H., et al. (2014). Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: A randomized clinical trial. JAMA Psychiatry, 71, 547–556.PubMedCentralCrossRefPubMedGoogle Scholar
  15. Brady, K. T., Killeen, T. K., Brewerton, T., & Lucerini, S. (2000). Comorbidity of psychiatric disorders and posttraumatic stress disorder. Journal of Clinical Psychiatry, 61(Suppl. 7), 22–32.PubMedGoogle Scholar
  16. Brooks, J. S., & Scarano, T. (1985). Transcendental meditation in the treatment of post-Vietnam adjustment. Journal of Counseling and Development, 64, 212–215.CrossRefGoogle Scholar
  17. Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822–848.CrossRefPubMedGoogle Scholar
  18. Carter, J. J., Gerbarg, P. L., Brown, R. P., Ware, R. S., D’Ambrosio, C., Anand, L., et al. (2013). Multi-component yoga breath program for Vietnam veteran posttraumatic stress disorder: Randomized controlled trial. Journal of Traumatic Stress Disorders and Treatment, 2, 3.CrossRefGoogle Scholar
  19. Catani, C., Kohiladevy, M., Ruf, M., Schauer, E., Elbert, T., & Neuner, F. (2009). Treating children traumatized by war and Tsunami: A comparison between exposure therapy and meditation-relaxation in North-East Sri Lanka. BMC Psychiatry, 9, 22–33.PubMedCentralCrossRefPubMedGoogle Scholar
  20. Chopko, B. A., & Schwartz, R. C. (2013). The relation between mindfulness and posttraumatic stress symptoms among police officers. Journal of Loss and Trauma, 18, 1–9.CrossRefGoogle Scholar
  21. Delizonna, L. L., Williams, R. P., & Langer, E. J. (2009). The effect of mindfulness on heart rate control. Journal of Adult Development, 16, 61–65.CrossRefGoogle Scholar
  22. Descilo, T., Vedamurtachar, A., Gerbarg, P. L., Nagaraja, D., Gangadhar, B. N., Damodaran, B., et al. (2009). Effects of a yoga breath intervention alone and in combination with an exposure therapy for posttraumatic stress disorder and depression in survivors of the 2004 South-East Asia tsunami. Acta Psychiatrica Scandinavica, 121, 289–300.CrossRefPubMedGoogle Scholar
  23. Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences. Therapist guide. New York: Oxford University Press, Inc.CrossRefGoogle Scholar
  24. Foa, E. B., Riggs, D. S., Massie, E. D., & Yarczower, M. (1995). The impact of fear activation and anger on the efficacy of exposure treatment for posttraumatic stress disorder. Behavior Therapy, 26, 487–499.CrossRefGoogle Scholar
  25. Garland, E. L., & Roberts-Lewis, A. (2013). Differential roles of thought suppression and dispositional mindfulness in posttraumatic stress symptoms and cravings. Addictive Behaviors, 38, 1555–1562.PubMedCentralCrossRefPubMedGoogle Scholar
  26. Gilbert, P., & Tirch, D. (2009). Emotional memory, mindfulness, and compassion. In F. Di Donna (Ed.), Clinical handbook of mindfulness (pp. 99–110). New York: Springer Science.CrossRefGoogle Scholar
  27. Gordon, J. S., Staples, J. K., Blyta, A., & Bytqi, M. (2004). Treatment of posttraumatic stress disorder in postwar Kosovo high school students using mind-body skills groups: A pilot study. Journal of Traumatic Stress, 17, 143–147.CrossRefPubMedGoogle Scholar
  28. Gordon, J. S., Staples, J. K., Blyta, A., Bytyqi, M., & Wilson, A. T. (2008). Treatment of posttraumatic stress disorder in postwar Kosovar adolescents using mind-body skills groups: A randomized controlled trial. Journal of Clinical Psychiatry, 69, 1469–1476.CrossRefPubMedGoogle Scholar
  29. Hayes, S. C., Strosahl, K. D., Bunting, K., Twohig, M., & Wilson, K. G. (2005). What is acceptance and commitment therapy? In S. C. Hayes & K. D. Strosahl (Eds.), A practical guide to acceptance and commitment therapy (pp. 3–29). New York: Springer Science + Business Media.Google Scholar
  30. Henning, K. R., & Frueh, B. C. (1997). Combat guilt and its relationship to PTSD symptoms. Journal of Clinical Psychology, 53, 801–808.CrossRefPubMedGoogle Scholar
  31. Hollis-Walker, L., & Colosimo, K. (2011). Mindfulness, self-compassion, and happiness in non-meditators: A theoretical and empirical examination. Personality and Individual Differences, 50, 222–227.CrossRefGoogle Scholar
  32. Howell, A. J., Digdon, N. L., & Buro, K. (2010). Mindfulness predicts sleep-related self-regulation and well-being. Personality and Individual Differences, 48, 419–424.CrossRefGoogle Scholar
  33. Imel, Z. E., Laska, K., Jakupcak, M., & Simpson, T. L. (2013). Meta-analysis of dropout in treatments for posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 81, 394–404.PubMedCentralCrossRefPubMedGoogle Scholar
  34. Jacobsen, L. K., Southwick, S. M., & Kosten, T. R. (2001). Substance use disorders in patients with posttraumatic stress disorder: A review of the literature. American Journal of Psychiatry, 158, 1184–1190.CrossRefPubMedGoogle Scholar
  35. Jha, A. P., Krompinger, J., & Baime, M. J. (2007). Mindfulness training modifies subsystems of attention. Cognitive, Affective & Behavioral Neuroscience, 7, 109–119.CrossRefGoogle Scholar
  36. Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your mind to face stress, pain and illness. New York: Dell.Google Scholar
  37. Kalill, K. S., Treanor, M., & Roemer, L. (2014). The importance of non-reactivity to posttraumatic stress symptoms: A case for mindfulness. Mindfulness, 5, 314–321.CrossRefGoogle Scholar
  38. Kartha, A., Brower, V., Saitz, R., Samet, J. H., Keane, T. M., & Liebschutz, J. (2008). The impact of trauma exposure and posttraumatic stress disorder on healthcare utilization among primary care patients. Medical Care, 46, 388–393.PubMedCentralCrossRefPubMedGoogle Scholar
  39. Kearney, D. J., McDermott, K., Malte, C. A., Martinez, M., & Simpson, T. L. (2012). Association of participation in a mindfulness program with measures of PTSD, depression and quality of life in a veteran sample. Journal of Clinical Psychology, 68, 101–116.CrossRefPubMedGoogle Scholar
  40. Kearney, D. J., McDermott, K., Malte, C., Martinez, M., & Simpson, T. L. (2013). Effects of participation in a mindfulness program for veterans with posttraumatic stress disorder: A randomized controlled pilot study. Journal of Clinical Psychology, 69, 14–27.CrossRefPubMedGoogle Scholar
  41. Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013). National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria. Journal of Traumatic Stress, 26, 537–547.PubMedCentralCrossRefPubMedGoogle Scholar
  42. Kim, S. H., Schneider, S. M., Bevans, M., Kravitz, L., Mermier, C., Qualls, C., et al. (2013). PTSD symptom reduction with mindfulness-based stretching and deep breathing exercise: Randomized controlled clinical trial of efficacy. Journal of Clinical Endocrinology and Metabolism, 98, 2984–2992.PubMedCentralCrossRefPubMedGoogle Scholar
  43. Kim, S. H., Schneider, S. M., Kravitz, L., Mermier, C., & Burge, M. R. (2013). Mind-body practices for posttraumatic stress disorder. Journal of Investigative Medicine, 61, 827–834.PubMedCentralPubMedGoogle Scholar
  44. Kimbrough, E., Magyari, T., Langenberg, P., Margaret, C., & Berman, B. (2010). Mindfulness intervention for child abuse survivors. Journal of Clinical Psychology, 66, 17–33.PubMedGoogle Scholar
  45. King, A. P., Erickson, T. M., Giardino, N. D., Favorite, T., Rauch, S. A., Robinson, E., et al. (2013). A pilot study of group mindfulness-based cognitive therapy (MBCT) for combat veterans with posttraumatic stress disorder. Depression and Anxiety, 30, 638–645.PubMedCentralCrossRefPubMedGoogle Scholar
  46. Klein, D. A., & Miller, A. L. (2011). Dialectical behavior therapy for suicidal adolescents with borderline personality disorder. Child and Adolescent Psychiatric Clinics of North America, 20, 205–216.CrossRefPubMedGoogle Scholar
  47. Lang, A. J., Strauss, J. L., Bomyea, J., Bormann, J. E., Hickman, S. D., Good, R. C., et al. (2012). The theoretical and empirical basis for meditation as an intervention for PTSD. Behavior Modification, 36, 759–786.CrossRefPubMedGoogle Scholar
  48. Lange, B. (2011). Co-creating a communicative space to develop a mindfulness meditation manual for women in recovery from substance abuse disorders. Advances in Nursing Science, 3, 1–13.CrossRefGoogle Scholar
  49. Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.Google Scholar
  50. Mitchell, K. S., Dick, A. M., DiMartino, D. M., Smith, B. N., Niles, B. L., Koenen, K. C., et al. (2014). A pilot study of a randomized controlled trial of yoga for PTSD symptoms in women. Journal of Traumatic Stress, 27, 121–128.CrossRefPubMedGoogle Scholar
  51. Niles, B. L., Klunk-Gillis, J., Ryngala, D. J., Silberbogen, A. K., Paysnick, A., & Wolf, E. J. (2012). Comparing mindfulness and psychoeducation treatments for combat-related PTSD using a telehealth approach. Psychological Trauma: Theory, Research, Practice, and Policy, 4, 538–547.CrossRefGoogle Scholar
  52. Niles, B. L., Vujanovic, A. A., Silberbogen, A. K., Seligowski, A. V., & Potter, C. M. (2013). Changes in mindfulness following a mindfulness telehealth intervention. Mindfulness, 4, 301–310.CrossRefGoogle Scholar
  53. Oman, D., & Bormann, J. E. (2015). Mantram repetition fosters self-efficacy in veterans for managing PTSD: A randomized trial. Psychology of Religion and Spirituality, 7, 34–45.CrossRefGoogle Scholar
  54. Omidi, A., Mohammadi, A., Zargar, F., & Akbari, H. (2013). Efficacy of mindfulness-based stress reduction on mood states of veterans with posttraumatic stress disorder. Archives of Trauma Research, 1, 151–154.PubMedCentralCrossRefPubMedGoogle Scholar
  55. Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29, 95–129.CrossRefPubMedGoogle Scholar
  56. Ostafin, B. D., & Marlatt, G. A. (2008). Surfing the urge: Experiential acceptance moderates the relation between automatic alcohol motivation and hazardous drinking. Journal of Social and Clinical Psychology, 27, 404–418.CrossRefGoogle Scholar
  57. Owens, G. P., Walter, K. H., Chard, K. M., & Davis, P. A. (2012). Changes in mindfulness skills and treatment response among veterans in residential PTSD treatment. Psychological Trauma: Theory, Research, Practice, and Policy, 2, 221–228.CrossRefGoogle Scholar
  58. Ramchand, R., Schell, T. L., Karney, B. R., Osilla, K. C., Burns, R. M., & Calderone, L. B. (2010). Disparate prevalence estimates of PTSD among service members who served in Iraq and Afghanistan: Possible explanations. Journal of Traumatic Stress, 23, 59–68.PubMedGoogle Scholar
  59. Rathus, J. H., & Miller, A. L. (2015). DBT Skills training manual for adolescents. New York: Guilford Press.Google Scholar
  60. Resick, P. A., & Schnicke, M. K. (1993). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60, 748–756.CrossRefGoogle Scholar
  61. Rosenthal, J. Z., Grosswatd, S., Ross, R., & Rosenthal, N. (2011). Effects of transcendental meditation in veterans of operation enduring freedom and operation Iraqi freedom with posttraumatic stress disorder: A pilot study. Military Medicine, 176, 626.CrossRefPubMedGoogle Scholar
  62. Sareen, J., Cox, B. J., Stein, M. B., Afifi, T. O., Fleet, C., & Asmundson, G. J. G. (2007). Physical and mental comorbidity, disability, and suicidal behavior associated with posttraumatic stress disorder in a large community sample. Psychosomatic Medicine, 69, 242–248.CrossRefPubMedGoogle Scholar
  63. Schnurr, P. P., & Jankowski, M. K. (1999). Physical health and posttraumatic stress disorder. Review and synthesis. Seminars in Clinical Neuropsychiatry, 4, 295–304.PubMedGoogle Scholar
  64. Schonert-Reichl, K. A., Oberle, E., Lawlor, M. S., Abbott, D., Thomson, K., Oberlander, T. F., et al. (2015). Enhancing cognitive and social-emotional development through a simple-to-administer mindfulness-based school program for elementary school children: A randomized controlled trial. Developmental Psychology, 51, 52–66. doi: 10.1037/a0038454.PubMedCentralCrossRefPubMedGoogle Scholar
  65. Schottenbauer, M. A., Glass, C. R., Arnkoff, D. B., Tendick, V., & Gray, S. H. (2008). Nonresponse and dropout rates in outcome studies on PTSD: Review and methodological considerations. Psychiatry: Interpersonal and Biological Processes, 71, 134–168.CrossRefGoogle Scholar
  66. Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2013). Mindfulness-based cognitive therapy for depression (2nd ed.). New York: Springer Press.Google Scholar
  67. Seppala, E. M., Nitschke, J. B., Tudorascu, D. L., Hayes, A., Goldstein, M. R., Nguyen, D. T., et al. (2014). Breathing-based meditation decreases posttraumatic stress disorder symptoms in U.S. military veterans: A randomized controlled longitudinal study. Journal of Traumatic Stress, 27, 397–405.CrossRefPubMedGoogle Scholar
  68. Smith, B. W., Ortiz, J. A., Steffen, L. E., Tooley, E. M., Wiggins, K. T., Yeater, E. A., et al. (2011). Mindfulness is associated with fewer PTSD symptoms, depressive symptoms, physical symptoms, and alcohol problems in urban firefighters. Journal of Consulting and Clinical Psychology, 79, 613–617.CrossRefPubMedGoogle Scholar
  69. Staples, J. K., Abdel Atti, J. A., & Gordon, J. S. (2011). Mind-body skills groups for posttraumatic stress disorder and depression symptoms in Palestinian children and adolescents in Gaza. International Journal of Stress Management, 18, 246–262.CrossRefGoogle Scholar
  70. Tesh, M., Learman, J., & Pulliam, R. M. (2015). Mindful self-compassion strategies for survivors of intimate partner abuse. Mindfulness, 6, 192–201.CrossRefGoogle Scholar
  71. Thompson, R. W., Arnkoff, D. B., & Glass, C. R. (2011). Conceptualizing mindfulness and acceptance as components of psychological resilience to trauma. Trauma, Violence, and Abuse, 12, 220–235.CrossRefPubMedGoogle Scholar
  72. Thompson, B. L., & Waltz, J. (2010). Mindfulness and experiential avoidance as predictors of posttraumatic stress disorder avoidance symptom severity. Journal of Anxiety Disorders, 24, 409–415.CrossRefPubMedGoogle Scholar
  73. Tirch, D. D. (2010). Mindfulness as a context for the cultivation of compassion. International Journal of Cognitive Therapy, 3, 113–123.CrossRefGoogle Scholar
  74. Van Dam, N. T., Sheppard, S. C., Forsyth, J. P., & Earleywine, M. (2011). Self-compassion is a better predictor than mindfulness of symptom severity and quality of life in mixed anxiety and depression. Journal of Anxiety Disorders, 25, 123–130.CrossRefPubMedGoogle Scholar
  75. van der Kolk, B. A., Stone, L., West, J., Rhodes, A., Emerson, D., Suvak, M., et al. (2014). Yoga as an adjunctive treatment for posttraumatic stress disorder: A randomized controlled trial. Journal of Clinical Psychiatry, 75, e559–e565.CrossRefPubMedGoogle Scholar
  76. Vujanovic, A. A., Bonn-Miller, M. O., & Marlatt, G. A. (2011). Posttraumatic stress and alcohol use coping motives among a trauma-exposed community sample: The mediating role of non-judgmental acceptance. Addictive Behaviors, 36, 707–712.CrossRefPubMedGoogle Scholar
  77. Vujanovic, A. A., Niles, B., Pietrefasa, A., Schmertz, S., & Potter, C. M. (2011). Mindfulness in the treatment of posttraumatic stress disorder among military veterans. Professional Psychology: Research and Practice, 42, 24–31.CrossRefGoogle Scholar
  78. Vujanovic, A. A., Youngwirth, N. E., Johnson, K. A., & Zvolensky, M. J. (2009). Mindfulness-based acceptance and posttraumatic stress symptoms among trauma-exposed adults without axis I psychopathology. Journal of Anxiety Disorders, 23(2), 297–303.PubMedCentralCrossRefPubMedGoogle Scholar
  79. Wagner, E., Rathus, J. H., & Miller, A. L. (2006). Mindfulness in dialectical behavior therapy (DBT) for adolescents. In R. Baer (Ed.), Mindfulness-based treatment approaches: Clinicians’ guide to evidence base and applications (pp. 167–189). Boston: Academic.CrossRefGoogle Scholar
  80. Wahbeh, H., Lu, M., & Oken, B. (2011). Mindful awareness and non-judging in relation to posttraumatic stress disorder symptoms. Mindfulness, 2, 219–227.PubMedCentralCrossRefPubMedGoogle Scholar
  81. Walser, R. D., & Westrup, D. (2007). Acceptance & commitment therapy for the treatment of post-traumatic stress disorder and trauma-related problems: A practitioner’s guide to using mindfulness and acceptance strategies. Oakland, CA: New Harbinger Publication.Google Scholar
  82. Witkiewitz, K., & Bowen, S. (2010). Depression, craving, and substance use following a randomized trial of mindfulness-based relapse prevention. Journal of Consulting and Clinical Psychology, 78, 362–374.PubMedCentralCrossRefPubMedGoogle Scholar
  83. Witkiewitz, K., Bowen, S., Douglas, H., & Hsu, S. H. (2013). Mindfulness-based relapse prevention for substance craving. Addictive Behaviors, 38, 1563–1571.PubMedCentralCrossRefPubMedGoogle Scholar
  84. Witkiewitz, K., Greenfield, B. L., & Bowen, S. (2013). Mindfulness-based relapse prevention with racial and ethnic minority women. Addictive Behaviors, 38, 2821–2824.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Anka A. Vujanovic
    • 1
    Email author
  • Barbara L. Niles
    • 2
  • Jocelyn L. Abrams
    • 1
  1. 1.Department of Psychiatry and Behavioral SciencesUniversity of Texas Health Science Center at HoustonHoustonUSA
  2. 2.National Center for PTSD—Behavioral Science Division, VA Boston Healthcare System, and Department of PsychiatryBoston University School of MedicineBostonUSA

Personalised recommendations