Mindfulness-Based Intervention Improves Depression, Anxiety, and Quality of Life in Unstably-Housed Women with PTSD and Substance Use Disorder

Abstract Objective This study sought to evaluate the efficacy of Mindfulness-based Stress Reduction (MBSR) on symptoms of posttraumatic stress, depression, anxiety, and perceived stress and quality of life in unstably-housed women undergoing substance use disorder (SUD) treatment. Despite the potential for MBSR to be a helpful adjunct to ongoing care, prior research on the benefit of MBSR in this population is limited. Method Participants were 156 unstably-housed women residing in a state-funded residential SUD treatment program. Using a community-engaged approach, we conducted an open-label, cluster-based clinical trial. Clusters of participants were assigned to 8-week, 9-session MBSR or Health Promotion Attention Control (HP Control) interventions. Participants were evaluated at Time 1 (T1, baseline), Time 2 (T2, immediately post-intervention), and Time 3 (T3, 6-months post-baseline). Mixed-effects modeling examined group-by-time effects on primary (posttraumatic stress) and secondary (depression, anxiety, quality of life, perceived stress) outcomes. The trial was registered on ClincialTrials.gov. Results Posttraumatic stress symptoms improved from T1 to T2 and T3 ( p -values < 0.001); however, MBSR and HP groups did not differ significantly ( p -values > 0.05). Depression also improved over time, with significant between-group differences. Participants reported lower depression at T2 and T3 ( p -values < 0.05); MBSR participants reported significantly greater improvements at T2 ( contrast = -3.57, p = 0.008, 95% CI, -6.23, -0.91) and T3 ( contrast = -5.65, p < 0.001, 95% CI, -8.68, -2.63) compared to HP participants. Anxiety similarly improved over time: MBSR compared to HP participants reported lower anxiety at T3 ( contrast = -3.74, p = 0.007, 95% CI, -6.44, -1.04). Quality of life and perceived stress improved from T1 to T2 and T3; between-group differences were significant ( p -values < 0.05). Small to medium effect sizes were consistently indicated. Conclusions MBSR-based interventions may help ameliorate comorbidities and improve quality of life in unstably-housed women recovering from trauma and SUD. Preregistration Study design and proposed analyses were preregistered on ClinicalTrials.gov (NCT04605198).