Table 3.
Session Outline for TIPSS
| Session Title | Session Goal | Session Activity | Homework | |
|---|---|---|---|---|
| Session 1 | Introduction and Overview | Rapport Building and Treatment Description | Treatment overview and expectations. Motivational Interviewing |
Write about the role of substance use in their lives when they first started and now. |
| Session 2 | Education, History, & Triggers | Psychoeducation on PTSD/SUD. | Psychoeducation on use and maintenance model of PTSD. Discuss substance use triggers. | Valued Living Questionnaire |
| Session 3 | Values | Identify values related to recovery from PTSD and SUD. | Valued Action Worksheet and psychoeducation on coping skills. | Self- monitoring coping of trauma cues and cravings. |
| Session 4 | Coping Skills | Learn new coping skills for handling cravings and trauma- related stress. | Deep breathing, mental grounding, guided imagery, and mindfulness. | Impact statements on trauma and substance use. |
| Session 5 | Impact of Trauma and Substance Use | Psychoeducation on relatedness of thoughts and feelings. | ABC model is taught. | ABC worksheets |
| Session 6 | Identification of Thoughts and Feelings | Participant identification of relatedness between their thoughts and feelings. | Review ABC worksheets and use of Socratic questioning to identify alternatives. | Written trauma narrative |
| Session 7 | Remembering the Trauma | Identify thoughts and feelings related to trauma. | Read trauma narrative aloud and discussion of related thoughts and feelings. | Re-write trauma narrative to include more detail and read narrative daily. |
| Session 8 | Remembering the Trauma II | Emotional and cognitive processing of the trauma | Emotional processing and Socratic questioning related to stuck points. | Challenging Beliefs Worksheet |
| Session 9 | Problem Thinking | Analyze and confront stuck points related to PTSD and SUD. | Additional Challenging Questions Worksheets and Problematic Thinking Patterns Worksheet are completed and discussed. | Problematic Thinking Patterns Worksheet |
| Session 10 | Themes: Trust and Safety | Relate PTSD and substance use behavior to themes of trust and safety. | Discussion of themes using Socratic questioning. | Challenging Beliefs Worksheets to identify stuck points related to the specified themes. |
| Session 11 | Themes: Power, Control, and Intimacy | Relate PTSD and substance use behavior to themes of power, control, and intimacy. | Discussion of themes using Socratic questioning. | Challenging Beliefs Worksheets to identify stuck points related to the specified themes. |
| Session 12 | Graduation and Wrap-up | Review treatment and prepare for consolidation. | Discuss PCL-5 scores, elicit feedback, and motivate to engage. | N/A |
Note. TIPSS is composed of a synthesis of content derived from cognitive processing therapy (Resick & Schnick, 1992) and cognitive-behavioral therapy for SUD (McGovern, et al., 2009). Each session begins with a review of the participant’s reported substance use, cravings, and PTSD symptoms since the last session. Instances of substance use are debriefed with identification of any trauma-related or other pertinent triggers; and functional analyses are conducted to help the participant better understand the antecedents and consequences of substance use. Relevant coping skills to employ in instances of future cravings are also discussed. Valued Action Worksheet based on materials developed by Wilson and DuFrene (2012). ABC = Antecedent-Behavior-Consequence. PCL-5 = PTSD Checklist for DSM-5 (Blevins, et al., 2015). Valued Living Questionnaire derived from Wilson and colleagues (2010).