Seeking Safety (SS for Adolescents)
Type of Approach:
Provider Education Level:
Type of services:
Present-focused, coping skills therapy for adolescents that targets trauma /posttraumatic stress disorder (PTSD) and/or substance abuse and can be delivered as group or individual sessions.
Any setting including inpatient, outpatient, community mental health centers, residential settings, prisons, and home-based care.
Type of service provider:
Therapist/clinician; has also been conducted by peers, domestic violence advocates, case managers, and other types of service providers.
Length of program/number of sessions:
Highly flexible; there are 25 topics provided, but clinicians can choose to do as many as time allows, in whatever order they choose, with any session length and number of sessions per week
Type(s) of trauma addressed:
All trauma types; substance abuse
Seeking Safety addresses cognitive, behavioral, and interpersonal domains. Each topic offers a “safe coping skill.” Topics include:
- PTSD: Taking Back Your Power
- Asking for Help
- Healing from Anger
- Creating Meaning
- Recovery Thinking
- Taking Good Care of Yourself
- Coping with Triggers
- Detaching from Emotional Pain
This intervention, originally developed for adults, has been both implemented and researched with adolescents in a wide range of settings.
Seeking Safety was the first psychotherapy for dual diagnosis of PTSD and substance abuse disorder with published outcome results and has been rated as Level 1 for PTSD/substance use disorder (effective) in the International Society for Traumatic Stress Studies guidelines.
At the time of the randomized trial with adolescent girls, there were no other published treatment studies using a manual designed for this population.
This intervention addresses the reality that substance abuse and PTSD are often connected (most adolescents in the randomized trial believed their PTSD and substance abuse were related). Both of these disorders are well-documented consequences of childhood exposure to domestic violence.
Information for this summary was abstracted from the NCTSN publication, Trauma-Informed Interventions: Clinical and Research Evidence and Culture-Specific Information Project and other publications.
Ethnic Racial Group:
Age range of children:
Parent/adult caregiver included in intervention:
Contact with parent(s) at the first session and brief updates with parents if the adolescent agrees to it.
Ethnic/racial and other groups served:
The randomized, controlled trial described in the evaluation section had a small study population of which 21.2% of the participants were minority youth. The manual for Seeking Safety was found to be helpful without modification in this outcome study.
English, Spanish, French, German, Dutch, Chinese, and Swedish
Seeking Safety is a cognitive behavioral model that focuses on current problems/issues to help people attain safety from trauma/PTSD and/or substance abuse.
There have been 21 studies of Seeking Safety, including one with adolescent girls. That one is summarized below. For all other studies, see www.seekingsafety.org section Outcomes.
A randomized, controlled trial was conducted with 33 outpatient adolescent girls (average age=16 years old) who met current DSM-IV criteria for both PTSD and substance use disorder. Girls who received Seeking Safety plus treatment-as-usual were compared to girls who received treatment-as-usual alone. The most common trauma history was sexual abuse (87.9%); many had multiple trauma and the average age when the first trauma occurred was 8.75 years. The average attendance was 11.78 sessions.
At the end of the intervention, girls who participated in Seeking Safety had significantly better outcomes compared to girls who received just treatment-as-usual. The findings included:
- Positive outcomes for self-reported substance abuse and associated problems
- Improved cognitions related to substance abuse and PTSD
- Reduction of some trauma-related symptoms
- Improvements in various psychopathology including some problems not targeted in the treatment (e.g., anorexia, somatization)
Effect sizes were generally in the moderate to high range. Some gains were sustained at 3-month follow-up.
“Najavits LM, Gallop RJ, Weiss R. Seeking Safety therapy for adolescent girls with PTSD and substance use disorder: A randomized, controlled trial. Journal of Behavioral Health Services and Research. 2006;33(4):453-463.
Other evaluation studies:
A comprehensive literature review of all published evaluation studies, including randomized controlled trials, can be found at www.seekingsafety.org, section Outcomes
Other publications about the program:
An extensive list of publications about the Seeking Safety model is also available at www.seekingsafety.org
Rated/Reviewed by Evidence Based Registries:
NREPP: SAMSHA’s National Registry of Evidence-Based Programs and Practices (For Adults)
California Evidence-Based Clearinghouse for Child Welfare
Evidence-Based Practices for Children Exposed to Violence: A Selection from Federal Databases (For Adolescents)
Najavits LM. 2002. Seeking Safety: A Treatment Manual for PTSD and Substance Abuse. New York: Guilford Press.
Najavits LM. 2009. Seeking Safety: An Implementation Guide. In A. Rubin & DW Springer (Eds). The Clinician’s Guide to Evidence-Based Practice. Hoboken, NJ. John Wiley.
Languages other than English:
The Seeking Safety book/manual is available in Spanish, French, German, Chinese, Dutch, and Swedish. A card deck and poster of the Seeking Safety safe coping skills are available in English and Spanish.