PTSD and Severe Mental Disorders: A Group Model for Men

描述(申请人提供)：患有严重精神障碍的人有很高的身体和性虐待发生率，这一人群的创伤后应激障碍的发生率也非常高。除了重复经历、回避和高度唤醒等显著的创伤后应激障碍症状外，这些人还面临着更高的其他问题的风险：精神健康症状(抑郁、普遍焦虑、躯体化)、敌意、人际关系困难和再次受害。男性创伤恢复和赋权模式(M-TREM)是针对女性TREM组治疗的男性的初步适应，已被发现在解决患有严重精神障碍的女性中的创伤后应激障碍和密切相关的人际暴力后果方面有效。拟议的项目有两个主要目标：(1)完善初步的M-TREM小组干预，并完成领导人手册和配套材料，包括修订的用于评估领导人遵守治疗模式的忠诚度量表；(2)在一项试点研究中检查MTREM小组的有效性。为了实现这些目标，来自华盛顿特区和新汉普郡-达特茅斯精神病学研究中心的一个研究和临床团队将执行以下任务：(1)修订现有手册；进行两个M-Trem小组；收集成员、领导人和观察员的反馈；并相应地改进治疗手册；(2)招募60名患有创伤后应激障碍和严重精神障碍的男性，并随机分配到控制条件为照常服务(SAU)或M-Trem加SAU(后者将使用改进的手册)；(3)在基线、治疗后和3个月随访点评估以下结果：创伤后应激障碍症状严重程度、其他心理健康症状(抑郁、焦虑和躯体化)、敌意、社会关系和再受害；(4)检查组内随时间的变化，并对M-TREM与SAU相比将导致症状减少和社会关系增强的假设进行初步测试。

DESCRIPTION (provided by applicant): People with severe mental disorders have a high prevalence of physical and sexual abuse and rates of PTSD in this population are also extremely high. In addition to the hallmark PTSD symptoms of reexperiencing, avoidance, and hyperarousal, these individuals are at increased risk of other problems: mental health symptoms (depression, generalized anxiety, somatization), hostility, interpersonal difficulties, and revictimization. The Men's Trauma Recovery and Empowerment Model (M-TREM) is a preliminary adaptation for men of the women's TREM group treatment, which has been found to be effective in addressing PTSD and closely related consequences of interpersonal violence among women with severe mental disorders. The proposed project has two major aims: (1) to refine the preliminary M-TREM group intervention and to complete the leader's manual and accompanying materials, including a revised Fidelity Scale for assessing leader adherence to the treatment model; and (2) to examine the effectiveness of the MTREM group in a pilot study. In order to accomplish these aims, a research and clinical team from Community Connections in Washington, DC and the New Hampshire-Dartmouth Psychiatric Research Center will carry out the following tasks: (1) revise the existing manual; conduct two M-TREM groups; gather member, leader, and observer feedback; and refine the treatment manual accordingly; (2) enroll and randomly assign 60 men with PTSD and severe mental disorders to either a control condition of Services as Usual (SAU) or to M-TREM plus SAU (the latter condition will use the refined manual); (3) assess at baseline, post-treatment, and 3-month follow-up points the following outcomes: PTSD symptom severity, other mental health symptoms (depression, anxiety, and somatization), hostility, social relations, and revictimization; (4) examine within-group changes over time and conduct preliminary tests of the hypotheses that M-TREM will, in comparison to SAU, lead to decreased symptoms and enhanced social relations.