Treatment of PTSD in Recently Battered Women Living in Shelters

最近遭受虐待的收容所妇女的创伤后应激障碍 (PTSD) 治疗

• 批准号: 7293245
• 负责人: DAWN M JOHNSON
• 金额: $ 17.57万
• 依托单位: SUMMA HEALTH
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-13 至 2010-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7293245
• 关键词: Address; Adherence; Battered Women; Behavior Therapy; Behavioral; Caring; Case Management; Child; Clinical; Cognitive; Communities; Competence; Complex; Data; Development; Domestic Violence; Effectiveness; Emergency Situation; Emotional; Face; Family; Functional disorder; Future; Goals; Individual; Knowledge; Lead; Left; Life; Literature; Manuals; Measures; Mental Health; Modeling; Pain; Participant; Phase; Pilot Projects; Population; Post-Traumatic Stress Disorders; Procedures; Psychological Impact; Randomized; Randomized Controlled Trials; Research; Research Support; Resources; Role; Safety; Self Care; Services; Shelter facility; Social Functioning; Social Problems; Social support; Standards of Weights and Measures; Symptoms; Testing; Time; Training; Vulnerable Populations; Woman; Work; base; clinically significant; coping; depressive symptoms; design; experience; functional disability; intimate partner violence; programs; psychoeducation; psychologic; size; skills training; social; stressor; therapy development

DESCRIPTION (provided by applicant): Intimate partner violence is a pervasive social problem with potentially severe mental health and functional consequences consistent with PTSD. Shelters provide an integral resource for battered women in that they provide emergency shelter, support, and access to community resources that can aid in their establishing long- term safety for themselves and their children. However, recent research suggests that symptoms of PTSD can compromise battered women's ability to access and effectively use these vital personal and social resources, emphasizing the importance of initiating PTSD treatment at this time. Despite the fact that annually 300,000 battered women and children access shelter services, and domestic violence shelters provide a prime time to initiate psychological treatment, virtually no research has systematically investigated the psychological treatment of PTSD in sheltered battered women. We have already developed a shelter-based treatment for battered women with PTSD or subthreshold PTSD, Helping to Overcome PTSD through Empowerment (HOPE). HOPE is a brief cognitive-behavioral treatment that emphasizes stabilization and empowerment, goals consistent with the theoretical and empirical literature on battered women and PTSD. Although preliminary research supports the initial feasibility and efficacy of the shelter version of HOPE, it also demonstrates that battered women continue to suffer from significant symptoms of PTSD, multiple safety concerns, continued deficits in access to and effective use of resources, and multiple ongoing secondary stressors immediately after they leave the shelter. These findings suggest that more extensive treatment and treatment that facilitates a successful transition from the shelter to the community is indicated. Thus, in this research plan we propose to modify and expand HOPE to include post-shelter sessions and to test the initial acceptability, feasibility, and efficacy of this expanded version of HOPE in battered women with PTSD or subthreshold PTSD. The proposed research plan will be divided into two major phases: 1) a development phase in which we will modify and expand HOPE and gain clinical experience with this expanded version of HOPE, and 2) a randomized pilot study phase in which we will test the feasibility and initial efficacy of the expanded HOPE in a group of sheltered battered women with PTSD or subthreshold PTSD (N = 60), and compare this group to women who receive standard care. Primary hypotheses are that women who receive the expanded HOPE will show greater reductions in symptoms of PTSD, greater effectiveness in obtaining community resources, and fewer losses of personal and social resources than will women who receive standard care. Secondary hypotheses are that women who receive the expanded HOPE will show greater reductions in symptoms of depression; greater improvement in psychological empowerment, social functioning, and social support; as well as less revictimization than women who receive standard care. To our knowledge our proposed research program represents the first attempt to develop and empirically evaluate a comprehensive treatment for sheltered battered women with PTSD. HOPE is designed to decrease battered women's emotional suffering and to help them to more effectively use the personal and social resources required to establish long-term safety for themselves and their children. HOPE is manualized and easily portable, and thus can potentially provide a national model of treatment for sheltered battered women with PTSD.

描述（由申请人提供）：亲密伴侣暴力是一个普遍存在的社会问题，具有与PTSD一致的潜在严重心理健康和功能后果。庇护所为被殴打的妇女提供了一种不可或缺的资源，因为它们提供紧急庇护所、支持和获得社区资源的机会，这些资源可以帮助她们为自己和子女建立长期的安全。然而，最近的研究表明，创伤后应激障碍的症状可能会损害受虐妇女获得和有效利用这些重要的个人和社会资源的能力，强调此时开始创伤后应激障碍治疗的重要性。尽管每年有30万名受虐妇女和儿童获得庇护所服务，家庭暴力庇护所提供了开始心理治疗的黄金时间，但几乎没有研究系统地调查庇护受虐妇女的创伤后应激障碍心理治疗。我们已经为患有创伤后应激障碍或阈下创伤后应激障碍的受虐妇女开发了一种基于庇护所的治疗方法，即通过赋权帮助克服创伤后应激障碍（希望）。希望是一种简短的认知行为治疗，强调稳定和赋权，目标与受虐妇女和创伤后应激障碍的理论和经验文献一致。虽然初步研究支持庇护所版本的HOPE的初步可行性和有效性，但它也表明，受虐妇女继续遭受创伤后应激障碍的严重症状，多重安全问题，在获得和有效利用资源方面的持续赤字，以及在离开庇护所后立即出现的多种持续的次要压力。这些调查结果表明，需要进行更广泛的治疗，以促进从收容所到社区的成功过渡。因此，在这项研究计划中，我们建议修改和扩大希望，包括庇护后的会议，并测试最初的可接受性，可行性，和有效性，这个扩大版本的希望在受虐妇女与创伤后应激障碍或阈下创伤后应激障碍。拟议的研究计划将分为两个主要阶段：1）开发阶段，我们将修改和扩展HOPE，并获得HOPE扩展版本的临床经验，以及2）随机试点研究阶段，我们将在一组患有PTSD或阈下PTSD的庇护受虐妇女（N = 60）中测试扩展HOPE的可行性和初步疗效，并与接受标准护理的女性进行比较。主要假设是，接受扩大HOPE的妇女将表现出更大的减少创伤后应激障碍的症状，更有效地获得社区资源，和更少的个人和社会资源的损失将比接受标准护理的妇女。次要的假设是，接受扩大的希望的妇女将表现出更大的减少抑郁症的症状;更大的改善心理赋权，社会功能和社会支持;以及较少的再受害比妇女谁接受标准的护理。据我们所知，我们提出的研究计划是第一次尝试开发和经验评估一个全面的治疗庇护受虐妇女创伤后应激障碍。“希望”方案的目的是减少被殴打妇女的情感痛苦，帮助她们更有效地利用必要的个人和社会资源，为自己和子女建立长期安全。HOPE是手动的，易于携带，因此可以潜在地为患有创伤后应激障碍的受庇护受虐妇女提供一个全国性的治疗模式。