PTSD and Severe Mental Disorders: A Group Model for Men

描述（由申请人提供）：患有严重精神障碍的人有很高的身体虐待和性虐待的患病率，这类人群中PTSD的发病率也非常高。除了创伤后应激障碍的标志性症状，如再经历、逃避和过度觉醒，这些人出现其他问题的风险也更高：精神健康症状（抑郁、广泛性焦虑、躯体化）、敌意、人际关系困难和再次受害。男性创伤恢复与赋权模式（M-TREM）是男性对女性TREM群体治疗的初步适应，已被发现对严重精神障碍女性创伤后应激障碍及密切相关的人际暴力后果有效。拟建项目有两个主要目的：(1)完善M-TREM小组干预的初步方案，完成领导者手册和随附材料，包括修订的忠诚度量表，用于评估领导者对治疗模式的依从性；(2)在试点研究中检验MTREM组的有效性。为了实现这些目标，来自华盛顿特区社区联系和新罕布什尔-达特茅斯精神病学研究中心的研究和临床团队将执行以下任务：(1)修订现有手册；组织两个M-TREM小组；收集成员、领导和观察员的反馈；并相应完善治疗手册；(2)招募并随机分配60名患有创伤后应激障碍和严重精神障碍的男性，将其分为两组，一组为正常服务（SAU）对照组，另一组为M-TREM + SAU组（后者将使用改进后的手册）；(3)在基线、治疗后和3个月随访时评估以下结果：PTSD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相比会导致症状减轻和社会关系增强的假设进行初步检验。

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.