Treatment of PTSD in Recently Battered Women Living in Shelters

描述(申请人提供)：亲密伴侣暴力是一种普遍存在的社会问题，具有潜在的严重心理健康和与创伤后应激障碍相一致的功能后果。收容所为遭受虐待的妇女提供了不可或缺的资源，因为它们提供紧急住所、支助和获得社区资源的机会，这有助于她们为自己和子女建立长期安全。然而，最近的研究表明，创伤后应激障碍的症状会损害受虐妇女获取和有效利用这些重要的个人和社会资源的能力，强调了在这个时候开始创伤后应激障碍治疗的重要性。尽管每年有30万被虐待妇女和儿童获得庇护服务，家庭暴力庇护中心提供了启动心理治疗的黄金时段，但几乎没有研究系统地调查被庇护受虐妇女的创伤后应激障碍的心理治疗。我们已经为患有创伤后应激障碍或阈值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，帮助通过赋权(HOPE)克服创伤后应激障碍。HOPE是一种简短的认知行为疗法，强调稳定和赋权，目标与关于受虐妇女和创伤后应激障碍的理论和经验文献一致。虽然初步研究支持收容所版本的希望的初步可行性和有效性，但它也表明，遭受虐待的妇女在离开收容所后立即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不足以及多种持续的次级应激源。这些发现表明，需要更广泛的治疗和治疗，以促进从庇护所向社区的成功过渡。因此，在这项研究计划中，我们建议修改和扩大HOPE，以包括收容所后的会议，并测试这种扩展版本的HOPE在患有创伤后应激障碍或阈值下创伤后应激障碍的受虐妇女中的初步可接受性、可行性和有效性。拟议的研究计划将分为两个主要阶段：1)发展阶段，我们将修改和扩大HOPE，并获得扩展版本的临床经验；2)随机试验阶段，我们将在一组患有创伤后应激障碍或阈值下创伤后应激障碍(N=60)的庇护受虐妇女(N=60)中测试扩大的HOPE的可行性和初步疗效，并将这一组妇女与接受标准护理的妇女进行比较。基本假设是，与接受标准护理的女性相比，接受扩大希望的女性将显示出更大的创伤后应激障碍症状的减轻，在获得社区资源方面更有效，以及更少的个人和社会资源损失。第二个假设是，与接受标准护理的女性相比，接受扩大希望的女性将显示出更大的抑郁症状减少；在心理赋权、社会功能和社会支持方面有更大的改善；以及更少的再次受害。据我们所知，我们提议的研究计划是第一次尝试开发并经验性地评估患有创伤后应激障碍的庇护受虐妇女的综合治疗。HOPE旨在减少受虐待妇女的精神痛苦，并帮助她们更有效地利用为自己及其子女建立长期安全所需的个人和社会资源。HOPE是手动的，很容易携带，因此有可能为患有创伤后应激障碍的收容所遭受虐待的妇女提供一个全国治疗模式。

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.