Treatment of PTSD in Residents of Battered Women's Shelters

描述(由申请人提供)：亲密伴侣暴力(IPV)是一个普遍存在的社会问题，与高比例的创伤后应激障碍(PTSD)有关。此外，创伤后应激障碍与IPV受害者的相当高的发病率和再次滥用的风险更高有关。家庭暴力庇护所为IPV受害者提供了一个不可或缺的资源，因为它们提供了紧急庇护所、支持和获得社区资源的途径，这有助于他们为自己及其子女建立长期安全。然而，创伤后应激障碍症状会损害受虐待妇女获取和有效利用这些重要的个人和社会资源的能力，有效地为她们和她们的孩子建立安全。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虐待妇女庇护所居民的创伤后应激障碍的治疗情况。为了解决文献中的这一空白，我们为患有创伤后应激障碍的IPV患者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治疗方法，它采用赋权的方法进行治疗，强调稳定和安全，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。希望是一种新的治疗方法，因为它采用了一种赋权的方法来治疗创伤后应激障碍，并强调了稳定和安全；这是创伤后应激障碍妇女收容所居民的重要需求。在这项申请中，我们建议扩展我们与HOPE的试点工作，并在186名患有IPV相关创伤后应激障碍的遭受虐待妇女收容所的女性居民中测试HOPE相对于支持性治疗(即以当前为中心的治疗，PCT)的有效性。为了促进未来希望的传播，社区治疗师将提供课程，研究将在一系列庇护所系统中进行。此外，与我们的试点工作不同，目前的提案将把HOPE与注意力匹配的对照条件进行比较，有较长的随访期，以确定积极的结果是否随着时间的推移而持续，将评估HOPE对虐待儿童可能性的影响，将纳入应激反应的客观衡量标准(例如，对创伤线索的注意偏差和生理反应)，将探索新的治疗介体和调节器，并将包括成本效益分析。这些发现将被用来为未来的希望传播研究提供信息。 公共卫生相关性：这项拟议的研究调查了一项创新的认知行为治疗计划(HOPE)的有效性，因为它采用了一种赋权模式来治疗创伤后应激障碍，重点是提高亲密伴侣暴力(IPV)受害者及其子女的安全性的策略，帮助妇女有效地使用建立长期安全所需的庇护所和社区资源，并解决受虐妇女面临的许多治疗障碍。此外，拟议的研究还将评估治疗的创新结果，包括再次虐待严重程度、赋权、儿童虐待潜力、对创伤线索的皮质醇反应以及对与威胁有关的信息的注意偏差，将调查创新的变化机制(例如，赋权)，并将评估希望的成本效益。将心理健康治疗纳入收容所可能会改善这一弱势和服务不足的妇女群体在其生命中的这一关键时期可能得到的标准收容服务。

DESCRIPTION (provided by applicant): Intimate partner violence (IPV) is a pervasive social problem associated with high rates of posttraumatic stress disorder (PTSD). Moreover, PTSD is associated with considerable morbidity and a higher risk of re- abuse in victims of IPV. Domestic Violence Shelters provide an integral resource for IPV victims 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, PTSD symptoms can compromise battered women's ability to access and effectively use these vital personal and social resources, effectively establishing safety for themselves and their children. 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 treatment of PTSD in residents of battered women's shelters. To address this gap in the literature, we have developed a shelter-based treatment for victims of IPV with PTSD, Helping to Overcome PTSD through Empowerment (HOPE). HOPE is a brief cognitive-behavioral treatment that that adopts an empowerment approach to treatment, emphasizing stabilization and safety, goals consistent with the theoretical and empirical literature on battere women and PTSD. HOPE is a novel treatment in that it adopts an empowerment approach to treating PTSD and emphasizes stabilization and safety; important needs of residents of battered women's shelters with PTSD. In this application we propose to expand upon our pilot work with HOPE and test the efficacy of HOPE relative to supportive therapy (i.e., Present Centered Therapy, PCT) in a sample of 186 female residents of battered women shelters with IPV- related PTSD. In an effort to facilitate future dissemination of HOPE, sessions will be delivered by community therapists and the study will be conducted in a range of shelter systems. Furthermore, the current proposal, unlike our pilot work, will compare HOPE to an attention matched control condition, have a longer follow-up period in order to determine whether positive findings are sustained over time, will assess the impact of HOPE on child abuse potential, will incorporate objective measures of stress responding (e.g., attentional biases and physiological reactivity to trauma cues), will explore novel mediators and moderators of treatment, and will include a cost-effectiveness analysis. Findings will be used to inform a future dissemination study of HOPE. PUBLIC HEALTH RELEVANCE: The proposed research investigates the efficacy of an innovative cognitive behavioral treatment program (HOPE) in that it adopts an empowerment model to the treatment of PTSD, focuses on strategies to increase safety for victims of intimate partner violence (IPV) and their children, helps women effectively use the shelter and community resources necessary to establish long-term safety, and addresses many of the barriers to treatment faced by battered women. Further, the proposed study will also assess innovative outcomes of treatment, including re-abuse severity, empowerment, child abuse potential, cortisol reactivity to trauma cues, and attentional biases to threat-related information will investigate innovative mechanisms of change (e.g., empowerment), and will evaluate the cost-effectiveness of HOPE. Incorporating mental health treatment in the shelter may improve the standard shelter services that this vulnerable and under-served group of women may receive during this critical period in their lives.