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）是一个普遍的社会问题，与创伤后应激障碍（PTSD）的高发病率有关。此外，创伤后应激障碍与IPV受害者相当高的发病率和较高的再滥用风险相关。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，这些资源可以帮助他们为自己和子女建立长期的安全。然而，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，从而有效地为自己和子女建立安全。尽管每年有300 000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受虐妇女庇护所居民的创伤后应激障碍治疗情况。为了解决文献中的这一空白，我们为IPV患者开发了一种基于庇护所的治疗方法，即通过赋权帮助克服PTSD（HOPE）。HOPE是一种简短的认知行为治疗，采用赋权的方法进行治疗，强调稳定和安全，目标与被殴打妇女和创伤后应激障碍的理论和经验文献一致。HOPE是一种新颖的治疗方法，它采用了增强权能的方法来治疗创伤后应激障碍，并强调稳定和安全;创伤后应激障碍患者受虐妇女庇护所居民的重要需求。在本申请中，我们建议扩展我们的HOPE试点工作，并测试HOPE相对于支持性治疗的疗效（即，本中心治疗，PCT）的样本中的186名女性居民的受虐妇女庇护所与IPV相关的创伤后应激障碍。为了促进未来的希望传播，将由社区治疗师提供会议，并将在一系列住房系统中进行研究。此外，与我们的试点工作不同，目前的提案将把希望与注意力匹配的控制条件进行比较，有更长的随访期，以确定积极的发现是否会随着时间的推移而持续，将评估希望对虐待儿童可能性的影响，将纳入压力反应的客观措施（例如，注意力偏差和对创伤线索的生理反应），将探索治疗的新介质和调节剂，并将包括成本效益分析。调查结果将用于通知未来的传播研究的希望。 公共卫生相关性：这项拟议的研究调查了一种创新的认知行为治疗计划（HOPE）的有效性，它采用了一种赋权模式来治疗创伤后应激障碍，重点关注增加亲密伴侣暴力（IPV）受害者及其子女安全的策略，帮助妇女有效地利用建立长期安全所需的庇护所和社区资源，并解决了受虐妇女在治疗方面面临的许多障碍。此外，拟议的研究还将评估治疗的创新结果，包括再虐待严重程度，赋权，虐待儿童的可能性，皮质醇对创伤线索的反应，以及对威胁相关信息的注意力偏差，将调查创新的变化机制（例如，并将评估HOPE的成本效益。在庇护所内提供心理健康治疗可能会改善这一弱势和得不到充分服务的妇女群体在其生命的这一关键时期可能获得的标准庇护所服务。

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.