Trauma history in African-American women living with HIV: effects on psychiatric symptom severity and religious coping.

Women living with HIV (WLHIV) have rates of post-traumatic stress disorder (PTSD) up to 5 times higher than the general population. Individuals living with HIV and a concurrent diagnosis of PTSD have poorer HIV-related outcomes; however, the prevalence and impact of PTSD on African-American WLHIV seeking mental health treatment is unknown. The aim of this study is to examine the associations between PTSD symptoms with psychiatric symptom severity and psychological/religious coping strategies in African-American WLHIV who are seeking mental health treatment. This is a cross-sectional study of 235 African-American WLHIV attending an urban community mental health clinic. Bivariate analyses were conducted to evaluate associations between a PTSD symptoms scale (PSS≥21 versus PSS<21) and (1) psychiatric severity, (2) coping strategies, and (3) religious coping strategies. Thirty-six percent reported symptoms consistent with PTSD (PSS≥21). These women were significantly more likely to have worse mental health symptoms and were more likely to employ negative psychological and religious coping strategies. On the contrary, women with a PSS<21 reported relatively low levels of mental health symptoms and were more likely to rely on positive psychological and religious coping strategies. Over one-third of African-American WLHIV attending an outpatient mental health clinic had symptoms associated with PTSD. These symptoms were associated with worse mental health symptoms and utilization of dysfunctional religious and nonreligious coping strategies. Untreated PTSD in WLHIV predicts poorer HIV-related health outcomes and may negatively impact comorbid mental health outcomes. Screening for PTSD in WLHIV could identify a subset that would benefit from evidence-based PTSD-specific therapies in addition to mental health interventions already in place. PTSD-specific interventions for WLHIV with PTSD may improve outcomes, improve coping strategies, and allow for more effective treatment of comorbid mental health disorders.

Evaluation of a spiritually focused intervention with older trauma survivors.

This study evaluated the effectiveness of an 11-session, spiritually focused group intervention with older women survivors (age 55 years and older) of interpersonal trauma (child abuse, sexual assault, or domestic violence) in reducing trauma-related depressive symptoms, posttraumatic stress, and anxiety. Forty-three community-dwelling women survivors of interpersonal trauma were randomized into treatment (n = 21) or control (n = 22) groups. Participants in group psychotherapy discussed spiritual struggles related to abuse and developed spiritual coping resources. The treatment group had significantly lower depressive symptoms, anxiety, and physical symptoms at posttest compared with the control group. In a separate analysis, posttraumatic stress symptoms also dropped significantly in the treatment group. Gains were maintained at three-month follow-up. This study provides strong initial support for the effectiveness of spiritually focused group intervention for older survivors of interpersonal trauma from a Christian background.

The Trauma Recovery and Empowerment Model: A Quasi-Experimental Effectiveness Study.

OBJECTIVE: A quasi-experimental study tested the effectiveness of the Trauma Recovery and Empowerment Model (TREM), a group intervention for women trauma survivors, in comparison to services as usual. METHODS: Two hundred fifty-one women with histories of physical and/or sexual abuse and co-occurring serious mental illnesses and substance use disorders completed comprehensive study assessments at baseline and at 6 and 12 months. TREM groups were added to standard services at two community mental health agencies in Washington, DC (n = 153). Comparison group participants received usual services at two agencies in Baltimore, MD (n = 98). RESULTS: TREM participants showed greater reductions in alcohol and drug abuse severity, anxiety symptoms, and current stressful events, and they showed greater increases in perceived personal safety. There were no group differences in change for posttraumatic stress disorder and global mental health symptoms, physical and mental health-related quality of life, and exposure to interpersonal abuse. Changes in trauma recovery skills were associated positively with gains in study outcomes for TREM group participants. CONCLUSIONS: Despite design limitations, this study provides preliminary evidence for the effectiveness of the TREM intervention for a heterogeneous population of women trauma survivors with co-occurring disorders when added to usual services.

Spirituality and religion in recovery: some current issues.

This paper addresses current perspectives on the roles of spirituality and religion in recovery from serious mental health problems. Drawing on a variety of discussion groups and consultations in addition to the published literature, consumer perceptions as well as those of mental health and religious professionals are reviewed. Consumers note both potentially supportive and burdensome roles of religion and spirituality in recovery. Professionals report both hope for, and discomfort with, these domains in the context of mental health services. From each perspective emerge key recommendations regarding the appropriate place of spirituality and religion in psychiatric rehabilitation and related supports.

Implementing trauma-informed alcohol and other drug and mental health services for women: lessons learned in a multisite demonstration project.

On the basis of the 9-site, Substance Abuse and Mental Health Services Administration-funded Women, Co-Occurring Disorders, and Violence Study, this article discusses recommendations for implementing trauma-informed mental health, substance abuse, and other support services. These guidelines for best practices represent the consensus of a diverse trauma work group that drew on both cross-site and site-specific qualitative data.

Qualitative interviews on substance abuse relapse and prevention among female trauma survivors.

OBJECTIVE: Complex relationships among trauma, substance abuse, and mental disorders raise significant questions for the study of long-term recovery. The purpose of this qualitative study was to examine key themes in sustaining recovery among women with co-occurring disorders who had survived trauma. METHODS: In semistructured interviews conducted at one of the nine sites of the Women, Co-occurring Disorders, and Violence Study, 27 female trauma survivors described the influences they considered most important in sustaining and hindering their recovery, with an emphasis on recovery from substance abuse. Recurring themes in the interviews were identified. RESULTS: Seven themes emerged from this analysis. Four of these themes supported recovery: connection, self-awareness, a sense of purpose and meaning, and spirituality. Three others served as obstacles to recovery: battles with depression and despair, destructive habits and patterns, and lack of personal control. The women in this study reported that, although caring relationships provided important supports for sustained recovery, some of these same relationships increased emotional stress and conflict and thus may impede recovery. CONCLUSIONS: It is important for women and clinicians to place a high priority on the development of boundary management and other relationship skills. In addition, clinicians need to attend to negative feelings such as boredom and loneliness and to help women develop a range of meaningful activities that are consistent with a strong sense of identity. Individual relapse prevention skills by themselves seem insufficient to sustained abstinence.

Religious/spiritual coping among women trauma survivors with mental health and substance use disorders.

This study examines the types of religious/spiritual coping used by women trauma survivors with co-occurring mental health and substance use disorders. Analyses based on data from 2 large racially diverse samples indicate that women from the study population rely considerably more on positive, than negative, religious coping, and that their reliance on religious coping, in general, is significantly higher than that of the general population. Numerous significant relationships were also found between the severity of trauma-related and mental health symptoms and more negative religious coping. This study further suggests that more frequent childhood abuse and childhood sexual violence are especially associated with negative religious coping in adulthood. Findings support the importance of spiritual coping for women trauma survivors with co-occurring disorders and suggest the value of increased attention to spirituality in behavioral health services, especially in assessment and therapeutic relationships.

The Trauma Recovery and Empowerment Model (TREM): conceptual and practical issues in a group intervention for women.

This article describes the Trauma Recovery and Empowerment Model (TREM), a manualized group intervention designed for women trauma survivors with severe mental disorders, and discusses key issues in its conceptualization and implementation. TREM recognizes the complexity of long-term adaptation to trauma and addresses a range of difficulties common among survivors of sexual and physical abuse. Focusing primarily on the development of specific recovery skills and current functioning, TREM utilizes techniques shown to be effective in trauma recovery services. The group's content and structure are also informed by the role of gender in the ways women experience and cope with trauma.