This Mentored Research Scientist Development Award is designed to provide training in intervention research testing the effectiveness of anxiety and depression treatment modalities with low-income and minority women. Posttraumatic stress disorder (PTSD) is a debilitating problem affecting more than one in ten women. Although efficacious treatments for PTSD have been developed, these have been tested almost exclusively with highly training therapists in academic research settings where low-income minority populations are generally underrepresented. Little is known about the generalizability of these findings to therapists and clients outside of specialty clinics. Prolonged exposure (PE) is the most fully documented psychosocial treatment to date. I am, therefore, proposing a preliminary trial examining PE's effectiveness as compared to usual care in a 2 (treatment) X 3 (pretest, posttest, 3-month follow-up) mixed model factorial design with repeated measures on the second factor. The study will be conducted at an urban clinic serving a poor minority population, and treatment will be provide by community clinicians without poor training in behavior therapy. Sixty low-income, predominantly African- American women with DSM-IV PTSD will be randomly assigned to PE or usual care. It is hypothesized that PE will lead to greater improvement in (a) PTSD symptoms and (b) psychological and social functioning and usual care, as evidenced by an advantage for PE of at least a moderate effect size (Cohen, 1988). PE and usual care will be compared as to the number of eligible women who refused or drop out of treatment. No predictions are made about the relative acceptability of PE versus usual care. If effect size analyses show PE to be superior to usual care for PTSD, I will develop an RO1 proposal testing the effectiveness of PE in a full-scale controlled trial for low-income women conducted at several community sites. If PE fails to prove more beneficial than usual care, I will use the resulting data and the skills acquired during the award period to prepare a proposal aimed at crafting a more effective treatment for use with low-income and minority women in community settings. Mentored career development and research activities are designed to provide training in: (a) the treatment, assessment, and etiology of PTSD, (b) factors that effect the mental health treatment of low-income and minority women, (c) the assessment and treatment of depression, and (d) statistical methods for the evaluation of treatment outcome data. The skills I will develop during the award period will provide a cohesive framework for achieving my long-term goal of establishing a scientific career focused on effectiveness research with disadvantaged and minority women.
