This application is a request for a Mentored Patient-Oriented Research Career Development Award (K23) that will enable Dr. Johnson to begin developing a programmatic line of research in the assessment and treatment of the traumatic effects of domestic violence on battered women and their children. Intimate partner violence is a pervasive social problem with negative psychological consequences for both women and children. Posttraumatic Stress Disorder (PTSD) is extremely common in battered women, especially those in domestic violence shelters. Symptoms of PTSD may compromise battered women's ability to effectively access resources and establish them and their children. However, no research has systematically and empirically evaluated the treatment of PTSD in battered women in shelters. Thus, research on treatment with this vulnerable population is sorely needed. Dr. Johnson's training goals are to: (1) Increase understanding of treatment development process, with a focus on methods for developing and evaluating treatments for PTSD in naturalistic settings, (2) Acquire expertise in conducting research with, and providing clinical treatment for, battered women with PTSD, (3) Develop a better understanding of the effects of exposure to domestic violence on the children of battered women and how this impacts the treatment needs of battered women; (4) Learn new assessment techniques for children appropriate for measuring the effects of exposure to domestic violence, (5) Develop more advanced skills in research design, methodology, and statistical analyses, particularly techniques relevant to clinical trials, and (6) Improve grant writing and manuscript preparation skills. These training goals will be achieved through (1) the resources available at the Brown University Medical School, (2) the high quality mentorship provided by Drs. Caron Zlotnick, Ernest Jouriles, Ronald Seifer, and Cris Sullivan, and the expertise of the assembled consultant team (Drs. Mary Ann Dutton and Janice Krupnick), (3) focused coursework, trainings, and clinical experiences, and (4) the proposed research project. The proposed research plan involves further developing and empirically testing a new treatment for battered women in shelters with PTSD or subthreshold PTSD. The proposed treatment, Helping to Overcome PTSD through Empowerment (HOPE) incorporates the empirical and theoretical literature on battered women, trauma, and PTSD. It is a nine session individual cognitive-behavioral treatment that emphasizes stabilization and empowerment. The specific research aims are to: (1) Refine HOPE and its manual, gain clinical experience with the treatment procedures and develop HOPE therapist training procedures and adherence and competence rating scales and (2) Evaluate the initial acceptability, feasibility, and efficacy of HOPE in a randomized controlled study, comparing HOPE combined with standard shelter services to standard shelter services alone.
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