People with severe mental disorders have high prevalence rates of physical and sexual abuse, and those served by the public mental health system usually bring histories of longstanding abuse and multiple, repeated trauma. Rates of posttraumatic stress disorder (PTSD) among people with severe mental disorders and histories of interpersonal violence are very high. In addition, they are at increased risk for many negative outcomes, such as, revictimization, depression, and substance abuse, leading to higher use of intensive services. There is a need for effective trauma treatments that can be implemented in routine mental health settings. The Trauma Recovery and Empowerment Model (TREM) is a 29-session group-based intervention that addresses PTSD and closely related consequences of sexual and physical abuse among women diagnosed with severe mental disorders. Preliminary work indicates that TREM can be implemented with high fidelity. ? Group completion rates are high, and preliminary studies show gains for participants in several domains, including PTSD symptom severity. This application is for a randomized controlled trial of TREM for women trauma survivors with severe mental disorders and PTSD in two urban public-sector mental health settings. Eligible women will be randomly assigned to two conditions, Services as Usual (n=150) and TREM (n=150), with assessments conducted at baseline 6, 12, and 18 months. The primary hypothesis is that TREM is superior to Services as Usual in reducing PTSD symptom severity. Secondary hypotheses concern reductions in distorted beliefs, substance abuse, depressive symptoms, revictimization, and high-cost service use. As awareness of the impact of trauma on people with severe mental disorders has grown, there has been increasing pressure to bring forth evidence-based practices to address co-occurring posttraumatic disorders. This RCT will provide essential scientific evidence concerning the effectiveness TREM in reducing the suffering of women with severe mental disorders who have experienced interpersonal abuse. ? ?
