Johnson, D. M., Zlotnick, C., Hoffman, L., Palmieri, P. A., Johnson, N. L., Holmes, S. C., & Ceroni, T. L. (2020). A Randomized Controlled Trial Comparing HOPE Treatment and Present-Centered Therapy in Women Residing in Shelter with PTSD from Intimate Partner Violence. Psychology of Women Quarterly, 44(4), 539-553.
This double-blinded experimental study evaluated the efficacy of an intervention designed to alleviate IPV – related post-traumatic stress disorder (PTSD). Study participants were randomly offered HOPE Treatment utilizing an empowerment framework (n = 83) or an adapted version of present-centered therapy using safety planning, PCT+ (n = 89). This study hypothesized that HOPE, relative to PCT+, would be associated with greater reductions in IPV-related PTSD severity and degree of IPV re-victimization across the 12-month follow-up. One hundred seventy-two female shelter residents in six shelters in the mid-western United States with IPV-related PTSD during a four-year period (2013 - 2017) met the study inclusion randomization criteria and were assessed on five occasions; baseline, post shelter, post-treatment, and six, and twelve months follow-up.
This study used a 16 HOPE session treatment module that adopted a cognitive behavior therapy (CBT) approach to address trauma-influenced areas, including trust, power, intimacy, and esteem, while focusing on safety, self-care, and empowerment. The PCT+ treatment was 16 sessions that were problem-focused and are regularly used as a matched control condition in PTSD clinical trials. HOPE components (e.g., cognitive restructuring, new behavioral skills acquisition) were often cited as critical differences between HOPE and PCT+. In addition, study participants, in all six shelters received the standard shelter services (e.g., case management, therapeutic milieu environment, and educational groups). Both HOPE and PCT+ were delivered with good intervention fidelity by four trained master's-level therapists in both therapy protocols.
Study primary outcomes included PTSD and IPV severity, while secondary outcomes included depression severity, empowerment, post-traumatic cognitions, health-related quality of life, and satisfaction with treatment. Study results indicate that HOPE is an efficacious treatment for IPV-related PTSD and is associated with reductions in IPV in shelter residents. Community-based master's-level therapists can effectively deliver HOPE.. Both HOPE and PCT+ were associated with reduced IPV rates and improved health-related quality of life across follow-up. However, most participants did not achieve clinically significant improvement in the degree of empowerment or post-traumatic cognitions suggesting that participants were still experiencing mild to subthreshold symptoms of PTSD and clinically significant levels of depressive symptoms. Unfortunately, this is not entirely surprising as mean scores suggest that many participants continued to experience some IPV across follow-up.
In practical terms, findings highlight that a trauma-informed approach to therapy in the shelter system can be successfully and effectively offered to residents both during and after a shelter stay. Since both PCT+ and HOPE were similarly efficacious, the therapeutic relationship might play an essential role in healing trauma. Moreover, PCT+ may be preferable to HOPE as a treatment model for residents of shelters with IPV-related PTSD as it is easy to adapt and require less oversight and feedback during the training phase, and PCT+ includes a safety planning component that paraprofessionals can deliver.
Study limitations include the lack of a no-treatment control group and the inability to control variables that may influence treatment outcome (e.g., length of shelter stay). Changes to the study design (e.g., using community therapists) may have diluted treatment effects, contributing to the lack of significant findings. In addition, low sample size and attrition was an issue (HOPE; n = 56 and PCT+; n = 71) at the last follow-up, and contamination effect as both PCT+ and HOPE was offered in all six shelters. Findings may not generalize to shelter residents with severe mental illness (i.e., bipolar disorder, psychotic symptoms, recent substance use disorder, and suicide risk) and may not generalize to other IPV populations that do not seek shelter.
This study's findings highlight that HOPE is associated with significant treatment gains relative to PCT +. Thus, agencies that fund shelters are encouraged to prioritize funding to train staff to deliver trauma-informed interventions in shelter settings.