Predictors of engagement and outcome in an integrative trauma treatment for women with co-occurring mental disorders

To make psychiatric and substance use treatment more effective for individuals with histories of trauma and co-occurring disorders, clinicians have recently developed several treatment models that aim to address trauma sequelae, substance abuse, and general mental health problems as the interconnected parts of a whole problem, rather than treating each individual disorder separately. One such treatment is the Trauma Recovery and Empowerment Model (TREM), a 33-session manualized group therapy. Recent research findings suggest that integrative trauma treatments like TREM are effective in reducing PTSD symptoms, substance abuse problems, and general psychiatric symptoms. However, few studies have examined how and for whom these treatments are most efficacious. The present study examined predictors of engagement and outcome in the District of Columbia Trauma Collaboration Study. A total of 153 women received TREM and a range of community support services at two Washington-based mental health agencies, and 98 women received services as usual and no trauma-specific services at two mental health agencies based in Baltimore, MD. In-person assessments were conducted at baseline, 3 months, 6 months, 9 months and 12 months. Change scores from baseline to 12 months were computed for a range of symptom measures. Greater pretreatment clinical severity on measures of trauma symptoms, general psychiatric functioning, and drug and alcohol use were generally associated with a greater posttreatment reduction in general mental health and trauma symptoms. In addition, TREM participants who reported having recently experienced interpersonal abuse at the start of treatment demonstrated substantially greater reductions in general mental health and trauma symptoms at 12 months relative to participants in usual care and those with no recent experience of interpersonal abuse. Greater attendance at TREM sessions and higher clinician-rated participation were associated with better outcomes. As one of the first studies to examine predictors of engagement and outcome in TREM, the present study was intended to help mental health service providers more effectively use the often-limited resources available for the treatment of individuals with co-occurring disorders.