Evaluation of a Psycho-Social-Spiritual Intervention with Older Women Survivors of Interpersonal Trauma

Background and Purpose: There is consistent evidence that the positive use of religious and spiritual (R/S) resources is associated with lower depression, and emerging evidence that negative R/S coping is associated with higher levels of posttraumatic stress symptoms and depression for survivors of interpersonal trauma (childhood abuse, domestic violence, and sexual assault). However, little is known, both about the cumulative effects of violence and abuse for older survivors and about R/S struggles that are related to abuse. This dissertation study evaluates an 11-session psycho-social-spiritual group treatment with women aged 55 and older experiencing trauma symptoms and spiritual distress. The intervention was previously developed and conducted in a community mental health agency serving survivors of interpersonal violence and abuse who had co-occurring disorders (Fallot & The Spirituality Workgroup, 2001-2004). Drawing on theoretical models for treating trauma, including cognitive restructuring and R/S coping, the treatment assists women in discussing their spiritual distress and connecting or re-connecting with their personal and community R/S resources. Thus, it promotes positive spirituality. Hypotheses were that the intervention would reduce symptoms commonly associated with trauma, including depression, anxiety, PTSD, physical symptoms, and spiritual distress; as well as improve spiritual coping and spiritual well-being.

Methods: The intervention was adapted for evaluation in this study using a randomized-controlled treatment design. Three groups receiving therapy were compared with three delayed treatment control groups (n = 43). Survivors were recruited from the community and were not in therapy at the time of the study. They came from a Christian background, and most were currently involved in a congregation. Participants identified that they were experiencing spiritual distress, including trouble forgiving themselves or others, difficulties in their relationship with God, or struggles within their religious congregations.

Results: All symptoms were assessed using standardized treatment measures. Posttraumatic stress and spiritual distress outcomes were dropped from the final analysis due to multicollinearity with other measures. Findings, upon completing a multivariate analysis of the variance (MANOVA), are that survivors who experienced the treatment had significantly lower depression and anxiety at posttest than women in the control group. Women also reported lower physical symptoms and improved spiritual well-being. Treatment gains were maintained at 3-month follow-up testing. Furthermore, this research offers preliminary support for negative R/S coping partially mediating the effects of the intervention on depression and anxiety, meaning that reducing negative R/S coping (cognitive appraisals of abandonment or punishment by God, anger at God, or having doubts about the existence of God) may in turn lead to lower depression and anxiety.

Conclusions and Implications: The intervention significantly lowered depression, anxiety, and physical symptoms and improved spiritual well-being, thus providing strong initial evidence for an effective and cost-efficient group treatment for older women trauma survivors from a Christian background who manifest trauma symptoms and spiritual struggles connected with interpersonal trauma. This study is one of the first to establish a causal relationship between religion and spirituality and mental health. Future research should adapt this intervention for diverse religious and ethnic/racial groups.