A Comparative Effectiveness Study of the Trauma Recovery Empowerment Model (TREM) and an Attachment-Informed Variation of TREM

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Doctor of Social Work (DSW)
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group therapy
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Abstract A Comparative Effectiveness Study of the Trauma Recovery Empowerment Model (TREM) and an Attachment-Informed Variation of TREM (ATREM) Melanie Masin-Moyer, University of Pennsylvania Dr. Phyllis Solomon, Dissertation Chair, University of Pennsylvania Dr. Malitta Engstrom, Dissertation Committee Member, University of Pennsylvania Objective: An evidenced-based women’s trauma group was modified to create a new protocol, Attachment-Informed Trauma Recovery Empowerment Model (ATREM), which included attachment-based concepts and strategies to determine if well-being could be enhanced beyond the Trauma Recovery Empowerment Model (TREM). A quasi-experimental design was used to test the hypothesis that ATREM would be associated with greater improvement in attachment security, perceived social support, emotion regulation, substance use, depression, anxiety, and PTSD symptoms than TREM. Methods: Sixty-nine women completed the group interventions (n = 37 ATREM; n = 32 TREM), along with pre- and-post-test questionnaires. The questionnaires included sociodemographic questions and the following standardized scales: Relationship Scale Questionnaire, Social Group Attachment Scale, Social Support Scale, Difficulties in Emotional Regulation, Brief Symptom Inventory 18, PTSD Symptom Scale, and modified versions of the Lifetime Stressor Checklist Revised and the Addiction Severity Index. The continuous variables were analyzed using paired t-tests for within-group comparisons and independent t-tests for between-group comparisons, and the categorical variables were analyzed using Chi-Square or Fisher’s Exact Test. Results: Both ATREM and TREM were associated with statistically significant within-group improvement in individual and group attachment styles, perceived social support, emotion regulation capacities, depression, anxiety, and PTSD. Only ATREM was associated with statistically significant improvement in individual attachment avoidance. The gains associated with ATREM did not exceed those associated with TREM as hypothesized. Conclusion: This pilot study extends prior findings on TREM by demonstrating that novel infusions of attachment-focused strategies into this evidence-based practice can facilitate comparable growth across a variety of measures of well-being. ATREM was also able to promote significant reductions in individual attachment avoidance, a style of interacting often considered challenging to modify. ATREM’s integrated design with cognitive-behavioral and psychodynamic elements holds potential to enhance responsiveness and effectiveness of TREM in meeting the diverse needs of women who have experienced trauma. Further, this study demonstrates the effectiveness of brief trauma-focused group therapy and provides insight into the emerging concept of group attachment style.

Phyllis Solomon
Malitta Engstrom
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