Warrior Renew is a holistic approach to treatment whereby the curriculum includes a variety of classes such as psychoeducation, emotional processing, creative self-expression, and relaxation. Each individual class also incorporates cognitive and experiential components so that the process of transformation is multi-faceted. The design is to toggle between the cognitive and experiential systems—this helps titrate the emotional experience increasing participants’ tolerance and mastery. The toggling also engages multiple areas of the brain to facilitate learning. As per Cognitive-experiential theory (Epstein, 2014), this enables change to occur at a deep and lasting level.
While Warrior Renew participants learn new skills to manage and decrease symptoms, the program’s emphasis is on improving self-concept, self-esteem, and optimism. Rather than identifying a specific event of trauma, participants examine the total impact of living through multiple events of trauma and how this has influenced interpersonal patterns in their lives, such as repeating themes re-enacted in relationships. Components of the patterns are identified such as core violations (e.g., the quality of what was most distressing such as being neglected, rejected, trapped, or betrayed), personalized beliefs (e.g., the meaning the experience has for the participants such as feeling worthless, inadequate, or gullible), protective strategies to avoid distress, and compensating strategies to secure love, safety, attention, and acceptance. Participants learn that living in a pattern of abuse and trauma has erroneously shaped their perceptions of self, others, and the world.
Participants learn that their trauma-based perceptions are distinct from their true identity (e.g., the essence of who they are) and distinct from what is possible and who they can choose to be. From the perspective of their current age and place in life, they reexamine their lives as an objective observer, seeing context, and the role of others (e.g., perpetrators and bystanders). This facilitates releasing self-blame and shame while embracing positive factors such as seeing their younger self as loveable and free.
The original Renew program was established in 2005. It was a 12-week comprehensive program designed to serve outpatients and homeless women Veterans who received housing and sustenance at a community partner housing program. The outcome studies conducted on this program were approved and monitored by an Internal Review Board and no adverse events were reported.
STUDY 1: Pre- to Post-treatment Outcomes for Women Veterans in the Renew Program
The first outcome study examined pre-and post-treatment scores on various measures of negative symptoms such as PTSD, Posttraumatic Negative Thoughts, and Psychiatric symptoms of anxiety and depression and positive factors of self-esteem, optimism, and satisfaction with life (Katz, Cojucar, Douglas, & Huffman, 2014). Of the 119 women Veterans enrolled in an uncontrolled outcome study (e.g., completed pre- and post-treatment questionnaires), 80 of the participants reported multiple traumas across their lifespan and 95 experienced MST. Of the 112 who started treatment, 97 graduated (13% dropout rate). Graduates showed a significant reduction in PTSD, psychiatric symptoms, and posttraumatic negative cognitions (up to 60% had reliable clinical change at the 95% confidence interval), and significant increases in self-esteem, optimism, and satisfaction with life with large to moderate effect sizes.
STUDY 2: Long-Term Outcome Study
The next outcome study examined graduates of the original Renew program from baseline to 1 year from baseline. Preliminary data was also presented at the International Society of Traumatic Stress Studies conference. Participants of the Renew program were recruited for interviews at Baseline (before treatment), 3 months (after treatment) and 6, 9, and 12-months post-treatment for a total of 5 interviews. Participants also completed urine toxicology screens at each visit and were paid $15 per interview. Forty-one participants enrolled in the study, 37 completed the Renew program, 30 completed the study. Of those who completed the Renew program, 81% completed the full 12-month follow-up study. All factors showed significant repeated measures ANOVA over time. Consistent with the first outcome study (Katz, et al, 2014), from pre to post treatment, participants had significant decreases in negative symptoms and significant increases in positive factors of self-esteem, and quality of life. These changes were stable and consistent from post-treatment (3 months from baseline) to nine months later (12 months from baseline) with all means trending in the direction of continued improvement with Quality of life showing the strongest trend for continued improvement (Katz, Cojucar, Hoff, Lindl, Huffman, & Drew, 2015).
STUDY 3: Improved Attachment Style in women Veterans who graduated Renew
Sixty-two women Veterans who graduated the original Renew program completed the Relationship Scale Questionnaire (RSQ: Griffin & Bartholomew‚ 1994) and the Brief Symptom Inventory (BSI: Derogatis, 2000) before and after treatment. Attachment style is considered a stable trait and not easily changed which may be why there are so few studies examining change in attachment and currently none examining women Veterans. However, Renew proposes that the treatment addresses participant’s underlying attachment style. Attachment is the basis for forming relationships with others and the basis for internal working models of feeling secure in the world. Thus, this study examined if the intervention indeed improves that which it proposes. Findings revealed that graduates reported significant decreases in fearful and dismissive insecure attachment, and significant increases in secure attachment. As hypothesized, secure attachment was negatively associated with symptoms of anxiety and depression, while insecure-fearful attachment was positively associated with these factors. Findings lend support to an upward spiral hypothesis associated with long-term positive outcomes found in previous research on Renew (Katz, Park, Cogucar, Huffman, & Douglas, in press).
STUDY 4: Efficacy of Warrior Renew group therapy for women veterans with military sexual trauma treated at a VA
This is an evaluation of the Warrior Renew treatment protocol delivered in an outpatient therapy group for survivors of military sexual trauma (MST) at a Department of Veterans Affairs medical center. The group met twice a week covering 12-weekly topics: 1) defining military sexual trauma, 2) coping with feelings, 3) sleep and nightmares, 4) triggers and anxiety, 5) anger and resentments, 6) remembering trauma, 7) relationship patterns, 8) self-blame and shame, 9) losses and grief, 10) healthy intimate relationships, 11) communication skills, and 12) meaning, purpose and joy. This evaluation was conducted as part of routine clinical care in a naturalistic setting. Forty women veterans enrolled in the treatment, 38 started and 29 completed the program (24% dropout rate). Of the 29 graduates, 27 opted to complete pre- and post-treatment assessments. Findings revealed significant decreases in symptoms of anxiety, depression, posttraumatic negative thinking, and PTSD. Analyses revealed large effect sizes as measured by Cohen’s d, where Cohen (1998) gives approximate cutoffs defining “large” as d = .80. The average effect size for these results was 1.08, with a range of .83-1.25. In addition, 78% of the sample had a reliable clinical change at the 95% confidence interval. Results suggest Warrior Renew is an effective outpatient group therapy to address the unique issues related to MST (Katz, in review).
The workbook can be utilized and structured in several different ways according to the needs of your site. Here are a few program options: 1) a 12-week Comprehensive program, 2) a 6-week Intensive program, 3) a 14-week Outpatient program, 4) two 7-week accelerated programs: a 7-week MST Symptoms group and a 7-week MST Relationships group, and 5) a week-long intensive workshop (run by Dr. Katz). Suggested schedules and classes are available in the Facilitator's Handbook.
Residential Treatment-- Daily programming:
12- week Comprehensive Warrior Renew Program.
This treatment consists of classes and activities 4-hours a day, 5-days a week, with optional evening programming. This model is for those who would benefit from a longer-term treatment with additional classes in coping skills. This is ideal for programs who serve the complex needs of homeless Veterans. Nearby or on-site housing would be needed. Current programs in this category have developed community partnerships to provide supportive housing, sustenance, and case-management.
Short-term Intensive Warrior Renew Program.
This treatment consists of classes and activities 5.5-hours a day, 5 days a week, with some evening programming. This is ideal for sites with supportive housing (e.g., domiciliary, or community housing) that can serve Veterans and Active Duty service members who have commitments and would prefer a shorter intensive program or would need to return to duty.
Outpatient Treatment weekly groups:
12- week Warrior Renew OutpatientProgram.
This treatment consists of 2-hour classes twice a week or 2-hour classes once a week. In the former version all reading is conducted in the class, in the later version, participants read the chapter before coming to class for discussion and experiential exercises. Outpatient groups are ideal for outpatient commuters and could be implemented without additional costs to an organization (e.g., using existing staff and facilities). This model is ideal for clinicians who want to expand their services to address MST in their existing clinics
7-week Accelerated Warrior Renew Programs.
This treatment is similar to the outpatient group but is half of the time. The Warrior Renew MST symptoms group includes the chapters on: What is Military Sexual Trauma?; Coping with Feelings; Nightmares and Getting a Good Night’s Sleep; Triggers and anxiety; Anger and Resentment; Guilt, Self-Blame and Shame; Meaning, Purpose and Joy. The MST Relationships group includes the chapters on: What is Military Sexual Trauma?; Remembering and understanding trauma; Defining relationship patterns; Guilt, self-blame and shame; Losses and grief; Healthy intimate relationships; and Effective communication. This model is ideal for busy outpatient clinics with demands for time-limited treatment.
Custom designs are also available!
What type of facility do you have? A clinic, a retreat-center, ranch, spa, yoga center, farm, eco-lodge? What type of existing services do you have? Or what type of community partnerships are available to you? We can build a program utilizing your unique offerings. For example, let’s say you wanted to create a 1-week MST healing retreat, or you wanted a program with an emphasis on yoga, dance, art, or equine therapy, or you wanted a program addressing special needs of a certain population-- We can work with you!
The Warrior Renew program has been specifically designed to address unique aspects of Military Sexual
Trauma (MST) for male and female Veterans and Active Duty service members who have incurred MST. It is designed to address MST as well as on-going trauma, multiple discrete events, and/ or sexual trauma across the life span. It gives participants skills to manage trauma symptoms, and guides them towards resolving and accepting their past, and the inspiration to move forward in their lives in a meaningful way. In addition, it delves into interpersonal issues, where MST may have disrupted the ability to form secure relationships with others. By definition, MST is an interpersonal type of trauma, often characterized by betrayal, shame, and lack of support from others –leading to unrealistic self-blame, difficulty trusting others, and avoidance of emotional and physical intimacy.
The Warrior Renew Program
The mission of Warrior Renew is to provide a structured program that promotes healing
from Military Sexual Trauma with compassion and understanding.
The vision is that when participates graduate Warrior Renew, they will have more flexible thinking, less intense and less frequent symptoms of distress, seek and maintain healthier relationships, and ultimately be able to live and contribute to the world to their full potential.