June 5, 2013
Congolese rape survivors helped by cognitive processing therapy
Survivors of sexual violence have long gone without treatment and suffered debilitating symptoms of depression, anxiety and post-traumatic stress disorder.
But a randomized controlled study of 405 rape survivors in eastern Democratic Republic of Congo proves that short-term therapy delivered by paraprofessionals is effective at reducing mental health symptoms, according to a study released June 6 in the New England Journal of Medicine.
The study, “Controlled Trial of Psychotherapy for Congolese Survivors of Sexual Violence,” provided 154 women with cognitive processing therapy (one individual session and 11 group sessions) and 248 women with individual supportive counseling. The therapy was conducted between April and July in 2011 by Johns Hopkins University and University of Washington researchers working with the International Rescue Committee and local psychosocial workers.
Six months after treatment, just 9 percent of women in the therapy group met criteria for probable depression and anxiety, compared to 42 percent of women in the individual-support group, according to the study.
“We saw women, who once felt too stigmatized to be part of their community, re-engage after receiving cognitive processing therapy,” said Judith K. Bass, lead author of the study and assistant professor with the Department of Mental Health at Johns Hopkins Bloomberg School.
The great success of group therapy shows that a manual for treatment — a step-by-step guide for therapists — helped both the therapists and the survivors, said Debra Kaysen, an associate professor of psychiatry and behavioral sciences at the University of Washington, and an author on the study.
Kaysen said cognitive processing therapy was developed in the mid-1980s by Patricia Resick, the director of the Women’s Health Sciences Division of the National Center for PTSD, part of the U.S. Department of Veterans Affairs and located in Boston.
Kaysen said the therapy has been used in six randomized trials – three among veterans suffering post-traumatic stress disorder and three among civilians who have experienced sexual or physical victimization – and is now being used widely throughout the Veterans Administration and the Department of Defense to treat post-traumatic stress disorder among active-duty military.
Kaysen said while there has been a great push for this therapy to be available to veterans, there are not the same mechanisms to get the therapy to survivors of sexual violence in community settings.
“I hope this study will make this therapy more available to survivors of sexual violence globally,” Kaysen said. “There is such a huge need out there.”
While most rapes are not reported and estimates vary widely, the U.S. Department of Justice in 2006 estimated that in the United States alone one in six women and one in 33 men have experienced a rape or attempted rape. Eastern Democratic Republic of Congo, where the trial was conducted, has experienced conflict for more than 20 years. In that country rape and sexual violence rates are described as among the worst in the world. A recent study showed that 40 percent of its women – two out of every five – had experienced rape.
Kaysen said researchers now have data five to 10 years out from people receiving this therapy. Their symptoms of post-traumatic stress disorder, anxiety and depression have remained low. She said cognitive processing therapy goes after the root of symptoms. In the case of survivors of sexual violence, this form of mental health therapy deals with how the person’s outlook and sense of self was affected by the trauma in such areas as safety, trust, power, control, esteem and intimacy.
In the study in the Democratic Republic of Congo, women were chosen among villages being served by three Congolese non-governmental organizations. Qualitative studies in different languages were used to identify locally important psychosocial issues among sexual violence survivors. Abandonment and rejection by friends, concerns about providing for self and family, and fear and stigma were major issues.
The women were then evaluated for depression and anxiety by using the Hopkins Symptoms Checklist and for post-traumatic stress syndrome by using the PTSD Checklist-Civilian Version, both of which were adapted to the local culture. Women were also scored on their ability to perform important tasks of daily living. Participants were chosen for the study based on their scores.
The U.S. Agency for International Development Victims of Torture Fund and the World Bank sponsored the project.
In addition to Bass and Kaysen, the project researchers were Jeannie Annan, Sarah McIvor Murray, Shelly Griffith, Talita Cetinoghu, Karin Wachter, Laura K. Murray, and Paul Bolton.