Recovery Stages after Sexual Assault

Research has indicated that seeking support and discussing the trauma with others can be a therapeutic measure for victims of sexual assault ( Ullman). In a group setting, individuals are able to connect with others that have experienced the same trauma and hear different. Studies examining CPT in group settings for assault-related trauma have found it to be effective. A study conducted found that the use of CPT lead to significant reductions in the symptoms of chronic PTSD and depression in a group setting. Specifically, they discovered that when used for 12 sessions, none of the 19 participants met the full criteria for PTSD while only five women were found to have symptoms of major depression. also noted, that the participants of this study maintained these improvements for 6 months post-treatment. This is significant as it indicates the effectiveness of CPT as a treatment intervention for symptoms associated with chronic PTSD. However, it also highlights that although CPT can reduce depressive symptoms it may not work for all victims with major depression. As such, counselors should be aware of its implementation when treating sexual assault victims.

Prolonged exposure is an effective form of cognitive-behavioral therapy used to help sexual assault victims confront their traumatic memories and the fear associated with it. In particular, it attempts to decrease the anxiety of the event so that the victim can reconstruct the memory’s meaning (Vickerman & Margolin, 2009). In its essence, Prolonged exposure has the victim repeatedly recount details of the trauma so that it no longer has the same emotional distress attached to it. Through multiple imaginal and in vivo exposures, the victim’s emergencies themselves in the memory and describe it out loud as though they were presently experiencing it (Vickerman & Margolin, 2009). Although it can initially be stress-inducing for victims, this treatment can address the trauma-related triggers and emotional associations of their assault.

When implementing Prolonged exposure therapy a counselor begins with psychoeducation, breathing training, and creating an avoidance hierarchy for the use of vivo exposure (Vickerman & Margolin, 2009). This allows the client to understand what the process will look like and what they should expect emotionally as the therapy progresses. This treatment may lead to resistance as victims of sexual assault are likely to engage in avoidance behaviors related to their trauma. As such, Leiner et al. (2012) conducted a study examining the impact of avoidant coping on the efficacy of PTSD treatment and found that Prolonged Exposure as well as EMDR lead to a significant reduction of this coping style in victims with severe symptoms. In particular Leiner et al. (2012), examined avoidant coping in regards to hyperarousal, emotional numbing, and reexperience of traumatic events. These styles are consistent with how a sexual assault victim may react in order to minimize the distress of the event. Notably, Leiner et al. (2012), also found that PE and EMDR interventions were not efficient in sexual assault participants with low levels of avoidant coping.

Sexual Assault Victims May Present With Other

A randomized controlled study conducted by Markowitz et. al, (2015), examined the efficacy of prolonged exposure therapy as well as interpersonal therapy for treating PTSD with major depressive disorder comorbidity. Markowitz et. al,() findings indicated that although PE was effective in treating PSTD and took effect more rapidly in these participants, it also lead to higher rates of dropout with depressed participants in comparison to interpersonal therapy. This finding is important as sexual assault victims may present with depression as well as symptoms of PTSD and need an intervention that works for all aspects of their experience. These two studies presented empirical support regarding the effectiveness of using PE while also noting its limitations such as high dropout rates, use for only intact memories of trauma, and its use for treating PTSD with major depressive comorbidity. PE research has highlighted the need for more studies regarding coping styles and improvement in treatment.

Another treatment used when working with sexual assault victims is Eye Movement Desensitization and Reprocessing therapy. According to Shaoirpo (2001), this intervention entails eight phases and can occur over a few months. Throughout EMDR, the client confronts their emotional distress regarding the memory of a traumatic event by focusing on an external stimuli and through the use of cognitive interweaves (Rothbaum, Astin, & Marsteller, 2005). As such, this intervention assists the victim in reprocessing the experience while combating the negative cognitions associated with it. The primary goal of this intervention is to desensitize the traumatic memory and cause adaptive cognitive modifications (Rothbaum, Astin, & Marsteller, 2005).

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This is particularly relevant when discussing the development as well as treatment of PTSD. A study conducted by Rothbaum (2005), found that 75% of sexual assault victims that were treated with EMDR no longer exhibited symptoms of PTSD. This study compared the use of EMDR against prolonged exposure therapy and noted that the EMDR participants were less likely to drop out of the intervention than those in PE. This finding is important as it indicates EMDR’s ability to reduce symptoms as well as keep the client engaged in treatment. However, research in comparing EMDR to PE has found mixed results (Rothbaum, Astin, & Marsteller, 2005).

Similarly, a study conducted by Marcus, Marquis, and Sakai (2004), discovered that after treatment 100% of their single trauma participants and 77% of multiple trauma participants had no presentation of PTSD symptoms such as anxiety or depression. This study also noted, that after 6.5 sessions of 50 minutes, their participants were able to maintain the results for 6 months and it lead to further improvement. This is significant for a counselor as it can be used as an invention when under time constraints and still garner success. These studies demonstrate the effectiveness of EMDR as an intervention for PTSD and how it is incorporated to treat symptoms associated with sexual assault but also question the eye movement component. Although there is empirical research indicating that it is a successful intervention against PTSD, more research is needed in clinical settings and with larger groups of participants. 

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