Support after Sexual Assault
The purpose of the paper is to explore the different treatment interventions for victims of sexual assault. Sexual violence is a pervasive issue that millions of individuals face. It is associated with changes in an individual’s cognition as well as their behavior. As such, this paper will examine how these interventions are conducted as well as the efficacy of its implementation. It will also examine its relation to societal views and the impact it has on symptomology. Through a literature review, the current state of these interventions will be noted and gaps in research will be addressed. The studies discussed in this paper relate to the most commonly used interventions such as Cognitive Behavioral therapy, Cognitive Processing therapy, Prolonged Exposure therapy, and Eye Movement Desensitization and Reprocessing therapy. The studies examined will also note how these interventions compare against one another. In particular, this study will focus on the symptoms associated with PTSD and how these interventions are able to treat it.
Treatment Interventions used for Victims of Sexual Assault
Sexual assault has been noted as one of the most prevalent traumatic triggers for psychological and physiological disorders. According to the 2018 National Intimate Partner and Sexual Violence Survey, approximately 55.2 million women and 27.6 million men in the United Stated have experienced some form of sexual violence (Smith et al., 2018). After an assault, an individual’s perception of themselves and the way they relate to others may change. Research has indicated that sexual victimization is associated with significant health issues and risky behaviors (Smith & Breiding (2011). As such, there should be empirically researched treatment options to address these symptoms. Due to societal attitudes regarding assault, a victim may internalize self-blame and face difficulties establishing relationships with others. Their sense of self and trust is affected by this trauma. Therefore, providing a safe environment is imperative in a therapeutic relationship. The following studies examine various interventions and their efficacy treating sexual assault.
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Following a sexual assault, an individual may experience adverse effects to their physical health as well as their mental health. As such, a counselor must be aware of these consequences in order to properly address them and the role they play in seeking professional help. A national survey conduct by Smith and Breiding (2011), found that sexual victimization is linked to excessive alcohol intake, lack of preventive health care, and risky sexual health behaviors. As such, these behaviors interfere with a victims daily functioning and quality life. This can affect a victim’s employment as well as stable housing. Smith and Breiding (2011) also discovered that victims of sexual assault were more likely to have health issues such as heart disease, stroke, and asthma. These poor health consequences may be associated with the development of Post-Traumatic Stress Disorder after a sexual assault. According to the American Psychiatric Association (2015), PTSD is associated with avoidance, alterations in mood, intrusion symptoms, changes to arousal and activity following a traumatic event. American Psychiatric Association (2015), also notes that these symptoms must be present for at least one month after the event and cause distress. Although not every victim presents with the same symptoms, many will experience emotional distress. Studies have shown a link between the development of PTSD, depression, and anxiety after a sexual assault (Vickerman & Margolin, 2009).
Sexual victimization can affect an individual’s social relationships as well as their self-perception. Researchers Ullman and Fillipas (2001) discovered that stigma and negative social reactions to disclosure such as being treated differently after a sexual assault are predictors of developing PTSD. Therefore, this study indicates the importance of combating social stigma at an early stage after the assault. In particular, Ullman and Fillipas (2001) noted that societal stigmas may cause a victim to internalize self-blame and lead to feelings of victimization. These societal attitudes may lead to a sense of hopelessness and invalidation. Ullman and Fillipas (2001) also found that ethnic minority women were more likely to engage in avoidance behaviors and experience self-defeating cognitions. As a result, a sexual assault victim may not disclose their victimization in fear of being viewed differently. This directly impacts their ability to rely on a support system and their treatment. In order to reduce these beliefs, the counselor may address these attitudes in a non-judgmental approach and encourage autonomy. Based on the findings of this study, it may be inferred that a supportive response from a counselor mitigates the effects of this trauma. This study is significant as it notes the role of societal attitudes and race on disclosure of trauma as a predictor of developing PTSD. As such, future research regarding this role of ethnicity and sexual assault trauma can be examined.
The implementation of Cognitive Behavioral Therapies is often used when working with sexual assault victims. According to a treatment outcome study conducted by Vickerman and Margolin (2009), cognitive behavioral therapy approaches are more effective in reducing symptoms associated with sexual assault than supportive counseling. As noted in the study, these interventions lead to quicker recovery and prevent the progression of symptoms. Through the use of cognitive behavioral therapies the counselor can target common cognitive distortions and maladaptive thoughts found in sexual assault victims. Techniques such as cognitive restructuring, coping skills training, and systematic desensitization are associated with this intervention (Vickerman & Margolin, 2009). By using these techniques the victim can identify and assess their beliefs as well as make behavioral changes. As noted by Vickerman and Margolin (2009), interventions such as Cognitive Processing therapy and Prolonged Exposure therapy have received the most empirical support for sexual assault victims. This study is significant as it gives counselors research on the most effective interventions. However, this study also noted limitations in research such as lack of data on recent victimization, comorbidities, and high dropout rates.
In order to address maladaptive thoughts as well as symptoms associated with sexual trauma, the implementation of Cognitive Processing therapy is used. CPT assists a victim in identifying and processing stuck points relating to their trauma (Vickerman & Margolin, 2009). These points prevent a victim from recovering from the traumatic event. CPT helps challenge these thoughts of self-blame through Socratic questioning and writing details about the event (Vickerman & Margolin, 2009). Therefore these writings allow the client to revisit the meaning of the traumat and readdress conflicting beliefs about what occurred. In particular, the goal of this intervention is to decrease avoidance and intrusive cognitions associated with trauma (Vickerman & Margolin, 2009). This allows the victim to regain control over the event and work towards a healthier functioning. A controlled trial study by Resick, Nishith, Weaver, Astin, and Feuer (2002), found that CPT and PE were effective in treating chronic PTSD as well as depressive symptoms. More specifically, by the end of the study 19.5 % participants of CPT and 17.5% of PE participants had PTSD symptoms. This is significant as it illustrates CPT’s ability to reduce symptomology found in sexual assault victims in comparison to another established treatment. Notably Resick et al. (2002) also revealed that CPT has greater success in reducing guilt cognitions than the use of PE. In particular, Resick et al. (2002) found that CPT showed less hindsight bias as well as lack of justification in its participants. Based on these findings, this intervention can be used to the address thoughts regarding self-blame and guilt commonly found in sexual assault victims.
Research has indicated that seeking support and discussing the trauma with others can be a therapeutic measure for victims of sexual assault (Ullman & Filipas, 2001). In a group setting, individuals are able to openly connect with others that have experienced similar trauma. In particular, they are able to receive social support and learn various skills from their peers. Studies examining CPT in group settings for assault related trauma have found it to be effective. A study conducted by Resick and Schnicke (1992), 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. Resick and Schnicke (1992) 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 victim with comorbidities. The findings of this study also indicate the necessity for counselors to be trained in how to address chronic symptomology.
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 immerses themselves in the memory and describes 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 pyschoeducation, 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. Leiner, Kearns, M. C., Jackson, Astin, and Rothbaum (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 led to a significant reduction of this coping style in victims with severe symptoms. These findings are significant as it compares two established treatment modalities on coping and notes it success. Leiner et al. (2012), examined avoidant coping in regards to hyper arousal, emotional numbing, and re-experience 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 comorbidities as such there should be research that addresses its treatment. 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 a major depressive disorder comorbidity. Markowitz et. al.,(2015) 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 depression. 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 Shapiro and Maxfield (2002), 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 stimulus 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 et al., 2005). This is particularly relevant when discussing the development as well as treatment of PTSD. A study conducted by Rothbaum et al. (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 et al., 2005). 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 as it can be used as an intervention when under time constraints and still garners 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.
This review notes the current state of research regarding sexual assault and its treatments. In particular, it discusses the effectiveness of different treatment approaches to symptoms of sexual assault such as PTSD and anxiety. Various empirical studies were examined and the results were documented in this study. These interventions included Cognitive Behavioral Therapy, Cognitive Processing Therapy, Prolonged Exposure, and Eye Movement Desensitization and Reprocessing therapy. The findings of this study noted that Cognitive-behavioral therapies were the most effective to address sexual assault and the progression of PTSD. In particular, CP was found to be the most effective in addressing the negative cognitions of the assault as well as restructuring beliefs of the trauma. Throughout this review, gaps in the research were noted. There were few studies regarding a sexual assault with large samples and only a few treatment sessions were examined. Many of the studies noted high dropout rates for these interventions as well as lack of significant data on comorbidities. They also noted a lack of data regarding counseling against the effects of sexual assault on ethnicity, men, and adults.