African women living in a war zone who have post-traumatic stress disorder from enduring or witnessing sexual violence are more apt to overcome it with group therapy than with private counseling, researchers report in the June 6 New England Journal of Medicine.
The approach, called cognitive processing therapy, encourages people with PTSD to reassess how they think about an event. Victims of sexual violence often place blame on themselves. “They might think, ‘It was my fault,’ or ‘I should have prevented this,’” says Boston University psychologist Patricia Resick.
Cognitive processing therapy provides step-by-step mental techniques to identify such maladaptive thoughts or beliefs, says study coauthor Judith Bass, a psychiatric epidemiologist at Johns Hopkins University in Baltimore. Then, she says, the women “can move forward.”
To test the strategy in groups against individual support therapy by lay counselors, researchers enlisted 405 women in 15 villages in eastern Democratic Republic of Congo, a rural area that has been beset by warfare for nearly two decades. Armed militias and government soldiers continue to roam the region, often attacking civilians. Nearly all the women in the study had been raped.
Psychological assessments of the women showed that most of them had PTSD along with depression or anxiety. Many were also functionally impaired — unable to perform routine tasks. The researchers assigned 248 women in eight villages to get individual support counseling as needed, a standard crisis response; 157 women in the other seven villages were put in groups of six to eight and got up to 12 sessions of cognitive processing therapy.
After four months, the proportion of women with probable PTSD dropped from 60 percent to 8 percent in the cognitive processing therapy group; the proportion of those with depression or anxiety plummeted from 71 to 10 percent. Their functional impairment scores dropped by half. In the women who received individual support counseling, rates of probable PTSD, depression or anxiety declined less, from 83 percent to about 54 percent.
Resick, who devised the 12-session cognitive processing strategy, has used it to treat PTSD in rape victims, battered women and combat veterans. She says testing the therapy in war-torn Congo is a real accomplishment, in part since many of the women were illiterate. The therapeutic strategy normally involves giving clients notebooks to record and recognize problem thoughts and to write down coping techniques. “I was very impressed, actually amazed,” she says, “that they were able to pull off a randomized, controlled trial under those kinds of circumstances.”
The approach should translate to other war-weary areas, Bass says. “We’ve shown we can do it in low-literacy, conflict areas. These are the hardest parts of the world.”
J. Bass et al. Controlled trial of psychotherapy for Congolese survivors of sexual violence. New England Journal of Medicine. Volume 368, June 6, 2013, p. 2182. doi: 10.1056/NEJMoa1211853. [Go to]
A. Arieff. Sexual violence in African conflicts: CRS report for Congress prepared for members and committees of Congress. Nov. 30, 2010. [Go to]
Sexual violence in conflict: Report of the Secretary-General. United Nations, March 14, 2013. [Go to]
C. Watts, M. Hossain and C. Zimmerman. War and sexual violence – mental health care for survivors. New England Journal of Medicine. Volume 368, June 6, 2013, p. 2152. doi: 10.1056/NEJMp1304712. [Go to]
K. Johnson et al. Association of sexual violence and human right violations with physical and mental health in territories of the eastern Democratic Republic of the Congo. JAMA, Volume 304, Aug. 4, 2012, p. 553. [Go to]
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