By Monica Purmalek
One in six women and one in 33 men in the U.S. has been raped or been the victim of attempted rape.1 After being sexually assaulted, it can be difficult to know where to turn for help. It is just as important to get help for the emotional impact of sexual assault as it is to receive care for physical wounds. Even if they think they are coping well, survivors of sexual assault often experience self-blame, lowered self-esteem, panic attacks, eating disorders, difficulty sleeping and concentrating, and problems with work and social interactions. The National Women’s Study found that 30% of rape survivors suffer from depression.2 Rape survivors are also at an increased risk for suicide and drug abuse.2 Post-traumatic stress disorder (PTSD), anxiety, and fear are common among rape survivors.2 Interestingly, therapies that were designed to help soldiers with PTSD are now being used to help victims of sexual assault.
Several studies suggest that group therapy is more effective at reducing PTSD, anxiety, and depression than individual therapy for both war veterans and rape survivors.3 A study done at a Veteran’s PTSD Rehab Program showed that almost 60% of veterans experienced either improvement or recovery in PTSD symptoms after receiving a form of group therapy called Cognitive Processing Therapy or CPT.4 Only 40% of veterans receiving a general form of group therapy showed either improvement or recovery in PTSD symptoms.4 A study done in the Democratic Republic of Congo, where rape was used as a weapon of war, showed that after six months of therapy, only 9% of survivors receiving group CPT still met the criteria for depression or anxiety while 42% of survivors receiving individual therapy still had depression or anxiety.5 Other kinds of therapy can be provided in a group setting, but Cognitive Processing Therapy is one of the few with clinical data and has been shown to be effective.
What is Cognitive Processing Therapy?
Victims of rape sometimes avoid thinking about what happened to them as a way of coping with the trauma, but avoiding painful memories can interfere with recovery. Cognitive Processing Therapy (CPT) helps victims identify their “stuck points,” the parts of their rape story that are the most difficult to revisit and overcome. In CPT, survivors are encouraged to write about the traumatic event and then read their writings as a way to process what has happened to them. Like other types of cognitive therapy, the therapist helps the survivor think about the rape in a constructive way that will enable them to cope with it. For example, the therapist helps the survivor decrease self-blame and increase acceptance of the rape while reinforcing that it was not their fault.6 CPT can be provided as either group therapy or individual therapy.
A study by researchers in Boston found that only 22% of CPT individual therapy patients still had PTSD 5 to 10 years after their rape, which suggests that this type of therapy has lasting effects.7 PTSD symptoms can last for years 8 and it does not seem to usually go away on its own,9 although there is limited information about the longevity of PTSD among rape victims.
What are Other Options?
Though it has been proven more effective than individual therapy on average, group therapy may not be the best choice for everyone. Other forms of therapy available to rape survivors include one-on-one sessions with a therapist (psychotherapy) and medication (pharmacotherapy). The most popular forms of individual therapy for rape victims include Stress Inoculation Training (SIT), Prolonged Exposure Therapy (PE), and Eye Movement Desensitization and Reprocessing (EMDR). These individual therapies have shown improvements for some, but the outcomes differ for every survivor. Often, a survivor will try a few therapies before he or she finds the one that best fits his or her needs.
Stress Inoculation Training
Stress inoculation training (SIT) helps a person gain confidence in his or her ability to cope with anxiety and fear due to trauma. Whether used with rape survivors or others, SIT incorporates three primary treatment elements: (1) psychoeducation to help victims understand and normalize their fear, (2) repeated exposure to situations or places that trigger fear and anxiety (for example, to help survivors overcome rape-related phobias like fear of darkness), and (3) self-calming and coping skills like muscle relaxation and deep breathing to manage anxiety.2 SIT may help with depression, fear, anxiety, PTSD, hostility, mood, assertiveness, and self-esteem.
Prolonged Exposure Therapy
In Prolonged Exposure Therapy (PE), rape survivors reconstruct and organize their rape story as a way to better understand it and decrease anxiety. Survivors are asked to relive the rape scene and describe it aloud as they are imagining it, using present tense and vivid details. The survivor’s retelling of their rape is recorded and they are asked to listen to their own retelling at home for further exposure. Repeated exposure to the rape story is thought to desensitize the survivor and help them accept the event so they can move on. This is similar to some of the therapies used with patients who have irrational fears and phobias. These patients are exposed to the things they fear (such as heights, flying, spiders, etc.), either in their imagination or in reality, so that they will learn to accept that the fear won’t overwhelm them. PE may improve symptoms of PTSD and depression, and help relieve guilt, anxiety, and rape-related fears.2
The same study in Boston that was cited previously regarding CPT found that only 18% of PE individual therapy patients still had PTSD 5 to 10 years after their rape, suggesting that this therapy also has lasting effects.7 As previously noted, PTSD symptoms often last for years and do not go away on their own, so it is important to find effective treatment sooner rather than later.8 A study in Philadelphia found that PE was more effective than SIT, but both of these therapies reduced the severity of PTSD and depression compared to survivors on a waiting list who were receiving no treatment.10
Eye Movement Desensitization and Reprocessing
Eye Movement Desensitization and Reprocessing (EMDR) is a nontraditional and relatively new form of psychotherapy used to treat PTSD. During an EMDR session, the therapist asks the survivor to mentally focus on a particularly upsetting image while the therapist moves his or her fingers in front of the survivor’s face. This is done to stimulate rapid back and forth movement of the eyes, like when watching a fast paced tennis match. Later, when this traumatic thought returns, it is supposedly not as disturbing as before.11 Studies suggest that EMDR is an effective therapy for rape survivors, but it is unclear whether the eye movement component is necessary or if just recalling the rape and becoming less sensitive to the memories of it is beneficial on its own.12 A study in France of survivors of domestic violence who underwent EMDR found significant improvements in PTSD, depression, and anxiety after treatment compared to a control group that was not treated.13
Antidepressants and atypical antipsychotic medications (such as Abilify, Seroquel, Zyprexa, and Risperdal) are often prescribed to soldiers and survivors of sexual assault in an effort to help them cope with PTSD, depression, insomnia, and anxiety. However, there is little scientific evidence to show that these medications are effective, and they have substantial risks. In fact, the numbing impact of the medication could be seen as having the opposite effect as the therapies listed above, which are considered effective. Because of the lack of evidence that they work for survivors of sexual assault, and the known safety risks, other therapies should be tried before medications.
The road to recovery from rape and sexual assault is not a simple one. The mental and social effects of trauma can stay with a survivor for years, and a specific therapy may not work for everyone. Luckily, there are several types of effective therapy.
Group therapy is beneficial because it allows the survivor to learn from the experiences of other group members. Cognitive Processing Therapy (CPT) can be provided in a group setting and has been successful even among women where rape has been used as a tool of war, as in the Democratic Republic of Congo.
For help finding mental health counseling or therapy in your area, visit the National Institute of Mental Health’s website. For information provided by the National Institute of Mental Health regarding PTSD, click here. Also, visit the Rape, Abuse, and Incest National Network’s website to find group counseling in your area, or information on helping a loved one who has been raped.
- United States. US Department of Justice. Bureau of Justice Statistics. Sex Offenses and Offenders. Office of Justice Programs. Accessed 11 July 2013 <http://www.bjs.gov/content/pub/pdf/SOO.PDF> ▲
- Rape Treatment Outcome Research: Empirical Findings and State of the Literature Katrina A. Vickerman, M. A.a and Gayla Margolin, Ph.D.a Clin Psychol Rev. 2009 Jul;29(5):431-48. Epub 2009 Apr 17. ▲
- Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. Monson CM, Schnurr PP, Resick PA, Friedman MJ, Young-Xu Y, Stevens SP. J Consult Clin Psychol. 2006 Oct;74(5):898-907. ▲
- The comparative effectiveness of cognitive processing therapy for male veterans treated in a VHA posttraumatic stress disorder residential rehabilitation program. Alvarez J, McLean C, Harris AH, Rosen CS, Ruzek JI, Kimerling R. J Consult Clin Psychol. 2011 Oct;79(5):590-9. ▲
- Controlled trial of psychotherapy for Congolese survivors of sexual violence. Bass JK, Annan J, McIvor Murray S, Kaysen D, Griffiths S, Cetinoglu T, Wachter K, Murray LK, Bolton PA. N Engl J Med. 2013 Jun 6;368(23):2182-91. ▲
- A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Resick PA, Nishith P, Weaver TL, Astin MC, Feuer CA. J Consult Clin Psychol. 2002 Aug;70(4):867-79. ▲
- Long-term outcomes of cognitive-behavioral treatments for posttraumatic stress disorder among female rape survivors. Resick PA, Williams LF, Suvak MK, Monson CM, Gradus JL. J Consult Clin Psychol. 2012 Apr 80(2):201-10. ▲
- Post-Traumatic Stress Disorder (PTSD). NIMH. N.p., n.d. Web. 30 July 2013. <http://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-ptsd/index.shtml>. ▲
- Five Years Later: Recovery from Post Traumatic Stress and Psychological Distress among Low-income Mothers Affected by Hurricane Katrina. Paxon, Christina, Elizabeth Fussell, Jean Rhodes, and Mary Waters. Social Science & Medicine 74 (2012): 150-57. ▲
- A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. Foa EB, Dancu CV, Hembree EA, Jaycox LH, Meadows EA, Street GP. J Consult Clin Psychol. 1999 Apr;67(2):194-200. ▲
- EMDR – 20/20 Report. 20/20. N.d. YouTube. 27 Jan. 2012. Web. 11 July 2013. <http://www.youtube.com/watch?v=GTLLfdcJE0Q>. ▲
- What Is EMDR? EMDR International Association. Web. 09 July 2013. <http://www.emdria.org/>. ▲
- Eye Movement Desensitization and Reprocessing (EMDR) Therapy in the Victims of Domestic Violence: A Pilot Study. Tarquinio C., Brennstuhl M.J., Rydbery J.A., Schmitt A., Mouda F., Lourel M., Tarquinio P. Revue europeenne de psychologie appliquee 62 (2012) 205-212. ▲