The Aftermath of Rape

Cognitive-behavioural treatment for post-traumatic stress disorder

Debra Kaysen, PhD

Reprinted from "Trauma and Victimization" issue of Visions Journal, 2007, 3 (3), pp. 27-28

Women and men, young and old, rich and poor—sexual assault is common and cuts across gender, age, race and socioeconomic status. It is normal and usual to feel a wide variety of emotions after a rape. Survivors may feel very isolated and alone afterwards. They may feel like they can never tell anyone, like they will never heal. But in fact, reactions to rape vary widely from person to person. And many people actually recover on their own, or with the help of family, friends or their faith.

Some people, however, may develop chronic reactions that signal a need for professional help. These reactions can include feeling like they are reliving the rape, having nightmares about it, trying not to think about it or remember it, avoiding things that may make them think about it, feeling cut off from their feelings or relationships, feeling jumpy or on guard, having problems sleeping or concentrating, and feeling depressed or down.

Some survivors may have been experiencing psychological troubles before the rape, which may make recovery more difficult. Survivors may try to manage their reactions by using alcohol or drugs. Alcohol or drugs might work momentarily to improve s­ymptoms, but do not work well over time, leading to possible substance dependence on top of the other reactions.

Debra is an Assistant Professor in Psychiatry and Behavioral Sciences at the University of Washington in Seattle. Her research has focused on PTSD in female victims of interpersonal violence and, specifically, on the relationship between PTSD and alcohol problem

The cognitive-behavioural treatment option

Post-traumatic stress disorder (PTSD) is the most common diagnosis associated with rape. The good news is that there are a number of treatments that have been developed for PTSD. There are both medications and several psychotherapies (talk therapies) that researchers have found treat PTSD well.1 The focus of this article is on cognitive-behavioural therapy (CBT).

CBT has been found across a variety of research studies to effectively treat PTSD symptoms.2-3 This therapy is generally focused and short term, and includes learning new skills. It may involve practicing new skills between sessions. It will often include teaching clients and their families about how people get PTSD and how treatment is likely to help them get better.

Treatment may involve exposure.4 This can include exposure to memories of the event and exposure to safe reminders of the event. Both of these parts of treatment allow the survivor to re-experience reminders of the event in a safe place. They also allow survivors to look at their reactions and beliefs about the rape. This allows survivors to resolve strong feelings, like shame, fear, anger, guilt or disgust that are common for rape victims. The other goal for exposure treatments is to teach survivors how to cope with their reactions to the rape without getting overwhelmed or avoiding.

Therapy may also work directly on thoughts or beliefs about the rape. This has also been found to be helpful.5 Beliefs may have been shaped by the rape in a way that is either inaccurate or unhelpful. Survivors are taught skills to find these unhelpful beliefs, test them and change them if they are not working. The idea is that by changing beliefs you can change emotions and behaviours too.

Therapy might also include learning: breathing skills or biofeedback to reduce anxiety, new ways to manage or reduce anger, coping skills for future trauma reactions, and ways to communicate more effectively with people.

Both exposure-based and cognitive therapies have been found to be generally safe and effective and appear to have lasting benefits.6-8 These therapies can be conducted individually with a therapist or in a group setting. To benefit from these therapies, survivors need to be able to step forward and ask for help. And, they have to be willing to talk about the rape with the therapist. Even now, rape is a vastly under-reported crime.

Impact of alcohol and drugs on PTSD treatments

PTSD together with substance use can be a particularly difficult combination for survivors and treatment providers to address. PTSD symptoms may make it more difficult for survivors to finish substance abuse treatment and to remain clean and sober. At the same time, substance abuse may make it harder for survivors to finish PTSD treatment. Also, many therapists will not offer cognitive-behavioural therapy for PTSD to someone who is currently substance dependent, because of concerns about treatment drop-out or making someone’s substance use worse.

A number of researchers and clinicians believe that treating both the PTSD and substance dependence at the same time is the best option.9-11 Several combined CBT treatments have been created that teach people ways of coping without using alcohol or drugs and also help treat PTSD symptoms. Another option that some people choose is to have separate PTSD and substance abuse/dependence treatment providers. Both PTSD and substance use are then treated at the same time, but by experts in each treatment area.

In summary

It is not uncommon for rape survivors to give up hope that their post-rape reactions can improve. They can get better, however. Some people may need to seek additional help or resources. Treatments exist for PTSD and for substance dependence that work. CBT treatments are the ones we know the most about how well they work. The first step toward recovery may be picking up the phone.

 
About the author

Debra is an Assistant Professor in Psychiatry and Behavioral Sciences at the University of Washington in Seattle. Her research has focused on PTSD in female victims of interpersonal violence and, specifically, on the relationship between PTSD and alcohol problems.

Footnotes:
  1. Seedat, S., Stein, D.J. & Carey, P.D. (2005). Post-traumatic stress disorder in women: Epidemiological and treatment issues. CNS Drugs, 19(5), 411-427.

  2. Bradley, R., Greene, J., Russ, E. et al. (2005). A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162(2), 214-227.

  3. Foa, E.B. (2000). Psychosocial treatment of post-traumatic stress disorder. Journal of Clinical Psychiatry, 61(Suppl. 5), 43-48; discussion 49-51.

  4. Foa, E. & Rothbaum, B. (2001). Treating the trauma of rape. New York, NY: Guilford.

  5. Shipherd, J.C., Street, A.E. & Resick, P.A. (2006). Cognitive therapy for post-traumatic stress disorder. In V.M. Follette & J. Ruzek (Eds.), Cognitive-behavioral therapies for trauma (2nd ed., pp. 96-116). New York, NY: Guilford Press.

  6. Foa, E.B., Keane, T.M. & Friedman, M.J. (2000). Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies. New York, NY: Guilford

  7. Foa, E.B., Hembree, E.A., Cahill, S.P. et al. (2005). Randomized trial of prolonged exposure for post-traumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73(5), 953-964.

  8. Resick, P.A., Nishith, P., Weaver, T.L. et al. (2002). A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic post-traumatic stress disorder in female rape victims. Journal of Consulting & Clinical Psychology, 70(4), 867-879.

  9. Read, J.P., Brown, P.J. & Kahler, C.W. (2004). Substance use and post-traumatic stress disorders: Symptom interplay and effects on outcome. Addictive Behaviors, 29, 1665-1672.

  10. Ouimette, P.C., Moos, R.H. & Finney, J.W. (2003). PTSD treatment and 5-year remission among patients with substance use and post-traumatic stress disorders. Journal of Consulting & Clinical Psychology, 71(2), 410-414.

  11. Triffleman, E., Carroll, K. & Kellogg, S. (1999). Substance dependence post-traumatic stress disorder therapy: An integrated cognitive-behavioral approach. Journal of Substance Abuse Treatment, 17(1-2), 3-14

 

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