Treating sexual violence in war-torn countries

In conflict-ridden countries around the world, rape and other forms of sexual violence are being used as weapons of war, and in these settings, treatment services for victims are limited. A trial led by researchers at the Johns Hopkins Bloomberg School of Public Health examined an evidence-based group psychotherapy treatment for sexual violence survivors in the Democratic Republic of the Congo. According to the study, this group therapy achieved more dramatic results in reducing symptoms of post-traumatic stress disorder, depression, and anxiety than did individual support services. The results are published in the June 6 edition of the New England Journal of Medicine.

"Survivors of sexual violence have high rates of depression, anxiety, and post-traumatic stress symptoms," says Judith K. Bass, lead author of the study and an assistant professor in the Bloomberg School's Department of Mental Health. "We know what works for treating these victims in developed countries, but very little has been done to determine what treatments can help women in war-torn, resource-poor settings."

Eastern Democratic Republic of the Congo, where the trial was conducted, has experienced conflict for more than 20 years. A recent study showed that 40 percent of the women—two out of every five—had experienced rape.

For the Johns Hopkins trial, researchers worked with the International Rescue Committee and local psychosocial workers to provide sexual violence survivors with either individual support or cognitive processing therapy, or CPT, which consisted of one individual session and 11 group sessions. The psychosocial CPT providers were trained and supervised by study collaborators at the University of Washington. Treatment was randomly assigned across 16 villages. All participants were screened for symptoms of PTSD, depression, and anxiety.

While the researchers observed reduced symptoms of PTSD, depression, and anxiety in both the individual-support and CPT participants, the results were significantly more dramatic among CPT participants. Six months after treatment, only 9 percent of the women who had received the CPT treatment met criteria for probable PTSD, depression, or anxiety compared to 42 percent of women who had received individual support.

"We saw women who had once felt too stigmatized to be a part of their community re-engage after receiving CPT, and they expressed that they felt they could again be productive members of their families and communities," Bass says.

Funding for the research was provided by the U.S. Agency of International Development's Victims of Torture Fund and the World Bank.