Interventions to Reduce Distress in Adult Victims of Sexual Violence and Rape: A Systematic Review

Abstract

The Campbell systematic review aims to examine the effectiveness of psychotherapeutic interventions in reducing symptoms of distress and trauma for victims of sexual assault and rape. Six studies including 405 participants met eligibility criteria, with data from 358 participants available for analysis. Results of this systematic review provide tentative evidence that cognitive and behavioural interventions, in particular Cognitive Processing Therapy, Prolonged Exposure therapy, Stress Inoculation Therapy, and Eye Movement Desensitization and Reprocessing can be associated with decreased symptoms of Post‐Traumatic Stress Disorder (PTSD), depression and anxiety in victims of rape and sexual assault. There is a need for further well‐designed controlled studies which differentiate victims of sexual assault and rape from other traumatic events. Executive summary/Abstract BACKGROUND Beginning with the articulation of Rape Trauma Syndrome (Burgess 1974), the traumatic aftermath of sexual assault on victims has become a focus of social and legal policy, scholarly inquiry, and mental health interventions. The wide variety of psychosocial treatment modalities for victims of sexual violence reported in the literature and used in practice are predominantly based on psychodynamic, cognitive‐behavioural or feminist‐informed theoretical frameworks. Some modalities have been specifically designed for victims of sexual violence while others have been adapted from use with other traumatized populations. Although there is evidence of effective treatments for addressing traumatic stress in victims of many types of trauma, modalities specific to victims of sexual assault have not been systematically tested. Evidence suggests that trauma associated with rape or sexual assault differs from trauma stemming from other experiences, in part due to the strong element of self‐blame, the individualized nature of this type of trauma, social support and social acceptance factors, and the higher incidence of concurrent depression. Therefore, it is critical to examine the effectiveness of interventions specific to victims of sexual violence and rape. OBJECTIVES To examine the effectiveness of psychotherapeutic interventions in reducing symptoms of distress and trauma for victims of sexual assault and rape. SEARCH STRATEGY Both published and unpublished work was considered eligible for the review. Electronic searches were conducted in June 2009 and in April 2011 within the following databases: Cochrane Central Register of Controlled Trials (CENTRAL); Cochrane Database of Systematic Reviews (CDSR); MEDLINE; EMBASE; EMBASE Classic; All EBM Reviews; PsycINFO; ASSIA (Applied Social Sciences Indexes and Abstracts); ERIC; Social Sciences Abstracts; Social Services Abstracts; Social Sciences Citation Index; Criminal Justice Abstracts; Violence and Abuse Abstracts; Social Work Abstracts; Dissertation Abstracts International (DAI); CINAHL; Gender Studies Database; and Contemporary Women's Issues. Reference lists of all relevant articles were also screened and requests for additional studies made to authors and key informants. To supplement the electronic searches, seven journals relevant to the sexual assault, rape or sexual violence were hand‐searched up to April 2009: Journal of Traumatic Stress; Journal of Interpersonal Violence; Victims and Offenders; Trauma Abuse and Violence; Violence against Women; American Journal of Psychiatry; and British Journal of Psychiatry. SELECTION CRITERIA Studies were eligible for the review if (a) the allocation of study participants to experimental or control groups was by random allocation or quasi‐experimental parallel cohort design; (b) participants were adults who had experienced sexual assault or rape as adults; and (c) the intervention specifically focused on victims of sexual assault or rape. Studies with participants that identified primarily as victims of childhood sexual abuse were not included. DATA COLLECTION AND ANALYSIS Two review authors screened abstracts and read the full‐text of all eligible articles. Standardised mean differences with 95% confidence intervals were calculated for all relevant outcomes. RESULTS Six studies including 405 participants met eligibility criteria, with data from 358 participants available for analysis. Two of the studies evaluated Cognitive Processing Therapy (CPT, totalling 80 participants); three evaluated Prolonged Exposure (PE, n= 94); two evaluated Stress Inoculation Therapy (SIT, n=26); one evaluated Supportive Psychotherapy (SP, n=12) and two examined Eye Movement Desensitization Reprocessing therapy (EMDR, n=34). Meta‐analysis comparing all treatments against no treatment for the randomized controlled trials revealed significant results for PTSD symptoms, both independently observed [SMD ‐1.81 (95% CI ‐2.90 to ‐0.72, four studies)] and self‐reported [SMD ‐1.90 (95% CI ‐2.73 to ‐1.07, three studies)] at post‐treatment. Meta‐analyses of relevant outcomes from the six included studies revealed that all the treatments had a statistically significant effect on PTSD and depression symptoms in comparison to the control groups at post‐test. The four studies that included anxiety as an outcome also showed significant improvements. Other outcomes that demonstrated improvements included guilt (following CPT and to a lesser extent, PE) and dissociation (following EMDR treatment). AUTHORS' CONCLUSIONS Results of this systematic review provide tentative evidence that cognitive and behavioural interventions, in particular Cognitive Processing Therapy, Prolonged Exposure therapy, Stress Inoculation Therapy, and Eye Movement Desensitization and Reprocessing can be associated with decreased symptoms of Post‐Traumatic Stress Disorder (PTSD), depression and anxiety in victims of rape and sexual assault. There is a need for further well‐designed controlled studies which differentiate victims of sexual assault and rape from other traumatic events.