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Practice Profile

Psychotherapy with Adults Sexually Abused in Childhood

Evidence Ratings for Outcomes:

Promising - One Meta-Analysis Mental Health & Behavioral Health - Trauma/PTSD
Promising - One Meta-Analysis Mental Health & Behavioral Health - Internalizing behavior
Promising - One Meta-Analysis Mental Health & Behavioral Health - Externalizing behavior

Practice Description

Practice Goal/Target Population
Psychotherapy for adults sexually abused in childhood is intended to address the psychological consequences of child sexual abuse. These therapeutic approaches are designed to improve psychological distress, reduce maladaptive behavior, or enhance adaptive behavior through counseling, structured or unstructured interaction, or a predetermined treatment plan (Weisz et al. 1987). The practice target adults, ages 18 or older, who experienced some form of child sexual abuse (penetrative or non-penetrative) that was perpetrated by a biological caregiver, family friend, neighbor, sitter, or another familiar adult. Some or all participants meet the DSM-IV diagnostic criteria for posttraumatic stress disorder (PTSD), depression/mood disorder, or various other disorders.

The goals of psychotherapy targeting adults sexually abused as children are to 1) reduce the symptoms of PTSD, trauma, or other more specific problems (e.g., anxiety, anger, self-blame); and 2) improve physical, psychological, and social functioning (Martsolf and Draucker 2005).

Practice Components
Psychotherapeutic approaches for adults experience sexual abuse in childhood often include individual cognitive–behavioral approaches such as cognitive–behavioral therapy or insight–experiential therapy. Other relevant treatment types include prolonged exposure, stress inoculation training, supportive counseling, brief prevention programs, imagery rehearsal therapy, cognitive-processing therapy, and eye movement desensitization reprocessing.

The treatment is often conducted by trained professionals, professionals in training, and paraprofessionals. These psychotherapeutic approaches can be offered as individual, group, couple, or mixed group therapy and take place in a variety of clinical or nonclinical settings, such as a research university.

The duration of treatment, number of sessions, session length, and frequency of sessions may vary, depending on the requirements of the type of therapy offered and the needs of the participants. Such approaches may be manualized, semi-structured, or unstructured. Therapy may or may not include homework outside of the clinical setting, and the process can be dialogue-based, instructional, or self-directed.

Meta-Analysis Outcomes

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Promising - One Meta-Analysis Mental Health & Behavioral Health - Trauma/PTSD
Aggregating the results from three studies, Taylor and Harvey (2010) found an overall statistically significant weighted mean effect size of 1.04 in favor of psychotherapeutic approaches with regard to reducing trauma and posttraumatic stress disorder (PTSD). This means that psychotherapeutic approaches were associated with decreases in trauma and PTSD symptoms of treatment group adults, compared with the control group adults, more than 6 months posttreatment.
Promising - One Meta-Analysis Mental Health & Behavioral Health - Internalizing behavior
Aggregating the results from three studies, Taylor and Harvey (2010) found an overall statistically significant weighted mean effect size of 1.08 in favor of psychotherapeutic approaches with regard to internalizing symptoms. This means that the psychotherapeutic approaches were associated with decreases in internalizing symptoms (i.e., depression, anxiety, fear) for treatment group adults, compared with the control group adults.
Promising - One Meta-Analysis Mental Health & Behavioral Health - Externalizing behavior
Aggregating the results from three studies, Taylor and Harvey (2010) found an overall statistically significant weighted mean effect size of 0.40 in favor of psychotherapeutic approaches with regard to externalizing symptoms. This means that the psychotherapeutic approaches were associated with decreases in externalizing symptoms (i.e., aggressive, oppositional, and other problem behaviors) for treatment group adults, compared with the control group adults.
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Meta-Analysis Methodology

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Meta-Analysis Snapshot
 Literature Coverage DatesNumber of StudiesNumber of Study Participants
Meta-Analysis 11989 - 2008191189

Meta-Analysis 1
Taylor and Harvey (2010) conducted a meta-analysis to evaluate the impact of different types of psychotherapeutic approaches for adults who were sexually abused as children. Therapy was defined as any intervention designed to reduce psychological distress, symptoms of posttraumatic stress disorder (PTSD), and trauma through counseling, structured or unstructured interaction, training programs, or predetermined treatment plans. A comprehensive search for studies of psychotherapeutic approaches included a keyword search of online abstract and literature databases. The literature search included studies that were published in peer-reviewed journals and other studies not published in journals (such as government or private agency sources or dissertations).

Literature included in the review was published between 1989 and 2008. Only studies that met the following criteria were included: 1) the interventions in the study met the definition of therapy; 2) the study examined treatment outcomes of people who had experienced sexual assault and PTSD or rape trauma; 3) the results were based on quantitative findings; 4) the study was written in English; 5) the study was not a case report; 6) the majority of the treated sample had been sexually assaulted; 7) sufficient data were available to calculate effect sizes; and 8) studies reported independent datasets to ensure that each study was coded only once. Primary outcomes for the review were categorized as six domains. These included PTSD/trauma symptoms, internalizing symptoms, externalizing symptoms, interpersonal functioning, self-concept/esteem, and global symptoms or functioning.

Of the 59 studies identified in the literature search, 45 met the criteria for inclusion in the meta-analysis. Of these 45 studies, two meta-analyses were conducted based on study design. One meta-analysis used independent samples designs that included comparison groups (19 studies), and one meta-analysis used repeated measures designs that did not include comparison groups (26 studies). Regarding therapeutic goals, six of the studies intended to treat PTSD after child sexual abuse, and 13 studies intended to treat either psychological effects of symptoms of child sexual abuse or other more specific problems (e.g., anxiety, anger, self-blame, interpersonal problems). The CrimeSolutions.gov review focused on the outcomes reported only for the meta-analysis of the independent samples designs.

The independent samples studies comprised 25 independent studies, 16 of which were experimental designs and 9 of which were quasi-experimental designs. Random assignment to treatment groups occurred in 14 studies. There were 757 treatment group participants and 432 control group participants, the majority of whom were female. The majority of the sample population was white (60 percent), 8 percent were African American, and the race/ethnicity of the remaining samples was not identified. Most participants were between the ages of 31 and 45 years (96 percent). Most of the participants in the studies experienced sexual abuse only (84 percent), as opposed to sexual abuse in addition to other types of abuse. Because of missing data, other demographic characteristics were not reported for the entire sample. Eighteen studies were conducted in the United States, two took place in Europe, four in Canada, and one in another location. Twenty-two studies were published as journal articles, and three were book chapters.

A random effects or mixed effects model was used to calculate weighted mean effect sizes. Because studies with small sample sizes were included in the analysis, an effect size statistic (Hedge’s g) was used. Studies using independent samples and repeated measures designs were meta-analyzed separately. The treatment effects for the independent samples were represented by standardized mean difference scores.
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Cost

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There is no cost information available for this practice.
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Other Information

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Taylor and Harvey (2010) conducted additional tests (called moderator analyses), to assess whether characteristics of the samples, treatments, and methods included in the analysis impacted the mean effect sizes and thereby improved outcomes. They found that modality (group, individual, or mixed), context, and the source and type of measurement had an impact on effect sizes. Their analyses suggested that 1) individual therapies (especially cognitive–behavioral therapies) were consistently associated with larger effects than group approaches, as were interventions that included homework; and 2) information sourced from professionals during an interview (typically structured interviews for posttraumatic stress disorder) indicated stronger mean effects than those from participants using self-report measures. The authors also found that better outcomes were associated with experimental study designs, random assignment to conditions, session lengths of 91–120 minutes, and manualized approaches.
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Evidence-Base (Meta-Analyses Reviewed)

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These sources were used in the development of the practice profile:

Meta-Analysis 1
Taylor, Joanne E., and Shane T. Harvey. 2010. “A Meta-Analysis of the Effects of Psychotherapy with Adults Sexually Abused in Childhood.” Clinical Psychology Review 30(6):749–67.
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Additional References

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These sources were used in the development of the practice profile:

Ehring, Thomas, Renate Welboren, Nexhmedin Morina, Jelte M. Wicherts, Janina Freitag, and Paul M.G. Emmelkamp. 2014. “Meta-Analysis of Psychological Treatments for Posttraumatic Stress Disorder in Adult Survivors of Childhood Abuse.” Clinical Psychology Review 34:645–57.

Martsolf, Donna S., and Claire B. Draucker. 2005. “Psychotherapy Approaches for Adult Survivors of Childhood Sexual Abuse: An Integrative Review of Outcomes Research.” Issues in Mental Health Nursing 26(8):801–25.

Weisz, John R., Bahr Weiss, Mark D. Alicke, and M.L. Klotz. 1987. “Effectiveness of Psychotherapy with Children and Adolescents: A Meta-Analysis for Clinicians.” Journal of Consulting and Clinical Psychology 55(4):542–49.
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Related Programs

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Following are CrimeSolutions.gov-rated programs that are related to this practice:

Eye Movement Desensitization and Reprocessing (EMDR) for Traumatized Young Women Promising - One study
This is a therapeutic approach designed to treat individuals who are dealing with the aftermath of a traumatic life event. The goal is to help those who have experienced traumatic stress to reprocess and store traumatic memories adaptively. The program is rated Promising. Program participants reported statistically significant improvements in posttraumatic stress disorder, depression, anxiety, self-concept, avoidance, and intrusive thoughts, compared with control group participants.

Trauma Affect Regulation: Guide for Education and Therapy (TARGET) Effective - More than one study
A manualized, trauma-focused psychotherapy for adolescents and adults suffering from posttraumatic stress disorder. The program is rated Effective. There were significant reductions in measures of PTSD symptoms and anxiety for the treatment group compared to the control group.

Prolonged Exposure Therapy Effective - More than one study
A cognitive–behavioral treatment program for individuals suffering from posttraumatic stress disorder. The program is rated Effective. The program reduced the severity of PTSD and depression; anxiety; trauma-related guilt; and improved social functioning.

Cognitive-Processing Therapy for Female Victims of Sexual Assault Effective - One study
This is a cognitive therapeutic program that is intended to assist female victims of sexual assault with posttraumatic stress disorder (PTSD). The program is rated Promising. Both PTSD and depression symptoms decreased with cognitive treatment, when compared with the control group.
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Practice Snapshot

Age: 20 - 45

Gender: Both

Race/Ethnicity: Black, Other, White

Targeted Population: Victims of Crime

Settings: Inpatient/Outpatient, Other Community Setting

Practice Type: Children Exposed to Violence, Cognitive Behavioral Treatment, Group Therapy, Individual Therapy, Victim Programs

Unit of Analysis: Persons

Researcher:
Joanne E. Taylor
Associate Professor
School of Psychology, Massey University
Private Bag 11222
Palmerston North 4474
Phone: +646.951.8068
Fax: +646.350.5673
Website
Email