Processing Therapy for Sexual Assault Victims|
Priscilla Schulz, LCSW
from an article of the same title by:
Patricia A. Resick and Monica K. Schnicke, University of Missouri-St.
Journal of Consulting and Clinical Psychology,
V. 60 (5), 748-756, 1992
Why is this article important to providers serving sexual assault survivors?
Cognitive Processing Therapy (CPT) is a treatment specifically designed
to address posttraumatic stress disorder (PTSD) in sexual assault survivors.
This article describes the theoretical basis behind a cognitive processing
approach, and presents data from a preliminary outcome study. Certain aspects
of PTSD are common among rape survivors. CPT
is designed to treat these specific aspects of PTSD.
The study presented looks at the effectiveness of CPT when used in
a group format with rape survivors suffering with chronic PTSD.
What is the origin of cognitive processing therapy for sexual assault
Cognitive Processing Therapy (CPT) combines information processing theory
and knowledge gleaned from prolonged exposure treatments that have been
effective in alleviating PTSD in survivors of other traumas. In particular,
CPT draws upon an information processing theory of PTSD that proposes that
information about a traumatic event is stored in the brain in "fear networks."
These networks consist of memories of traumatic stimuli and responses along
with their meanings. The entire network is designed to stimulate avoidance
behavior in the trauma survivor to prevent future threat to survival. Unfortunately,
as researchers have discovered, these "fear networks" seem to be responsible
for a set of beliefs or expectations (schemata) of trauma survivors that
causes them to have an attentional bias toward evidence of threat, ambiguous
or otherwise, and to disregard evidence to the contrary. Such attention
to cues of threat serves to trigger typical fear responses of escape and
avoidance, and seems to account for the re-experiencing phenomena of PTSD.
How rape survivors interpret the trauma (the meaning or cognitive appraisal
of the event) effects subsequent reactions to the experience. Studies have
found that rape survivors who experience conflict between their prior beliefs
and the rape experience are more likely to have more severe reactions to
the rape and to have more difficulty recovering. Examples of schema conflicts
are "Rape doesn't happen to nice women", a prior belief that the situation
in which an assault occurred had been safe, or that the victim was somehow
particularly invulnerable to crime. As a result of such schema conflicts,
feelings of shame, guilt, humiliation, anger, betrayal, anxiety and especially
confusion are commonly seen in sexual assault survivors with PTSD.
Information processing theory explains that in an attempt to resolve schema
conflicts caused by a traumatic event such as a rape, survivors respond
How does Cognitive Processing Therapy address the treatment needs
of sexual assault survivors with PTSD?
- Assimilating the new, albeit horrific, information into their existing
belief system by altering the event (e.g., "Maybe it wasn't a rape"
or "I must have done something bad that brought this on, because good
people don't get raped"), or
- Accommodating their prior beliefs to the traumatic experience. The
statement "Sometimes bad things happen to good people" exemplifies
a healthy accommodation. Oftentimes rape survivors in situations without
good social support or guidance make accommodations that are maladaptive
and extreme, such as "No one can be trusted" or "I can never be safe".
Cognitive Processing Therapy consists of three components:
Cognitive Processing Therapy for sexual assault survivors consists of 12
weekly group sessions of 1.5 hours in duration each. In the latter sessions,
CPT explores and helps survivors modify "stuck points" in the five major
areas of functioning that are usually affected by victimization: safety,
trust, power and control, esteem, and intimacy. What is the purpose of this
Education about PTSD symptoms and
information processing theory Exposure to the traumatic experience
by directing clients to write about and read their accounts of the
event. This exercise elicits the feared memories of sexual assault
survivors and encourages processing of emotions. Ultimately it enables
survivors' fears to habituate, similar to how other exposure therapies
Cognitive therapy which addresses
rape survivors' intense feelings of anger, betrayal, disgust, shame,
guilt, humiliation, anxiety and confusion by identifying and modifying
schema conflicts ("stuck points"). Whereas CPT believes that many
of the problems of rape survivors result from schema conflicts,
at times therapy reveals previously existing distorted or dysfunctional
thinking patterns and ways of coping with emotions which are activated
by the assault. In such cases CPT addresses these problems by teaching
clients how to recognize and challenge faulty thinking patterns
and how to cope with distressing emotions. These methods of CPT
are similar to the established Beckian method of cognitive therapy
The purpose of the study presented in this article is twofold:
Note: Of the 19 study participants who
completed the study, 16 had received treatment for symptoms of PTSD and
depression at some time before the study, but all participants had PTSD
at the time they entered the study. True random assignment of subjects to
either the treatment or control groups was not achieved, so the investigators
present the study as "quasi-experimental". What are the study's findings?
- To examine the effectiveness of CPT in a group format in the treatment
of chronic, rape-induced PTSD.
- To examine the effectiveness of CPT in also reducing symptoms of
depression among study participants.
Group Cognitive Processing Therapy was effective in reducing symptoms of
resulted in significant improvements in both PTSD and depression among
participants reported substantial improvements in the quality of their
lives as a result of participating in the treatment.
- When treatment ended, none of the study participants met full
criteria for PTSD and this was maintained at the 6-month follow-up
- At the end of treatment 42% (5 subjects) met criteria for depression
compared to 99% at pretreatment, but by the six-month follow-up,
only 1 study participant still met criteria for depression.
Reviewed by Priscilla Schulz, September 1999