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. 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 (DRC). According to the study, this group therapy achieved more dramatic results in reducing symptoms of post-traumatic stress disorder (PTSD), depression and anxiety compared to 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,” said Judith K. Bass, PhD, MPH, lead author of the study and assistant professor with 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 DRC, where the trial was conducted, has experienced conflict for more than 20 years. A recent study showed that 40 percent of the women – 2 out of every 5 women – 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 (CPT), which consisted of 1 individual session and 11 group sessions. The psychosocial CPT providers were trained and supervised by 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 among women 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 women in the CPT condition met criteria for probable PTSD, depression or anxiety compared to 42 percent of women in the individual-support condition.

“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.” said Bass.

“Controlled Trial of Psychotherapy for Congolese Survivors of Sexual Violence” was written by Judith K. Bass, PhD, MPH; Jeannie Annan, PhD; Sarah McIvor Murray, MSPH; Debra Kaysen, PhD; Shelly Griffiths, MSW; Talita Cetinoglu, MD; Karin Wachter, MEd; Laura K. Murray, PhD; and Paul A. Bolton, MBBS.

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

Johns Hopkins Bloomberg School of Public Health media contact: Tim Parsons at 410-955-7619 or tmparson@jhsph.edu.