The impact of Cognitive Processing Therapy on stigma among survivors of sexual violence in eastern Democratic Republic of Congo

Results from a cluster randomized controlled trial

S. M. Murray, J. Augustinavicius, D. Kaysen, D. Rao, L. K. Murray, Karin Wachter, J. Annan, K. Falb, P. Bolton, J. K. Bass

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Sexual violence is associated with a multitude of poor physical, emotional, and social outcomes. Despite reports of stigma by sexual violence survivors, limited evidence exists on effective strategies to reduce stigma, particularly in conflict-affected settings. We sought to assess the effect of group Cognitive Processing Therapy (CPT) on stigma and the extent to which stigma might moderate the effectiveness of CPT in treating mental health problems among survivors of sexual violence in the Democratic Republic of Congo. Methods: Data were drawn from 405 adult female survivors of sexual violence reporting mental distress and poor functioning in North and South Kivu. Women were recruited through organizations providing psychosocial support and then cluster randomized to group CPT or individual support. Women were assessed at baseline, the end of treatment, and again six months later. Assessors were masked to women's treatment assignment. Linear mixed-effect regression models were used to estimate (1) the effect of CPT on feelings of perceived and internalized (felt) stigma, and (2) whether felt stigma and discrimination (enacted stigma) moderated the effects of CPT on combined depression and anxiety symptoms, posttraumatic stress, and functional impairment. Results: Participants receiving CPT experienced moderate reductions in felt stigma relative to those in individual support (Cohen's D = 0.44, p = value = 0.02) following the end of treatment, though this difference was no longer significant six-months later (Cohen's D = 0.45, p = value = 0.12). Neither felt nor enacted stigma significantly moderated the effect of CPT on mental health symptoms or functional impairment. Conclusions: Group cognitive-behavioral based therapies may be an effective stigma reduction tool for survivors of sexual violence. Experiences and perceptions of stigma did not hinder therapeutic effects of group psychotherapy on survivors' mental health. Trial registration: ClinicalTrials.gov NCT01385163.

Original languageEnglish (US)
Article number121
JournalConflict and Health
Volume12
Issue number1
DOIs
StatePublished - Feb 12 2018
Externally publishedYes

Fingerprint

Democratic Republic of the Congo
Sex Offenses
Cognitive Therapy
sexual violence
Survivors
Randomized Controlled Trials
Mental Health
mental health
Therapeutic Uses
Group Psychotherapy
psychosocial care
group therapy
Group
Emotions
Therapeutics
Anxiety
Organizations
Depression
Values
discrimination

Keywords

  • Cognitive therapy
  • Psychotherapy
  • Rape
  • Sexual violence
  • Social stigma
  • Sub-Saharan Africa

ASJC Scopus subject areas

  • Health(social science)
  • Public Health, Environmental and Occupational Health

Cite this

The impact of Cognitive Processing Therapy on stigma among survivors of sexual violence in eastern Democratic Republic of Congo : Results from a cluster randomized controlled trial. / Murray, S. M.; Augustinavicius, J.; Kaysen, D.; Rao, D.; Murray, L. K.; Wachter, Karin; Annan, J.; Falb, K.; Bolton, P.; Bass, J. K.

In: Conflict and Health, Vol. 12, No. 1, 121, 12.02.2018.

Research output: Contribution to journalArticle

Murray, S. M. ; Augustinavicius, J. ; Kaysen, D. ; Rao, D. ; Murray, L. K. ; Wachter, Karin ; Annan, J. ; Falb, K. ; Bolton, P. ; Bass, J. K. / The impact of Cognitive Processing Therapy on stigma among survivors of sexual violence in eastern Democratic Republic of Congo : Results from a cluster randomized controlled trial. In: Conflict and Health. 2018 ; Vol. 12, No. 1.
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AU - Rao, D.

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AU - Wachter, Karin

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