Psychotherapy significantly reduces symptoms in female Congolese sexual-violence victims

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1. Group cognitive processing therapy and individual support resulted in significant improvement in functionality and symptoms of PTSD, depression, and anxiety. Effects were greater with group therapy, but persisted to 6 months in both groups.

2. Psychotherapy using community-based paraprofessionals was an effective intervention for victims of sexual violence, despite the low income level, continuing conflict and violence, and poor literacy in the communities treated. 

Evidence Rating Level: 2 (Good) 

Study Rundown: Group cognitive therapy was more effective at reducing symptoms of depression, anxiety and PTSD than individual support; however, both interventions improved the participant’s symptom score from baseline. Characteristics of the women in the two treatment groups differing significantly with the women assigned to the individual support group having a higher baseline symptom score.  Superior treatment effect of group therapy was maintained when the authors adjusted for baseline symptom severity. Proposed reasons for why group therapy was superior to individual support included  1) more training and supervision by mental health professionals of the group-therapy community based paraprofessionals than the individual support professionals and 2) community support provided by the other women in the treatment groups. Other studies previously indicated that psychotherapy is unlikely to be effective if trauma is ongoing.  This study importantly demonstrates that mental health interventions are effective even in low income, conflict ridden areas, and with high illiteracy rates. Moreover, despite ongoing trauma/violence that nearly all of the women experienced over the course of the intervention, symptom improvement persisted six months past the study period. In addition, the effects of therapy were produced by community based paraprofessionals, not highly trained professionals. In light of this study, community-based mental health interventions for victims of sexual violence is highly effective and should be aggressively pursued in conflict-ridden communities. 

Click to read the study in NEJM

Relevant Reading: Psychotherapy for posttraumatic stress disorder

In-Depth [non-blinded, randomized study]: This trial, conducted in 16 villages in the South and North Kivu provinces of the DRC, evaluated an adapted version of cognitive processing therapy provided by community based paraprofessionals. Female victims of sexual violence were assessed for PTSD, depression, anxiety and functional impairment by the Hopkins symptom check list for anxiety and depression and the PTSD checklist for civilians at baseline, one month and six months after therapy completion. A composite score of >55 was required for inclusion. 405 women participated in the study and were assigned in block by village to receive either group therapy (11 group, 1 individual session) or unlimited individual support (consisting of psychosocial support and economic, medical and legal referrals.) 90% of patients completed 9 sessions of group therapy; women receiving individual support went at least once, but an average of 5 times. The relative risk of meeting criteria for PTSD, depression and anxiety was significantly greater in individual support than therapy at the end of treatment and 6 months after treatment (p>0.001 for all comparisons.) 

By Jessica Mitchell and Mitalee Patil 

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