Group therapy works better than individual support for women in low-income
countries who have been victims of sexual violence, according to the results of
a new study done in the Democratic Republic of Congo (DRC).
The method has already been shown to be effective in wealthier countries.
Because measures of depression, anxiety, general functioning and post-traumatic
stress disorder improved faster with group therapy, the technique may be useful
in other countries were war and unrest often contribute to sexual violence,
researchers reported in the New England Journal of Medicine.
"We're giving them the skills to rethink the meaning they're giving to their
thoughts and feelings" about their attack, said lead author Judith Bass of the
Johns Hopkins Bloomberg School of Public Health in Baltimore.
The study "offers promising evidence" that a form of group therapy can help
women who have been exposed to sexual violence, Charlotte Watts and her
colleagues at the London School of Hygiene and Tropical Medicine wrote in a
How the research was done
In the DRC, 40% of women have been victims of some type of sexual violence.
The researchers evaluated 157 women in seven villages who were offered one
individual session and 11 group sessions of so-called cognitive processing
"The women were being taught to identify what thoughts are not helpful to
them," Bass explained. "Thinking 'It's my fault' is not helpful to them. And it
involves how to deal with that and get over some of these thoughts that are
keeping them from healing."Those women were compared with 248 women in eight
villages who received individual support that included counselling and
Women in both treatment groups improved even though each village had at least
one major security incident during the trial, including attacks and armed
robberies. But the improvement was most pronounced with group cognitive
On a combined scale of depression and anxiety, where the worst score was 3
and the best was 0, women in the cognitive therapy group went from 2.0 at the
outset to 0.8 at the end of treatment. Six months after treatment their average
score was 0.7.
High rates a problem
The respective scores for women receiving individual support started at 2.2,
dropped to 1.7 and eventually fell to 1.5.After six months, 9% of group therapy
participants and 42% of women who received individual support still likely had a
diagnosis of depression or anxiety, Bass and her colleagues found.
The study did not include the most severe cases - seven of the 494 women
screened for the study were found to be severely suicidal and were treated
"Despite illiteracy and ongoing conflict, this evidence-based treatment can
be appropriately implemented and effective," the researchers concluded.
"Given the high rates of sexual violence globally, and especially in
conflict-affected countries such as the DRC, this finding is very important,"
the Watts team wrote in its editorial.
"Rape during war is not unique to the DRC; indeed, it affects many, if not
most, countries that are at war, including several African states and, more
recently, countries in the Middle East."The study was funded by the World Bank
and the US Agency for International Development Victims of Torture Fund.
"We do this because we see mental health as such a large cause of disability
and dysfunction," Bass said.
"We want to improve people's health. But when you have such high rates of
rape and violence, and such a high rate of mental health problems, it's an
often-neglected piece in the bigger development picture."