An individual treatment programme for sexually abused adult males: description and preliminary findings

Growing recognition of male sexual abuse and its potentially debilitating effects has underscored the need to develop effective treatment interventions for this population. The present study describes an individual treatment programme that was developed for adult males who have experienced childhood sexual abuse. The treatment programme focused on three areas related to sexual abuse, specifically feelings of self‐blame, anger and anxiety. The study also presents preliminary findings on treatment effects, using self‐report measures that five participants completed prior to treatment and at various assessments following treatment termination. Overall findings indicated improvements in behavioural self‐blame, anger, state anxiety and trait anxiety. Treatment did not appear to have an effect on characterological self‐blame over the long term. The study's findings are limited by the reliance on self‐report data and the absence of a comparison group. As such, our findings should be viewed as an initial contribution to the currently limited empirical data on treatment effects for sexually abused adult males. Copyright © 2005 John Wiley & Sons, Ltd.     

A Survey of the First Five Years' Work of a Child Sexual Abuse Team

This paper describes a survey of the first 5 years' work of a specialist NHS child sexual abuse team (CSAT), which provides a post-disclosure treatment service to young people aged between 13 and 19. Information was obtained on the demographic characteristics of young people referred, the nature of their abuse and its perpetrators, and the type, length and outcome of the treatment provided. The survey was also used to ask four questions. Was the team providing a service to its target population, young people whose sexual abuse had been severe? Did the severity of abuse predict the intensity or length of therapy provided? Were there differences in the service provided to boys as opposed to girls? Finally, did experienced therapists achieve different results when compared with non-experienced therapists? It was found that the service was being used by its target group and that severity of abuse was associated with longer or more intensive therapy. The service did not appear to be adequately meeting the needs of boys. There was some indication that experienced therapists achieved the same treatment outcome as inexperienced therapists in a shorter period of time.     

Post-traumatic Stress Disorder in Childhood Sexual Abuse: A Synthesis and Analysis of Theoretical Models

The notion that post-traumatic stress disorder (PTSD) may be found in children who have experienced sexual abuse has become an important issue in research and clinical practice. To date however, there is a lack of consensus on what theoretical model(s), if any, best account for PTSD within this population. As a way of contributing to the existing body of literature pertaining to PTSD and its relationship to childhood sexual abuse, this paper synthesizes and presents a critical analysis of contemporary theoretical models.     

Acute stress reactions to everyday stressful life events among sexual abuse survivors with PTSD

This study examined symptoms of Acute Stress Disorder (ASD), which is often thought of as a precursor to PTSD, among 54 women who already had PTSD for childhood sexual abuse for which they were seeking treatment. We examined the prevalence of ASD symptoms as well as their relationships to trauma symptoms measured by the Trauma Symptom Checklist-40. The ASD diagnosis requires the occurrence of a traumatic life event as well as meeting specific symptoms criteria. We found that fourty-four percent of participants met all symptom criteria for ASD, but only three of these 24 participants described a traumatic life event. Moreover, ASD symptoms were significantly related to trauma symptom scores. These findings suggest that a significant proportion of women with PTSD for childhood sexual abuse may be highly symptomatic for everyday stressful events that would not be experienced as traumatizing to others. Thus, these individuals need assistance in coping with everyday life stressors that do not involve a serious threat or injury in addition to needing help to alleviate their trauma symptoms.     

Dating violence: mental health consequences based on type of abuse

This study aims to determine the relationship between psychological, physical, and sexual abuse, and mental health symptoms. Female college students (N = 499) completed anonymous online surveys to report experiences of abuse, as well as symptoms of depression, posttraumatic stress disorder (PTSD), and physical injuries. Five groups of participants were found: no abuse; psychological abuse; physical abuse; psychological and physical abuse; and psychological, physical, and sexual abuse. The multiple abuse groups showed the highest rate of mental health symptoms. In addition, increased frequency of abuse was related to more mental health symptoms and more physical injuries.     

Increasing the usability of cognitive processing therapy for survivors of child sexual abuse

There is an ongoing need for empirically based treatments for child sexual abuse (CSA) that are time-efficient and cost-effective. This article describes a modification of cognitive processing therapy for child sexual abuse (CPT-SA) that increases the therapy's usability by reducing the number of individual therapy sessions required. The modifications are based on the developing literature on stage-based approaches to the treatment of CSA and incorporate dialectical behavior therapy skills training into the treatment protocol. Initial pilot data (N = 6) on modified CPT-SA suggests the therapy may be effective for the treatment of posttraumatic stress disorder (PTSD) and depression.     

An Evaluation of a Group Treatment for Sexually Abused Young Children

ABSTRACT

The present study measured outcomes of a group treatment for five-to eight-year-old sexually abused children. Although research completed in the last 10 years has produced some outcome studies on the effectiveness of group treatment for this population, no previous research has measured the effectiveness of psychoeducational interventions, such as the teaching of sexual information and abuse prevention strategies which are often included in this type of treatment. Also, the effects of different lengths of treatment have not been studied. The results of the current study found that children improved significantly from pre-treatment to mid-treatment on measures of problematic behavior, sexual information and abuse prevention. The children also made significant improvements from mid-treatment to post-treatment and from pre-treatment to post-treatment on all of the outcome measures with the exception of mid-treatment to post-treatment changes on the maternal acceptance self-esteem subscale. These results suggest that young children do benefit from a sexual abuse group treatment and that a longer treatment may be more beneficial.     

Victimization and posttraumatic stress disorder among runaway and homeless adolescents

This article presents lifetime and 12-month prevalence rates and comorbidity for posttraumatic stress disorder (PTSD) among a sample of 428 homeless and runaway adolescents. Data are from baseline interviews of a longitudinal diagnostic study of 428 (187 males; 241 females) homeless and runaway adolescents aged 16-19 years (mean age = 17.4 years, SD = 1.05). The data were collected by full-time street interviewers on the streets and in shelters in eight Midwestern cities of various populations. About one-third (35.5%) of the runaways met lifetime criteria for PTSD and 16.1% met 12-month criteria for the disorder. More than 90% of the adolescents who met criteria for PTSD met criteria for at least one of the other four diagnoses. Multivariate analyses indicated that correlates of PTSD were age of adolescent, being female, having experienced serious physical abuse and/or sexual abuse from an adult caretaker, and having been assaulted or injured by weapon when on the street. The multiplicative interaction between sexual abuse by caretaker and sexual assault when the adolescents were on their own was statistically significant, indicating that rape victims were highly likely to meet criteria for PTSD regardless of early sexual abuse. At very high levels of early sexual abuse, the probability of meeting criteria for PTSD converges with that for sexual assault victims.     

The neurodevelopmental outcome in infants who have sustained a subdural haemorrhage from non‐accidental head injury

Subdural haemorrhage (SDH) in infants arises most commonly from non‐accidental head injury (NAHI) from shaking. Patients present with a varied severity of illness and a variety of symptoms and signs. Data on long‐term outcome of the survivors are not widely reported. The aim of this paper is to describe the physical and educational outcomes of children <2 years diagnosed with non‐accidental head injury and formulate guidelines on follow‐up. Data on 65 children <2 years with non‐accidental head injury and subdural haemorrhage diagnosed on CT/MRI/postmortem were extracted from the hospital and community notes and education reports. The Kings Outcome Scale for Childhood Head Injury (KOSCHI) was used. Sixteen children died (24.6%), 13 within 6 weeks and three 5 years after the injury. Of the 45 children followed up (follow‐up time 21.7–103 months), 25 had a good outcome, six were moderately disabled and 11 were severely disabled, while three were in persistent vegetative state. Problems identi?ed included cerebral palsy—16, ongoing seizures—5, visual problems—11, speech and language problems—17 and behavioural problems—13. Of the 29 children of school age on whom data were available, 12 children had a statement of educational needs. In conclusion, young children who survive non‐accidental head injury can have signi?cant physical, cognitive and behavioural problems. Regular follow‐up by a multidisciplinary team, which includes a community paediatrician, therapists, school health personnel and ophthalmologic services, until the child is established in school may facilitate early identi?cation of emerging problems and optimize management. Care must be taken not to discharge children with good outcomes, as behavioural and cognitive problems can emerge with time. Only a prospective study will help outline the subtle problems that can emerge with time in children with a so‐called good outcome. Copyright © 2004 John Wiley & Sons, Ltd.     

Post-Traumatic Stress Disorder Among College Student Victims of Acquaintance Assault

Summary

Post-traumatic stress disorder symptomatology was evaluated among 316 college women who reported coercive sexual experiences. History of victimization, attributions of blame, and current symptoms were assessed. Acquaintance assault victims reported significantly higher levels of Post-Traumatic Stress Disorder (PTSD) symptoms than non-victims, and one-third exceeded criteria for clinical levels of distress. Situational variables, including the type of assault, were not associated with PTSD status or symptoms. Cognitive appraisals, however,'were significantly associated with PTSD symptomatology. Attributions of blame were all associated with PTSD status, with characterological self-blame also being associated with level of current symptomatology. The results document the negative psychological consequences of acquaintance assaults among college students and help to focus the efforts of treatment programs for acquaintance assault victims. In addition, the results highlight the importance of cognitive appraisals in mediating effects of sexual victimization.     

Personality disorders, coping strategies, and posttraumatic stress disorder in women with histories of childhood sexual abuse

Using a treatment-seeking sample of adult female survivors of childhood sexual abuse, the relationships between coping strategies, personality disorders (PD) and Posttraumatic Stress Disorder (PTSD) were explored. A variety of PDs were found to exist in this population, with avoidant, antisocial, dependent PDs having higher frequencies than borderline PD. Avoidant coping and PTSD severity significantly correlated with many of these PDs. PTSD severity and avoidant coping were also significantly correlated. Additionally, women with PTSD displayed higher rates of avoidant and dependent PDs, as well as more avoidant coping, than did women without PTSD. Results support a more complex conceptualization of the trauma-related symptoms that occur in adult survivors of childhood sexual abuse that incorporate the relationships between avoidant coping, personality disorders, and PTSD.     

Ethnicity and child sexual abuse experiences of female college students

This research examines the understudied issue of race/ethnicity in relation to child sexual abuse experiences (CSA) in a cross-sectional convenience sample of 461 female college students completing a survey. Comparisons of students' abuse experiences revealed ethnic differences in sexual abuse prevalence, severity of abuse, the victim- offender relationship and post-abuse coping. Black students reported more sexual abuse than other ethnic groups, followed by Hispanics, Whites, and Asians. Although timing and extent of disclosure of sexual abuse did not vary by ethnicity, negative social reactions to disclosure were more common for certain ethnic groups than others. No ethnic differences emerged for depressive or PTSD symptoms. Implications are drawn for future research on the issue of ethnic differences in the aftermath of CSA experiences.     

War-related mental health problems of today's veterans: new clinical awareness

1. Veterans of the military conflicts in Iraq and Afghanistan may have been exposed to significant psychological stressors, resulting in mental and emotional disorders. 2. Posttraumatic stress disorder (PTSD) is characterized by symptoms in three domains: reexperiencing the trauma, avoiding stimuli associated with the trauma, and symptoms of increased autonomic arousal. 3. Treatment of PTSD often requires both psychological and pharmacological interventions. 4. In addition to PTSD, other mental disorders may be precipitated or worsened by exposure to combat, including depression, anxiety, psychosis, and substance abuse.     

Experiences of Mothers Who Are Child Sexual Abuse Survivors: A Qualitative Exploration

Child sexual abuse has been associated with a number of problems affecting women over their lifespan, including difficulties with parenting. However, there is a modest number of qualitative studies examining the impact of child sexual abuse on survivors who are mothers. There is a particular need for qualitative investigations that ask survivors who are mothers general questions about the impact of child sexual abuse on their lives rather than those that specifically ask about the impact of child sexual abuse on parenting. The former approach would allow survivors to describe effects that may impact parenting but that survivors do not consciously link to affecting their parenting. Such information may inform interventions to assist this population of survivors. This secondary data analysis examined themes revealed in interviews with 44 survivors of child sexual abuse who were mothers. Participants were seeking treatment for their child sexual abuse and completed an in-person interview in which they were asked open-ended questions about the sexual abuse they experienced as a child and how their abuse affects them now as adults. The interviews were recorded, transcribed, and coded using thematic analysis. The following six themes emerged from the narratives: (a) being a parent, (b) family of origin dysfunction, (c) the impact of abuse, (d) the abuse history and response to abuse, (e) coping, and (f) hopes and desires for the future. This study highlights several ways in which child sexual abuse impacts survivors who are mothers, areas for further study, and the need for interventions to assist this population in meeting the challenges they face as mothers.     

Impact Evaluation of a Cognitive Behavioral Group Therapy Model in Brazilian Sexually Abused Girls

This study evaluated the impact of a cognitive behavioral group therapy model in Brazilian girls who had experienced sexual abuse. The effect of the waiting period before treatment and the enduring effectiveness of the treatment after six and 12 months were also evaluated. Forty-nine female sexual abuse victims between the ages of 9 and 16 completed instruments measuring depression, anxiety, stress, and post-traumatic stress disorder before, during, and after the group therapy. The group therapy had a positive impact on their psychological functioning, significantly reducing symptoms of anxiety, stress, and post-traumatic stress disorder. The therapeutic effects lasted six to 12 months after the treatment ended. The model proved effective for treating young female victims of sexual abuse.     

Child-Parent Relationship Therapy with Extra-Familial Abused Children

Sexual abuse by a perpetrator outside of the family is the most prevalent form of child sexual abuse. It is associated with serious consequences for both the child and his family. Surprisingly, however, the issue of extra-familial sexual abuse has received very little research and clinical attention. The purpose of the current study was to explore the effectiveness of Child-Parent Relationship Therapy (CPRT), which uses nondirective play therapy tools, among parents of extra-familial abused children and their parents. In order to do so, data was collected from 51 parents who participated in CPRT, at three points in time: pretreatment stage, at the beginning of the first meeting; and in the post treatment stage. The data included the parents’ reports via three questionnaires: Parenting Stress Inventory (PSI), Compassion Fatigue Self-Test (CFST), Child Behavior Checklist (CBCL). Overall, the results indicated a decrease in internalizing and externalizing symptoms among the children, as well as in parenting stress and in parental secondary trauma symptoms. This study contributes to the literature on interventions with victims of extra-familial child abuse and their parents. Specifically, the results highlight the benefits and importance of involving both parents and children in therapeutic interventions for victims of extra-familial child sexual abuse, with particular emphasis on the benefits of Child-Parent Relationship Therapy.     

Prevention of child abuse and neglect and improvements in child development

The aim of the study was to evaluate the implementation of a section in the Danish Social Assistance Act which encourages local authorities to offer families services in order to support children at risk of child maltreatment. The specific purpose of the present paper is to answer the question: Will the socio‐psychological development of children known to social services be improved when abuse and neglect are reduced? A sample of 1,138 children was drawn at random from new social services cases starting in 1998. Subsequently, about 80 per cent were evaluated by local caseworkers on the basis of a standardised questionnaire covering a period of four years. The most damaging family conditions seemed to be psychological maltreatment, physical/sexual abuse and neglect. Maltreated children were more often in a depressed state, unhappy, socially isolated, or they had an eating disorder, inadequate or under‐nutrition, suicidal tendencies, lack of concentration, or disturbed behaviour, compared to those children who were not exposed to abuse and neglect. If parental behaviour improved, effects on children's well‐being were also observed and positive changes in children's socio‐psychological development were identified. The questionnaire explored the impact of various interventions, including services geared to strengthen the child's network, but results indicated that the child displayed reduced risk of reactive symptoms only when parental behaviour improved and abuse and neglect were reduced. Copyright © 2009 John Wiley & Sons, Ltd.     

Childhood sexual experience and adult offending: an exploratory comparison of three criminal groups

The study explored the links between adult offending and exploitative sexual experiences during childhood. A questionnaire was administered to three criminal groups (child molesters, rapists and non‐sexual offenders) with the aim of investigating the statistical relationships between the men's early childhood sexual experiences. The sample comprised a total of 125 males. Fifty‐eight were in prison for non‐sexual crimes, 23 were serving sentences for rape and the remaining 44 were undergoing therapeutic treatment for their child molestation crime at a special treatment programme within the prison. Significant differences were found across the groups with respect to family context: education, subsequent occupation, religious family background and levels of abuse experienced during childhood. The two sex offending groups reported higher levels of physical and sexual abuse. The rapists reported significantly higher levels of emotional abuse and neglect. The child molester group was more likely to report both consenting and non‐consenting activity with other children and there was significance across the range of sexual behaviours. Higher abuse reporting by the child molester and rapist groups suggests that early experience may influence developmental trajectories and offending pathways. Copyright © 2008 John Wiley & Sons, Ltd.     

Acute Stress Disorder Symptoms Among Female Sexual Abuse Survivors Seeking Treatment

ABSTRACT

This exploratory study examined relationships between acute stress disorder (ASD) symptoms and sexual abuse history, distress, and social support among sexual abuse survivors seeking treatment. Participants were 32 women recruited for a pilot study of group treatment for sexual abuse survivors who completed self-report and interview measures. Many participants (37.5%) met criteria for all ASD symptoms. Also, ASD symptoms were significantly related to seeing the self as the causal locus of the abuse, forgetting the abuse for a period of time, and the number of abusers, the distress of a recent life event, other forms of distress, and poor social support, Acute stress disorder may occur among many sexual abuse survivors seeking treatment, requiring special intervention to help these patients to manage their reactions to ongoing stresses.     

Internet-Based Interventions for Addictive Behaviours: A Systematic Review

Internet-based interventions have emerged as a new treatment and intervention modality for psychological disorders. Given their features of treatment flexibility, anonymity and confidentiality, this modality may be well suited in the management of addictive behaviours. A systematic literature review of the effectiveness and treatment outcomes of Internet-based interventions for smoking cessation, problematic alcohol use, substance abuse and gambling was performed. Studies were included if they met the following criteria: clients received a structured therapeutic Internet-based intervention for a problematic and addictive behaviour; included more than five clients; effectiveness was based on at least one outcome; outcome variables were measured before and immediately following the interventions; had a follow-up period; and involved at least minimal therapist contact over the course of the program. Sixteen relevant studies were found; nine addressed the effects of Internet-based interventions on smoking cessation, four on gambling, two on alcohol and one on opioid dependence. All studies demonstrated positive treatment outcomes for their respective addictive behaviours. The current review concluded that Internet-based interventions are effective in achieving positive behavioural change through reducing problematic behaviours. This mode of therapy has been found to have the capacity to provide effective and practical services for those who might have remained untreated, subsequently reducing the barriers for help-seekers. This in turn provides imperative information to treatment providers, policy makers, and academic researchers.