Objective: To investigate the
changes in psychological and social domains associated with treatment in
survivors of child sexual abuse. Method: Participants from four centers were
assessed at baseline and were followed up after six and 12 months. The battery
covered posttraumatic and general distress symptoms, attachment, coping styles,
self-worth, and social support. Results: The estimated prevalence of Posttraumatic
Stress Disorder (PTSD) was 78% at baseline; this rate declined to 40% after one
year. There were no differences in outcome measures across the different
centers or between the individual and group treatments. Half of the PTSD
variation at 12 months was explained by four factors: education, avoidance
attachment, emotional coping, and social support. Conclusion: The findings in
this study indicated a substantial reduction in mental health problems in
survivors following 12 months of treatment and identified personality and
social factors important for recovery.
...In this study, we found that 12 months of treatment had a strong
effect on trauma symptoms and had moderate effects on the general distress and
self-worth outcome measures. The possible PTSD cases reduced from 78% to 40%.
Four variables explained almost half of the variation of PTSD symptoms. A long
education, avoidance attachment, and social support were negatively associated
with PTSD severity, while emotional coping style had a positive association
with PTSD outcome.
The treatment in the regional centers appeared to be
effective. The effects of the treatment during the second half of the year were
less than in the first six months, as one could expect. However, it would be
likely that there would still be a number of symptoms in clients that would
have to be addressed even after one year of treatment. It is possible that a
number of the clients left treatment during the first year due to improved
psychological well-being; but it is also possible that some have left treatment
due to lack of improvement. We do not have any data on attrition; this would be
very valuable for future evaluations.
Educational level improved the effectiveness of our model’s
ability to predict PTSD severity, which no other demographic variable was able
to do. Higher educational level is, all things been equal—synonymous with more
resources, knowledge, insight, and improved access to social networks and other
resources in time of need. Individuals with a higher level of education are
likely to benefit more from the treatment. Therefore, it is reasonable to
expect that it would be strongly associated with a reduction of PTSD over time.
In line with previous studies [20,22],
the clients had high scores of avoidant and anxious attachment. The combination
of the two dimensions is equivalent to the fearful attachment style. Elklit [22]
found that half of a similar sample was characterized by fearful attachment
style. The final regression analysis showed that the avoidance attachment style
was associated with PTSD after 12 months. High avoidance attachment at baseline
was a fairly strong predictor for positive treatment outcome one year later. An
avoidant attachment style in many cases may have functioned as a protective
shield against being betrayed and let down again. A high level of avoidance
attachment may reflect difficulties in trusting others in close relationships.
Trust is essential for the working alliance in therapy. For many survivors, the
reconstruction of basic trust in others is a long and difficult process. In the
hands of a caring and competent therapist who gets to know the survivor well,
this distrust can be changed into a stable and positive relationship, which
could potentially be transferred to other relationships outside of the therapy
room.
Emotional coping was positively associated with PTSD
severity after one year. Emotional coping is generally considered maladaptive
after trauma and it has found to be associated with negative outcomes. Folkman
and Lazarus [29]
mentioned that emotional coping can be adaptive in situations where there are
no possibilities to act, for example, when the individual is in a state of
helplessness. Typically, the young child is subjugated to the total control of
the perpetrator. Due to the young age when the abuse starts, they often believe
what the perpetrator tells them, including the terrible things that will happen
if they ever reveal the abuse.
Social support turned out to be negatively associated with
PTSD outcome after one year, therefore high levels of social support will be
predictive of a later decrease in PTSD. In this study, we viewed social support
as an outcome of the treatment, as it was expected that trust would build up
within the therapeutic relationship. Social support has traditionally been
viewed as something that occurs outside of therapy and in many studies it has
been treated as a moderator or a mediator. Our finding is in line with two
influential meta-analyses [43,44]
on the protective function of social support in relation to PTSD...
By: Ask Elklit
Department of Psychology, University of Southern Denmark,
Campusvej 55, DK-5230 Odense M, Denmark; Tel.: +45-6550-2320
