认知加工疗法对刚果民主共和国东部性暴力幸存者耻辱感的影响：一项整群随机对照试验的结果
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.
作者信息
Murray S M, Augustinavicius J, Kaysen D, Rao D, Murray L K, Wachter K, Annan J, Falb K, Bolton P, Bass J K
机构信息
1Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N Broadway Street, Baltimore, MD 21205 USA.
2Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA.
出版信息
Confl Health. 2018 Feb 12;12:1. doi: 10.1186/s13031-018-0142-4. eCollection 2018.
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, = value = 0.02) following the end of treatment, though this difference was no longer significant six-months later (Cohen's D = 0.45, = 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.
背景
性暴力与众多不良的身体、情感和社会后果相关。尽管有性暴力幸存者报告称存在污名化现象，但关于减少污名化的有效策略的证据有限，尤其是在受冲突影响的环境中。我们试图评估团体认知加工疗法（CPT）对污名化的影响，以及污名化在多大程度上可能会调节CPT在治疗刚果民主共和国性暴力幸存者心理健康问题方面的效果。
方法
数据来自405名报告有心理困扰和功能障碍的成年女性性暴力幸存者，她们来自北基伍省和南基伍省。通过提供心理社会支持的组织招募女性，然后将她们整群随机分为团体CPT组或个体支持组。在基线、治疗结束时以及六个月后再次对女性进行评估。评估人员对女性的治疗分配情况不知情。使用线性混合效应回归模型来估计：（1）CPT对感知污名和内化（感受性）污名的影响；（2）感受性污名和歧视（表现性污名）是否调节了CPT对抑郁和焦虑症状、创伤后应激障碍以及功能损害综合症状的影响。
结果
接受CPT治疗的参与者在治疗结束后，相对于接受个体支持的参与者，感受性污名有适度降低（科恩d值 = 0.44，p值 = 0.02），不过六个月后这种差异不再显著（科恩d值 = 0.45，p值 = 0.12）。感受性污名和表现性污名都没有显著调节CPT对心理健康症状或功能损害的影响。
结论
基于团体认知行为的疗法可能是减少性暴力幸存者污名化的有效工具。污名化的经历和认知并没有阻碍团体心理治疗对幸存者心理健康的治疗效果。
试验注册
ClinicalTrials.gov NCT01385163
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