Rape-related symptoms in adolescents: short- and long-term outcome after cognitive behavior group therapy

Efficacy studies on treatment in adolescent victims of single rape are lacking, even though sexual victimization is most likely to occur during adolescence and despite the fact that adolescents are at risk to develop subsequent posttraumatic stress disorder. The aim of this prospective observational study was to evaluate the short- and long-term outcomes of a nine-session cognitive behavior group therapy (STEPS), including a parallel six-session parents’ group on rape-related symptomatology in female adolescents (13–18 years). STEPS includes psychoeducation, exposure in sensu as well as in vivo, cognitive restructuring, and relapse prevention. Fifty-five female adolescents with mental health problems due to single rape, but without prior sexual trauma, received STEPS while their parents participated in a support group. Subjects were assessed on posttraumatic stress (PTS) and comorbid symptoms using self-report questionnaires prior to and directly after treatment, and at 6 and 12 months follow-up. Repeated measures analysis showed a significant and large decrease in symptoms of PTS, anxiety, depression, anger, dissociation, sexual concerns, and behavior problems directly after treatment, which maintained at 12 months follow-up. Time since trauma did not influence the results. Dropout during STEPS was 1.8%. The results potentially suggest that the positive treatment outcomes at short- and long-term may be caused by STEPS. The encouraging findings need confirmation in future controlled studies on the effectiveness of STEPS because it may be possible that the treatment works especially well for more chronic symptoms, while the less chronic part of the sample showed considerable improvement on its own.

针对单次强奸青少年受害者的治疗疗效研究尚且匮乏，尽管性侵害最常发生于青春期阶段，且青少年群体罹患后续创伤后应激障碍（posttraumatic stress disorder, PTSD）的风险显著升高。本项前瞻性观察研究旨在评估为期9节的认知行为团体治疗（STEPS）的短期与长期疗效，该疗法同步配套面向家长的6节针对强奸相关症状的团体支持课程，研究对象为13至18岁的女性青少年。STEPS疗法涵盖心理教育、想象暴露与现场暴露技术、认知重构以及复发预防。共计55名因单次强奸出现心理健康问题、且既往无其他性创伤史的女性青少年参与本研究，她们接受了STEPS疗法，其家长同时参与了配套的支持团体课程。研究人员分别在治疗前、治疗即刻，以及随访6个月、12个月时，采用自评问卷对受试者的创伤后应激（posttraumatic stress, PTS）与共病症状进行评估。重复测量分析结果显示，治疗即刻后，受试者的创伤后应激、焦虑、抑郁、愤怒、解离、性困扰及行为问题症状均出现显著且大幅的缓解，且该改善效果在12个月随访时仍得以维持。创伤发生至接受治疗的时间间隔并未对研究结果产生影响。STEPS疗法的受试者脱落率为1.8%。本研究结果初步提示，STEPS疗法所带来的短期与长期积极治疗疗效，可能源于该疗法本身的作用。本研究的积极发现仍需在未来的对照研究中进一步验证STEPS的有效性，因为存在一种可能性：该疗法可能仅对慢性程度较高的症状疗效显著，而样本中慢性程度较低的群体可能仅通过自然恢复就已获得显著改善。