Cognitive therapy for Congolese survivors of sexual violence

N Engl J Med2013;368:2182-92OpenUrlCrossRefPubMed

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We know that certain forms of cognitive therapy can help survivors of sexual violence who live in high income countries. A controlled trial suggests that group therapy can also work in the eastern Democratic Republic of Congo, where nearly 40% of women report sexual violence in communities affected by poverty, political instability, and conflict. A dozen group sessions of cognitive processing therapy improved women’s mental health significantly more than individual counselling, and the difference persisted for at least six months after the end of treatment. Symptoms of post-traumatic stress disorder (PTSD), depression, and anxiety all improved more for women given cognitive therapy, which was provided by experienced local support workers after two weeks of extra training⇑.

Researchers recruited 405 women from 15 villages. All had experienced or witnessed sexual violence and had symptom scores indicating high risk of PTSD, anxiety, or depression. The trial had a cluster randomised design, so whole villages were randomised to one group or the other. The groups weren’t well matched at baseline, among other limitations, but the authors are confident that cognitive processing therapy made a noticeable difference to women in this setting. Six months after the end of treatment, 9% (12/138) of women given cognitive therapy and 42% (73/175) of controls had “probable” PTSD (P<0.001).