Source: International Rescue Committee
Structured group therapy has dramatically reduced symptoms of depression, anxiety and post-traumatic stress disorder (PTSD) among survivors of sexual violence in the Democratic Republic of Congo, according to a study carried out by the International Rescue Committee, Johns Hopkins University and the University of Washington.

Published in the New England Journal of Medicine (Thursday, June 6), the research is the first rigorous impact assessment of psychological support to survivors of sexual violence in conflict affected countries. The study found overall trauma symptoms decreased roughly twice as much among survivors who received group therapy compared to those who only received individual counseling.

"Sexual violence against women and girls is a major threat in most of the conflict zones where we work and it's a significant problem in Congo," says Catherine Poulton, an IRC adviser for women's protection and empowerment programs. "While most survivors show incredible resilience, others need more specialized assistance."

For more than a decade, the IRC has provided a range of services in Congo to help survivors of rape and other forms of violence recover, including individual counseling, medical care and economic and legal support. Over the past 12 months alone, the IRC has provided assistance to more than 2,500 women and girls in eastern provinces. But IRC-trained counselors have long recognized the need for better and more targeted care for women with persistent symptoms of trauma and depression.

In 2011, the IRC partnered with Johns Hopkins University and the University of Washington to introduce group-based Cognitive Processing Therapy (CPT) to women who were either raped or witnessed rape, had high symptoms of depression, anxiety and PTSD, and were struggling to complete daily tasks, such as caring for children or working. CPT is a structured treatment that helps people confront and cope with memories and thoughts of traumatic events that trigger distress, fear, shame and other debilitating feelings. The three groups then carried out a rigorous evaluation to test CPT's effectiveness in this context.

The research involved 405 women from 15 villages in North Kivu and South Kivu Provinces of eastern Congo. The study found that after six months of treatment, only nine percent of women who received CPT were still classified as having probable PTSD, depression or anxiety compared to 42 percent of women who did not participate in the group sessions.

"Women who were too afraid to work or were overcome by feelings of shame told us that after the group therapy, they have been able to turn their lives around and once again be part of the community," says Poulton.

"This is critical, because if women feel marginalized and stigmatized because of the devastating impact of sexual violence, they are unable to help their families or communities recover from conflict."

One participant described the impact of CPT this way: "Before, I felt ashamed when I passed by others. I felt that they were judging me. I no longer feel ashamed, I feel at ease. I can walk around without shame and without fear of being judged."

The IRC has continued to use CPT and individual counseling to aid women in Congo and hopes to expand the use of CPT in other countries where the IRC assists survivors of sexual violence.

The project and evaluation were funded by the US Agency for International Development (USAID), World Bank, Swedish International Development Cooperation Agency (SIDA), Open Square Foundation and European Commission's Department of Humanitarian Aid and Civil Protection (ECHO).
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