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How can teens recover from sexual abuse?

What's an effective treatment for post traumatic stress disorder in girls who have been sexually abused? A recent University of Pennsylvania study points to a type of cognitive-behavioral therapy known as prolonged exposure.

Teenage girls are sexually assaulted with alarming frequency and many will go on to develop post traumatic stress disorder (PTSD).  If left untreated, PTSD can make life hell for the sufferer for years after the original trauma, and increase the likelihood of other problems – most common are anxiety, depression, substance abuse, and self-destructive behaviors.

But what treatment is appropriate – not to mention effective – for PTSD in girls who have been sexually abused?  A very important study, recently conducted right here in Philadelphia, points to a type of cognitive-behavioral therapy (CBT) known as prolonged exposure (PE).

Typically, sufferers of PTSD go to great – and understandable – effort to avoid memories or reminders of the traumatic event. Even if the individual with PTSD attends therapy for relief, they will often avoid bringing up the trauma. Many well-meaning therapists, fearful of increasing their patients' distress, will allow the avoidance.

The problem is that avoidance doesn't work and tends to worsen the symptoms of intrusive memories, flashbacks, and emotional numbing.  In Prolonged Exposure, sufferers of PTSD are encouraged by their therapists to stop avoiding and instead tell the story of their trauma over several sessions.  By repeatedly recounting the details, sufferers are able to process their fear and gain firsthand experience that memories, although extremely upsetting, are not in themselves unsafe. PTSD symptoms decrease as a result.

There is much evidence that Prolonged Exposure is a highly effective therapy for adults with PTSD, but had not been researched with adolescents.  Edna Foa, PhD. and colleagues from the Center for the Treatment and Study of Anxiety at the University of Pennsylvania addressed this by completing a study with 61 teen girls aged 13 to 18 who had been sexually abused and were seeking treatment at Philadelphia's Women Organized Against Rape (WOAR). The teens, after consenting to the study, were randomly assigned to receive either Prolonged Exposure therapy or traditional supportive counseling by therapists at WOAR.

Results showed that the girls who received Prolonged Exposure therapy did a lot better than those who received traditional supportive counseling: They were significantly less likely to have PTSD – and depression – at the end of the study and at a follow-up one year later. Of note: none of the girls who were assigned to supportive counseling chose to describe their trauma during that treatment.

The results are particularly important, says Foa, lead author of the study, because "the therapists were counselors in a clinic that serves sexually abused survivors. Prolonged Exposure in the hands of these counselors significantly reduced PTSD, depression, and dysfunctional symptoms than supportive counseling in their adolescent clients despite the fact that [the therapists], while proficient in delivering supportive counseling, were not familiar with Prolonged Exposure until they received a 5-day workshop at the beginning of the study."

And on that, I will end this post with a special shout-out to all the counselors at WOAR who provided their services for the study and are daily on the frontlines of treatment for sexual assault survivors – you are hometown heroes.

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Katherine K. Dahlsgaard, Ph.D.
Lead Psychologist - The Anxiety Behaviors Clinic, CHOP