Recent Changes

Tuesday, April 21

  1. page Sexual Abuse edited ... Longer term therapy treatments had better results than shorter term therapy results. Followin…
    ...
    Longer term therapy treatments had better results than shorter term therapy results.
    Following up on treating children who have suffered from CSA, a slightly older literature review by Putnam (2002) indicated that CBT for both the child and a non-offending parent was the best treatment. The need to involve a non-offending parent is important because of the support the parent can provide for the child. Additionally, the parent will also need some therapeutic support of their own, as the CSA is often traumatic for the parents as well, especially if the perpetrator was a loved one.
    ...
    sexual abuse, indicates children may also
    ...
    mention if these studies have supportedevidence to support these approaches as being testedused with adults
    Treatment for Adult Survivors of CSA
    Although there is a fair amount of research out there on treating children who have experienced CSA, less solid research has been conducted on treating adults who have suffered from CSA.
    ...
    group intervention. That said, more evidence is required before conclusions are drawn.
    In our readings, Rellini notes that larger studies with control groups are needed to further test the potential benefits of mindfulness. She also describes that many clinicians working with survivors of sexual abuse have noted that these clients often discussed distraction caused by intrusive thoughts about the abuse, but this may not apply to all of these survivors. As such, it is important during assessment to determine what negative impacts, if any, the history of sexual abuse is currently having in the person’s life.
    {https://lh6.googleusercontent.com/pIojcsZHesOpETNhDGn2YSMlykaouqxa8Bh2YIUDpO45Wl-xlHSQJC2CzoVkDPuev7liis5Q8qPIrG1Dl7t-slBHhS8aClBHswuD3k9PzmrxCwBubZ9QHYzuKohPxDaYeh0LHBk}
    Research by Edmond and Rubin (2004) indicated 59 female survivors of sexual abuse may benefit from eye movement desensitization and reprocessing (EMDR) which was maintained over an 18 month period of time. However, these results should be interpreted with caution, as previous reviews of EMDR indicate the approach tends to only be effective due to its cognitive processing therapy components, while the eye movements seem to have little benefit (Wilson, Silver, Covi, & Foster, 1996).
    {https://lh4.googleusercontent.com/IKFXddBmg25l56YD-c2dtfA0wPO0PotPoKV2cLR52KAKq4QRXd83BUl1JoahSg_o_Ub8s3EMhBNcEO8prqWH8o-ptWCmyXORoy7u89MjLle80ndPWhmqxH3d41UY0uFFVK5Inos}
    ...
    also {https://lh5.googleusercontent.com/PeGLxzNorhtKzjUxUfawiY_yc8adh8mVimLRbJx4i9_F7Y9_6rFlS_QQEEgi07MN6XCcP3iBnRDDr5ljx8mJ7jeUHsJ_UJjgJKpCwKNzoY1ijqCxHovFPPCCloyK6PeVnxQ6zg0} involveinvolves acceptance of
    ...
    to the SA,sexual abuse, and shaping
    {https://lh4.googleusercontent.com/7N4LekQRZrqDINLjjUUxnFPP0dLlEcQ7fuJoS0kA3SfBuBzRWLZVUiTrYxu1ANz7I-lPyE9x02m0UOCfbkarJqIkHbcha36_cfOI_1HiWvOrkwaJUsJuCRToyCrfPHkD6GcwjAg} A study by MacIntosh & Justin (2008) also indicated that Emotionally Focused Therapy (EFT) could be helpful for a survivor of CSA and their partner. The article also notes that EFT is one of the two empirically validated couples interventions, and has also been known to help couples suffering from other types of psychological difficulties. This study only included 10 couples, all with one partner that suffered from CSA, and did not contain a control group. The couples completed 19 sessions of EFT, and half of the couples showed statistically significant improvements in relationship satisfaction, and statistically significant decreases in trauma symptoms.
    {EFT ppt.pdf}
    (view changes)
    8:25 am
  2. page Sexual Abuse edited ... Treatments Treatment for Children and Adolescent Survivors of CSA ... to be the largest …
    ...
    Treatments
    Treatment for Children and Adolescent Survivors of CSA
    ...
    to be the largest and
    Used data from 33 studies. Combined, this led to data from 44 treatment groups and 7 control groups. Not all studies were controlled and randomized, as there were far fewer control groups.
    Studies used different outcome measures, but the most common were sexualized behaviors, anxiety, depression, self-esteem, and behavior problems.
    (view changes)
    8:14 am

Monday, April 20

  1. page Sexual Abuse edited {https://lh5.googleusercontent.com/juehRw7IfwI8Z8U9DTcZodLa7Ha52bkKI1AxcjEM0PW2c8l_pk44siWIM515Ywj…
    {https://lh5.googleusercontent.com/juehRw7IfwI8Z8U9DTcZodLa7Ha52bkKI1AxcjEM0PW2c8l_pk44siWIM515YwjlWggIZYOKIUEWY1mHAhTrF6WU_TTmkn2USE6VZNB3-LO2HUgWTnFd0PhYgI8ONEYqkMFSGaE}
    ...
    abuse?, n.d.).
    Prevalence
    According to the __CDC__ (2010), one in five women and one in 71 men has been raped in their lifetime. For sexual violence other than rape, CDC reported lifetime prevalence of one in two women and one in five men.
    ...
    These negative affect and perspective appears to be significant emotional problems that can interfere with sex or concepts of sexuality (as cited in Zwickl & Merriman, 2010)
    Sexual Schemas (Rellini & Meston, 2011)
    Three3 subtypes of
    Romantic/Passionate (+): romantic, passionate, unromantic, warm, loving, feeling, sympathetic, arousable, stimulating, and revealing.
    Open/Direct (+): direct, straightforward, frank, outspoken, broad-minded, experienced, casual, open-minded, and uninhibited
    Embarrassed/Conservative (-): cautious, timid, self-conscious, prudent, embarrassed, conservative, and inexperienced.
    CSA women who have more Embarrassed/Conservative and less Romantic/Passionate sexual self-schemas predicted negative affect prior to exposure to sexual stimuli.
    ...
    sexual script!)
    Sexual Function vs. Sexual Distress (Stephenson, Hughan, & Meston, 2012)
    A study on 176 women in Southwestern USA using the Sexual Satisfaction Scale for Women and the Female Sexual Function Index
    ...
    Treatments
    Treatment for Children and Adolescent Survivors of CSA
    ...
    many studies.
    Used
    Using 33 studies (making this the largest meta-analysis at this point in time in child sexual abuse), trauma-focused CBT combined with supportive therapy and a psychodynamic element (such as play therapy) were found to be the most effective treatments. A therapist must keep in mind that this meta-analysis was treating CSA in children and adolescents, and thus might not apply to adults being treated for CSA or adult sexual abuse.
    Used
    data from
    ...
    control groups.
    Studies

    Studies
    used different
    ...
    behavior problems.
    All

    All
    of the
    ...
    self esteem.
    The

    The
    studies used
    ...
    play therapy.
    Of

    Of
    these many
    ...
    behaviors simultaneously.
    Authors

    Authors
    state that
    ...
    to person.
    Since

    Since
    this meta-analysis
    ...
    younger children/adolescents.
    Longer

    Longer
    term therapy
    ...
    therapy results.
    Using 33 studies (making this the largest meta-analysis at this point in time in child sexual abuse), trauma-focused CBT combined with supportive therapy and a psychodynamic element (such as play therapy) were found to be the most effective treatments. A therapist must keep in mind that this meta-analysis was treating CSA in children and adolescents, and thus might not apply to adults being treated for CSA or adult sexual abuse.

    Following up on treating children who have suffered from CSA, a slightly older literature review by Putnam (2002) indicated that CBT for both the child and a non-offending parent was the best treatment. The need to involve a non-offending parent is important because of the support the parent can provide for the child. Additionally, the parent will also need some therapeutic support of their own, as the CSA is often traumatic for the parents as well, especially if the perpetrator was a loved one.
    A recent study by Misurrell, Springer, & Tyron (2011), which included 48 elementary school aged children who had experienced sexual abuse, may also benefit from a game-based CBT group program. The game focused on changing internalizing symptoms, externalizing behaviors, sexually inappropriate behaviors, social skills deficits, self-esteem problems, and psychoeducation. The game significantly improved externalizing behaviors and internalizing symptoms and reduced sexually inappropriate behaviors, but did not significantly improve social skills or self-perception. Even so, this study indicates such a group based CBT game could also help treat this population.
    ...
    Research by Edmond and Rubin (2004) indicated 59 female survivors of sexual abuse may benefit from eye movement desensitization and reprocessing (EMDR) which was maintained over an 18 month period of time. However, these results should be interpreted with caution, as previous reviews of EMDR indicate the approach tends to only be effective due to its cognitive processing therapy components, while the eye movements seem to have little benefit (Wilson, Silver, Covi, & Foster, 1996).
    {https://lh4.googleusercontent.com/IKFXddBmg25l56YD-c2dtfA0wPO0PotPoKV2cLR52KAKq4QRXd83BUl1JoahSg_o_Ub8s3EMhBNcEO8prqWH8o-ptWCmyXORoy7u89MjLle80ndPWhmqxH3d41UY0uFFVK5Inos}
    ...
    further research.
    {https://lh4.googleusercontent.com/7N4LekQRZrqDINLjjUUxnFPP0dLlEcQ7fuJoS0kA3SfBuBzRWLZVUiTrYxu1ANz7I-lPyE9x02m0UOCfbkarJqIkHbcha36_cfOI_1HiWvOrkwaJUsJuCRToyCrfPHkD6GcwjAg}

    {https://lh4.googleusercontent.com/7N4LekQRZrqDINLjjUUxnFPP0dLlEcQ7fuJoS0kA3SfBuBzRWLZVUiTrYxu1ANz7I-lPyE9x02m0UOCfbkarJqIkHbcha36_cfOI_1HiWvOrkwaJUsJuCRToyCrfPHkD6GcwjAg}
    A study
    ...
    trauma symptoms.
    {EFT ppt.pdf}
    {Emotionally focused therapy for couples and childhood sexual abuse survivors.pdf}
    (view changes)
    2:16 pm
  2. page Sexual Abuse edited ... {https://lh3.googleusercontent.com/KZXxyK4lisC7wmMvB0C4EIn1QBejy2mTHms1hDp4xWrdWLH4XAYcjOxAX5K…
    ...
    {https://lh3.googleusercontent.com/KZXxyK4lisC7wmMvB0C4EIn1QBejy2mTHms1hDp4xWrdWLH4XAYcjOxAX5KWVPQqzDwGFmZciMvoP0qSsYbZkgQhQWniPsGD_3QR6LXpNJiJ7jygnJXrFo4J3IKZwIvrsCpm0hI}
    Child sexual abuse found to be associated with (Nasim & Nadan, 2013; Cohen et. al, 2004; Putnam, 2003):
    depression
    re-victimization
    Depression
    Re-victimization
    in adulthood
    suicidality
    sexual

    Suicidality
    Sexual
    promiscuity
    anxiety
    substance

    Anxiety
    Substance
    abuse
    borderline

    Borderline
    personality disorder
    somatization

    Somatization
    disorder
    posttraumatic

    Posttraumatic
    stress disorder (PTSD)
    dissociative

    Dissociative
    identity disorder
    bulimia

    Bulimia
    nervosa
    {https://lh3.googleusercontent.com/Hj2RiPUwVnGSuop1eQl_0E1b7h_nrn1L1sQ9kHBObImmpUOgQjqUtgAnXnYPTSu_bMhy71vQxr42aUTpTa9skoHrHoJPJVokX6PfXKLejnZynRDTX6Fjmo6VHif9gEiCtJ3b-EY}
    Depression is amongst the most common effects of child sexual abuse. Research states that 43-67% of victims meet the diagnostic criteria of depression (Walsh & DiLillo, 2011). Combined with high levels of anxiety, substance abuse is a common way to escape and cope with the depression and anxiety (Hornor, 2010; Walsh & DiLillo, 2011). A study performed by the National Institute on Drug Abuse (Zickler, 2002) found that child sexual abuse is strongly associated with substance abuse, compared with depression, anxiety, and other psychiatric disorders.
    ...
    Male partners of female CSA survivors experience “secondary trauma,” including higher reports of individual distress and symptoms of trauma (Nelson & Wampler, 2002). Most survivors of CSA do not report as children; many first disclose their victimization to their intimate partners later in life (Miller & Sutherland, 2014). If the partner reacts to disclosure in a way that dismissive or nonprotective, the victim may also be retraumatized (Nasim & Nadan, 2013).
    Couples with history of CSA receiving sex therapy reported more negative effect on dyadic adjustment (both dyadic satisfaction and dyadic consensus) (Berthelot et al. 2014). In this study with 218 adults, all clinically depressed clients were CSA survivors. How does depression affects sexual functioning?
    Partners inIn Healing (Miller
    ...
    outcomes for therapy.Accordingtherapy.
    According
    to the
    ...
    its occurrence. According to the article,The authors state, "It is
    ...
    impacted his/her partner.Thepartner.
    The
    partner is
    ...
    the partner, etc., highlighting toetc. These highlight the importance
    ...
    partner respond sensitively.Insensitively.
    In
    therapy, the
    ...
    revictimized in adulthood.Non-offending familyadulthood.
    Non-offending family,
    friends and
    ...
    positive healing, the essence of which is the thrust of this article, many specific
    ...
    than invalidating messages.Timemessages.
    Time
    and patience
    {Classes of childhood sexual abuse and women’s adult couple relationships..pdf}
    {Relational Challenges and Recovery Processes in Male Survivors of Childhood Sexual Abuse.pdf}
    ...
    {https://lh4.googleusercontent.com/ULFkWuT0wBkZxMHo12tGUBlCkbBXELSiCWrup78jNyohjfYbX9GdNjGO7MGS7PCvwTNpx1VYakod3C0S5iKTkao6rt_dTzA1Oiek7iHnctKs53kDKVpF2T2AnIMVmwWfYM4yquQ}
    Many studies have documented the association between CSA and adult sexual dysfunction, yet results remain inconsistent (Lenoard et al., 2008; Berthelot et al., 2014). This is largely due to differences in operational definition of sexual abuse and sexual dysfunction and lack of standardized measure for sexual dysfunctions (Zwickl & Merriman, 2010). In addition, sample from most of these studies are college students, which is difficult to generalize to the population.
    Negative affectAffect and perspectivePerspective on sexualitySexuality
    {https://lh3.googleusercontent.com/FDTpoAVx53bo0Iebvcjr6N3omvEW7kTAV9AmeaDCeok-7MRj4OddAZX9VGR16wlZb78HDRvJPkYTp4Q0JyhaIkj_GtNK84s6wn90eBEoVZuVdjRjJ_UVbC4i3qEWW9NTcBsxSyQ}
    Women with CSA reported more negative sexual affect (fear, anger, and disgust) during sexual arousal and more sexual dissatisfaction than women without CSA. They are also more likely to think their sexual feeling as reduced or inhibited (Bartoi & Kinter, 2008; Schloredt & Heiman, 2003).
    Negative perspectiveperspectives about sexuality
    These negative affect and perspective appears to be significant emotional problems that can interfere with sex or concepts of sexuality (as cited in Zwickl & Merriman, 2010)
    ...
    Meston, 2011)
    Three

    Three
    subtypes of sexual self-schema are identified by
    ...
    Sexual Self-Schema Scale):Scale) as:
    Romantic/Passionate (+): romantic, passionate, unromantic, warm, loving, feeling, sympathetic, arousable, stimulating, and revealing.
    Open/Direct (+): direct, straightforward, frank, outspoken, broad-minded, experienced, casual, open-minded, and uninhibited
    Embarrassed/Conservative (-): cautious, timid, self-conscious, prudent, embarrassed, conservative, and inexperienced.
    CSA women arewho have more Embarrassed/Conservative
    ...
    sexual stimuli.
    More

    More
    negative sexual
    ...
    sexual experiences; and in turn,
    ...
    script!)
    Sexual functionFunction vs. sexual distressSexual Distress (Stephenson, Hughan,
    A study on 176 women in Southwestern USA using the Sexual Satisfaction Scale for Women and the Female Sexual Function Index
    ...
    distress despite of experiencing high
    ...
    activity and experienceexperienced clinically relevant
    ...
    with CSA hashave increased risk of being over-diagnosed with
    ...
    sexual functioning.
    This

    This
    population experience aexperiences unique cognitive
    ...
    processes and filterfilters their sexual
    ...
    differentiation of self) self.)
    Theoretical Model (Zwickl & Merriman, 2010)
    TheorisedTheorized outcomes only,
    Clinical implications:
    mayMay beneficial for
    ...
    their coping process.
    provide
    process
    Provide
    an alternative
    ...
    sexual experiences
    exploration

    Exploration
    of new
    ...
    and self-destructive methods.methods
    {https://lh4.googleusercontent.com/O5K-NGj2A_vlz8O7vm7pWMwj4mOuQOJ72Efs2o9oxSg4c9oi5_DYlOkukiMAQgsUOe-70JYqdOTiRQLIEIEIbugDM6TaNoqXT_LPswT3s_bkNqt2UwpbPC2v0hzY5iCCg1YYTJQ}
    {Sexual Self-Schemas, Sexual Dysfunction, and the Sexual Responses of Women with a History of Childhood Sexual Abuse.pdf}
    (view changes)
    2:01 pm

Saturday, April 18

  1. page Sexual Abuse edited ... Many adult survivors of CSA use “emotional avoidance” and may have negative associations with …
    ...
    Many adult survivors of CSA use “emotional avoidance” and may have negative associations with emotional or sexual intimacy, particularly when the perpetrator was a close friend or family member. This may lead to difficulty with entering into committed relationships (Watson & Halford, 2010).
    Male partners of female CSA survivors experience “secondary trauma,” including higher reports of individual distress and symptoms of trauma (Nelson & Wampler, 2002). Most survivors of CSA do not report as children; many first disclose their victimization to their intimate partners later in life (Miller & Sutherland, 2014). If the partner reacts to disclosure in a way that dismissive or nonprotective, the victim may also be retraumatized (Nasim & Nadan, 2013).
    Another cause for the increased risk of revictimization of CSA survivors is that they frequently enter into and maintain relationships in which they are at a lower position of power (Miller & Sutherland, 2014).
    Couples
    Couples with history
    ...
    sexual functioning?
    Partners in Healing (Miller & Sutherland, 2014)
    This article discusses the significant potential for either healing or reinforcement of negative effects that a partner may have through their relationship and responses to a person who is a survivor of CSA. Because CSA victims are more prone to sexual dysfunctions in adulthood, this article proposes that the partner should be involved in therapy for CSA survivors as they are pivotal to the outcomes for therapy.According to the article, many adult survivors first report their abuse as adults to their partner, and that it is a minority of children who disclose abuse at the time of its occurrence. According to the article, "It is naive and limiting to view the process of recovery as solely an individual journey" (pg. 99). In taking this systemic perspective, part of what the authors suggest is that through therapy, the partner should be supported in increasing his/her understanding of how CSA has impacted his/her partner.The partner is not only influential, but is affected. The article describes this as secondary posttraumatic stress. Among the ways in which the partner's response has potential for damage are denial, downplaying the impact, being insensitive or ignorant, blaming the partner, etc., highlighting to the importance of helping the partner respond sensitively.In therapy, the authors emphasize the importance of addressing any power differences and for clinicians to assess for safety concerns. The literature has been clear that survivors of CSA are more likely to be revictimized in adulthood.Non-offending family friends and partners offer the greatest potential for healing, as reported by survivors. In terms of potential for positive healing, the essence of which is the thrust of this article, many specific suggestions were made for the conducting of couples' therapy. These included exploring the impact the CSA has had, increasing connection by preventing negative affect cycles and trust-building, creating a context of safety, and moderating the process of disclosure about the abuse. The latter can be done by ensuring that the victim has control over the process of recovery and attending to the responses by the partner to encourage supportive rather than invalidating messages.Time and patience is required in the process and should be normalized. As the dynamics change, for example if the partner become more assertive, the relationship may need to be renegotiated. Ultimately, the primary therapeutic goal is to maintaining the partner's position as a supportive agent toward healing, and the therapy room as a safe environment for the process to unfold.

    {Classes of childhood sexual abuse and women’s adult couple relationships..pdf}
    {Relational Challenges and Recovery Processes in Male Survivors of Childhood Sexual Abuse.pdf}
    (view changes)
    11:41 am

Thursday, April 16

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