CBT for Adolescent Survivors of Sexual Assault

May 17, 2023 | Life Transitions, Sexual Abuse

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In the United States, 1 in 9 girls and 1 in 53 boys under the age of 18 experience sexual abuse or assault at the hands of an adult. 18% of girls and 3% of boys say that by age 17 they have been victims of a sexual assault by another adolescent (Shattuck et al., 2014). The effects of sexual trauma on children and adolescents can be long-lasting and seriously detrimental to the survivor’s mental health.

Healing from the complex trauma of sexual violence requires a multifaceted approach tailored to each individual client. Such evidence-based psychotherapeutic approaches can include cognitive-behavioral therapy and narrative exposure therapy. 

Criteria for Posttraumatic Stress Disorder

The criteria for post-traumatic stress disorder according to the DSM-5 are guidelines, and the experiences of survivors of sexual violence vary widely. However, the following criteria is helpful for many survivors to create a validating framework for their experience.

This abbreviated list applies to an individual who has been exposed to a traumatic event involving actual or perceived threat of death or serious injury (American Psychiatric Association, 2022). The survivor may report response of intense fear and helplessness to the traumatic event, frequent nightmares, flashbacks of the event, significant distress resulting from internal and external “triggers” that are reminiscent of the traumatic event, intentional avoidance of thoughts, places, objects that evoke memories of the traumatic event, hypervigilance, and impairment in social, occupational, or other areas of functioning. 

Cognitive Behavioral Therapy for Survivors

Trauma-focused cognitive behavioral therapy (TF-CBT) has been shown to be extremely effective in treating adolescent survivors of sexual trauma (U.S. Department of Health and Human Services, 2018) TF-CBT helps survivors address the harmful effects of trauma. A trauma-informed compassionate approach to CBT has demonstrated effectiveness in a variety to settings, with children and adolescents from diverse cultural backgrounds, and different types of trauma or multiple traumas. 

This therapeutic approach can include education about traumatic stress reactions, the development of effective coping and interpersonal skills, relaxation techniques as well as cognitive restructuring to process the trauma (DOHHS, 2018). Cognitive restructuring can include guided imaginal reliving of the rape memory to reduce intrusive flashbacks and emotions of shame or disgust. This technique is called “narrative exposure therapy” or NET.

Narrative Exposure Therapy

Narrative exposure therapy was first used with refugee and asylum-seeking populations of children and adolescents (Stratford et al, 2020). NET is a short-term individual intervention that centers the premise that during a traumatic event wherein there was a psychological alarm response, these traumatic memories are processed in a manner that may be detrimental to wellbeing.

Traumatic memories that cause intense distress to the survivor can be summarized as the body still reacting to the danger, long after the danger has passed. Traumatic stress reactions are your body’s way of protecting you, but triggers and flashbacks can cause prolonged suffering and impairment in functioning. Through the process of NET, traumatic events are ordered chronologically to re-process the memories of the event and contextualize them (Stratford et al, 2020). This process can help mend the lasting associations of the event and heal shame and feelings of helplessness that many survivors experience. 

If you or your teenager has experienced sexual assault, please reach out for help. The National Sexual Assault Hotline is 1-800-656-4673. You deserve to feel safe and to heal; therapy may be able to help.

References

  • Fazel, M., Stratford, H. J., Rowsell, E., Chan, C., Griffiths, H., & Robjant, K. (2022, January 1). Five applications of narrative exposure therapy for children and adolescents presenting with post-traumatic stress disorders. https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00019/full  
  • American Psychiatric Association. (2022). Posttraumatic Stress Disorder. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). 
  • Finkelhor, D., Shattuck, A., Turner, H. A., & Hamby, S. L. (2014). “The lifetime prevalence of child sexual abuse and sexual assault assessed in late adolescence.” Journal of Adolescent Health, 55(3), 329–333. https://doi.org/10.1016/j.jadohealth.2013.12.026 
  • U.S. Department of Health and Human Services, Children’s Bureau (2018, October). Trauma-focused cognitive behavioral therapy: A primer for child welfare professionals. https://www.childwelfare.gov/pubs/trauma/ 
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Written By Emma Lukin

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