From the Guidelines
Treating a client with cumulative sexual trauma who is being retriggered by life changes requires a trauma-informed approach, prioritizing evidence-based therapies such as prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing psychotherapy, as recommended by the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline 1.
Key Considerations
- Establishing safety and stabilization through grounding techniques, mindfulness practices, and creating a predictable therapeutic environment is crucial.
- Trauma-focused therapies, including Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR), or Cognitive Processing Therapy (CPT), are effective evidence-based treatments.
- Medication management, such as SSRIs like sertraline or fluoxetine, may help manage symptoms of depression, anxiety, and PTSD, while prazosin can reduce trauma-related nightmares.
Treatment Approach
- Implement specific coping strategies for triggers, including developing a written safety plan with identified triggers and corresponding coping mechanisms.
- Addressing somatic symptoms through body-based interventions like yoga, progressive muscle relaxation, or somatic experiencing can help process trauma stored in the body.
- A collaborative approach that empowers the client, respects their autonomy, and acknowledges their resilience is essential throughout treatment.
Evidence-Based Recommendations
- The 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline recommends the use of specific manualized psychotherapies over pharmacotherapy 1.
- Brief CBT, consisting of prolonged exposure plus elements of stress inoculation training, has been shown to speed the rate of recovery in women victims of sexual and nonsexual assault who meet symptom criteria for PTSD 1.
Prioritizing Client Needs
- Maintaining a client-centered approach that prioritizes the client's needs, preferences, and values is crucial in treating cumulative sexual trauma.
- Regular assessment and monitoring of the client's progress, symptoms, and treatment response are necessary to adjust the treatment plan as needed.
From the Research
Treatment Approaches for Cumulative Sexual Trauma
- Cognitive Behavioral Therapy (CBT) with a trauma focus, Cognitive Processing Therapy (CPT), Eye Movement Desensitisation and Reprocessing (EMDR), and Prolonged Exposure (PE) are among the most common interventions offered to survivors to alleviate post-traumatic stress disorder (PTSD) and other psychological impacts 2, 3.
- These interventions may be beneficial in reducing PTSD symptoms and depressive symptoms in survivors of rape, sexual assault, and sexual abuse 2, 3.
- The combination of a selective serotonin reuptake inhibitor (SSRI) and cognitive behavioral therapy (CBT) may also be effective in reducing symptoms of depression and anxiety in youth 4.
Considerations for Treatment
- The needs and preferences of individuals must be considered in selecting suitable approaches to therapy and support 2.
- The therapeutic benefits and costs for subpopulations such as male survivors and those living with complex PTSD require further investigation 2.
- Dropout from trauma-focused psychological treatments can be higher than for other forms of psychological treatment for PTSD in adults 3.
- Adverse events and dropout rates should be carefully monitored in treatment studies 2, 5.
Specific Interventions
- Prolonged Exposure (PE) therapy has been shown to be effective in reducing PTSD symptoms in adolescent girls with sexual abuse-related PTSD 6.
- Cognitive Processing Therapy (CPT) and Eye Movement Desensitisation and Reprocessing (EMDR) may also be beneficial in reducing PTSD symptoms and depressive symptoms 2, 3.
- Selective serotonin reuptake inhibitors (SSRIs) may be effective in reducing PTSD symptoms, but the evidence is not as strong as for psychological interventions 5.