Children who have been sexually abused experience a variety of symptoms, but some symptoms occur more often than others. Feelings of betrayal and powerlessness are common. These children also feel stigmatized-marked as "different"-because of the abuse they have suffered. Finally, their experience of abuse may lead them to develop sexually inappropriate behaviors and confusion about what is appropriate for their own and others' sexuality. This study was designed to test whether sexual abuse-specific cognitive behavioral therapy (SAS-CBT) would be a more effective means of addressing these symptoms than nondirective supportive therapy (NST).
Eighty-two children, aged 7 to 15-together with a parent or guardian-were recruited for the study. A total of 49 completed all the treatment sessions: thirty children who had been randomly assigned to SAS-CBT, and nineteen children who were assigned to NST. SAS-CBT was designed to target the symptoms described above, which sexually abused children often have. Using cognitive behavioral techniques such as positive imagery, relationship and social-skills building, and monitoring and modifying thoughts, therapists worked with children and parents over the course of 12 sessions. The treatment required that the traumatic events be discussed directly.
Those assigned to NST also had 12 sessions of therapy, but in their case therapists used supportive treatments of the type commonly provided to sexually abused children in community treatment settings. In order to clearly differentiate this treatment from SAS-CBT, the therapists did not provide specific directive suggestions and advice, or ask that the children talk directly about the abuse. Empathy and professional support on the part of the therapist was stressed, and therapists worked to help the children reestablish trusting personal relationships.
SAS-CBT proved to be more effective than nondirective supportive therapy in reducing children's symptoms of depression. The researchers were surprised to find, however, that SAS-CBT was not significantly more effective in reducing inappropriate sexual behaviors than NST. Earlier research with preschoolers had shown more of a difference. It may be that SAS-CBT was more effective for younger children for this symptom because the preschoolers who were treated with NST were unlikely to directly speak about their abuse. Older children treated using NST were comfortable discussing the abuse. Since direct discussion of trauma seems necessary to treat it effectively, the older children's greater tendency to discuss the abuse, unprompted, may have made NST more effective in 7 to 15-year-olds than toddlers.
Further research on these children and their caregivers is reported in "Predictors of treatment outcome in sexually abused children" by Cohen and Mannarino.