Why is it that 33% to 53% of HIV-infected people have histories of childhood sexual abuse?
Just take a look at the symptoms of childhood sexual abuse – helplessness, low self-esteem, dissociation, denial, self-destructiveness . . . these psychological difficulties that can result from childhood sexual abuse are often related to HIV risk behavior.
Studies show that childhood sexual abuse is associated with avoidant coping, which can lead to increased traumatic symptoms . . . so perhaps changing the coping strategy of people who experienced childhood sexual abuse could be useful?
Duke University professor Kathleen J. Sikkema, PhD conducted a study to examine whether a coping intervention could reduce traumatic stress and poor health outcomes in adult survivors of childhood sexual abuse living with HIV.
First, Dr. Sikkema and her colleagues recruited 247 HIV-positive participants who had experienced sexual abuse as a child or adolescent.
Next, a computer-assisted interview was completed by all participants, with follow-up assessments every 4 months over a 16-month period. After the first interview, participants were randomly assigned to one of two groups.
The experimental group participated in an intervention called Living in the Face of Trauma (LIFT). LIFT uses cognitive appraisal and coping skills training to help people deal with the stress related to childhood sexual abuse and HIV. The participants in the control took part in HIV support group sessions.
In between the first and second assessments, both groups attended 15 90-minute weekly sessions conducted by therapists in a community health center.
During each of the five assessments, participants completed self-report measures of traumatic stress symptoms and the use of avoidant coping strategies.
Was the coping intervention more successful than the support group intervention?
Subjects who participated in the LIFT coping intervention reported a greater decrease in traumatic stress and avoidant coping than subjects in the support intervention.
And because both interventions were conducted in a group setting, it is likely that the significant reductions in avoidant coping in the LIFT group were a result of the focus on developing coping skills and not just the social support.
However, one limitation of this study is that the sample had a very small number of heterosexual men, and therefore, we have to be careful about how far we generalize these results. More work needs to be done to understand the impact of sexual abuse among heterosexual men.
But for people living with HIV who have experienced childhood sexual abuse, the LIFT intervention may help them focus on current stressors and develop better coping skills to improve their health and reduce traumatic stress.
To learn more about this study, you can find it in the Journal of Consulting and Clinical Psychology, Volume 81, No. 2.
If you want to learn other ways to address trauma symptoms, check out our series on Rethinking trauma.
Have you ever worked with patients who used avoidant coping strategies? How did you help them to improve their method of coping? Please leave a comment below.