A disproportionately high number of childhood sexual abuse (CSA) survivors have HIV/AIDS. It is well established that survivors of CSA are at risk for numerous negative physical and mental health outcomes, including posttraumatic stress (PTSD), anxiety, depression, suicide, substance misuse, relationship and intimacy issues, and risky sexual behavior. Many people with a history of CSA have difficulty expressing their emotions and use negative coping strategies such as emotional avoidance, suppression, and denial. Feelings of low self-esteem, shame, and helplessness are common among CSA survivors and people with HIV. Because of the constellation of issues that these individuals face, interventions designed to prevent HIV may not be adequate. Strategies that teach adaptive coping skills could help CSA survivors with HIV learn how to handle emotional challenges in ways that can minimize future risk.
Kathleen J. Sikkema of the Department of Psychology and Neuroscience at Duke University in North Carolina recently led a study that compared two interventions aimed at CSA survivors with HIV/AIDS. She recruited 247 individuals and assigned half of them to Living in the Face of Trauma (LIFT), a program that empowers survivors by teaching them ways to cope with and process their emotions. The rest of the participants were assigned to a comparison intervention. All of the participants were evaluated before and after the program, and at three separate four-month intervals post-intervention.
The results revealed that the LIFT program, which taught people how to handle current life stressors with improved coping strategies, was far more effective than the traditional intervention. Sikkema believes the success can be attributed to the unique design of LIFT, which addresses the stress of HIV and CSA simultaneously while focusing on the emotional and behavioral byproducts of CSA and HIV. Even though PTSD was not specifically targeted in LIFT, the participants who had clinical levels of PTSD prior to beginning the program saw significant reductions in symptoms at the conclusion and throughout the follow-up period. Shame also was minimized, which could decrease future victimization in people who are at risk. Although the data was based on self-reports and was underrepresented by heterosexual men, Sikkema believes the findings can have broad clinical implications. “This mediation analysis enhances our understanding of the role of coping and related interventions to improve the mental health of people living with HIV/AIDS,” she said.
Sikkema, K. J., Ranby, K. W., Meade, C. S., Hansen, N. B., Wilson, P. A., Kochman, A. (2012). Reductions in traumatic stress following a coping intervention were mediated by decreases in avoidant coping for people living with HIV/AIDS and childhood sexual abuse. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0030144
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