Journal of the American Academy of Child & Adolescent Psychiatry
New ResearchA Randomized Controlled Trial of Trauma-Focused Cognitive Behavioral Therapy for Sexually Exploited, War-Affected Congolese Girls
Section snippets
Trial Design
A single-center, equal-randomization, single-blind (outcome assessors), parallel-group (active and wait-list control) study was chosen to address this question.
An additional resilience questionnaire was piloted, translated, and back-translated for the study, but was eventually discarded after feedback from the interviewers/outcome assessors suggested that the clinical interview was long enough and that asking more questions could lead to fatigue and inaccurate responses.
Participants
Fifty-two war-affected
Baseline Characteristics
Randomized allocation placed 24 participants in the trauma-focused cognitive behavioral therapy group and 28 participants in the wait-list control group (Figure 1). Table 1, Table 2 summarizes ages, traumatic events exposure, and psychological and psychosocial symptoms at baseline. The mean age of the 52 participants at baseline was 16.02 years.
Inappropriate sexual touch was the most common traumatic event experienced (48 of 52), and lack of food or water, severe punishments, seeing blood or
Discussion
To our knowledge, this is the first randomized controlled trial of a trauma intervention for war-affected girls in low- and middle-income countries (LAMIC) who have been exposed to rape and sexual abuse. Findings show that group-based, culturally modified, TF-CBT significantly reduced psychological distress and psychosocial difficulties among this population. These gains were either maintained or improved (in the case of depression and anxiety symptoms and prosocial behavior) 3 months
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This project was funded by World Vision, and by family and friends who contributed toward the carpentry and mechanics tools and the hygiene kits given to every girl in the study. World Vision and Conférence Régionale de l'Afrique de l'Ouest Francophone (CERAO; a local, Congolese community-based organisation) provided material support including local staff time to conduct the intervention, assistance in the logistical aspects of both the study design and interventions and assistance in interviews during the project. Neither organisation was involved in the management or analysis of the data.
This article is discussed in an editorial by Dr. Judith A. Cohen on page 344.
Dr. O’Callaghan had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
The trial protocol is available on request from the lead author at: [email protected]
The authors acknowledge the invaluable support and assistance provided by Dr. Judith A. Cohen and Dr. Ben Saunders in planning this trauma-focused cognitive behavioural therapy intervention in the Democratic Republic of Congo. The authors also thank the staff of World Vision and CERAO, in particular Anna Fenten, Fernand Azonnannan, Françoise Maroyi, and Jonas Makusudi, who worked with World Vision and CERAO at the time the study was conducted, for their support and help in delivering the intervention. Finally, a special mention and thanks must go to the girls who participated in the project, who are truly an inspiration to the authors in courage, resilience, and honesty, with smiles and humor that lifted everyone.
Disclosure: Drs. O’Callaghan, McMullen, Shannon, Rafferty, and Black report no biomedical financial interests or potential conflicts of interest.