Innovative therapy helps survivors of sexual violence in the DRC

Violence against women and girls is a significant problem in the Democratic Republic of Congo (DRC), particularly in the country’s conflict-ridden eastern provinces. Few emergency or long-term care services are available to rape survivors in eastern Congo. Many survivors experience high levels of distress and most live in extreme poverty, exacerbated by the stigma faced in families and communities.

A recent study conducted by the International Rescue Committee (IRC) in partnership with Johns Hopkins University found that providing survivors of sexual violence with an innovative form of group therapy called Cognitive Processing Therapy (CPT) resulted in a dramatic decrease in overall trauma symptoms. Adapted specifically to the context in DRC, the therapy was targeted for survivors of sexual violence who reported high trauma and depression symptoms and difficulty completing day-to-day activities.

Survivors who benefitted from CPT were twice as likely to experience a decrease in trauma symptoms than those who did not receive the therapy. These women also showed improved ability in carrying out daily tasks, worked 8 more hours per week, and spent 30% more on food – demonstrating a strong improvement in their economic well-being.

The idea to introduce therapy into IRC’s women’s protection programmes began because some sexual violence survivors had symptoms so severe, that they persisted even after emotional support and case management services. Case management is the one-on-one support the IRC provides to survivors so they can access all the services necessary to help them heal, such as medical treatment, crisis counselling, and legal support.

In addition to a reduction in trauma symptoms, the study also showed that:

• CPT complements case management. While all survivors need coordinated individual help, CPT can help those who have high and persistent symptoms continue on the path to healing.

• With the right support, communities can provide specialised mental health therapy. In the DRC, specialised psychological services are rarely accessible. In this study, CPT was implemented at the community-level by local counsellors, most of whom had a high school-level education or less.

• CPT is effective in a context marked by ongoing conflict and extreme poverty. Most of the sites where CPT was implemented experienced some form of insecurity during the period when group therapy was offered, and all had been affected by previous decades of turmoil.

Results for the mental health outcomes of the study were published in the New England Journal of Medicine in June 2013. This ground breaking and innovative study garnered much media attention when results were released, and was featured in the New York Times, the Guardian, and BBC.

With such positive and dramatic results on improved functioning, the main question left after the impact evaluation is how to scale-up this effective therapy to make it more available to sexual violence survivors in eastern DRC.

With funding from HIF, the IRC will be integrating CPT into the public health system via a pilot in seven health centres, testing a model that has the potential make CPT widely available to women at low cost through an existing health system that is currently unable to meet the mental health care needs of survivors.