Rape Truama Stress Disorder: A Primer

Studies show that 97% of rape survivors will experience PTSD. Almost 50% of survivors still meet the criteria for PTSD even three months after the rape. Nearly 1/3 of people with addictions have been raped. For many people, alcohol and drugs helps them sleep and numb the memories of the rape. So while many people can heal and move forward, a large percentage of survivors simply cannot. We all know that rape is not about sex. It is about power, control, and intimidation. Rape is a violent crime which produces painful psycho- and physio-logical reprecussions. Every person that is raped expresses fear for his or her life whether or not a weapon is used. Rape trauma syndrome usually goes through three relatively predicatable phases. The first phase "impact and disorganization" involves a great deal of chaos in the victim's life as a result of the rape. Victims often cannot concentrate, make decisions and their short term memory is usually poor. Going to the grocery store or other mundane activities are very difficult. Fear, anxiety, guilt and anger may be prominent. During the second phase, reorganization, the victim begins to organize his or her lifestyle. A change in activities including changing residences, hobbies and beginning to have nightmares, and phobias are likely during this period. The third phase, "resolution and integration" involves the victim begining to re-establish her emotional equilibrium and regains her adapted lifestyle.

One of the immediate problems that a victim may experience is the difficulty sleeping. This problem may be heightened if the person was home asleep when he or she was attacked or if the rape took place within the home. A large number of the victims will move after they have been raped, as the fear that the man knows who they are and may return: some will resort to moving out of town or out of the state and not just across town. Another commong post-rape emotion that people experience is fear. There may be a general fear of people or of men as the person struggles with learning to trust people again. A victim may also experience a period of time immediately after the rape when he or she unwilling to come into contact with anyone,even family and loved ones. A mother may notice a sudden change in her behavior and reactions with her children. Many parents suddenly become over-protective of their children. They may also have difficulty with irritability and exaggerated anger responses to situations in which they perceives a threat to their child(ren).

Victims will often try to justify to themselves that everything is alright. By doing this they often suppresses their feelings. One way of relieving these suppressed feelings is by daydreaming or adopting a dangerous lifestyle doing things that they would not ordinarily do, just to prove to themselves that they are not afraid and can still do whatever they want. Eventually, survivors realize that they cannot go on without facing these feelings and dealing with the reality of the situation. They may drastically change their lifestyle at this point by moving, getting a dog, acquiring a roommate or lover, or by limiting or increasing physical activity.

Most rape victims experience strong feelings of guilt. This is often one of the most difficult parts of the rape to deal with. Victims of aquaintance rape or "date rape" can be even more traumatized than with other types of sexual assault because feelings or shame, guilt, fear, disbelief, and lowered self esteem are often very strong. It becomes hard for the person to know who he or she can trust. Because the perpetrator was a trusted person may cause the victim may initially deny the experience as if nothing happened. Whatever the victim's feelings are after the assault, it is important that he or she be able to talk about them to someone who is willing to let her express his or her feelings and who will not make personal judgements or decisions about how he or she is reacting or how he or she should have handled the situation. The amount of support and understanding that a survivors receive from their family and friends is of critical importance in their recovery and restoration to their prior level of functioning.

Treatment of PTSD

It is important for all counselors and addictions professionals to be aware of how rape affects people and the treatments available. Once a patient has confided in you, he or she may not want to switch to a victim advocate or other therapist to treat the PTSD. Today, there are good treatments available. Patients who have PTSD can (and usually will) find dealing with the past can be hard. Instead of telling others how they feel, they may keep their feelings bottled up. But talking with a counselor can help. Cognitive-behavioral therapy (CBT) is one type of counseling. It appears to be the most effective type of counseling for PTSD. There are different types of cognitive behavioral therapies such as cognitive therapy and exposure therapy. There is also a similar kind of therapy called eye movement desensitization and reprocessing (EMDR) that is used for PTSD. Medications such as antidepressants have also been shown to be effective. Additionally, telemental health has also been shown to be helpful for some patients who would not ordinarily be willing or able to seek services.

What is telemental health?

Telemedicine, also known as telehealth, uses electronic communications to provide and support healthcare when distance separates the participants (Field, 1996). Telemedicine uses various communication methods to connect clinicians and patients - in lieu of them meeting in person. The term telemental health services typically refers to behavioral health services that are provided using communication technology. These services include clinical assessment, individual and group psychotherapy, psycho-educational interventions, cognitive testing, and general psychiatry. The term telemental health describes the overall situation in which a clinician uses various technologies to deliver mental health care to a patient who is miles away. The major benefit of telemental health is that it eliminates travel that may be disruptive or costly. In addition, telemental health is a useful tool in situations, where the patient cannot get to the clinician. Telemental health also allows mental health providers toconsult with or provide supervision to one another. Telemental health may utilize a variety of technologies, and is still considered an untapped opportunity for many psychologists, social workers, and counselors (Maheu, Whitten, & Allen 2001). Telemental health can make use of electronic mail (e-mail), electronic administration of psychological tests, online self-help groups, chat rooms, blogs, and websites.

Telemental Health and PTSD

While preliminary research has shown that a variety of telemental health modalities are feasible, reliable, and satisfactory for general clinical assessments and care (Frueh et al., 2000; Hilty, Marks, Urness, Yellowlees, & Nesbitt, 2004), much less is known about the clinical application and general effectiveness of telemental health for the assessment or treatment of PTSD. For individuals with a history of trauma exposure, the first step in getting the necessary treatment is to have an accurate assessment of psychiatric or psychological symptoms, related problems, and factors influencing functioning. The accuracy of a PTSD diagnosis is important for both treatment implications and benefit claims. If possible, the initial assessment should be done face-to-face or at least via video conferencing. After that, treatment may occur via telemental health. Based on early pilot studies, telemental health appears to be a promising way to offer skills-training and assessment from a distance to individuals with PTSD.

Clinical considerations

Using telemental health for clinical work requires planning and preparation. It is important to consider logistics, such as preparation of the room and equipment, and to be sure there is technological and clinical backup support. It is also important to consider the patient's convenience, privacy and access to emergency services. It is recommended that trauma-focused interventions, such as exposure therapy, not be provided using a telemental health technology. There is a great possibility that the client will experience intense emotional distress with this type of treatment, and it may be very difficult to manage the discussion and contain the situation when providing remote services. Since telemental health is offered (in most cases) because there is not adequate or specialized services at the patient's site, it is unethical to delve into traumatic experiences without having the necessary clinical backup available. However, telemental health can be used to successfully provide clinically significant interventions such as basic PTSD education, symptom management, coping-skills training, and stress management.

Dr. Dawn-Elise Snipes received her PhD in Counseling and Education from the University of Florida. She has worked for 10 years in community mental health. Currently she runs a small internet-based church http://www.stlukesfamilychurch.info and two online continuing education sites http://www.allceus.com and http://www.engineeringceus.comBernie Blog72467
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