May 30, 2013 | Tricia Chandler , PhD
Childhood sexual abuse (CSA) has been defined as the experience of any unwanted sexual abuse of a person under age 18 perpetrated by someone at least 5 years older than the victim. Current statistics reflect that as many as 25-45% of girls and 5-10% of boys under age 18 have been sexually abused, though it is unclear whether the higher numbers observed today are the result of better reporting or an actual increase in the incidence of sexual abuse. Also, the much lower statistics for males may reflect even less reporting by that gender. Current CSA research finds that CSA is associated with diminished self-worth, mood disorders, impaired coping strategies, interpersonal problems, and sexual problems. Research has emphasized that the psychological and behavioral effects of sexual abuse often continue into adulthood and affect many areas of functioning. How do people heal from childhood sexual abuse? How do mind-body-spirit modalities contribute? These questions are critical because CSA is common and damaging.
Children who have been repeatedly traumatized show signs of distinct alterations in consciousness, including dissociation, depersonalization, flashbacks, nightmares, disorientation, difficulties with attention regulation, and sensorimotor development disorders. These consciousness symptoms are common to posttraumatic stress disorder (PTSD), and the syndrome of CSA can be explained within the context of PTSD. CSA survivors typically carry these symptoms into adulthood and are also at higher risk for adulthood mood disorders, suicidal ideation, substance abuse, obesity, sexual promiscuity, sexually transmitted diseases, and domestic violence. Childhood trauma interferes with neurobiological development and, as a result, is linked with physiological dysregulation and increased risk for chronic health problems such as heart disease, cancer, stroke, diabetes, skeletal fractures, and liver disease in adult survivors. When child victims of CSA do receive mental health services, typical diagnoses include anxiety, depression, phobic disorders, disruptive behavior disorders, and attention deficit disorders.
Integrative Treatment Protocols
Integrative therapies, such as art therapy, journaling, equestrian therapy, massage, Reiki, acupuncture, homeopathy, yoga, guided imagery, meditation, and positive affirmations, are associated with positive outcomes for CSA survivors in addition to traditional psychotherapy. Spiritual practices, in particular, are believed to increase resiliency in CSA survivors. Unfortunately, some integrative therapies fall outside of the definition of mainstream psychotherapeutic treatment and are not often covered by insurance.
In 1998, Martin Seligman—then acting president of the American Psychological Association—proposed a new cognitive psychology called Positive psychology that is based on a wellness model that studies human strength, resilience, and optimal human functioning throughout life. Positive psychology shifted focus from a preoccupation with mending what has been damaged to building an attitudinal foundation that can weather the difficulties that naturally come along in life. Positive psychology is about developing a strong sense of well-being, optimism, contentment, and faith that allows an individual to see life from a perspective of hope rather than despair, which contributes to resiliency in the face of misfortune and tragedy.
Mindfulness-based cognitive approaches are a departure from traditional, cognitive-behavioral treatment. Cognitive-behavioral therapy includes a clear goal of changing negative behaviors and thinking patterns, whereas mindfulness practice suggests that clients observe their thoughts as impermanent and refrain from evaluating them. ACT, mindfulness-based stress reduction, and dialectical behavior therapy all show promise as therapies that may support women with CSA histories to focus on strategies that support improved health.
Resilience has been defined as good life outcomes in people who have experienced serious threats to their development and has been associated with stable characteristics such as well-being, optimism, faith, wisdom, creativity, self-control, morality, gratitude, forgiveness, and hope. Resiliency theory research has examined the factors that help people grow as a result of adversity, and is a meta-theory that encompasses many theories across varied academic disciplines. The common idea is that all living things have innate energy or resilience and that the energy drives the individual from survival to self-actualization may be called God, chi, spirit, or resilience.
Resiliency inquiry developed from identifying and considering the characteristics of survivors that have lived in high-risk situations. The first wave of resiliency inquiry identified the internal and external qualities that enable people to cope and grow despite high-risk circumstances. The second wave of resiliency inquiry defined the process of coping and what factors aided development of protective factors. The third wave of research in resiliency assisted the discovery of what drives a person toward self-actualization and applying reintegration of resiliency after adversity has been encountered. Maslow (1971) called transpersonal psychology the Fourth Force in psychology, implying an understanding of psyche that goes beyond ego and re-embraces the concept of psychology as the study of the soul. “In resilience theory, soul refers to the whole, integrated being of an individual with one’s transpersonal nature, or human spirit, as the primary guiding force of the system” (p. 315).
Integrative healing techniques that are newer to mental health treatment, but are finding efficacy in treating the whole person include: acupuncture, homeopathy, art therapy, dance/movement therapy, eye movement desensitization and reprocessing therapy (EMDR), massage therapy, Reiki, somatic therapies, and mindfulness training. Survivors of CSA have routinely endorsed the need for holistic and integrative therapies that address all the underlying issues and symptoms related to sequel of abuse. Individualized treatment that addresses the whole person appear to regain resilience over time, when that treatment includes methods of integrating mind-body wisdom, learning and practicing mindfulness and breath techniques, and a variety of creative outlets, that lead to development of appropriate coping methods, find meaning and purpose in their lives, and eventually incorporating self-forgiveness and integrating their past abuse over time. Survivors have pointed the way to research that may lead to better protocols of healing modalities for other trauma survivors and eventually to education that may lead to better prevention and intervention strategies to break the cycle of CSA for future generations.