Why is it that 33% to 53% of HIV-infected people have histories of childhood sexual abuse?
Just take a look at the symptoms of childhood sexual abuse – helplessness, low self-esteem, dissociation, denial, self-destructiveness . . . these psychological difficulties that can result from childhood sexual abuse are often related to HIV risk behavior.
Studies show that childhood sexual abuse is associated with avoidant coping, which can lead to increased traumatic symptoms . . . so perhaps changing the coping strategy of people who experienced childhood sexual abuse could be useful?
Duke University professor Kathleen J. Sikkema, PhD conducted a study to examine whether a coping intervention could reduce traumatic stress and poor health outcomes in adult survivors of childhood sexual abuse living with HIV.
First, Dr. Sikkema and her colleagues recruited 247 HIV-positive participants who had experienced sexual abuse as a child or adolescent.
Next, a computer-assisted interview was completed by all participants, with follow-up assessments every 4 months over a 16-month period. After the first interview, participants were randomly assigned to one of two groups.
The experimental group participated in an intervention called Living in the Face of Trauma (LIFT). LIFT uses cognitive appraisal and coping skills training to help people deal with the stress related to childhood sexual abuse and HIV. The participants in the control took part in HIV support group sessions.
In between the first and second assessments, both groups attended 15 90-minute weekly sessions conducted by therapists in a community health center.
During each of the five assessments, participants completed self-report measures of traumatic stress symptoms and the use of avoidant coping strategies.
Was the coping intervention more successful than the support group intervention?
Subjects who participated in the LIFT coping intervention reported a greater decrease in traumatic stress and avoidant coping than subjects in the support intervention.
And because both interventions were conducted in a group setting, it is likely that the significant reductions in avoidant coping in the LIFT group were a result of the focus on developing coping skills and not just the social support.
However, one limitation of this study is that the sample had a very small number of heterosexual men, and therefore, we have to be careful about how far we generalize these results. More work needs to be done to understand the impact of sexual abuse among heterosexual men.
But for people living with HIV who have experienced childhood sexual abuse, the LIFT intervention may help them focus on current stressors and develop better coping skills to improve their health and reduce traumatic stress.
To learn more about this study, you can find it in the Journal of Consulting and Clinical Psychology, Volume 81, No. 2.
If you want to learn other ways to address trauma symptoms, check out our series on Rethinking trauma.
Have you ever worked with patients who used avoidant coping strategies? How did you help them to improve their method of coping? Please leave a comment below.
As a person with an long h/o infantile and youthful severe, unrelenting, physical abuse with a sexual tinge from meine birth mutter. As an survivor, I don’t know what you mean by ‘coping strategies’. To me an good coping strategy would be to jump off the Brooklyn Bridge. The minute an Phd in this busineess provides me with an so called ‘coping excersize’ is when I start to throw up. Of course some of the at least 500 complex ingenious and sometimes sublime Feldenkrais(R) movement lessons might be regarded as ‘coping strategies’, but the fact is that trauma seems to last forever even though Feldenkrais lessons,and various psychotherapists keep me going, but sometimes it h’ain’t no fun life
in
Six years legal removal away from mutter with kinder Foster Parents must have saved me. Of course I was eventually sent back to the birth mutter. Every child needs his birth mutter, even if she kills him. That’s just incidental,
No. I don’t have HIV.
John Quinn
In my VAW course training, our teachers explained that CSA involves early life breach of bodily boundaries and/or betrayal by core attachment figures. So, what happens is that children grow up having lost the ability to protect themselves from dangerous experiences and cannot set boundaries. Coupling that with possible addiction (distress intolerance; affective storms; desire for anesthesia), means that people must do dangerous things in order to make drug/alcohol money, or they are put in situations where they are vulnerable to predators (injured prey). e.g. a woman who drinks to cope will be passed out and may be assaulted. In teens, some kids are in denial about sexual activity (out of shame), and this puts them at increased risk of harmful sequelae, also.
I would love to hear more about the formulation of healthy boundaries when the child of abuse does not know what these are…when there were none. I have yet to discover a program which teaches this successfully.
When I went to a recent ACES gathering, this would have been an excellent question to bring up or program to suggest.
Boundary in a Box was once suggested to me. I listened to a session to check it out and realized this was not created for one with no understanding of how their lives were un-boundaried !
Many studies relating adult health and early death to “Adverse Childhood Experiences” are available through the ACES website and the download page.
Improvement of coping strategies for those living the effects of early adverse experiences (especially chronic ones) is indeed what treatment is or ought to be all about.
Treatment of adults also has a preventive effect, in that through treatment adults will become more able to protect children from the intergenerational transmission of adverse childhood experiences and from their later effects.
As people who understand the centrality of these issues for physical/mental health, our ethical civic and professional duty includes doing what we can to direct social resources to this most critical enterprise, whether we conceive of it as being for the sake of the social savings (monetary and otherwise) or for the more basic and more worthy goal of just plain preventing early childhood suffering.
This LIFT study is encouraging & fits well with the Adverse Childhood Experiences (ACE) study by Felitti, as well as Resiliency studies by Werner. The ACE study identifies sexual abuse as one of 7 ACE issues. When a child experiences these ACE event(s) & there are no interventions, they are at risk of developing critical physical health problems as an adult (such as heart problems). In between those two age stages are the behaviors which can result in the medical health problems if there are no interventions. The ACE study gives data & mechanisms that correlate the Mind-Body connection of the early adverse experiences which correlate to high-risk behaviors in adolescent-early adulthood and later to the significant adult medical problems. Service providers had observed these correlations in clients & ACE documents the scientific evidence of what progression may occur without intervention. On the other hand, Resiliency studies, such as by Dr. Emmy Werner in Kauai, help us become familiar with various (intervention) factors that can help strengthen & improve future life outcomes for all of us. This is encouraging, as it demonstrates that a high risk childhood history does not inevitably destine someone to critical medical problems in later life. Using an ACE framework for the specific example above, adults with childhood sexual abuse histories may have developed avoidant coping strategies that contributed to high risk sexual behaviors that expose them to HIV risk. The participants using LIFT as an intervention benefited, resulting in decreased avoidant coping behaviors (hopefully leading to future reduction in unsafe sexual behaviors). Bless all the researchers for helping us find helpful models & tools!