Incorporating Self-Defense Training with Feminist Group Therapy to Facilitate Trauma Resolution - PowerPoint Presentation

Incorporating Self-Defense Training with Feminist Group Therapy to Facilitate Trauma Resolution in Adult Female Survivors of Sexual Abuse Dawn Ellison, LPC Mississippi college

Sexual Violence / Childhood Sexual Abuse Gendered problem – over 90% of victims are female (Cohen, 2008) 15-30% of women in general population experience physical or sexual abuse ( Blumer , Papay , & Erolin , 2013) 25% of females are victims of CSA prior to age 18 ( Blumer et al., 2013; Reese-Weber & Smith, 2007) Nearly 20% of females have been raped (Black et al., 2011) Interpersonal in nature; typically experienced alone No clear course of action for victim

Symptoms Guilt Helplessness Shame Anger HumiliationFearDifficulties in areas of trust Safety issuesFeelings of disempowermentDecreases in self-esteemSelf-injuryAddictionPTSD – Women are double the risk of men (Najavits, 2009) (Keller & Zoellner , 2010; Phanichrat & Townshend, 2010)

Trauma Occurs when event shocks person and overwhelms ability to cope or to integrate ideas and emotions (fear, helplessness, horror) involved in experience ( Finkelhor & Browne, 1985) Psychological and physical impact – even when no direct physical harm (Rothschild, 2000)Activation of limbic system: fight, flight, freeze responseSexual abuse survivors: most common reaction is to freeze – result of powerlessness; unable to escape or defend (Levine, 2010)Intense fear + freeze response traps body in perpetual state of arousal (Levine, 2010)

Hyperarousal “Tendency for brain and body’s nervous system to react in a rapid, extreme, and prolonged manner to stressors” (Ford & Russo, 2006, p. 336) Energy mobilized for action and not discharged – trapped in incomplete act of escape (Levine, 2010) Elevated arousal  hypervigilance  avoidance (Rothschild, 2000)Flashbacks / unwanted memories of trauma Search for an escape or defense that began with traumatic event is perpetuated by trauma symptoms (Levine, 2010)

Cognitive Behavior TherapyCBT – most rigorously studied and considered most effective Focus on arousal and avoidance of memories; dysfunctional cognitions Exposure is considered “key element” for treating trauma symptomology (Dietrich et al., 2000) Long term benefits of exposure treatment are superior to other treatments (Feinstein, 2010; van der Kolk et al., 2007)

Feminist Group TherapyGroup therapy is a preferred treatment modality for survivors of sexual abuse – observe and learn from others (Hebert & Bergeron, 2007) Feminist model – examine societal factors contributing to abuse; validate experiences (Cohen, 2008) Focus on empowerment (Worrell & Remer, 2003)“No intervention that takes power away from the survivor can possibly foster her recovery” (Herman, 1992, p. 133)

Self-Defense44-88% of women who participate in self-defense classes have been physically or sexually abused (Brecklin & Ullman, 2004; Hollander, 2010) Research has shown self-defense training may provide therapeutic benefits to survivors – reduced fear, increased self-confidence, perceived control (Brecklin, 2004; Hollander, 2010)Exposure therapy relies on sustained, heightened physiological arousal, tolerance of the arousal, and habituation to stimulus or trigger (Foa, Hembree, & Rothbaum, 2007)Self-defense training produces intense adrenalized state that mimics physiological state of arousal in original trauma (Ambrosio , 1996)

Proposal: Women’s T-I-M-ETrauma-Integration-Mediation-Empowerment

Statement of the ProblemThe problem of this study is developing an integrative treatment program for adult female survivors of sexual abuse incorporating self-defense training and feminist group therapy.

Purpose of the StudyThe purpose of the study is to Describe the impact of sexual abuse on women Determine core components of existing cognitive behavior trauma therapies Integrate self-defense training and feminist group therapy to address physiological and psychological impact of sexual abuse as evidenced by development of comprehensive treatment manual.

Significance of the Study Women seek help for complications of sexual abuse not address through traditional “talk” therapy Studies of women’s strategies for healing found that half used body work and physical activities to reduce stress and find sense of balance ( Leseho & Maxwell, 2010; Stenius & Veysey, 2005)Recent trends in research show movement toward focus on bodywork as alternative therapy – yoga, mindfulness (van der Kolk, 2014)Action-based techniques stimulate feelings  trigger unconscious issues  force into consciousness (Stuhlmiller, 1994) Feminist approach addresses overlooked complications of powerlessness, betrayal, and social stigma ( Tseris , 2013)

Research QuestionsWhat is the impact of sexual abuse / sexual assault on females ? What are the core components of cognitive behavior therapies for trauma? Do these core components address both the psychological and physiological impact of trauma? How can novel components be integrated into these core components to develop an integrative treatment program that simultaneously addresses the psychological and physiological impact of trauma?

Method Developmental Research and Utilization Model (DRU; Southern, 2007) Developmental research “involves the development, testing, evaluation, and modification of new models of practice” ( Gilgun & Sands, 2012, p. 349)Includes understanding of populations served, environmental factors influencing individuals, and the construction of interventions DRU – phase model designed to direct dissemination of knowledge along with the development, implementation, and adoption of new innovations or programs

DRU

DRU

Definition of Terms Sexual violence : encompasses “a variety of criminal acts, ranging from sexual threats to unwanted contact to rape” (NCVRW, 2013, p. 25). For the purpose of this study, sexual violence refers to sexual assault and rape. Childhood sexual abuse: involvement of children/adolescents with an adult or any person older/bigger where there is difference in age, size, or power, in which child is used as sexual object for gratification of desirePsychological impact: guilt, shame, helplessness, anger, humiliation, fear, difficulties in areas of trust and safety, decreases in self-esteem, depression, self-injury, addiction, PTSD, disempowermentPhysiological impact: “tendency for the brain and body’s nervous system to react in a rapid, extreme, and prolonged manner to stressors” (Ford & Russo, 2006, p. 336)Self-defense : “the act of defending yourself, your property, etc…skills that make you capable of protecting yourself during an attack” (Self-defense, n.d. )

References Ambrosio , P. (1996). Model mugging: How does a women’s self-defense course inform psychotherapy? Dissertation Abstracts International: Section B. Sciences and Engineering, 63(10-B), 4887. Black, M.C., Basile, K.C., Freiding, M. J., Smith, S. G., Walters, M. L., Merrick, M. T., . . . Stevens, M. R. (2011). The national intimate partner and sexual violence survey: 2010 summary report. Retrieved from http://www.cdc.gov/Violence- Prevention/pdf/NISVS_Report2010-a.pdf.Blumer, M. L. C., Papay, A. K., & Erolin, K. S. (2013). Feminist family therapy for treating female survivors of childhood sexual abuse. Journal of Feminist Family Therapy, 25, 65-79. doi : 10.1080/08952833.2013.777871 Brecklin, L. R. (2004). Self-defense/assertiveness training, women’s victimization history, and psychological characteristics . Violence Against Women, 10, 479-497. doi : 10.1177/1077801204264296 Brecklin , L. R., & Ullman, S. E. (2004). Correlates of postassault self-defense/assertiveness training participation for sexual assault survivors. Psychology of Women Quarterly, 28, 147-158. Bryant, R. A., Moulds , M. L., Guthrie, R. M., Dang, S. T., & Nixon, R. D. V. (2003). Imaginal exposure alone and imaginal exposure with cognitive restructuring in treatment of posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 71, 706-712. Cohen , J. N. (2008). Using feminist, emotion-focused, and developmental approaches to enhance cognitive- behavioral therapies for posttraumatic stress disorder related to childhood sexual abuse. Psychotherapy Theory , Research, Practice , Training, 45, 227-246. doi : 10.1037/0033-3204.45.2.227 Dietrich, A. M., Baranowksy , A. B., Devich -Navarro, M., Gentry, J. E., Harris, C. J., & Figley , C. R. (2000). A review of alternative approaches to the treatment of post traumatic sequale . Traumatology, 6, 251-271. Feinstein, D. (2010). Rapid treatment of PTSD: Why psychological exposure with acupoint tapping may be effective . Psychotherapy Theory, Research, Practice , Training, 47, 385-402.

References Finkelhor , D., & Browne, A. (1985). The traumatic impact of child sexual abuse: A conceptualization. American Journal of Orthopsychiatry, 55, 530-541.Foa, E. B., Dancu, C. V., Hembree, E. A., Jaycox, L. H., Meadows, E. A., & Street, G. P. (1999). A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. Journal of Consulting and Clinical Psychology, 67, 194-200. Foa , E. B., Hembree , E. A., Cahill, S. P., Rauch, S. A. M., Riggs, D. S., & Feeny , N. C. (2005). Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73, 953-964 . Foa , E. B., Hembree , E. A., & Rothbaum , B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences. New York , NY: Oxford University Press. Ford , J. D., & Russo, E. (2006). Trauma-focused, present-centered, emotional self-regulation approach to integrated treatment for posttraumatic stress and addiction: Trauma adaptive recovery group education and therapy ( TARGET). American Journal of Psychotherapy, 60, 335-355. Gilgun , J. F., & Sands, R. G. (2012). The contribution of qualitative approaches to developmental intervention research . Qualitative Social Work, 11 , 349-361. doi : 10.1177/1473325012439737 Hebert, M., & Bergeron, M. (2007). Efficacy of a group intervention for adult women survivors of sexual abuse. Journal of Child Sexual Abuse, 16, 37-59 . doi : 10.1300/J070v16n04_03 Herman, J.L. (1992). Trauma and recovery: The aftermath of violence—From domestic to political terror. New York , NY: Basic Books. Hollander, J. A. (2010). Why do women take self-defense classes? Violence Against Women, 16, 459-478. doi : 10.1177/1077801210364029 Keller, S. M., & Zoellner , L. A. (2010). Understanding factors associated with early therapeutic alliance in PTSD treatment: Adherence , childhood sexual abuse history, and social support. Journal of Connsulting and Clinical Psychology, 78, 974-979 . doi : 10.1037/a0020758

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