An intervention based on cognitive behavioral therapy (CBT) was found to be more effective than traditional therapy in helping women struggling with depression or anxiety after experiencing gender-based violence, research shows. It is estimated that more than a third of women around the world have been exposed to such violence, which includes rape, sexual assault and intimate partner violence.

The intervention, developed by the World Health Organization (WHO) to help anyone facing adversity, had already been proven effective for Pakistanis struggling emotionally after exposure to terrorism.

Psychologist Richard Bryant at the University of New South Wales in Sydney, Australia, developed the program with colleagues there and others from WHO and the World Vision Institute. To test its effectiveness, 421 women in Nairobi, Kenya, were treated with either five sessions of the CBT program administered by a lay health care worker, or were referred to area health care centers for standard treatment administered by nurses.

The nurses had four more years of education than the lay workers, who had no previous experience with mental health care. A program simple enough for lay volunteers to administer is important in areas with little mental health infrastructure.

Reducing symptoms

The study, published Tuesday in PLOS Medicine, found that women who received the CBT treatment showed 20 percent fewer anxious and depressive symptoms five weeks after the end of treatment than the control group, and 45 percent fewer than they did before treatment. Following this work, WHO will begin distributing the treatment more broadly to areas with little mental health infrastructure.

“The vast majority of people in the world don’t get access to evidence-based care for mental health problems,” Bryant told VOA. “So there really is, from a global mental health perspective, an urgent need to have a different way of thinking about how we deliver care. And we can’t be relying on specialists.  We can’t be relying on lengthy sessions, lengthy treatment durations. We can’t be relying on systems that require long trainings to upskill people.”

CBT was developed in the 1970s. Unlike psychoanalysis, which aims to reveal the historical, root causes for a patient’s problems, cognitive behavioral therapists work to reveal thoughts and behaviors that currently contribute to a patient’s troubles.

Bryant said this particular intervention was designed to be as easy to administer as possible, and focuses on changing behavior. The WHO treatment coaches patients to be active, engage in social networks, and problem solve. Bryant said much of the cognitive side of CBT was left out, not only to make it easier to train practitioners, but also to make the intervention shorter. That allows treating more people with less money. Traveling to treatment can be expensive and dangerous in many places, and missing work is costly, so a treatment that requires fewer sessions is beneficial to patients.

Avoiding stigma

One challenge in helping people who have been exposed to gender-based violence is finding them. Rape and abuse carry a heavy stigma, and it can be dangerous for women to speak out.

Consequently, the program wasn’t advertised as being about gender-based violence. Researchers instead looked for women experiencing anxiety and depression. However, during treatment, they found that four out of five participants had experienced some form of gender-based violence — most often from an intimate partner.

“Really, I think what this tells us is that when you go to many of these settings where we know that gender-based violence and other forms of violence are so prevalent, you can actually assist these people — alleviate many of their mental health problems in an effective way — without actually creating the problems of identifying them and exacerbating the social stigma,” Bryant said.

Since the completion of the study in 2015, 1,400 volunteer counselors in Kenya have been trained in CBT, and 3,500 women have received the treatment.

Researchers in Australia have been leaders in CBT, Bryant said. In the early 2000s, researchers at Australian National University developed MoodGYM, free software that allows anyone with an internet connection to receive online CBT treatment at any time.

Numerous studies have shown that patients who complete internet-delivered CBT fare as well as those who receive treatment in person. However, those self-administering CBT without external encouragement are much less likely to complete a full course of treatment.
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