Cognitive-behavioral treatments for couples affected by childhood sexual abuse PDF
Preview Cognitive-behavioral treatments for couples affected by childhood sexual abuse
Pacific University CommonKnowledge School of Graduate Psychology College of Health Professions 4-18-2014 Cognitive-behavioral treatments for couples affected by childhood sexual abuse: An extension of the literature Justin K. Donovan Pacific University Recommended Citation Donovan, Justin K. (2014). Cognitive-behavioral treatments for couples affected by childhood sexual abuse: An extension of the literature (Doctoral dissertation, Pacific University). Retrieved from: http://commons.pacificu.edu/spp/1124 This Dissertation is brought to you for free and open access by the College of Health Professions at CommonKnowledge. It has been accepted for inclusion in School of Graduate Psychology by an authorized administrator of CommonKnowledge. For more information, please contact [email protected]. Cognitive-behavioral treatments for couples affected by childhood sexual abuse: An extension of the literature Abstract Past research regarding cognitive-behavioral therapy (CBT) for childhood sexual abuse (CSA) survivors tended to focus on individual treatments even though it has been suggested that couples therapy may be beneficial or even necessary for CSA survivors in serious relationships. There is empirical support for CBT treatments for couples impacted by several forms of trauma, but past couples research generally neglected specific issues related to CSA. The purpose of this dissertation is to determine how CBT used for CSA survivors may translate into working with CSA survivors seeking couples therapy. Research on CBT for individual CSA survivors and couples impacted by trauma are reviewed and critically analyzed to determine potential adaptability for couples impacted by CSA. A proposed treatment combining findings from research on individual CSA treatments and couples trauma treatments is presented. Degree Type Dissertation Rights Terms of use for work posted in CommonKnowledge. Comments Library Use:LIH This dissertation is available at CommonKnowledge:http://commons.pacificu.edu/spp/1124 Copyright and terms of use If you have downloaded this document directly from the web or from CommonKnowledge, see the “Rights” section on the previous page for the terms of use. If you have received this document through an interlibrary loan/document delivery service, the following terms of use apply: Copyright in this work is held by the author(s). You may download or print any portion of this document for personal use only, or for any use that is allowed by fair use (Title 17, §107 U.S.C.). Except for personal or fair use, you or your borrowing library may not reproduce, remix, republish, post, transmit, or distribute this document, or any portion thereof, without the permission of the copyright owner. [Note: If this document is licensed under a Creative Commons license (see “Rights” on the previous page) which allows broader usage rights, your use is governed by the terms of that license.] Inquiries regarding further use of these materials should be addressed to: CommonKnowledge Rights, Pacific University Library, 2043 College Way, Forest Grove, OR 97116, (503) 352-7209. Email inquiries may be directed to:. [email protected] This dissertation is available at CommonKnowledge:http://commons.pacificu.edu/spp/1124 COGNITIVE-BEHAVIORAL TREATMENTS FOR COUPLES AFFECTED BY CHILDHOOD SEXUAL ABUSE: AN EXTENSION OF THE LITERATURE A DISSERTATION SUBMITTED TO THE FACULTY OF SCHOOL OF PROFESSIONAL PSYCHOLOGY PACIFIC UNIVERSITY HILLSBORO, OREGON BY JUSTIN K. DONOVAN IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PSYCHOLOGY APRIL 18, 2014 Abstract Past research regarding cognitive-behavioral therapy (CBT) for childhood sexual abuse (CSA) survivors tended to focus on individual treatments even though it has been suggested that couples therapy may be beneficial or even necessary for CSA survivors in serious relationships. There is empirical support for CBT treatments for couples impacted by several forms of trauma, but past couples research generally neglected specific issues related to CSA. The purpose of this dissertation is to determine how CBT used for CSA survivors may translate into working with CSA survivors seeking couples therapy. Research on CBT for individual CSA survivors and couples impacted by trauma are reviewed and critically analyzed to determine potential adaptability for couples impacted by CSA. A proposed treatment combining findings from research on individual CSA treatments and couples trauma treatments is presented. Key Words: childhood sexual abuse, couples therapy, cognitive-behavioral therapy, sexual trauma, cognitive-processing therapy, cognitive-behavioral couple therapy ii Acknowledgments The long and challenging experience of completing my dissertation would not have been possible without the wisdom, expertise, and support of many loved ones and colleagues. I would like to express my sincere gratitude to those who have made my journey possible. To Dr. Lisa Christiansen, my dissertation chair, thank you for all of your knowledge, patience, and encouragement throughout this process. To Dr. Jon Frew, you have been very influential in my development as a clinician, including being my clinical supervisor in two separate years that have helped me tailor my personal style and approach to therapy. To Dr. Phi Loan Le and Dr. Susana Salgado, the training and encouragement each of you provided during my pre-doctoral internship have been necessary to my development as a professional and will continue to stay with me throughout my career. To Jerry and Susan Donovan, my parents, thank you for your continued and unconditional love, support, and wisdom throughout all of my graduate school training, as well as everything you have done to help me achieve a happy and successful life. To Deirdre Silcott, thank you for all of your love and support that has made completing this difficult task much easier. Finally, thanks to my friends, family, and all others who have supported me throughout this process and throughout my life. iii TABLE OF CONTENTS Page ABSTRACT..................................................................................................................ii ACKNOWLEDGMENTS...........................................................................................iii INTRODUCTION AND SELECTED REVIEW OF THE LITERATURE .................1 Psychological Effects of Childhood Sexual Abuse...............................................1 Cognitive-Behavior Therapy for CSA...................................................................2 Relationship Problems and CSA............................................................................4 CBT Treatment for Couples...................................................................................6 Couples Therapy and CSA.....................................................................................8 Purpose of Review...............................................................................................10 METHOD....................................................................................................................11 LITERATURE REVIEW............................................................................................12 Individual Treatments for Trauma......................................................................12 Mind-body practices..................................................................................12 Eye-movement desensitization and reprocessing......................................14 Stress inoculation training..........................................................................20 Prolonged exposure....................................................................................23 Skills training in affect and interpersonal regulation.................................27 Cognitive restructuring..............................................................................32 Cognitive-processing therapy....................................................................39 Imagery rescripting....................................................................................44 Exposure, relaxation, and rescripting.........................................................47 Psychoeducation........................................................................................48 iv Summary....................................................................................................50 Couples Treatments............................................................................................50 TBCT vs IBCT...........................................................................................50 Cognitive-behavioral couple therapy.........................................................53 Behavioral family therapy..........................................................................56 Rational emotive behavior therapy............................................................59 Mind-body practices..................................................................................62 Eye-movement desensitization and reprocessing......................................66 Stress inoculation training..........................................................................67 Summary....................................................................................................70 ADAPTATION CONSIDERATIONS........................................................................71 General Challenges.............................................................................................71 Gender.................................................................................................................73 Treatments and Interventions..............................................................................75 Mind-body practices..................................................................................75 Eye-movement desensitization and reprocessing......................................76 Stress inoculation training..........................................................................79 Prolonged exposure....................................................................................82 Skills training in affect and interpersonal regulation.................................87 Cognitive restructuring..............................................................................88 Cognitive-processing therapy....................................................................91 Imagery rescripting....................................................................................92 Exposure, relaxation, and rescripting.........................................................94 v Traditional behavioral couples therapy......................................................95 Integrative behavioral couples therapy......................................................98 Cognitive-behavioral couple therapy.......................................................100 Proposed Treatment..........................................................................................101 DISCUSSION............................................................................................................110 Limitations and Future Research......................................................................113 Conclusion........................................................................................................114 REFERENCES..........................................................................................................116 APPENDIXES...........................................................................................................131 vi Introduction and Selected Review of the Literature Childhood sexual abuse (CSA) can create many difficulties throughout life, including social, psychological, and relationship issues in adulthood (Beitchman et al., 1992; Colman, & Spatz Widom, 2004; Fleming, Mullen, Sibthorpe, & Bammer, 1999). While cognitive-behavioral therapy (CBT) has been found to be effective in treating individuals who have experienced CSA (Cloitre, Koenen, Cohen, & Han, 2002; McDonagh et al., 2005), and CBT has also been demonstrated to be effective in treating couples (Baucom, Shoham, Mueser, Daiuto, & Stickle, 1998; Dattilio, 2010), very few studies have examined the potential for CBT as an intervention modality for couples in which one partner is a CSA survivor. Given that many of the common issues that arise from CSA are likely to impact one’s relationships, it follows logically that such issues may be most effectively treated in a couple’s therapy setting. This paper will explore the utility of modifying existing CBT couples therapy interventions and CBT individual interventions for CSA to create a CBT treatment modality for use in couples in which CSA has impacted the relationship. Psychological Effects of Childhood Sexual Abuse Psychological disorders that are associated with CSA include depression, substance-use disorders, eating disorders, and anxiety disorders, particularly posttraumatic stress disorder (PTSD; Rodriguez, Ryan, Vande Kemp, & Foy, 1997). Other maladjustment issues that may arise are low self-esteem (Romans, Martin, & Mullen, 1996), fear and shame (Beitchman et al., 1992), suicidal ideation and attempts (Mullen, Anderson, Romans, & Herbison, 1993), increased likelihood of physical and sexual abuse as an adult (Fromuth, 1986), and sexual dysfunctions (Mullen, Martin, Anderson, Romans, & Herbison, 1994). The effects of CSA are particularly 1
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