With the Democratic Republic of Congo plagued by nearly 25 years of conflict and civil war, researchers are hoping to win a different type of battle: for mental health and against mental illness.
Group therapy has significantly helped female survivors of sexual violence deal with depression and posttraumatic-stress disorder in the DRC, according to a groundbreaking study by the International Rescue Committee, Johns Hopkins University, and the University of Washington. “As far as we know, it’s the first such rigorous study of mental-health intervention for sexual violence in lower-income and conflict-affected areas,” said Jeannine Annan, IRC’s director of research and evaluation and a coauthor of the study.
The study found overall trauma symptoms decreased nearly twice as much among sexual-assault survivors of the North and South Kivu provinces who received group therapy compared to those who only received individual counseling.
IRC, which has been involved in the DRC for about 10 years, trains people in the communities to become counselors, countering gender-based violence with such tactics as active listening, as part of a holistic case-management system. When the counselors realized that some women were still not getting better—nightmares or feelings of blame got in the way of their daily life—they recognized something extra needed to be done. So researchers implemented a technique called CPT, or cognitive-processing therapy, which Annan said has also been used with war veterans in the U.S.
The CPT therapy revolved around the idea of “stuck thoughts,” which are irrational perceptions that are linked to an individual’s sexual assault, said Katie Robinette, IRC’s monitoring, evaluation, and research coordinator. For instance, if a woman is raped in her farming field, she sometimes feels like she can no longer work there. Each of the 12 sessions focused on a different topic, such as respect, power, or trust. Therapists would then try to change the way survivors thought about themselves. In turn, Robinette said that the survivors would almost become like therapists for each other and for others in their communities.
After the treatment, only 9 percent of the 405 women from 16 villages who received CPT were still prone to PTSD, depression, or anxiety. In comparison, 42 percent of women who did not participate in the group sessions continued to experience trauma symptoms.
“We chose to do it in a group, mostly because we felt that if it was effective—which it turns out it is—we’d be able to reach more people,” Annan said.
Sexual violence is the norm in the DRC, which was once described by a U.N. official as the “rape capital of the world.” Robinette said the country—particularly the eastern part—has a culture that’s traditionally oppressive toward women. DRC is ranked as the third worst in the world for intimate-partner violence, she said.
“What we see is a lot of sexual violence, while done by armed actors, is also now committed by neighbors and family members,” Annan said.
When women are sexually assaulted in the DRC, the blame is put on them—they are accused of being “too pretty” or even looking at someone too suggestively, Robinette said. Women are viewed as property, and if they are raped, they lose all of their value. They are then shunned or isolated by their family members and community, even if those were the players in the assault. Compounded with poverty, Robinette said that some survivors feel that the stigma and rejection is just as bad, if not worse, than the actual act of sexual violence.
“A lot of times, women feel so isolated within their families, within their communities, they feel like nobody’s going through the same thing as what they’re going through,” Robinette said.
Robinette related one powerful story about a 16-year-old girl who was raped by a relative and gave birth to a little boy. She faced harassment from her own parents, turned to prostitution, and even contemplated killing herself, the perpetrator, and even her own son. The girl told her therapist, “Why would I continue to take care of myself when somebody’s already raped me? Because I have nothing left to save.” But when she was 18, she started CPT therapy and was able to go back to school. A year after that, she became a primary-school teacher.
Even though the success of the CPT therapy is overwhelmingly positive, Robinette said it’s important to note that it’s not for everybody and that it’s not a stand-alone treatment. But the goal is to integrate this therapy into the health system, Annan said. And researchers hope it’ll eventually serve as a model for other areas around the world that are experiencing similar conflict situations.
Robinette said that the mental-health therapy is only one part of the research in the DRC right now. Currently there have also been some positive preliminary findings about an economic experiment called Village Savings and Loan Association. Each week, about 20 to 25 women get together to contribute 10 to 50 cents to a group pot; after it gets to a certain amount, they get loans, which are paid back with interest. After a year, they share out the entire amount of money. Since there are no banks in some villages, this money has been extremely helpful for poverty-stricken women and their families, Robinette said. She is currently collecting the final data for women who’ve participated in both CPT and the savings programs, and she said the outlook seems promising.