Karin Wachter

Controlled Trial of Psychotherapy for Congolese Survivors of Sexual Violence

BACKGROUND Survivors of sexual violence have high rates of depression, anxiety, and post-traumatic stress disorder (PTSD). Although treatment for symptoms related to sexual violence has been shown to be effective in high-income countries, evidence is lacking in low-income, conflict-affected countries. METHODS In this trial in the Democratic Republic of Congo, we randomly assigned 16 villages to provide cognitive processing therapy (1 individual session and 11 group sessions) or individual support to female sexual-violence survivors with high levels of PTSD symptoms and combined depression and anxiety symptoms. One village was excluded owing to concern about the competency of the psychosocial assistant, resulting in 7 villages that provided therapy (157 women) and 8 villages that provided individual support (248 women). Assessments of combined depression and anxiety symptoms (average score on the Hopkins Symptom Checklist [range, 0 to 3, with higher scores indicating worse symptoms]), PTSD symptoms (average score on the PTSD Checklist [range, 0 to 3, with higher scores indicating worse symptoms]), and functional impairment (average score across 20 tasks [range, 0 to 4, with higher scores indicating greater impairment]) were performed at baseline, at the end of treatment, and 6 months after treatment ended. RESULTS A total of 65% of participants in the therapy group and 52% of participants in the individual-support group completed all three assessments. Mean scores for combined depression and anxiety improved in the individual-support group (2.2 at baseline, 1.7 at the end of treatment, and 1.5 at 6 months after treatment), but improvements were significantly greater in the therapy group (2.0 at baseline, 0.8 at the end of treatment, and 0.7 at 6 months after treatment) (P<0.001 for all comparisons). Similar patterns were observed for PTSD and functional impairment. At 6 months after treatment, 9% of participants in the therapy group and 42% of participants in the individual-support group met criteria for probable depression or anxiety (P<0.001), with similar results for PTSD. CONCLUSIONS In this study of sexual-violence survivors in a low-income, conflict-affected country, group psychotherapy reduced PTSD symptoms and combined depression and anxiety symptoms and improved functioning. (Funded by the U.S. Agency for International Development Victims of Torture Fund and the World Bank; ClinicalTrials.gov number, NCT01385163.).

The Effect of Cognitive Therapy on Structural Social Capital: Results From a Randomized Controlled Trial Among Sexual Violence Survivors in the Democratic Republic of the Congo

OBJECTIVES We evaluated changes in social capital following group-based cognitive processing therapy (CPT) for female survivors of sexual violence. METHODS We compared CPT with individual support in a cluster-randomized trial in villages in South Kivu province, Democratic Republic of the Congo. Local psychosocial assistants delivered the interventions from April through July 2011. We evaluated differences between CPT and individual support conditions for structural social capital (i.e., time spent with nonkin social network, group membership and participation, and the size of financial and instrumental support networks) and emotional support seeking. We analyzed intervention effects with longitudinal random effects models. RESULTS We obtained small to medium effect size differences for 2 study outcomes. Women in the CPT villages increased group membership and participation at 6-month follow-up and emotional support seeking after the intervention compared with women in the individual support villages. CONCLUSIONS Results support the efficacy of group CPT to increase dimensions of social capital among survivors of sexual violence in a low-income conflict-affected context.

Unsettled integration: Pre- and post-migration factors in Congolese refugee women’s resettlement experiences in the United States

By 2019, the United States plans to resettle approximately 50,000 refugees from the Democratic Republic of the Congo. The purpose of this study was to identify and understand the challenges, risks, and strengths of adult Congolese refugee women resettled in the United States to help policymakers, service providers, and other stakeholders prepare for the arrival of Congolese women and their families. Researchers conducted in-depth interviews and focus groups with Congolese refugee women (n = 28) and resettlement service providers (n = 29) in three US cities. The findings of this study reveal the complex and dynamic nature of Congolese refugee women’s resettlement experiences in the United States and highlight the importance of recognizing the intersection of pre- and post-migration factors during resettlement. This article offers concrete implications for the social work profession and practitioners.

Writing a Good Peer Review to Improve Scholarship: What Editors Value and Authors Find Helpful

The above quotes were recently published in Buzzfeed (Oakes, 2014), an online media and technology company, and ostensibly were culled from actual peer reviews published on another website. As is the case with much content on the Internet, it’s hard to determine if these are fabricated or real. Nonetheless, despite the intended humor for the general public, they clearly demonstrate the type of mean-spirited review comments that are not helpful to authors or editors. With increasing demands for faculty to publish in top ranked journals, editors continually are faced with the challenge of selecting high quality manuscripts that not only meet the specific criteria for their journals, but also retain or raise their journal’s prestige. The peer review process plays an indispensable role in these decisions and editors base their final decision on their reviewer’s comments combined with their own expertise, assessment, and judgment. In a 2009 large-scale international peer review survey of over 4,000 authors and reviewers, the study found that most respondents valued the peer review process and deemed it to be essential, and almost all researchers believed that the peer review process improved the quality of their papers. The vast majority of reviewers enjoyed not only reading other scholars ’ works, but also appreciated the ability to help authors improve their manuscripts. Notably, they also saw this as an important role as a member of the academic community and were committed to conducting reviews in the future. However, they also noted that in order to improve the peer review process, the training of new reviewers was needed (Mulligan, Hall, & Raphael, 2013). Although most journals provide specific guidelines for reviewers, in general, there is little or no mentorship when faculty are selected to conduct peer reviews. Although

Drivers of Intimate Partner Violence Against Women in Three Refugee Camps

This qualitative study examined the “drivers” of intimate partner violence (IPV) against women in displacement to identify protective factors and patterns of risk. Qualitative data were collected in three refugee camps in South Sudan, Kenya, and Iraq (N = 284). Findings revealed interrelated factors that triggered and perpetuated IPV: gendered social norms and roles, destabilization of gender norms and roles, men’s substance use, women’s separation from family, and rapid remarriages and forced marriages. These factors paint a picture of individual, family, community and societal processes that exacerbate women’s risk of IPV in extreme conditions created by displacement. Implications for policy and practice are indicated.

The impact of Cognitive Processing Therapy on stigma among survivors of sexual violence in eastern Democratic Republic of Congo: results from a cluster randomized controlled trial

BackgroundSexual violence is associated with a multitude of poor physical, emotional, and social outcomes. Despite reports of stigma by sexual violence survivors, limited evidence exists on effective strategies to reduce stigma, particularly in conflict-affected settings. We sought to assess the effect of group Cognitive Processing Therapy (CPT) on stigma and the extent to which stigma might moderate the effectiveness of CPT in treating mental health problems among survivors of sexual violence in the Democratic Republic of Congo.MethodsData were drawn from 405 adult female survivors of sexual violence reporting mental distress and poor functioning in North and South Kivu. Women were recruited through organizations providing psychosocial support and then cluster randomized to group CPT or individual support. Women were assessed at baseline, the end of treatment, and again six months later. Assessors were masked to women’s treatment assignment. Linear mixed-effect regression models were used to estimate (1) the effect of CPT on feelings of perceived and internalized (felt) stigma, and (2) whether felt stigma and discrimination (enacted stigma) moderated the effects of CPT on combined depression and anxiety symptoms, posttraumatic stress, and functional impairment.ResultsParticipants receiving CPT experienced moderate reductions in felt stigma relative to those in individual support (Cohen’s D = 0.44, p = value = 0.02) following the end of treatment, though this difference was no longer significant six-months later (Cohen’s D = 0.45, p = value = 0.12). Neither felt nor enacted stigma significantly moderated the effect of CPT on mental health symptoms or functional impairment.ConclusionsGroup cognitive-behavioral based therapies may be an effective stigma reduction tool for survivors of sexual violence. Experiences and perceptions of stigma did not hinder therapeutic effects of group psychotherapy on survivors’ mental health.Trial registrationClinicalTrials.gov NCT01385163.

From the Editor—Writing a Good Peer Review to Improve Scholarship: What Editors Value and Authors Find Helpful

As is the case with much content on the Internet, it is hard to determine whether these are fabricated or real. Nonetheless, despite the intended humor for the general public, they clearly demonstrate the type of mean-spirited review comments that are not helpful to authors or editors. With increasing demands for faculty to publish in top-ranked journals, editors continually are faced with the challenge of selecting high-quality manuscripts that not only meet the specific criteria for their journals but also retain or raise their journal’s prestige. The peer-review process plays an indispensable role in these decisions, and editors base their final decisions on their reviewers’ comments combined with their own expertise, assessment, and judgment. A 2009 large-scale international peer-review survey of more than 4,000 authors and reviewers found that most respondents valued the peer-review process and deemed it to be essential, and almost all researchers believed that the peer-review process improved the quality of their papers. The vast majority of reviewers not only enjoyed reading other scholars’ works but also appreciated the ability to help authors improve their manuscripts. Notably, they also saw this as an important role as a member of the academic community and were committed to conducting reviews in the future. However, they also noted that to improve the peer review process, the training of new reviewers was needed (Mulligan, Hall, & Raphael, 2013). Although most journals provide specific guidelines for reviewers, in general there is little or no mentorship when faculty are selected to conduct peer reviews. Although some may be fortunate to learn from colleagues or mentors, it is not uncommon for new reviewers to simply learn on their own by conducting reviews. By and large, there are some fairly standard criteria that most editors look for in a review, and you will see some of these common themes reflected here. However, because there is variation across journals in focus and scope, I have invited the editors (or immediate past editors) of Social Work Education: The International Journal, Social Work, Families in Society: The Journal of Contemporary Social Services, Affilia: The Journal of

Social support under siege: An analysis of forced migration among women from the Democratic Republic of Congo

In 2016, researchers conducted a qualitative study in a mid-sized town in the United States to address gaps in research and practice related to psychosocial consequences of forced migration among women. The loss of social support and its impacts on the well-being of women are rarely addressed in refugee resettlement policy or practice overwhelmingly concerned with economic self-sufficiency. The study sought to develop theory to explain how women (n = 27) who migrated from the Democratic Republic of the Congo recreate social support post-resettlement in the United States. An interpretive approach informed by postcolonial feminist perspectives guided the grounded theory methodology. A theoretical model emerged explaining pivots in the internal and relational lives of women as social support systematically constricted over time as a result of war, displacement, and resettlement. Upon arrival to the United States, women experienced partitioned lives through changing relationships to space and time, which contributed to women being alone and impacted well-being. Converging processes propelled women towards learning to stand alone, through which women could develop a sense self-reliance, but not without internal and relational consequences. The analysis contributes to the empirical literature knowledge of how resettlement is a life altering event that sets into motion psychosocial processes with implications for well-being and health. Implications for practice and future research are discussed.

Stigma modifies the association between social support and mental health among sexual violence survivors in the Democratic Republic of Congo: implications for practice

ABSTRACT Background and Objectives: The aim of this study was to further understanding of the relationship between social support, internalized and perceived stigma, and mental health among women who experienced sexual violence in the eastern Democratic Republic of Congo (DRC). Methods: Drawing from baseline survey data collected in eastern DRC, researchers conducted a secondary cross-sectional analysis using data from 744 participants. Regression and moderation analyses were conducted to examine associations between social support variables, felt stigma, and depression, anxiety and posttraumatic stress disorder (PTSD). Results: Emotional support seeking and felt stigma were positively associated with increased symptom severity across all three mental health variables. Stigma modified associations between emotional support seeking and depression (t = −2.49, p = .013), anxiety (t = −3.08, p = .002), and PTSD (t = −2.94, p = .003). Increased frequency of emotional support seeking was associated with higher mental health symptoms of anxiety and PTSD among women experiencing all levels of stigma. Conclusions: Enhancing understanding of social support and stigma may inform research and intervention among Congolese forced migrant populations across circumstances and geographic locations. Implications for practice and research are discussed.

Centering Subjectivities: Theoretical Considerations for Practice With Women in Forced Migration

Postcolonial feminist and African diaspora theories provide lenses through which to consider the impacts of forced migration on the internal and relational lives of women—aspects of experience less visible in policy, practice, and scholarship. Policy, practice, and research contribute to the framing of “refugees” as a static category of people irrespective of complex histories, geopolitical origins, and fluid identities impacted by structural forces. They can thus deny the subjective possibilities of women through the construction of identities that informs who refugees are and who they are expected to become. These overarching trends reflected in policy and practice have particular implications for women whose internal and relational processes remain to a large extent invisible. Drawing from postcolonial feminist and African diaspora theories, this article suggests that a practice of centering the subjectivities of women in forced migration may enhance the work of researchers and practitioners.