Emory Report

April 10, 2000

 Volume 52, No. 28

Study compares rape psychotherapy treatments


The therapist holds up a finger in front of the woman's face, rhythmically moving it back and forth like a brisk pendulum. The woman's eyes follow the finger, left, right, left, right, and she begins to speak about the night she was raped.

Another woman, after having told her therapist in detail about her sexual assault, is given a tape recording of the conversation and told to take it home and listen to it repeatedly. She also has another task, possibly something as simple as putting on clothes she has avoided wearing since her attack.

These methods of treating women suffering rape-related posttraumatic stress disorder (PTSD) are under study by Emory psychologists Barbara Rothbaum and Millie Astin. The ongoing project compares the two methods--eye movement desensitization and reprocessing, and prolonged exposure therapy--to determine which may produce results more quickly and with more prolonged effectiveness.

Eye movement desensitization and reprocessing is based on the theory that back-and-forth, "saccadic" eye movement while thinking of a traumatic memory is key to the processing and reprocessing of that memory. The same type of eye motion occurs during the rapid eye movement (REM) portion of sleep.

"When we're in REM sleep, we're dreaming, and we process a lot of emotional material in our dreams," explained Rothbaum, the study's principal investigator. An associate professor of psychiatry and behavioral sciences in the School of Medicine, Rothbaum is director of the newly established Trauma and Anxiety Recovery Program.

During a session involving eye movement desensitization and reprocessing, a patient is told to think back to her assault and focus on some aspect of the experience. As she expresses the feelings and mental images that arise, she follows the therapist's moving finger with her eyes. The hope is that the disturbing images eventually will fade and become less intrusive.

Prolonged exposure therapy, by comparison, requires people to directly confront their memories of a traumatic episode by talking about the event over and over again. People also learn to deal with feelings or situations they have avoided since the trauma because of some painful association.

"The way to get over it is through the pain," Rothbaum said. "There's no way around the pain."

One of PTSD's hallmark symptoms is avoiding memories of the traumatic event, according to Astin, an assistant professor of psychiatry and behavioral sciences and the study's project coordinator. "But [confronting the memory is] exactly what you need to do to get better," she added. "A lot of the people we see are many years past the trauma. They've coped by not thinking about it."

Women receiving prolonged exposure therapy in the study work with therapists to develop a list of things they avoid because they are tainted by the memory of their assault. The list is ranked according to the intensity of emotions each item evokes and how difficult it might be to confront these feelings.

"We start with the easier items and keep moving up the list until they can do what they need to do in life," Rothbaum said.

The treatment duration is relatively brief: nine 90-minute sessions. But this short-term therapy has shown great results, according to Rothbaum. "Most people tell us their PTSD symptoms decrease," she said. "They're not as bothered by the memory of the event; they don't have as much anxiety; they're sleeping better."

In some cases, women who previously blamed themselves for their sexual assault may change their perspective. "They'll think, 'I did the best I could,'" Rothbaum said.

Rothbaum and Astin still are enrolling volunteers for the study, which is funded by the National Institute of Mental Health. Eligible participants must be over 18 and have experienced sexual assault or sex against their will. They must be at least three months past the assault, and it can have occurred many years ago. Women accepted into the program will receive nine psychotherapy sessions over five weeks at no charge.

Women interested in participating may contact Astin at 404-778-2206.

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