Degree Date

2014

Degree

Doctor of Philosophy (PhD)

Department

Social Work and Social Research

Abstract

Childhood sexual abuse is a significant social issue that impacts individuals across racial, cultural, gender, and socioeconomic identities (Feiring, Simon, & Cleland, 2009). When these impacted individuals reach adulthood, they are at increased risk for a number of problematic mental health, physical health, and interpersonal outcomes. A variety of counseling options exist for adult survivors; however, research is inconclusive as to which treatment orientations are most effective for this population. This study, which consists of a systematic review, series of pairwise meta-analyses, moderator analyses, and network meta-analyses, investigates the comparative effectiveness of various treatments for adults who experienced sexual abuse as children.

Over 17,000 studies were screened for pre-determined eligibility criteria, resulting in the identification of a total of 38 reports from 18 independent, eligible studies. Data were extracted from these studies using a uniform process, and outcomes were used in a series of analyses. The results of the pairwise meta-analyses indicated that psychosocial treatment was more effective than a no contact waitlist condition for the treatment of PTSD, depression, anxiety, and dissociation. Treatment was also associated with a reduction in depression symptoms when compared to minimal attention; other meta-analyses that compared treatment to minimal attention were underpowered.

The network meta-analyses examining the comparative effectiveness of specific treatments were underpowered and likely biased. The network analyses examining treatments that placed a greater emphasis on trauma experiences versus those that placed a greater emphasis on present problems were more informative though still underpowered. The results suggest that trauma-centered approaches may work best for PTSD symptoms while more present-focused approaches may be more effective for depression.

Ultimately, this dissertation highlights a number of important directions for future research, including increasing the quality and quantity of primary studies on this population; creating standardized treatment categories; exploring specific subpopulations of survivors including men, incarcerated individuals, and survivors of multi-type maltreatment; and more consistently measuring client and treatment characteristics in primary studies.

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