Prevalence of posttraumatic stress disorder (PTSD) among rape victims and war refugees is high. Cognitive-behavioral interventions have demonstrated effectiveness in alleviating PTSD in rape survivors. Effectiveness of such interventions when rape is perpetrated as part of war hostilities has not been examined. Rape and plunder of civilian populations characterized the 1991 to 1995 war in the former Yugoslavia. Rape camps terrorized civilians on all sides of that conflict. This case study illustrates a course of cognitive-behavioral treatment for PTSD with a female, Bosnian refugee and rape survivor. At post treatment, the client no longer met criteria for PTSD, and improvements were evident at 6- and 12-month follow-ups. Approaches to treating PTSD in war refugees are discussed.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
2.
Arcel, L. T., Folnegovic-Smalc, V., Kozaric-Kovacic, D., & Marusic, A. (1995). Psycho-social help to war victims: Women refugees and their families from Bosnia and Herzegovina and Croatia. Copenhagen, Denmark: International Rehabilitation Council for Torture Victims.
3.
Beck, A. T. (1964). Thinking and depression: II. Theory and therapy. Archives of General Psychiatry, 10, 561-571.
4.
Beck, A. T., & Emery, G. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books.
5.
Breslau, N., Kessler, R. C., Chilcoat, H. D., Schultz, L. R., Davis, G. C., & Andreski, P. (1998). Trauma and posttraumatic stress disorder in the community: The 1996 Detroit area survey of trauma. Archives of General Psychiatry, 55, 626-632.
6.
Carlsson, E. B., & Rosser-Hogan, R. (1991). Trauma experiences, posttraumatic stress, dissociation, and depression in Cambodian refugees. American Journal of Psychiatry, 148, 1548-1551.
7.
Cernovsky, Z. Z. (1987). Repetitive escape nightmares of refugees. Psychological Reports, 65, 895-898.
8.
Cernovsky, Z. Z. (1990). Escape stress, sleep disorders, and assimilation in refugees. Social Behavior & Personality, 18(2), 287-297.
9.
Chemtob, C., Roitblat, H. L., Hamada, R. S., Carlson, J. G., & Twentyman, C. T. (1988). A cognitive action theory of post-traumatic stress disorder. Journal of Anxiety Disorders, 2, 253-275.
10.
Comision de derechos humanos de El Salvador-CDHS. (1986). La Tortura en El Salvador, Penal “La Esperanza.”San Salvador, El Salvador: Ayutuxtepeque.
11.
Dahl, S. (1993). Rape—a hazard to health. Oslo, Norway: Scandinavian University Press.
12.
Feeny, N. C., Zoellner, L. A., Fitzgibbons, L. A., & Foa, E. B. (2000). Exploring the roles of emotional numbing, depression, and dissociation in PTSD. Journal of Traumatic Stress, 13(3), 489-498.
13.
Foa, E. B., & Meadows, E. A. (1997). Psychosocial treatments for post-traumatic stress disorder: A critical review. In J. Spence, J. M. Darley, & D. J. Foss (Eds.), Annual Review of Psychology (Vol. 48, pp. 449-480). Palo Alto, CA: Annual Reviews.
14.
Foa, E. B., Riggs, D. S., Dancu, D. B., & Rothbaum, B. O. (1993). Reliability and validity of a brief instrument for assessing posttraumatic stress disorder. Journal of Traumatic Stress, 6, 459-473.
15.
Foa, E. B., & Rothbaum, B. O. (1998). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD. New York: Guilford.
16.
Foa, E. B., Rothbaum, B. O., Riggs, D. S., & Murdock, T. B. (1991). Treatment of post-traumatic stress disorder in rape victims: A comparison between cognitive-behavioral procedures and counseling. Journal of Consulting and Clinical Psychology, 59, 715-723.
17.
Foa, E. B., Rothbaum, B. O., & Steketee, G. S. (1993). Treatment of rape victims. Journal of Interpersonal Violence, 8(2), 256-276.
18.
Foa, E. B., Steketee, G., & Rothbaum, B. O. (1989). Behavioral/cognitive conceptualizations of post-traumatic stress disorder. Behavior Therapy, 20, 155-176.
19.
Forbes, D., Phelps, A., & McHugh, T. (2001). Treatment of combat-related nightmares using imagery rehearsal: A pilot study. Journal of Traumatic Stress, 14(2), 433-442.
20.
Green, B. L. (1990). Defining trauma: Terminology and generic stressor dimensions. Journal of Applied Social Psychology, 20(20), 1632-1642.
21.
Hartmann, E. (1996). Who develops PTSD nightmares and who doesn’t. In D. Barrett (Ed.), Trauma and Dreams (pp. 101-113). Cambridge, MA: Harvard University Press.
22.
Hauff, E., & Vaglum, P. (1994). Chronic posttraumatic stress disorder in Vietnamese refugees: A prospective community study of prevalence, course, psychopathology, and stressors. Journal of Nervous and Mental Disease, 182, 85-90.
23.
Horowitz, M. J. (1976). Stress response syndromes. New York: Jason Aronson.
24.
Horowitz, M. J. (2000). Stress response syndromes: Treatment manual. Unpublished manuscript.
25.
Husni, M., Cernovsky, Z. Z., Koye, N., & Haggarty, J. (2001). Nightmares of refugees from Kurdistan. Journal of Nervous and Mental Disease, 189(9), 557-559.
26.
Janoff-Bulman, R. (1992). Shattered assumptions: Towards a new psychology of trauma. New York: Free Press.
27.
Jones, J. C., & Barlow, D. H. (1990). The etiology of posttraumatic stress disorder. Clinical Psychology Review, 10, 299-328.
28.
Jukic, V., Sumic, J. C., Brecic, P., & Muzinic-Masle, L. (1999). Sleep disturbances and nightmares as symptoms of posttraumatic stress disorder. Psychiatria Danubina, 11(1-2), 13-17.
29.
Kellner, R., Neidhardt, J., Krakow, B., & Pathak, D. (1992). Changes in chronic nightmares after one session desensitization or rehearsal instructions. American Journal of Psychiatry, 149(5), 659-663.
30.
Kimble, M. O., Riggs, D. S., & Keane, T. M. (1998). Cognitive-behavioural treatment for complicated cases of post-traumatic stress disorder. In N. Tarrier, A. Wells, & G. Haddock (Eds.), Treating complex cases: The cognitive behavioural therapy approach (pp. 105-130). New York: John Wiley.
31.
Krakow, B., Hollifield, M., Johnston, L., Koss, M., Schrader, R., Warner, T. D., et al. (2001). Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder. Journal of the American Medical Association, 286(5), 537-545.
32.
Krakow, B., Hollifield, M., Schrader, R., Koss, M., Tandberg, D., Lauriello, J., et al. (2000). A controlled study of imagery rehearsal for chronic nightmares in sexual assault survivors with PTSD: A preliminary report. Journal of Traumatic Stress, 13(4), 589-609.
33.
Marks, I. (1978). Rehearsal relief of a nightmare. British Journal of Psychiatry, 133, 461-465.
34.
Marks, I., Lovell, K., Noshirvani, H., Livanou, M., & Thrasher, S. (1998). Treatment of post traumatic stress disorder by exposure and/or cognitive restructuring. Archives of General Psychiatry, 55, 317-325.
35.
McCann, I. L., & Pearlman, L. A. (1990). Psychological trauma and the adult survivor: Theory, therapy, and transformation. New York: Brunner/Mazel.
36.
McCann, I. L., Sakheim, D. K., & Abrahamson, D. J. (1988). Trauma and victimization: A model of psychological adaptation. The Counseling Psychologist, 16, 531-594.
37.
Meichenbaum, D. (1994). A clinical handbook/practical therapist manual for assessing and treating adults with post-traumatic stress disorder (PTSD). Waterloo, Canada: Institute Press.
38.
Mollica, R. F., Wyshak, G., & Lavelle, J. (1987). The psycho-social impact of war trauma and torture on Southeast Asian refugees. American Journal of Psychiatry, 144(12), 1567-1572.
39.
Nygard, M., & Malterud, K. (1995). Rapid screening for post-traumatic stress disorder among Bosnian war refugees. Tidsskrift for den Norske Legeforening, 115, 1971-1974.
40.
Paunovic, N., & Öst, L.-G. (2001). Cognitive-behavior therapy vs exposure therapy in the treatment of PTSD in refugees. Behaviour Research and Therapy, 39, 1183-1197.
41.
Resick, P. A. (1990). Victims of sexual assault. In A. J. Lurigio, W. G. Sokgan, & R. C. Davis (Eds.), Victims of crime: Problems, policies and programs (pp. 69-86). Newbury Park, CA: Sage.
42.
Resick, P. A. (2001). Stress and trauma. Philadelphia: Taylor & Francis.
43.
Resick, P. A., & Schnicke, M. K. (1993). Cognitive processing therapy for rape victims: A treatment manual. Newbury Park, CA: Sage.
44.
Ross, R. J., Ball, W. A., Sullivan, K. A., & Caroff, S. N. (1989). Sleep disturbance as the hallmark of post-traumatic stress disorder. American Journal of Psychiatry, 146, 697-707.
45.
Rothbaum, B. O., Foa, E. B., Riggs, D. S., Murdock, T., & Walsh, W. (1992). A prospective examination of post-traumatic stress disorder in rape victims. Journal of Traumatic Stress, 5(3), 455-475.
46.
Rothbaum, B. O., Meadows, E. A., Resick, P. A., & Foy, D. W. (2000). Cognitive-behavioral therapy. In E. B. Foa, T. M. Keane, & M. J. Friedman (Eds.), Effective treatments for PTSD (pp. 60-83, 320-325). New York: Guilford.
47.
Rothbaum, B. O., & Mellman, T. A. (2001). Dreams and exposure therapy in PTSD. Journal of Traumatic Stress, 14(3), 481-490.
48.
Rozee, P. D., & Van Boemel, G. (1989). The psychological effects of war trauma and abuse on older Cambodian refugee women. Women & Therapy, 8(4), 23-50.
49.
Somnier, F. E., & Genefke, I. K. (1986). Psychotherapy for victims of torture. British Journal of Psychiatry, 149, 323-329.
50.
Suarez-Orozco, M. M., & Robben, A. C. G. M. (2000). Interdisciplinary perspectives on violence and trauma. In A.C.G.M. Robben & M. M. Suarez-Orozco(Eds.), Cultures under siege: Collective violence and trauma (pp. 1-41). New York: Cambridge University Press.
51.
United Nations, Economic and Social Council (1994). Commission on human rights: Situation of human rights in the territory of the former Yugoslavia, 100. Geneva, Switzerland: Author.
52.
van der Kolk, B., Blitz, R., Burr, W., Sherry, S., & Hartmann, E. (1984). Nightmares and trauma: A comparison of nightmares after combat with lifelong nightmares in veterans. American Journal of Psychiatry, 141, 187-190.
53.
Weaver, T. L., & Clum, G. A. (1995). Psychological distress associated with interpersonal violence: A meta-analysis. Clinical Psychology Review, 15, 115-140.
54.
Weine, S. M., Becker, D. F., McGlashan, T. H., Laub, D., Sazrove, S., Vojvoda, D., et al. (1995). Psychiatric consequences of “ethnic cleansing”: Clinical assessments and trauma testimonies of newly resettled Bosnian refugees. American Journal of Psychiatry, 152(4), 536-542.
55.
Weine, S. M., Becker, D. F., Vojvoda, D., Hodzic, E., Sawyer, M., Hyman, L., et al. (1998). Individual change after genocide in Bosnian survivors of “ethnic cleansing”: Assessing personality dysfunction. Journal of Traumatic Stress, 11(1), 147-152.
56.
Weine, S. M., Kulenovic, A. D., Pavkovic, I., & Gibbons, R. (1998). Testimony psychotherapy in Bosnian refugees: A pilot study. American Journal of Psychiatry, 155, 1720-1726.
