Child sexual abuse CSA is a critical, psychologically traumatic and sometimes life-threatening incident often associated with sequel of adverse physical, behavioral, and mental health consequences.
Factors such as developmental age of the child, severity of abuse, closeness to the perpetrator, availability of medico-legal-social support network and family care, gender stereotypes in the community complicate the psychological trauma. Although the research on the effects of CSA as well as psychological intervention to reduce the victimization and promote the mental health of the child is in its infancy stage in India, the global research in the past three decades has progressed much ahead.
While nonspecific therapies covering a wide variety of outcome variables were prominent till s, the trend changed to specific and focused forms of trauma-focused therapies in next one-and-half decades.
Novel approaches to psychological interventions have also been witnessed.
One intervention non-RCT study on effects on general counseling has been reported from India. Children with sexual abuse undergo sequel of adverse physical, behavioral and mental health consequences which profoundly affect their overall development. However, some of the recent reviews have been published in the past,[ 56 ] focuses on various integrated approaches along with cognitive behavior therapy CBT.
However, there is a dearth of such efficacy studies based on these therapeutic models in Traumagenic sexualization of culture.
Moreover, there has been almost no such specific intervention developed keeping Indian cultural needs in mind. Thus, the aim of this paper is to review the existing reported evidence-based research in this area in last 30 years and to identify the gap exists between intervention studies worldwide and India as to highlight the need in the Indian context.
An electronic search of the articles was undertaken in PubMed from to Marchto include all studies of psychological treatments for children and their families where a child has been sexually abused. The publications that focused only on psychological treatment of child sexual abuse CSA were included in this paper. Titles and abstracts of all potentially relevant articles were reviewed for possible inclusion. Articles were included if:. The articles reporting treatment of abuse in general or those including community or group interventions were not included the study.
Full texts of the identified literature were obtained. The main outcome measure of interest was improvement in the mental health indicators of children with sexual abuse e. Where data was insufficient or not available in the published paper or by contacting authors, studies were excluded from the relevant analysis.
Articles describing the study protocols and dissertations, case reports, case series or reviews "Traumagenic sexualization of culture" the psychological treatment of CSA were also excluded from the analysis. Ten out of a total of identified potentially relevant records were reviews or meta-analysis. A total of 96 studies evaluating the role of psychological interventions in CSA were included in this review. The summary of the process of obtaining the studies for review and its further division are mentioned [ Figure 1 ].
A total of 17 11 studies during and 6 studies during studies evaluating the role of various forms of psychotherapy in CSA with rigorous RCT methodology were included. The characteristics of the studies and participants, results of the quality assessment and key findings are described in the following sections.
As summarized in Table 1 out of 17 studies, 14 studies are solely from the United States, one in Australia, and two in the United Kingdom. The study recruited participants from Traumagenic sexualization of culture variety of sources, mental health practitioners, child protection services, etc. Most studies included in their selection criteria children who experienced sexual abuse recently, which is verified by relevant child protection and youth justice agency.
Children with severe neurodevelopmental disorder, learning disability, psychosis or intellectual disability were excluded. "Traumagenic sexualization of culture" the 17 studies included in the review, five described the method of randomization. Only one study[ 13 ] described masking of therapist's assessment by clinicians.
Risk of selection Traumagenic sexualization of culture also varied across studies. The review reveals that the lowest age at which intervention has Traumagenic sexualization of culture carried out is 2 years[ 1120 ] and the age ranged from 8 to Most of these interventions since the early s adopted integrated therapeutic module where combined counseling sessions for children and parents were the key focus in symptoms reduction.
Some of the major skills that most of these studies have highlighted progressed from rapport building, teaching rules about sexual behavior, identifying stimuli and context that increases risk, explaining cycle of abuse, emotional regulation skills, cognitive coping skills, relaxation, sex education, self-control skills, abuse prevention skills, graded exposure, attachment with parents and caregivers, parent and child management skills, working on self-esteem, shame, fear, sexual urges, arousal, and reconditioning.
Many of these therapies also included components of stress inoculation therapy, group therapy, and family intervention. From onward, however, trend clearly shifted toward utilizing specific CBT framework of child CBT and trauma-focused CBT to teach children new skills of managing their affective, cognitive, and behavioral responses to the traumatic events.
Some of the studies have also utilized various expressive techniques along with supportive counseling techniques. The CBT therapy has been usually augmented with sessions with parents and caregivers on child behavior management skills, supporting them enough and working on building bonding and communication skills between them.
Overall, multidimensional therapy with a flexible and customization approach seemed to be useful in various studies. The average number of "Traumagenic sexualization of culture" to complete the recovery program was 11 with a variation in group or individual intervention format e. The key reason behind the variation may be attributed Traumagenic sexualization of culture the target symptoms and outcomes. Most of the therapy sessions were conducted once weekly for 45 min.
Overall, it took weeks to complete the entire therapeutic program depending upon the nature of therapeutic module utilized. The benefit of intervention has been mostly seen in reduction in PTSD, depression, and other internalizing symptoms.
Aspects of self-appraisal sexualized behavior and externalizing symptoms also show significant improvement. Less therapeutic benefit has been seen in coping skill, caregiver outcome, and social skills and competence.
Although non-RCT studies were not primarily within the purview of this paper, a selected number of studies were considered for inclusion to provide a trend in this regard.