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A type of talk therapy that has helped many American veterans overcome post-traumatic stress disorder can help rape victims in the developing world overcome the shame, depression and fear brought on by sexual assault, according to a study from the University of Washington and Johns Hopkins University.

The researchers worked with more than 400 women who had been assaulted — some multiple times — in the Democratic Republic of Congo (DRC). During decades of civil war, sexual violence has become a weapon of terror wielded by rebels and government soldiers. In some areas, as many as four out of 10 women have been attacked, leading the United Nations to brand Congo as the rape capital of the world.

Victims are often shunned and rejected by their husbands and families, said UW clinical psychologist Debra Kaysen. The women who participated in the study suffered from anxiety, depression and nightmares, and many were afraid to leave their homes and unable to care for themselves or their children.

But six months after participating in a dozen sessions of what’s called cognitive-processing therapy, more than 90 percent of the women no longer met the criteria for PTSD, depression or anxiety, the researchers reported in The New England Journal of Medicine. Among women who received a more traditional form of counseling, the success rate was 58 percent.

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“We were very excited to find that it had such a strong impact,” said study leader Judith Bass, of the Johns Hopkins Bloomberg School of Public Health. “But we weren’t surprised.”

Cognitive-processing therapy has been used for nearly two decades in wealthy countries to treat victims of rape and other trauma, including soldiers suffering from PTSD. Some studies have shown the benefits persist even after a decade.

But many mental-health experts were skeptical the treatment, which is usually administered by highly trained professionals, could be applied in places like Congo, where many people are illiterate and conflict continues to rage.

“If we can do this successfully in DRC, that means there are a lot of places where we can do this,” Kaysen said.

Cognitive-processing therapy helps people rewrite the dialogue inside their heads in which they blame themselves and convince themselves they are worthless, she explained.

Like victims around the world, the Congolese women couldn’t stop thinking about what they could have done differently: Avoiding the man’s gaze, taking another route to the fields, staying home that day.

Working with the International Rescue Committee, Kaysen and her colleagues trained community mental-health workers in 15 villages in eastern Congo, translated the program into five languages, and adapted it for people who could neither read nor write.

The women met mostly in group sessions, where they learned how to derail harmful and negative patterns of thinking. After the sessions, one participant — who had been so despondent she didn’t bathe or fix her hair — announced she was “ready to be a woman again.”

“This is a scar these women live with,” Bass said. “The therapy doesn’t erase that, but it gives them tools to deal with it themselves and figure out the process of healing.”

Several times, sessions were interrupted when fighting broke out and women fled their villages to hide in the bush.

The new study is particularly powerful because it provides the first rigorous comparison between cognitive-processing therapy in the developing world and standard counseling, which involves talking with women one on one and helping them file police reports and get medical care, said a commentary on the study by experts at the London School of Hygiene and Tropical Medicine.

Of the women who enrolled in the study, 157 received cognitive therapy, while 248 got traditional counseling.

But across much of Congo and other African nations, even basic mental-health care is lacking.

The goal is to scale up the treatment and incorporate it into the DRC’s community health programs, said study co-author Jeannie Annan, of the International Rescue Committee.

Sandi Doughton: 206-464-2491 or

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