Clinically Significant Change After Cognitive Restructuring for Adult Survivors of Childhood Sexual Abuse

This study investigated the outcome of cognitive restructuring for adult survivors of childhood sexual abuse in terms of clinically significant change. Twenty-six participants were assessed for depression, State anxiety, State anger, State guilt and self-esteem before and after 10 weekly sessions of group Rational-emotive behavior therapy, and at follow-up after 8 weeks. In contrast to a previous analysis of the data in terms of statistical significance, indicating significant improvements on all variables from pre- to posttreatment, an analysis based on clinically significant change showed a differentiated treatment effect. Cognitive restructuring was found to be highly effective in facilitating recovery on anxiety, depression and anger, but less effective for guilt and low self-esteem. Only 3 patients (11, 54%) recovered on all 5 variables, while 10 patients (38, 46%) showed recovery on at least 4 variables. Relationship to the perpetrator and pre-treatment irrational evaluative beliefs (measured by means of the Survey of Personal Beliefs) were found to be the best predictors of treatment outcome. A poor response to treatment was associated with the perpetrator being a close family member and with more Other-directed Shoulds, while recovery was associated with the perpetrator being a friend or stranger and with more Awfulizing, Self-directed Shoulds and negative Self-worth beliefs.