The effects of sexual trauma are very real and difficult to go through alone. Whether your trauma is recent or from your childhood, there are a number of methods that can offer tools for coping. If you think therapy would be beneficial but you've been shying away from reaching out, know that you're not alone—emotional avoidance is a common PTSD symptom that prevents many survivors from seeking help. But avoiding feelings or thoughts about a traumatic event can keep us stuck in suffering, says Kathryn Bell, Ph.D., who treats patients with sexual trauma-related PTSD.
"Here's something to consider," Bell says. "What are the costs of avoiding treatment or memories? How would your life be different if you addressed these issues?"
We've developed a guide that can help you learn more about different styles of therapy that are commonly used to treat sexual assault survivors. Given your individual needs, some of these may suit you better than others, but you don't have to stick with the first style of therapy or the first professional you work with. And most importantly, remember that you are strong, and you deserve to receive help, be well, and live the life you want.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is an umbrella term for several related treatment approaches. "CBT is an active treatment that targets the ways you think about yourself, other people, the world around you, the future, and the way you respond to your life," Bell says. In this form of therapy, the therapist serves the patient in a "coach-like role," working on their specific problems with them to help change thought patterns and certain behaviors.
Bell says that in CBT, the client and therapist set up treatment goals, and therapy progresses gradually, with regular check-ins, so that the client is informed about what to expect. This can alleviate some of the anxiety surrounding treatment; since the client has an active and empowered voice in their recovery, nothing should come as a surprise.
CBT can include cognitive processing therapy (CP), cognitive therapy, and prolonged exposure therapy, all evidence-based methods recommended by the APA Clinical Practice Guideline. Bell says that there's no particular CBT approach she recommends for survivors—which therapy they choose is entirely dependent on what the person is comfortable with. Many studies have indicated that CBT can be very effective for survivors of sexual assault.
How does CBT work?
Bell explains that CBT treatment for PTSD involves facing traumatic memories and processing the thoughts and emotions related to them. This process can help the patient change their thinking about the trauma and habituate to the anxiety related to traumatic memories. "The individual learns that, although the trauma was horrible, the trauma memories in themselves are not harmful," Bell says.
In cognitive therapy, the patient and therapist address the patient's thoughts, beliefs, emotions, and communication at present. Much of the work consists of developing self-help skills and changing unhelpful thought patterns.
In cognitive processing therapy, the focus is on the patient's thoughts and beliefs, and the therapist often utilizes writing as a tool. Clients may be asked to write a detailed account of their trauma, but this isn't always necessary.
Prolonged exposure therapy asks the individual to repeatedly recall the trauma over and over again, in great detail, both in session and at home. It has a high rate of success, but this style isn't a fit for everyone.
One exercise CPT therapists use involves the individual and the therapist finding "stuck points."
"Stuck points are beliefs that keep the person stuck in their recovery from the trauma. The therapist and client directly target them by challenging their accuracy," Bell says. For example, an individual's stuck point might be, "It was my fault I was raped because of how I was dressed."
The therapist and individual will then look for evidence that supports and challenges this belief. The patient might say, "If I hadn't been wearing that skirt, then I wouldn't have been raped." Then they'll poke holes in this argument, asking, "But is that really true?" "Is it possible that it didn't matter what I was wearing?" (It's possible.) "Does wearing a short skirt actually give permission for someone to violate me?" (No.) "Using Socratic questioning allows the client to investigate and think differently about the event, and helps them see that they're not to blame," Bell says.
The Association for Behavioral and Cognitive Therapies (ABCT) is a great place to search for a qualified CBT provider and to learn more about treatments that might appeal to you.
The National Center for PTSD is geared toward veterans, but you don't need to be a vet to use it. It details the most effective treatments for PTSD and what they entail.
"Through mindfulness, we learn to turn toward our own suffering with a balanced and compassionate eye," says Jennifer Ardis, M.A., founder of Blue Heron Mindfulness in Cork, Ireland. "We learn to cultivate a solid base in the present moment and how to return to the present. This can be a very helpful skill when trauma keeps pulling us back to the past."
Programs like mindfulness-based stress reduction (MBSR) or mindfulness-based cognitive therapy (MBCT) emphasize mind-body integration, both of which can be very helpful for people with a history of trauma, who can "lose touch with" their body, Ardis says.
Clinical studies have shown that mindfulness-based treatments can be helpful for people suffering from PTSD. The non-judgmental outlook that mindfulness works to cultivate can help folks accept their thoughts, emotions, and experiences, and reduce the avoidance, intrusive thoughts, and numbness symptoms characteristic of PTSD. Mindfulness practices may decrease survivors' feelings of guilt, shame, and other negative emotions, and increase their positive feelings toward themselves and others.
Breathwork, or breath awareness, is a common element of mindfulness-based PTSD treatments. Breathwork can range from simply paying attention to your breathing to participating in specific breathing exercises. Ardis recommends this practice as a starting place for mindfulness and notes that some promising research suggests that PTSD symptoms can be managed by a particular type of breathwork called Sudarshan Kriya (SKY). SKY has also been helpful for managing depression and stress-related chronic illnesses.
Michele Paolella, LMSW, of Day One, agrees that breathwork can be a helpful tool for dealing with PTSD. "Practical grounding techniques and controlled breathing exercises can be helpful in moments of increased fear or anxiety," she says. For instance, if you have to see the person who caused you harm or be in the place where you were hurt, breathwork can increase your chances of staying calm and thinking clearly in these situations.
Mindfulness and Breathwork Resources
The Mindful Way Through Anxiety: Break Free from Chronic Worry and Reclaim Your Life by Susan Orsillo and Lizabeth Roemer and its accompanying workbook, as well as The Mindful Way website, are excellent resources for learning more about mindfulness.
UC Berkeley's Mindful Awareness Research Center (MARC) has a helpful guided meditation for mindful breathwork.
Ardis's YouTube video, "Awareness of Breathing Guided Mindfulness Meditation," walks the viewer through basic breathwork.
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR therapy sessions feature a series of eye movements, hand taps, and buzzes while the patient accesses a trauma memory. When a traumatic event happens, it gets stuck in the limbic system in the brain, says Ginger Poag, MSW, LCSW, a trauma therapist who primarily uses EMDR to work with abuse and sexual assault survivors. EMDR can help get these trauma memories unstuck.
How does EMDR work?
After an unprocessed traumatic event, experiences in our daily lives can remind us of the trauma, setting off symptoms like panic, dissociation, flashbacks, and nightmares. Poag explains that EMDR accesses those memories and encourages the brain to heal itself. EMDR's series of eye movements, hand taps, and buzzes mimic REM sleep, which helps target specific trauma memories locked in the brain and move them to another part of the brain, where they can be processed like other memories and experiences. There are a wealth of studies that support this treatment's efficacy.
Who's a good candidate for EMDR?
Using EMDR, Poag has seen patients work through trauma that has been affecting them negatively for years—sometimes decades. This process can help them integrate their experiences so they can move on with their lives. EMDR is not for everyone all the time, however, and the APA's Clinical Practice Guideline for the Treatment of PTSD, which includes sexual trauma-related PTSD, lists EMDR as a conditionally recommended treatment.
The nature of EMDR is to dive right in, so the intense nature of this treatment might be too much for patients with acute or recent trauma, those who haven't had an opportunity to do much processing work, or who don't have much of a support system at the moment.
"EMDR brings up a lot very quickly—it can do what traditional therapy does over the course of years in a matter of months," Poag says. "I screen people first to see if they're able to self-soothe and to determine whether they would be good candidates at that moment in time."
If you're interested in starting EMDR but you aren't quite ready to go that deep that quickly, Poag recommends preparing yourself with trauma-informed yoga and/or somatic (body-centered) therapy. Both of these treatments are described in further detail below.
The EMDR Institute offers additional information on EMDR, as well as a directory to help you find a clinician in your area.
The Maiberger Institute also has good research, resources, and information available, as well as a therapist directory.
While group therapy has been shown to be an effective treatment for PTSD, Jennifer Lepke, MPS, LCAT, ATR-BC, founder of The Art Therapy Nest, believes that group shouldn't replace individual therapy, but is ideal for someone who would like a greater level of support to supplement their individual counseling. These treatments serve different, but complementary, purposes.
"Many people feel very isolated in their experience of sexual trauma and in the aftermath," she says. Even the people who love us and have our best interests at heart may not understand what we're going through or say hurtful or dismissive things out of fear or ignorance. This can make survivors feel like they're the only ones processing trauma. "Just walking into the group therapy space, you can see that there are other trauma survivors, and the act of sharing stories and experiences is powerful—you are understood and seen," Lepke says.
Group Therapy Resources
You can use Psychology Today's Support Group search to help find a group near you.
Good Therapy also has a helpful search, as well as information on different types of group therapy.
Nonviolent Communication by Marshall Rosenberg is a great resource for developing communication skills.
In the immediate wake of sexual trauma, survivors are not always responsive to talk therapy. This is why alternative therapies are so helpful before—or in conjunction with—talk therapy, says Anna Jadanova, M.A., senior research assistant and therapist at the Center for Addiction Services and Personalized Interventions Research (CASPIR).
Survivors who experienced abuse as children or teens may also be averse to talk therapy at first, since they may have issues surrounding trust and authority figures. "Starting off with alternative therapies, or combining alternative therapies and talk therapy, can be very helpful for establishing relationships, getting in tune with the body, and strengthening expression," Jadanova says.
"Somatic therapy is a body-oriented approach to healing trauma and other stress disorders," says Peter Levine, Ph.D., founder of the SomaticExperiencing Trauma Institute. People often dissociate from their bodies during a traumatic event, Poag says. Directing attention to physical sensations can help the patient understand and process parts of their trauma and the feelings around it.
"There's this assumption that all emotions are stored in the brain," Jadanova says. "But some emotions and experiences are so traumatic that they aren't processed the way other experiences are, and instead, they're stored in the body." That's why people with a history of trauma sometimes have unexplained pains afterward, indicating that there may be a memory or feeling stored there.
How Do You Choose a Somatic Therapy?
Different somatic therapies are a fit for different folks—options can include yoga, breathing exercises, progressive muscle relaxation, dance/movement therapy, vocal work, and guided imagery meditations.
However, silent meditation can be anxiety-inducing for some folks, and without professional guidance, can even be triggering. Jadanova says that a meditative practice is most effective for trauma survivors when they have a guided, structured, imagery-based meditation specifically designed to help process anxiety, which is reflected in a study measuring the effectiveness of guided meditations online.
A Somatic Therapy Exercise You Can Do at Home
Lepke suggests rubbing your hands together vigorously enough to create some heat, which connects the mind and body, giving you something unobtrusive to focus on and preventing you from dissociating. As you're rubbing your palms together, imagine that you are creating energy. Once you're content with the energy you've created, you can direct it to other parts of the body, perhaps bring your palms to rest on your eyes, heart, or any other location that could use a little love.
Somatic Therapy Resources
There's a "Find a Practitioner" search available via The SomaticExperiencing Trauma Institute.
Waking the Tiger: Healing Trauma by Peter A. Levine and Anna Frederick is a book covering Levine's somatic approach to trauma.
Healing Sex: a Mind-Body Approach to Healing Sexual Trauma by Staci Haines is a helpful book with suggestions, exercises, and survivor stories.
In recent years, trauma-informed yoga, also known as trauma-sensitive yoga, has gained a lot of support and attention, as a number of clinical studies have demonstrated its efficacy. "Sexual trauma survivors' bodies haven't always been a safe space," says Zoë Lepage, founder of Exhale to Inhale, a nonprofit organization that provides free trauma-informed yoga. "Yoga can bring the individual back into their body and back into the moment."
If you've ever been in a standard yoga class, you know that the teacher's instructions can feel pretty bossy. Trauma-informed yoga, however, gives the student more options. Suggestions take the place of directives, there are no hands-on assists, and students aren't singled out and corrected. The focus is to empower the students in their choices and to invite them to notice any sensation, or lack of sensation, they experience. The facilitators are also trained to help students work through triggers, should they arise.
Combining Trauma-Informed Yoga With Therapy
Poag says that yoga's mind/body connection helps patients work through stored memories. She notes that different postures might trigger memories or trauma-related feelings, which can be both a challenge and a tool for recovery.
Carly Conatser, a trauma-informed yoga teacher at The Nest, says that the community aspect of a trauma-informed yoga class is important. "You can see all the different types of people who have experienced a trauma like yours, and you never have to explain your trauma or tell a trauma story, and that can be very healing," she says. She recommends practicing trauma-informed yoga alongside another form of evidence-based treatment, like CBT, so that you're not prioritizing the body over the mind.
How to Choose a Yoga Class
If you can't find a trauma-informed class near you, Conatser recommends telling your yoga teacher your needs before class. "For instance, you might want to tell them that you don't want hands-on assists or that you don't want to be corrected during class," she says, noting that you don't have to disclose your trauma history in order to do this.
If you're attending a mainstream yoga class or working on your own, Conaster suggests choosing the type of yoga based on your current needs. If you'd like to feel more empowered, warrior poses might suit you, or if you want to feel more relaxed, then a gentle, restorative class might be a better fit.
Trauma-Informed Yoga Resources
You can search for a Trauma-Sensitive Yoga Facilitator through The Trauma Center Trauma Sensitive Yoga website, which also offers training and research.
This short video, A Trauma Sensitive Yoga Practice, offers a beginner's trauma-sensitive yoga flow that you can do in a chair.
Jadanova says that while EMDR, CBT, and other talk-based trauma therapy are the most popular and effective approaches, they also have the highest dropout rates for people with PTSD due to the intensity of the work and the classic PTSD avoidance.
As Van der Kolk, M.D., founder and medical director of The Trauma Center at JRI, notes in his book, The Body Keeps the Score, somatic and expressive therapies such as art, dance/movement, comedy, drama, and music therapy, can be especially helpful for those just starting their trauma recovery. Of course, these expressive therapies can also be beneficial at any stage in tandem with talk therapy.
How Do Expressive Therapies Work?
Jadanova explains that taking an improv class, for instance, can provide the participant with lots of tools for expression, whereas comedy and drama therapy can give them a safe space to recreate or direct their trauma, cast themselves in a role where they have more control over the outcome, and engage in the situation in a new way, from a place of empowerment.
"Language can be limited and can make you feel vulnerable," Lepke says. "Artwork is a way to grapple with and explore an experience with a level of safety." Survivors may say and process much more when developing the ability to communicate in a different mode.
Art has the uncanny ability to reach us on many discreet levels—intellectually, emotionally, and bodily all at once. If you've ever listened to a song that gave you goosebumps or seen a painting that just hit you in the chest, you know its power. Lepke incorporates talk therapy, meditation, movement, and art therapy in her sessions. "These are all under the umbrella of art," she says.
What's an Art Therapy Session Like?
Lepke's typical art therapy sessions for survivors begin by setting guidelines for a respectful, compassionate, and confidential community, followed by an icebreaker, meditation and movement, and an expressive art project, like mandalas or inside-outside boxes. The last 15-20 minutes of the group session are dedicated to sharing artwork and processing the feelings connected to it.
Art Therapy You Can Do at Home
If you want to try using art therapy at home, Lepke suggests keeping it simple: "I wouldn't recommend taking out paints if you're already feeling overwhelmed. It's helpful to have a sense of mastery when you're feeling out of control." She recommends instead keeping a journal to write, doodle, and collage in, as feelings arise.
Art Therapy Resources
Managing Traumatic Stress Through Art: Drawing from the Center by Bary M. Cohen, Mary-Michola Barnes, and Anita B. Rankin is a workbook full of art projects, writing exercises, and information on coping with stress after trauma.
Mended by the Muse: Creative Transformations of Trauma by Sophia Richman explores the way art can help trauma recovery.
We're all familiar with guide dogs, but there are also therapy dogs, emotional support dogs, and programs that pair dogs with trauma survivors for therapeutic purposes. "One of the reasons that animal therapy works so well for trauma survivors is that it can be easier for people to trust animals than it is for them to trust people," Jadanova says.
If you're struggling with trust, animal therapy can be helpful because you're establishing a safe relationship with the therapy animal and the therapist at the same time, she explains. Establishing trust with a therapy animal has been demonstrated to aid in recovery. Relatedly, equine therapy for adults and youth can be helpful for sexual trauma survivors, Jadanova says.
Animal Therapy Resources
Assistance Dogs International is a coalition of nonprofit assistance dog organizations that helps individuals find a dog to match their needs.
The SheHerdPower Foundation is dedicated to providing free equine-guided empowerment services to women survivors of sexual trauma.
General Alternative Therapy Resources
The Breathe Network offers information about alternative therapy options and a practitioner directory.
Deep Listening: A Healing Practice to Calm Your Body, Clear Your Mind, and Calm Your Heart by Jillian Pransky discusses deep relaxation practices that can help heal the body after trauma and extreme stress.