Social Support Prevents Further Distress in Victims of Violence

Researchers found that the inclusion of significant others in cognitive behavioral therapy for victims of violent crimes is beneficial for the victim and indirect victim.

The type of treatment and counseling victims of violent crimes (VVCs) receive can effect their long-term outcomes.1 As many as 89% of VVCs who are diagnosed with acute stress disorder are likely to acquire post-traumatic stress disorder (PTSD).1

Involving Significant Others in Cognitive Behavioral Therapy

In a 3-way comparison of cognitive behavioral therapy (CBT), CBT with a significant other (CBT-SO), and usual care (no psychological counseling), Dr Stéphane Guay of the School of Criminology, University of Montreal, Quebec, Canada, and colleagues found that early and brief CBT and CBT-SO bested usual care in preventing PTSD and depressive symptoms.1  

The study comprised 166 patients (mean age, 39.5; 59% women) and sought to determine whether VVCs may have better outcomes if a significant other participated with them in CBT sessions.1 While participants in the CBT and CBT-SO groups had fewer depressive symptoms at 12 months compared with the usual care group, there was no significant difference between the CBT and CBT-SO groups.1 Still, the researchers said that the involvement of significant others in therapy merits further study.1

What VVCs Want From Social Services

Globally, resources to assist VVCs vary widely. One study that highlights this range is Huang’s examination of VVCs in Taiwan, one of the few East Asian countries that is gradually recognizing the need for victim outreach.2 In a cross-sectional survey of VVCs (n=391 direct victims; n=1617 victims’ families), Huang discovered that there was a large unmet need for counseling services and that the VVCs who did receive help tended to be more satisfied with the services.2

Individuals most likely to be VVCs were female (53.8%), high school educated (38.5%), living with a parent or children (45.2%), unemployed (57.7%), and had no dependents <18 years old (51.0%).2 Among the most devastating post-crime sequelae were:

  • effect on family life (88%),
  • employment (51.6%), and
  • lowered household income (32.7%).2

Most troublesome to VVCs were their reduced income and differences in family dynamics.2

VVCs who availed themselves of government services were most likely to use the legal, psychosocial counseling, and financial services.2 Still, more than two-thirds of those patients surveyed felt that the services provided were inadequate.2 Individuals who expressed dissatisfaction with counseling tended to live with a spouse, have post-crime financial difficulties, and were awaiting a judicial verdict on the crime.2

Perception Matters in the Healing Process

How sexual assault victims perceive themselves can often predict their outcomes according to a survey of 138 undergraduate college women.3 Respondents who resonated as “victims” were more likely to feel shame and post-traumatic stress, whereas respondents who identified as “survivors” were angry, yet had fewer depressive symptoms.3

“Explicitly, suggesting that one must think like a survivor, [which] might make someone feel that not only has their agency and autonomy been challenged by their victimization, but that they should be stronger, prouder, more active or healed by now,” explained sociologist Kaitlin M. Boyle, PhD, assistant professor at Virginia Tech in Blacksburg. “As a sociologist, I would remind clinicians that healing from trauma is not just about psychiatric components, but about this management of identities.”

“Men may be more resistant to the victim identity because it has associations with stereotypes about submissive femininity and the failure to fight back,” Dr Boyle said. “A lesbian woman victimized by another woman may hesitate to define her assault as rape because of historical definitions of rape as male-to-female penile penetration. How she labels her assault and herself is shaped by societal stereotypes, and she may hesitate to speak out or seek help for fear of confirming homophobic beliefs about lesbian women.”

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“Indirect” Victims Suffer, Too

A 40-article systematic review by Jennifer A. Connolly, PhD, professor and director of the psychology undergraduate program at York University in Toronto, Ontario, Canada, and colleagues, found that persons who are co-victims of crime can have multiple negative effects after a family member’s homicide.4 In the review, 3 overall themes emerged: 19 articles focused on the homicide’s effects on the psychological, social, occupational, and academic functioning of family members; 13 emphasized how the judicial system affects the grieving process; and 8 investigated treatment options that helped surviving relatives.4

“Children can be especially hard hit by this loss and the evidence suggests that adolescents are particularly vulnerable to feelings of loss and guilt,” said Dr Connolly. “A developmental perspective is important in providing services to children or teenagers as the loss can impact them broadly in school, at home and with their friends.”

Assessing Rape Crisis Centers

For rape victims, rape crisis centers (RCCs) can ease recovery for victims of sexual violence.5 Via an online survey, Rachel Voth Schrag, PhD, LCSW, assistant professor from the School of Social Work at The University of Texas at Arlington and Tonya Edmond, Phd, professor, associate dean for diversity, inclusion, and equity, School of Social Work, Washington University, St Louis, Missouri, examined how counselors in Texas RCCs (N=83) formulated treatment goals and assessed the progress of their patients.5

Most treatment goals focused on self-esteem, relational functioning, empowerment, trauma, and mental health. Not as many counselors established goals for substance abuse and academic, occupational, and sexual functioning.5 Few counselors relied on standardized measures to assess patients’ treatment progress, which prompted the researchers to advocate for more standardized assessment of the counselors and their patients.5

Clinicians would benefit from using appropriately validated and standardized assessment tools more consistently,” said Dr Voth Schrag.  “This in turn could help guide treatment and provide feedback on intention efficacy.”

“Increasing use of such assessments would not only benefit the treatment planning process and help match evidence-based treatments with survivor needs, but also improve the ability of service providers and agencies to demonstrate the positive impact of their work to service recipients and potential funders alike,” Dr Voth Schrag said. “Not all assessment tools are developmentally appropriate for survivors at different points in their life course or valid across cultures and contexts. Clinicians should be careful to ensure a match between the survivor they are working with and the assessment tool they are using.”

Summary and Clinical Applicability

Victims of violent crime are at a high risk for acute stress disorder and post-traumatic stress disorder. Psychological assistance, such as cognitive behavior therapy has demonstrated efficacy in preventing further psychological trauma to victims of violence and abuse.

Limitations and Disclosures



1. Guay S, Sader J, Boyer R, Marchand A. Treatment of acute stress disorder for victims of violent crime. J Affect Disord. 2018;241:15-21.

2. Huang L. Unmet needs and service satisfaction of victim support for the direct and indirect victims of serious violence: results from a cross-sectional survey in Taiwan. PLoS One. 2018;13(2):e0192905.

3. Boyle KM, Clay-Warner J. Shameful “victims” and angry “survivors”: emotion, mental health, and labeling sexual assault. Violence Vict. 2018;33(3):436-452.

4. Connolly J, Gordon R. Co-victims of homicide: a systematic review of the literature. Trauma Violence Abuse. 2015;16(4):494-505.

5. Voth Schrag R, Edmond TE. Treatment goals, assessment, and evaluation practices in rape crisis centers. Violence Vict. 2018;33(6):1055-1071.