Mind and Heart: Addressing psychosocial needs for survivors of sexual violence in humanitarian settings

Humanitarian crises create immediate and long-term mental health and psychosocial impacts on individuals, families and communities. The psychological and social suffering that result from violence, displacement, poverty and the many other facets of humanitarian crises can undermine a populations ability to recover and develop, economically and politically, in the long term. The common mental health problems that are frequently identified among populations living in the context of an ongoing crisis include traumatic stress and depression-related symptoms as well as behaviour problems, including increased aggression and violence and alcohol and drug use problems. The impact of these problems is frequently compounded by the lack of appropriate and adequate mental health care in the countries where such crises are common. 

There is a growing body of evidence highlighting the increased rates of interpersonal and gender-based violence that occurs in contexts of humanitarian crises. The number of women and girls who are victims of rape, sexual assault, domestic violence and the denial of basic resources increases in protracted crises. 

“The United Nations OCHA estimates that one in five displaced women will experience sexual violence, nothing that in armed conflicts, rape is increasingly being used as a weapon of war and terror.”

The Mind and Heart Intervention is based on Cognitive Processing Therapy, an evidence-based cognitive behavioural therapy developed initially as a group intervention for sexual violence survivors with PTSD in the United States. The therapy is a 12-week intervention, with weekly group sessions. As part of a randomized clinical trial for survivors of sexual violence in DRC this treatment was adapted so it could be delivered by paraprofessionals to allow for the treatment to be used by beneficiaries with limited literacy, and to fit the Congolese context. The name Mind and Heart Therapy was picked by the counsellors trained in the intervention to represent the focus in the therapy on addressing both thoughts and emotions that are affected by trauma. The treatment provides beneficiaries with skills to notice beliefs they have related to the sexual violence that may not be accurate or helpful and learn to test those beliefs, which in turn reduces negative emotions and helps with processing the sexual violence. Through discussing the trauma and these beliefs, beneficiaries can decrease internalized stigma, reduce avoidance around trauma-related cues and reminders, shift their feelings and thoughts about the event, and cope better with daily challenges.

A randomized clinical trial with sexual violence survivors conducted in DRC found that Mind and Heart Therapy improved anxiety, depression, PTSD, and overall functioning, with results that were maintained out to 6 months after the 12 weeks of treatment were completed. As a result of these findings we have worked on other ways to implement Heart and Mind Therapy in DRC. The current program, conducted by IMAWorldHealth, JHU, and UW examined ways to expand access to CPT and leverage a small number of trained providers within an existing psychosocial program. Given limited numbers of providers trained in Heart and Mind Therapy, placing providers in each community was not feasible. Lack of transportation and insecurity reduced the feasibility of survivors travelling 1-2 days to receive treatment at a central location. This program approached this dilemma by implementing mobile therapy; utilizing motorbikes to transport providers to provide treatment in remote communities. Using mobile outreach services the program has a 5% dropout rate. Results support the use of mobile therapy to extend the reach of evidence-based treatments in low-resource settings.

The repercussions of sexual violence can include significant mental health problems as well as social stigma and deficits in functioning. The Mind and Heart intervention is designed to reach women who have experienced trauma and violence, including sexual violence, and give them the skills to understand their experiences and tools to address their emotions and behaviours in order to improve their mental health and well-being and allow them to function more fully in their families and communities. 

Learn more about the Mind and Heart Innovation by visiting this page.