Online expressive writing intervention for the psychosexual well-being of women with a history of childhood sexual abuse: a randomized clinical trial.

Abstract

Background: Sexual schema expressive writing that addresses nonconsensual sexual experiences has demonstrated initial support for improving psychosexual well-being for women with childhood sexual abuse (CSA) histories and is easily modifiable to an online modality for accessibility and scalability.

Aim: The current study aimed to assess the online efficacy of a 5-session sexual schema expressive writing intervention against a daily events writing condition and an assessment-only condition for women with CSA histories.

Methods: Women were initially randomized to 1 of the 2 active writing conditions (sexual schema, n = 73; daily events, n = 71); then, to minimize awareness of anticipated results, an assessment-only condition was recruited (n = 22). Outcomes were measured at baseline (T1), 3 weeks after baseline/posttreatment (T2), and at 1-month follow-up (T3). Additionally, participant-perceived change in sexual and psychological functioning across the course of the study was assessed at T2 and T3.

Outcomes: Outcomes included posttraumatic stress symptoms, sexual functioning, global self-esteem, and sexual self-concept.

Results: Mixed effects linear regression models controlling for participant age demonstrated significantly greater rates of change in sexual functioning and sexual self-concept for both active writing conditions (sexual schema and daily events) in comparison with the assessment-only condition, with no differences across conditions in posttraumatic stress symptoms or self-esteem. Furthermore, analyses of variance controlling for age indicated that women in the sexual schema writing condition reported significantly greater perceived change in sexual well-being and psychological well-being than the assessment-only condition, though the daily events writing condition reported significantly greater perceived change only in psychological well-being as compared with the assessment-only condition.

Clinical implications: The current study provides evidence for the use of online modalities for expressive writing for women with CSA histories and supports the use of sexual schema writing paradigms for improving sexual well-being in this population.

Strengths and limitations: The study is strengthened by its ecologically valid and diverse community sample and its rigorous multisession treatment protocol. The study is limited by being underpowered for some of its analyses. Additional research is needed on the daily events writing condition and ways to target more psychological outcomes in combination with sexual outcomes in online writing treatments.

Conclusions: Online expressive writing paradigms that allow for guided reflection and space on how individuals' nonconsensual sexual experiences have affected their sexuality may be a fruitful strategy for many women to begin to achieve sexual recovery following sexual trauma.