**5. Cognitive Behavioral Therapy (CBT)**

12 Sexual Abuse – Breaking the Silence

reported abused and non-abused males. An exploratory factor analysis that utilized a maximum likelihood extraction and orthogonal rotation suggested a one-dimensional structure. Based on an item analysis of SAQ-I, 78 items were retained for the second version

Study II (N=533), in addition to examining the psychometric properties of SAQ-II, also assessed the discriminant validity using the Beck Depressive Inventory (Beck, Steer, & Garbin, 1988) and the trait component of the State-Trait Anxiety Inventory (Spielberger, 1983). The SAQ-II correctly identified 86% of the male sample (73% of the abused participants and 86% of the non-abused participants). For women, 73% of the sample was correctly identified (64% of the abused participants and 74% of the non-abused participants). The SAQ-II was found to be a better post-dictor of abuse than the other two measures combined. The SAQ-II also yielded convergent validity with the TSC-40 (r=.67) and Keane's PTSSD subscale (r=.66). An exploratory factor analysis again suggested a one dimensional structure (see Lock, Levis, & Rourke, 2005). Item analysis of the SAQ-II resulted in the development of SAQ-III, a 45 item questionnaire. The SAQ-III was found to correctly identify a participant abuse history. Eighty-nine percent of the sample tested (83% of the male participants and 91% of the female participants were correctly identified (see

Castelda (2006) provided an examination of the relationship between the SAQ-III and the complex post-traumatic disorder (Lenzenweger, Loranges, Korfine, & Neff, 1997). Results showed that those scoring high on the SAQ reported more incidence of childhood abuse, greater levels of PTSD and Axis II psychopathology, and displayed smaller heart rate

Evidence has also been found which suggested the SAQ-III is also capable of identifying survivors of childhood physical abuse (see Krantweiss, 2004). Castelda (2003) confirmed Krantweiss's findings along with providing support for SAQ-III's ability to identify survivors of combined CSA and CPA histories. These findings are reconfirmed in Experiment I of Castelda, Levis, Rourke, and Coleman (2007) publication using a large sample of participant (N=3,505). Experiment II of this study evaluated the effectiveness of a newly developed 36 item abuse screen which was renamed the Binghamton Childhood Abuse Screen (BCAS). An ROC survey analysis was provided for determining the sensitivity and specificity indices for all possible BCAS cut-off scores across all abuse types, enabling examiners to choose cut-off scores that are suitable for their purposes. Additional criterion validity for the BCAS was established via the use of a modified Stroop task by Coleman,

Finally, the issue of malingering regarding the BCAS has been evaluated and support for the BCAS claim that it represent a non-face valid screen, has been obtained (Levis, Rourke, Bovier, Coleman, Heron, Castelda, and Esch, 2011). Although the BCAS has received sufficient support for its use with an undergraduate college population, it has yet to be validated on an out-patient population. However, some support for its use with an inpatient population has been recently obtained (Rowland, Ocelnik, Berryman, and Levis,

The previous review of the prevalence rates of childhood abuse in our society and the existing established link between childhood abuse and clinical symptomatology clearly

2011). Although the BCAS shows promise, it still remains a work in progress.

changes during an auditory startle test than those scoring low on the SAQ.

of the SAQ.

Krantweiss, 2001, 2004).

Rourke, and Levis (2008).

The first technique to be discussed is the technique of Cognitive Behavior Therapy (CBT). The technique of CBT was designed to be used to treat a wide variety of clinical symptoms including cases with a history of childhood abuse. CBT has been subjected to experimental validations (see Lynch, Lowe & McKenna, 2010) for a review of supporting data.

CBT has been defined as an intervention whose core elements include the recipient establishing links between their thoughts, feelings and actions and targeting symptoms correcting misperceptions, irrational beliefs, and reasoning biases related to these target symptoms, involving monitoring of one's own thoughts, feelings and behaviors with respect to the symptom; and/or the promotion of alternative ways of coping with target symptoms (Lynch, Lowe & McKenna, 2010).

Although CBT is a commonly used approach, the variety of techniques used to create cognitive restriction varies from one study to the other, frequently lacking operational specificity. Given the number of strategies and approaches used to change cognitive behavior, it appears to me to be similar to the insight approaches adapted in the 1940's and 1950's, (Alexander, 1965). It can be argued that the key agent of change in CBT is the approach ability to elicit emotional affects which in turn undergoes an extinction process that in turn results in a cognitive restructuring. This hypothesis leads to the discussion of the second approach to be discussed.
