Program Profile: Post-Rape Video Intervention

This intervention is designed to reduce distress associated with forensic rape examinations and reduce the victims’ risk of developing psychopathology and substance use after an assault. The program is rated No Effects. At the 6-month follow up, there were no statistically significant differences between the treatment and nontreatment groups in alcohol, marijuana, or hard drug use, or in symptoms of posttraumatic stress disorder, anxiety, or depression.

A No Effects rating implies that implementing the program is unlikely to result in the intended outcome(s) and may result in a negative outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals/Target Population

The Post-Rape Video Intervention (PRVI) is a two-part video intervention that was developed for use in acute post-rape time frames. The intervention has two goals: (1) to help reduce the distress and anxiety associated with a forensic rape examination, thereby reducing the risk of future emotional problems, and (2) to prevent the post-assault increased risk of later developing substance use and abuse issues. PRVI is delivered to rape victims who are receiving a standard forensic rape examination. These exams are usually conducted within 72 hours of the sexual assault.

Program Theory

The trauma of rape is associated with extreme acute distress and anxiety that can lead to increased risk of developing psychopathology and substance use or abuse problems post-rape. Often the degree of initial distress experienced by rape victims can predict future problems, such as drug or alcohol use. Unfortunately, the experience of undergoing an invasive post-rape forensic evidence collection procedure may exacerbate the anxiety and anguish of rape victims, which may in turn increase their risk of resorting to substance use to ameliorate distress. The PRVI was designed as a preventive technique to reduce the initial anxiety and distress associated with post-rape forensic procedures and to provide coping strategies following the procedure.

Program Components

The intervention features a 17-minute video that is shown immediately preceding the forensic medical examination. The video consists of two components. The first component is designed to reduce distress during the rape examination by explaining what happens in the exam and strategies for coping successfully. The second component contains information that can be used by victims to prevent future emotional problems and substance abuse. Among the reactions described are symptoms of physiological arousal that might be experienced following a rape. Information and strategies are presented that could help a victim limit future avoidance and inappropriate coping mechanisms (such as substance use). The video provides guidance on how to avoid high-risk cues.

Victims also receive standard services, which include attendance at the examination by a rape crisis counselor and completion of the forensic rape examination itself.

Study 1

Resnick, Acierno, Amstadter, and colleagues (2007a) examined the impact of the Post-Rape Video Intervention (PRVI) using random assignment of women who attended the study site hospital for a post-rape forensic examination. The study was a follow-up to a 2003 report by Acierno and colleagues that assessed the impact of PRVI at 6 weeks post-assault. The 2007 study updated previous findings using a larger sample as well as longer-term follow-up periods through 6 months or more post-assault.

Of the original sample, 268 (66 percent) completed at least one follow-up assessment at three times. Time 1 was less than 3 months post-assault, Time 2 was 3 to 6 months post-assault, and Time 3 was 6 months or more post-assault. A total of 216 participants completed the Time 1 assessment (n=133 treatment, n=83 nontreatment); 133 completed the Time 2 assessment (n=86 treatment, n=47 nontreatment); and 219 completed the Time 3 assessment (n=126 treatment, n=93 nontreatment). Individuals who could not provide informed consent (e.g., those who were mentally retarded, intoxicated, or highly agitated) were excluded from the study.

Treatment and nontreatment groups were predominantly white (59.8 percent nontreatment, 57.1 percent treatment). Participants who reported they were Hispanic, Black, Asian, or Native American were classified as a minority for race/ethnicity reporting (40.2 percent nontreatment, 42.9 percent treatment). The majority of participants were single (83.8 percent nontreatment, 80.1 percent treatment). Average age for participants in the nontreatment group was 26.49 years old and 25.93 years old for those in the treatment group. There were no significant differences in race, age, and marital status. The only significant difference between the groups was that a higher percentage of the treatment group reported hard drug use in the 6 weeks prior to the index assault. Pre-assault drug use was therefore used as a control variable where appropriate.

This follow-up study was originally designed to include participants from a second dismantling phase of the study who were exposed to either the first half of the video intervention, entitled Medical Exam Preparation (ME), or the second half, entitled Psychoeducation (PE), as well as those exposed to the full video or nonvideo conditions. The goal of this dismantling was to determine whether specific content designed to prepare women for the medical exam and reduce exam-related anxiety had unique or interactive effects versus content presenting strategies to cope with symptoms, including drug and alcohol use, that may occur post-sexual assault. However, due to the limited sample sizes, the analyses in this study focused on comparing those in the treatment group who received any video content to the nontreatment group.

All participants received standard services. The nontreatment group, referred to as the nonvideo condition, received services that included accompaniment at the examination by a rape crisis counselor and completion of a forensic sexual assault examination performed by a nurse or physician. The treatment group, referred to as the full video intervention, received standard services as well as a 17-minute video immediately preceding the exam. The video included the ME and PE components described above.

The researchers developed the Sexual Assault Interview, a structured clinical interview based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for alcohol and drug use. The interviews collected information on lifetime victimization and lifetime and recent substance use.

Multivariable regression analyses were used to assess the impact of the program, controlling for other factors. Since minority status, prior assault history, and prior substance use history were significantly related to the outcomes of interest, the investigators controlled for these variables where appropriate, and also examined interaction effects between treatment condition, prior assault history, minority status, and prior substance use.

Study 2

Resnick, Acierno, Waldrop, and colleagues (2007b) also assessed the impact of the PVRI on the same sample of women, but they examined outcomes related to posttraumatic stress disorder and other mental health symptoms.

The analyses were based on 140 study participants who completed at least two of the follow-up assessments (n=68 for the treatment group, n=72 for the nontreatment group). At the 6-week follow-up (Time 1), 123 individuals participated (treatment group=61, nontreatment group=62). At the 6-month follow-up (Time 2), 128 individuals participated (treatment group=62, nontreatment group=66). There were no significant differences in baseline characteristics between the groups, although the treatment group reported a higher average distress rating prior to rape examination than the nontreatment group.

The investigators used a variety of measures, including the Beck Depression Inventory, the Beck Anxiety Inventory, the Post-Traumatic Symptom Scale – Self-Report, the Family Resource Scale, and Subjective Units of Distress. Prior rape history was assessed using slight modifications of the National Women’s Study interview. The Treatment Manipulation Check was a 9-item quiz administered following the intervention to determine if rape victims could attend to and encode new information shortly after their assaults. No psychometric properties were reported for this measure.

Previous research has indicated that prior rape history moderated the relationship between the treatment condition and measured outcomes. A measure of perceived resources did not differ between the two conditions but was related to the outcomes of interest. Investigators used hierarchical multiple regression analysis to control for these variables.

Subgroup Analysis

Resnick and colleagues (2007a) conducted subgroup analyses on minority status, prior assault history, and prior alcohol or drug use. At the 6-month follow up, they found that non-minority status (being white), prior history of assault, and prior alcohol use were statistically significant predictors of frequent use of alcohol and marijuana. Prior hard drug use was statistically significantly related to hard drug use, at the 6-month follow up. Minority participants were statistically significantly less likely to report recent use of alcohol or marijuana prior to assault, and less likely to meet criteria for alcohol abuse at the follow up. Treatment participants who had been using marijuana prior to their sexual assault showed statistically significant reductions in frequency of marijuana use, compared with control group participants who had previously been using marijuana.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile: