Comparison the effectiveness of integrated Transdiagnostic and Solution-Focused Intervention Methods on post-traumatic stress in Sexual Assault Victims

Sexual assault is defined as a sexual act in which the victim is forced to engage against their will. Sexual trauma can have a devastating impact on both the victims and their family members (1). The aftermath can lead to severe, long-term consequences for survivors, increasing their risk of developing psychiatric disorders by nearly four times. (2). Studies have shown that nearly 70% of survivors of sexual assault experience significant levels of trauma, and 45% report symptoms of post-traumatic stress disorder (PTSD) (3). Women, in particular, are at greater risk of developing PTSD than other trauma victims (4), a trauma-related disorder requiring direct or indirect exposure to a traumatic event or prolonged exposure to stressful events (5).
Given that the psychological consequences of sexual assault pose a threat to the mental health of individuals in society, preventative and educational interventions need to be expanded, and families and social networks need to be strengthened to prevent it. Victims of sexual abuse should be identified and treated, and various therapeutic approaches have been used to improve the psychological status and emotional disorders of survivors of sexual assault. However, extensive studies focusing on integrated transdiagnostic and solution-focused approaches have not been conducted, particularly regarding women who are victims of sexual assault both inside and outside of Iran.
Transdiagnostic therapies encompass a heterogeneous group of interventions that target a more comprehensive range of disorders and can be used to treat multiple disorders simultaneously (13). Although rooted in cognitive-behavioral tradition, they emphasize emotions and maladaptive emotion regulation strategies. Emotional experience and response to emotions are the main basis of the transdiagnostic approach. Research findings indicate that interventions that address emotion regulation deficits can help reduce risky sexual behaviors and subsequent risk of re-victimization (15). Aguilera-Martin et al. (2022) also evaluated the cost-effectiveness and efficacy of individual transdiagnostic therapy versus group therapy for emotional disorders and found that both methods are effective, but group therapy is more cost-effective and less flexible (18).
Solution-focused brief therapy is also an integrated model that uniquely visualizes the client’s resources, reasons for living, and crisis time (18). There is no diagnosis, insight enhancement, or analysis of the past in this therapy. Instead, clients are encouraged to pay attention and take different actions. Solution-focused therapists help clients think about what they can do differently. As soon as a solution is identified, clients and therapists move step by step towards it (19). Leveraging its adaptability and a history of resolving clients’ issues, this approach serves as a solution to a broad range of individual problems. It's also applicable to nearly every clinical problem noted by healthcare professionals. These include trauma treatment (21), treatment for survivors of sexual abuse (1, 22), and treatment for post-traumatic stress disorder (26).
Therefore, considering that sexual abuse can cause severe and irreparable harm to victims and their families and hold back society from dynamism and prosperity, the current research aimed to examine the effectiveness of these two approaches on post-traumatic stress disorder in female sexual abuse survivors in this study. The main question in this research is whether there is a significant difference between the transdiagnostic intervention and the solution-focused approach in reducing post-traumatic stress in sexual abuse survivors.

This semi-experimental research was expanded with two experimental groups and one control group, which was done using pre-test, post-test, and follow-up methods. The research population consisted of all women who had been victims of sexual assault and had been referred to psychological clinics in Ahvaz, Iran, in 2022. Among them, three groups of 12 individuals were purposefully selected and randomly assigned to two experimental groups and one control group. The first experimental group received 10 weekly 90-minute integrated transdiagnostic intervention, and the second experimental group received 7 weekly 90-minute sessions of solution-focused interventions in individual sessions. Conversely, the control group did not receive any intervention during this time. After completing the training, a post-test was conducted one week later, and a follow-up test was performed one month after the post-test. The Foa et al. (1993) questionnaire was used to evaluate post-traumatic stress. This scale includes 17 items on post-traumatic stress symptoms in TR-IV-DSM and was analyzed using SPSS-22 software. Considering the experimental design and the research question, the statistical method used in this study was descriptive statistics, including calculating the mean and standard deviation and using repeated measures analysis of variance to determine the significant differences between the mean of the experimental and control groups' independent variables.

Before conducting repeated measures analysis of variance, the following conditions must be met to ensure the validity of the results. One of the assumptions of the repeated measures analysis of variance is to examine the homogeneity of variance-covariance matrices, for which Box's test was used (P<0.05, F=1.73, Box's M=4.11). The significant level of the Box's test is greater than 0.05, indicating that the variance-covariance matrices are homogeneous. Levene's test was used, which was not statistically significant, to examine the homogeneity of variance among the three groups in pre-test, post-test, and follow-up tests. Additionally, normality test results (P>0.05) indicate that the assumption of normal distribution and homogeneity of variances is met. Therefore, according to the results of the Box's, Kolmogorov-Smirnov, and Levene's tests, the assumptions of repeated measures analysis of variance are met. However, Mauchly's test is statistically significant, indicating the unmet sphericity assumption. Therefore, the Greenhouse-Geisser correction is used. Accordingly, repeated measures analysis of variance was used to compare the effectiveness of transdiagnostic intervention and solution-focused approach on post-traumatic stress in the experimental and control groups in pre-test, post-test, and follow-up tests. The results showed that the time factor (F=71.75, P<0.001) was significant, but the group factor (F=1.11, P=0.34) was not significant. Therefore, a significant difference was found between at least two-time points (pre-test, post-test, or follow-up). Table 1 shows the results of the Bonferroni post-hoc test to determine the effect of interventions on the research variable at different measurement stages. The comparison of mean differences between the pre-test and the post-test and between pre-test and follow-up test in experimental group 1 and experimental group 2 was significant, but the difference between post-test and follow-up test was not significant. This indicates the significant effect of both transdiagnostic intervention and solution-focused approaches on post-traumatic stress in sexual abuse survivors in the post-test stage and its continuity in the follow-up test stage. On the other hand, in the control group, all comparisons were not significant.
Table 6. Post-hoc results of the Bonferroni test for comparing the three groups at different measurement stages




Posttest-Follow up
Pretest-Follow up
Pretest-Posttest
Group
Variable


Mean difference
Standard error
Mean difference
Standard error
Mean difference
Standard error




13.08*
1.08
11.75*
1.43
1.33
0.74
Exprimental 1
PTSD


8.91*
1.08
9.41*
1.43
0.50
0.74
Exprimental 2


1.08
1.08
0.58
1.43
0.50
0.74
Control












*0.05>P

The research results have shown that these two treatments effectively reduce post-traumatic stress in victims of sexual assault to some extent. Therefore, it is recommended to hold counseling and psychological workshops titled integrated transdiagnostic interventions and solution-focused approaches to help these clients and assist them in living a better life.
Ethical Considerations
Compliance with ethical guidelines
All the subjects received information about the research. They were assured that all information would remain confidential and only be used for research purposes. Furthermore, the patients were assured that if they did not want to participate in the research, it would not lead to the termination of medical services in that center. In order to respect privacy, the details of the subjects were not recorded. Informed consent was obtained from the participants prior to conducting the research, and the researchers observed ethical considerations during the study. Notably, this research has an ethics code with the identifier IR.UMA.REC.1400.027 at the University of Mohaghegh Ardabili.

Authors’ contributions
Asad Asadi Hasanvand and Esmaeil Sadri Damirchi: Involved in selecting the subject, the study design, and the definition of concepts. All authors searched literature and research background. Asad Asadi Hasanvand: Collecting and analyzing data. Asad Asadi Hasanvand, Hossein Ghamari Kivi, and Ali Sheykholeslami: Writing and preparing a draft. All the authors discussed the results and participated in the article’s final version.

Funding
No financial assistance has been received from any organization.

Acknowledgments
The present study is based on a PhD dissertation in counseling from the University of Mohaghegh Ardabili. The authors would like to express their gratitude to all individuals who assisted us in conducting this research.
Conflicts of interest
The authored declared no conflict of interest.