A mixed methods study of the implementation and effectiveness of massed-prolonged exposure therapy for rape-related PTSD and depression among university students

Abstract

The prevalence of rape, post-traumatic stress disorder (PTSD) and depression among South African university students forms a complex triad of influence, further compounded by South Africa’s sociocultural and economic intricacies. Research on effective trauma-focussed therapies (TFTs) for universities, among other contexts in the Global South, is scarce. University mental health resources are constrained, with only 27.3% of South African students with PTSD receiving psychological treatment. This mixed-methods study evaluates the effectiveness of Massed-Prolonged Exposure Therapy (Massed-PE) for treating rape-related PTSD and comorbid depression among South African university students and asks whether these participants perceive Massed-PE to be acceptable, feasible and appropriate to implement. Baseline screening assessments confirmed PTSD and depression symptoms among participants (n=3). Similar assessments were conducted regularly during- and at post-intervention. Implementation measures and semi-structured interviews were also administered at post-intervention. One participant dropped out after the second of ten sessions. Both remaining participants no longer met the diagnostic criteria for PTSD at post-intervention. One of these participants no longer met the diagnostic criteria for comorbid depression, and the other demonstrated a decrease in her depressive symptoms, just reaching the clinical cut-off. Quantitatively, participants experienced the therapy as acceptable and feasible, but differed on its appropriateness. Qualitative insights lent contextually valuable nuance to these findings. This study provides preliminary results in support of the effectiveness and implementability of Massed-PE. It underscores the importance of implementation research to bridge the know-do gap in the evidence base for treating rape-related PTSD and comorbid depression in university contexts, whilst offering insights which may be applied more broadly to PTSD treatment in resource-constrained settings.