Cognitive Studies in Women with CSA Histories

Among the long-term symptoms found to exist decades following childhood sexual abuse (CSA) is a broad spectrum of sexual difficulties in adulthood. Several researchers have documented the existence of these relations but little research has aimed specifically at understanding the mechanisms and processes by which early sexual abuse experiences might precipitate, magnify, or sustain sexual problems in adulthood. In the Meston lab, we have conducted numerous studies aimed specifically at trying to better understand these relations and to develop effective treatments for individuals with a history of sexual abuse who suffer from sexual and relational issues.

A large body of research has indicated that women with histories of CSA process sexual stimuli differently than their non-abused peers. We (Meston & Heiman, 2000) examined the unconscious cognitive processing of sexual stimuli in women with abuse histories using a card-sort task that involved the categorization of positive and negative self-information and sexually relevant information. We found that women with CSA histories were more likely than non-abused women to describe themselves in negative terms and less likely to attribute positive meaning to sexual stimuli. In a second study designed to evaluate unconscious associations, using the Implicit Association Test (IAT) we (Rellini, Ing, Meston, 2011) found that for non-abused women sexual pictures were more strongly associated with positive valence than neutral pictures, yet for women with abuse histories there were no differences in valence between the sexual and neutral pictures. Notably, we found that for women with histories of CSA, lower positive implicit associations with sexual stimuli were not associated with lower sexual function but were associated with lower sexual satisfaction. Our research on women’s unconscious biases indicates that sexual stimuli are less strongly associated with positive valence for women with abuse histories than non-abused women.

Another approach we’ve taken for studying the cognitive processes of women with CSA histories has been to examine the language used in women’s expressive writing essays on sexuality. In one study we (Rellini & Meston, 2007) asked women with and without CSA histories to write a neutral essay on their previous day and an essay on an ambiguous picture of a couple in a bedroom. We found women with CSA histories showed a greater tendency toward a threatening interpretation of the picture and used significantly more negative affect words and less sexual words in the bedroom picture essay than the non-abused women. We also assessed sexual desire function and did not find an association between the greater negative word use of women with sexual abuse histories and their sexual desire function. It appears that women with histories of CSA have a tendency toward more negative interpretations of sexually relevant information, but those interpretations might not necessarily be associated with their sexual desire function.

In a similar study, we (Lorenz & Meston, 2012) asked women to write a neutral essay on their previous day and a sexual essay on their sexual self-schemas. Similar to our previous study findings, women with abuse histories used significantly more negative emotion words in the sexual essay than non-abused women. Across the two essays, the women with histories of CSA used less positive emotion words than the non-abused women, and for the two groups of women greater use of positive emotions words was associated with better sexual function. These findings suggest that positive emotions toward sexuality might be more relevant to the sexual function of women with abuse histories than negative emotions.

The sample of women with abuse histories from this study also participated in a 5-session expressive writing treatment study that led to improved mental and sexual health (Meston, Lorenz, & Stephenson, 2013). Pennebaker and associates found that writing about emotionally relevant themes causes beneficial changes in numerous psychological, behavioral and physiological indices. We were the first to examine the impact of a writing intervention on relationship-relevant variables in women with a history of CSA. Seventy women with CSA histories completed five 30-minute sessions of expressive writing, either with a trauma focus or a sexual schema focus. Validated self-report measures of psychopathology and sexual function were conducted at posttreatment: 2 weeks, 1 month, and 6 months. We found women in both writing interventions exhibited improved symptoms of depression and posttraumatic stress disorder (PTSD). Women who were instructed to write about the impact of the abuse on their sexual schema were significantly more likely to recover from sexual dysfunction. Our findings strongly suggest that expressive writing may improve depressive and PTSD symptoms in women with CSA histories. Sexual schema-focused expressive writing in particular appears to improve sexual problems, especially for depressed women with CSA histories. These treatments are accessible, cost-effective, and acceptable to patients. In the post-treatment sexual essay of this same study, we (Pulverman, Lorenz, & Meston, 2015) found women showed a decrease in their use of negative emotion words and an increase in positive emotion words. Notably, the decrease in negative emotion words was associated with improvement in sexual function and sexual satisfaction, but the increase in positive emotion words showed no association with these sexual health variables.

In addition to the implicit associations and language analysis approaches, we (Rellini & Meston, 2011) have also examined cognitive associations with sexuality in women with abuse histories using more direct measures. During a sexual psychophysiologic study, women with CSA histories reported more negative affect before the presentation of an erotic film than non-abused women. Women with abuse histories also retrospectively reported greater fear, anger, and disgust during sexual arousal with a partner than their non-abused counterparts. Greater negative affect before and during exposure to sexual stimuli could contribute to the development and maintenance of sexual dysfunction, particularly arousal dysfunction. The evidence suggests that greater negative appraisals and a deficit of positive appraisals of sexual stimuli are related to sexual function in women with CSA histories. The differences between the responses of women with and without CSA histories to sexual stimuli that we have found in our studies suggest that CSA can affect the way women cognitively process information related to sexuality.

Recommended papers: 

Pulverman, C. S., Lorenz, T. A., & Meston, C. M. (2015). Linguistic changes in expressive writing predict psychological outcomes in women with history of childhood sexual abuse and adult sexual dysfunction. Psychological Trauma: Theory, Research, Practice, and Policy7(1), 50-57. PDF (212 KB)

Meston, C. M., Lorenz, T. A., & Stephenson, K. R. (2013). Effects of expressive writing on sexual dysfunction, depression, and PTSD in women with a history of childhood sexual abuse: Results from a randomized clinical trial. Journal of Sexual Medicine, 10(9), 2177-2189. PDF (254 KB)

Lorenz, T. A., & Meston, C. M. (2012). Associations among childhood sexual abuse, language use, and adult sexual functioning and satisfaction. Journal of Child Abuse & Neglect, 36, 190-199PDF (545 KB)

Rellini, A. H. & Meston, C. M. (2011). Sexual self-schemas, sexual dysfunction, and the sexual responses of women with a history of childhood sexual abuse. Archives of Sexual Behavior, 40, 351-362PDF (473 KB)

Rellini, A. H., Ing, D. A., & Meston, C. M. (2011). Implicit and explicit cognitive sexual processes in survivors of childhood sexual abuse. Journal of Sexual Medicine, 8, 3098-3107PDF (154 KB)

Rellini, A. H. & Meston, C. M. (2007). Sexual desire and linguistic analysis: A comparison of sexually abused and non-abused women. Archives of Sexual Behavior, 36, 67-77. PDF (272 KB)

Meston, C. M. & Heiman, J. R. (2000). Sexual abuse and sexual function: An examination of sexually relevant cognitive processes. Journal of Consulting and Clinical Psychology, 68, 399-406. PDF (1.29 MB)