Every 2 min in the United States, someone is sexually assaulted. It is common for individuals who have experienced sexual assault to go through a period of severe disorganization, known as rape trauma syndrome (RTS), following the trauma. Symptoms of RTS include a drop in school, work, or occupational performance; the experience of flashbacks to the rape; and a flood of sensory images as if the rape is happening again.

People who have experienced sexual assault may experience initial and long-term challenges; these challenges result from the individual’s heightened level of sympathetic arousal. Traditional posttraumatic stress disorder (PTSD) treatment methods are unsuccessful for a significant percentage of women with rape-related PTSD, creating a need for alternative treatment methods to be developed to directly address the sensory components of sexual trauma.

The results of this research indicate that individuals who report experiencing sexual assault have distinct differences in their preferences that affect occupational performance when compared to those who report having not experienced sexual assault. An understanding of the body’s sensory system can help occupational therapists to develop interventions to ease the impact of flashbacks, which may enhance the recovery process for individuals who have experienced sexual assault. As holistic and client-centered practitioners, we must consider the ways in which trauma affects one’s functional performance and ability to engage in meaningful activities.

INNOVATION: Individuals with trauma histories may become overwhelmed or triggered if the type or intensity of stimulation is perceived as too much, if the pace is too fast, or if the stimulus is similar to the trauma experience; the ability to understand the body’s sensory system and to create functional adaptive responses are essential to recovery. Occupational therapists have the knowledge to create sensory supportive interventions to increase adaptive responses, enable participation in meaningful activities and roles, and increase quality of life—but currently there are no formal protocols to address the negative sensory effects of sexual assault. Occupational therapists may be an essential piece to the recovery process by working with the individual to identify sensory processing and trauma factors that may adversely influence functional performance and development, leading to the potential creation of an emerging practice area of occupational therapy. The client-centered nature of occupational therapy, combined with sensory integration focused treatment, is a natural combination for trauma-informed care within occupational therapy.

APPROACH: As a result of having experienced sexual assault, an individual may alter his or her participation in everyday occupations. Trauma-informed care is vital to the practice of occupational therapy. As holistic and client-centered practitioners, we must consider the ways in which trauma affects our functional performance. An understanding of the body’s sensory system can help us develop interventions to ease the impact of flashbacks, which may enhance the recovery process for individuals who have experienced sexual assault.

METHOD: An online survey was created, with questions asking about typical occupations of college students that involve touch. Data collected consisted of participants’ answers to survey questions, many of which were on a Likert scale: strongly disagree, disagree, neutral, agree, and strongly agree. A Likert scale was utilized because it is a widely used and quantifiable method of self-report from participants. Data were collected online and stored electronically using Qualtrics software. Participants were Ithaca College students. Using a random stratified sample to get a representative population of the college campus, we e-mailed this survey to a sample of 3,000 students out of the 6,670 student body members. Subject selection was made using a random stratified sample of 700 freshmen, 700 sophomores, 700 juniors, 700 seniors, and 200 graduate students (this stratification was roughly proportional to the student population totals in these categories). Of these students, 471 students initiated the survey, and 404 students completed it.

Survey questions were constructed on the basis of the description and list of daily occupations from the Occupational Therapy Practice Framework: Domain and Process, picking out those typical for college-age students (activities of daily living, instrumental activities of daily living, social participation, and education) and constructing survey items that reflect those occupations that require the sensory stimuli of touch. Questions were constructed in four categories using the following characteristics of touch: Passive/Active Touch, Expected/Unexpected Touch, Social/Nonsocial Touch, and Deep/Light Touch.

Statistical analysis was performed with the aid of SPSS and MINTAB statistics software. An index was created to investigate the research question “as a result of sexual assault, an individual may alter his or her participation in everyday occupations” on the basis of respondents’ answers to those questions that addressed altered participation.

In addition, eight indices were created corresponding to the categories used in creating the questions: Passive/Active Touch, Expected/Unexpected Touch, Social/Nonsocial Touch, and Deep/Light Touch. In each case, questions used in the indices were scored on a scale from 1 to 5 (with 5 being the choice indicating lowest touch aversion/lowest degree of altered behavior), and indices were derived from the sum of these scores.

This analysis was done on the basis of the replies of the 350 respondents who answered all of the questions contained in at least one of the indices. Because of the different numbers of questions in different indices, the indices had different numerical ranges. To compare different indices graphically, we standardized scores to M = 0 and SD = 1 within each index.

For each of the nine indices, scores were compared between respondents who reported having experienced sexual assault with those who did not. In particular independent samples, t tests were performed to test the equality of mean index scores between the two groups. The p values reported were for two-tailed tests with no assumption of equal variance. The distribution of the scores in all cases showed the absence of severe outliers or skewness, justifying the use of this test especially in light of the relatively large sample size (n₁ = 257, n₂ = 3).

Because there is disagreement in the literature on the appropriate interpretation of Likert-scale-based data, analysis was also done using nonparametric Whitney–Mann analysis for comparison. The Whitney–Mann analysis and t-test analysis agreed in all cases. Comparisons were also done for the indices on the basis of gender and experience with other trauma (auto accidents and muggings). Finally, exploratory comparisons were done using Whitney–Mann analysis on individual questions to determine which responses differed the most on the basis of history of sexual assault.

RESULTS: The results of this study indicate that individuals who report experiencing sexual assault have distinct differences in their preferences that affect occupational performance when compared to those individuals who report having not experienced sexual assault. Survey participants were asked whether they had previously experienced trauma of mugging or sexual assault, and their answers were compared within the nine indices. The indices of Passive Touch (p = ∼.005), Unexpected Touch (p = ∼.003), Social Touch (p = ∼.009), Light Touch (p = ∼.016), and Occupations That Involve Touch (p = ∼.020) showed noticeable differences between individuals who reported experiencing sexual assault one or more times, as compared to individuals who reported not having experienced sexual assault. The indices of Active Touch, Expected Touch, Nonsocial Touch, and Deep Touch showed no statistical difference between individuals who reported experiencing sexual assault one or more times, as compared to individuals who reported not having experienced sexual assault.

CONCLUSION: The results show a distinct difference in the way individuals who have experienced sexual assault engage in everyday occupations. The results of this study indicate a clear need for what Champagne has referred to as trauma-informed care. The client-centered nature of trauma-informed care suggests a gap in care provided in the health care system that can be filled by occupational therapy’s specific client-centered treatment focusing on reengaging the individual in meaningful occupations.