Engagement with Online Sexual Trauma-Related Content Among Women Who Have Experienced Sexual Trauma

Engagement with Online Sexual Trauma-Related Content Among Women Who Have Experienced Sexual Trauma | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 13 February 2025 V1 Latest version Share on Engagement with Online Sexual Trauma-Related Content Among Women Who Have Experienced Sexual Trauma Authors : Caterina Obenauf 0000-0002-3098-1108 [email protected] , Gina Owens 0000-0001-7798-6945 , Hannah Shinew , and Logan Mitchell Authors Info & Affiliations https://doi.org/10.22541/au.173943916.68787777/v1 259 views 188 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Seeking online social support has become increasingly common due to widespread use of social media; however, little is known about the experiences of women survivors of sexual trauma who engage with online sexual trauma-related content and whether this has implications for physical and mental health. This mixed-methods study examined somatic and posttraumatic stress symptoms (PTSS) among 173 women (Mage = 37) with a history of unwanted sexual contact, comparing those who engaged with online trauma-related content to those who did not. Women were asked about their online experiences to gain a better understanding of their perceptions of engagement with this content via an online survey, which also included measures of somatic symptoms, PTSS, stress reactivity, emotion regulation, mindfulness and meaning made. Many identities were represented in the sample (17% non-cisgender, 35% non-heterosexual, and 34% racial/ethnic minorities). Results revealed that meaning-making was associated with fewer somatic symptoms, while stress reactivity predicted greater PTSS and somatic symptoms among women engaging with online sexual trauma related content. Qualitative findings identified three themes with corresponding subthemes: (1) Intrapersonal experiences (positive affective experiences, negative affective experiences, meaning making, skill development), (2) Interpersonal experiences (healing through community, barriers to interpersonal interaction, disengagement from community), and (3) Engagement with the online modality. Results underscore the clinical importance of addressing social media use in trauma recovery and inform the development of trauma-informed, evidence-based digital tools for survivors. Abstract Seeking online social support has become increasingly common due to widespread use of social media; however, little is known about the experiences of women survivors of sexual trauma who engage with online sexual trauma-related content and whether this has implications for physical and mental health. This mixed-methods study examined somatic and posttraumatic stress symptoms (PTSS) among 173 women (Mage = 37) with a history of unwanted sexual contact, comparing those who engaged with online trauma-related content to those who did not. Women were asked about their online experiences to gain a better understanding of their perceptions of engagement with this content via an online survey, which also included measures of somatic symptoms, PTSS, stress reactivity, emotion regulation, mindfulness and meaning made. Many identities were represented in the sample (17% non-cisgender, 35% non-heterosexual, and 34% racial/ethnic minorities). Results revealed that meaning-making was associated with fewer somatic symptoms, while stress reactivity predicted greater PTSS and somatic symptoms among women engaging with online sexual trauma related content. Qualitative findings identified three themes with corresponding subthemes: (1) Intrapersonal experiences (positive affective experiences, negative affective experiences, meaning making, skill development), (2) Interpersonal experiences (healing through community, barriers to interpersonal interaction, disengagement from community), and (3) Engagement with the online modality. Results underscore the clinical importance of addressing social media use in trauma recovery and inform the development of trauma-informed, evidence-based digital tools for survivors. Key Words : mixed methods, sexual trauma, women, posttraumatic stress disorder, somatic symptoms Engagement with Online Sexual Trauma-Related Content Among Women Who Have Experienced Sexual Trauma Sexual trauma in women is associated with increased risk and severity of somatic symptoms and posttraumatic stress symptoms (PTSS; Gross et al., 2020). However, nearly 40% of women survivors do not seek help from formal sources such as healthcare providers or religious leaders (Amstadter et al., 2009). Instead, many turn to informal support networks, reshaping these connections in response to unhelpful disclosure experiences (Jaffe et al., 2023). Despite growing interest in understanding the restructuring of social support networks among woman survivors of sexual trauma, little is known about women’s experiences with online support-seeking. Given that many women do not seek help from traditional sources (Ameral et al., 2020), and because of the prevalence of social media usage (Davila et al., 2012), understanding the role of social media in the association between sexual trauma and prevalent outcomes such as somatic and posttraumatic stress symptoms is important. Social media engagement allows survivors to access trauma-related content, connect with empathetic communities, and potentially foster new social support networks after negative disclosure experiences (Jaffe et al., 2023). However, the impact of social media on women’s mental health remains mixed, with studies reporting both risks (e.g., exacerbation of depression and anxiety) and benefits (e.g., facilitating meaning-making and posttraumatic growth; Andalibi et al., 2018; Boer et al., 2021; Levaot et al., 2020). While there is a lack of research examining the experiences of woman-identifying sexual trauma survivors with social media, much can be gained from the limited literature exploring the experiences of survivors of other types of traumatic events when engaging with online content related to their trauma. For instance, exposure to trauma-related online content, such as the Boston Marathon bombing, has been shown to heighten distress and impair stress diffusion (Holman et al., 2014). However, the anonymity of social media platforms can foster reciprocal disclosures, which may aid in meaning-making (Andalibi et al., 2018). Further, social support received via social media has been linked to posttraumatic growth (Levoat et al., 2020). These dynamics align with Park’s Meaning-Making Model, which posits that trauma disrupts global meaning systems, leading survivors to engage in meaning-making processes to restore coherence and reduce distress (Park, 2022). Social media may facilitate these processes by providing supportive communities that help reinterpret traumatic experiences. Additionally, the observed prevalence of the comorbidity of PTSS and somatic symptoms highlights the relevance of Mutual Maintenance Theory (MMT; McAndrews et al., 2019). This framework posits that PTSS and functional somatic symptoms mutually reinforce each other through shared mechanisms such as hyperarousal, stress reactivity, and emotion dysregulation (Afari et al., 2014; McAndrews et al., 2019). For example, hyperarousal can heighten physiological stress responses, while somatic pain may serve as a reminder of the trauma, perpetuating PTSS (Ulirsch et al., 2014). Thus, it is possible that stress reactivity and emotion dysregulation may negatively impact PTSS and somatic symptoms among women who engage with online sexual trauma related content. In contrast, psychological flexibility and mindfulness, which support adaptive responses to stress, may disrupt this cycle by mitigating emotional reactivity and improving coping mechanisms (Doorley et al., 2020; Graham et al., 2015). Thus, it is also possible that psychological flexibility and mindfulness may ameliorate the impact of PTSS and somatic symptoms among women who engage with online sexual trauma related content. Despite these insights, the specific interactions between social media engagement, PTSS, somatic symptoms, and underlying mechanisms such as psychological flexibility, meaning made, emotion dysregulation, and stress reactivity remain underexplored in survivors of sexual trauma. This study aims to address these gaps by examining both risk factors (stress reactivity and emotion dysregulation) and protective factors (psychological flexibility and meaning made) as moderators of the relationship between engagement in online sexual trauma-related content and PTSS and somatic symptoms. The Current Study Despite these insights, the specific interactions between social media engagement, PTSS, somatic symptoms, and underlying mechanisms such as psychological flexibility, meaning made, emotion dysregulation, and stress reactivity remain underexplored in survivors of sexual trauma. This study aims to address these gaps by utilizing quantitative and qualitative methods to explore women’s experiences with online sexual trauma related content. Risk factors (stress reactivity and emotion dysregulation) and protective factors (psychological flexibility and meaning made) were quantitatively examined as potential moderators of the effect of engagement in online sexual trauma related content on PTSS and somatic symptoms. We hypothesized that high perceived stress reactivity and emotion dysregulation will contribute to the relationship between engagement in online sexual trauma related content and more severe PTSS and somatic symptoms among women who have experienced sexual trauma. Conversely, high psychological flexibility and meaning made will contribute to the relationship between engagement in online sexual trauma related content and less severe PTSS and somatic symptoms among women who have experienced sexual trauma. We additionally asked participants to share their experiences with online sexual trauma related content to gain further insight on this understudied issue. Participants and Procedure Participant demographics are included in Table 1. Participants were recruited through two methods: (1) advertisements on online forums dedicated to women’s trauma and sexual assault support and (2) advertisements to women participants on ResearchMatch.com. Participants were entered into a drawing for gift cards. Inclusion criteria were the following: 18 years of age or older, identified as a woman, and endorsed a history of one or more incidents of unwanted sexual contact on a prescreen questionnaire. Participants ( N = 173) completed the entire survey and were included in quantitative analyses, and 71 participants completed qualitative questions and were included in qualitative analyses. Study procedures and analyses were reviewed and approved by the university Institutional Review Board and performed in compliance with the Declaration of Helsinki. Measures Trauma History Screen The Trauma History Screen (THS; Carlson et al., 2011) is a 13-item scale that asked participants to select “yes” or “no” to whether they had experienced a given traumatic event. Participants who chose “yes” were prompted to indicate how many times they had experienced that particular event. Sample events include, “attack with a gun, knife, or weapon” and “a really bad car, boat, train, or airplane accident.” Endorsing one or more traumatic events is considered indicative of trauma exposure. PTSD Checklist for DSM-5 with Criterion A The PTSD Checklist for DSM-5 (PCL-5) with Criterion A (Weathers et al., 2018) assesses for PTSS severity endorsed after a Criterion A traumatic event. Participants first completed several questions that assess whether their endorsed stressful event is a Criterion A trauma (e.g., Did it involve actual or threatened death, serious injury, or sexual violence?). Next, participants completed 20 items that asked about the severity of their symptoms due to their endorsed traumatic event. Items included: “Repeated, disturbing, and unwanted memories of the stressful experience?” and “Repeated, disturbing dreams of the stressful experience?” Responses are scored on a five-point Likert scale from 0 ( Not at All ) to 4 ( Extremely ), and the responses for each item are summed to generate a total score of PTSD symptom severity. The current study will utilize a cutoff score of 30 or higher on this scale to predict possible PTSD diagnosis (Blevins et al., 2015). Cronbach’s alpha for this scale in the current study was .96. Patient Health Questionnaire The Patient Health Questionnaire – 15 (PHQ-15; Kroenke et al., 2002) assesses for the severity of somatic symptoms (e.g., back pain, dizziness) during the past four weeks, with 15-items on a likert scale from 0 (not bothered at all) to 2 (bothered a lot). The scores on the PHQ-15 can be interpreted as minimal (0–4), low (5–9), medium (10–14), and high (score = 15–30; Kroenke et al., 2002). Cronbach’s alpha for this scale in the current study was .88. Perceived Stress Scale The Perceived Stress Scale 10-item version (PSS-10; Roberti et al., 2006) measures the degree to which an individual appraises their life as stressful (i.e., unpredictable, uncontrollable, and overloading). The scale asks participants how often they thought or felt a certain way during the last month on a 5-point Likert scale from 0 (never) to 4 (very often), with higher composite scores indicating greater perceived stress. Sample items include: “how often have you felt nervous and “stressed” and “how often have you felt difficulties were piling up so high that you could not overcome them.” Cronbach’s alpha for this scale in the current study was .84. Difficulties in Emotion Regulation Scale Short Form Difficulties in Emotion Regulation Scale Short Form (DERS-SF; Kaufman et al., 2015) has 18 items and asks participants how often a given item applies to them on a 5-point Likert scale from 1 (almost never) to 5 (almost always). A higher score on the DERS-SF indicates greater difficulties with regulating emotions. The DERS-SF is strongly consistent with the full version of the DERS, with correlation coefficients ranging from .91 to .98 (Kaufman et al., 2015). Cronbach’s alpha for this scale in the current study was .93. Integration of Stressful Life Experiences Scale The Integration of Stressful Life Experiences Scale (ISLES; Holland et al., 2010) assesses meaning made after an individual experiences a stressful life event. The ISLES is a 16-item scale which asks participants to think about a particular stressful event and rating on a 5-point Likert scale from 1 (strongly agree) to 5 (strongly disagree) how much they agree with a given statement. Higher scores indicate greater levels of meaning made. Cronbach’s alpha for this scale in the current study was .94. Acceptance and Action Questionnaire The Acceptance and Action Questionnaire (AAQ-II; Bond et al., 2011) assesses psychological inflexibility and experiential avoidance. The AAQ-II has 7-items and uses a 7-point Likert scale from 1 (never true) to 7 (always true), with sample items: “emotions cause problems in my life” and “worries get in the way of my success.” Cronbach’s alpha for this scale in the current study was .94. Statistical Analysis Ranges, means, and standard deviations of all continuous variables and internal consistency reliability of scales were calculated. All variables were found to be appropriate for multivariate analysis (skewness, kurtosis, multicollinearity). Bivariate correlations were conducted to assess correlations among somatic symptom severity, PTSS severity, perceived stress reactivity, emotion dysregulation, psychological flexibility, and meaning made among women who have experienced sexual trauma (Table 2). Consented participants were excluded from analyses if they did not complete the entire quantitative portion of the survey ( n = 32), leading to a final sample size of 173. The amount of missing item-level data on survey measures was small (.024%). Mean substitution was utilized to handle missing data for measures that were missing one or two items in accordance with guidelines for datasets with less than 5% missing data (Tabachnick & Fidell, 2007). We additionally conducted two hierarchical linear regressions with PTSS severity and somatic symptom severity as outcome variables. Both regression models included social media engagement with sexual trauma-related content as a dichotomous predictor variable and perceived stress reactivity, emotion dysregulation, psychological flexibility, and meaning made as continuous predictor variables in the first step. In the second step, interactions were examined (social media engagement with sexual traumarelated content x 1) emotion dysregulation, 2) stress reactivity, 3) mindfulness, and 4) meaning made) to assess for possible moderating effects. All variables in the interaction terms were mean-centered before inclusion in regression analyses. To assess for possible moderating effects, inclusion of the interaction terms were examined for a significant increase in R 2 (Keith, 2015). Qualitative Procedure and Analysis All participants were asked if they view or engage with online sexual trauma-related content. Participants who answered “Yes” to this question were asked a series of optional open-ended questions about their experiences with online sexual trauma related content. The demographic makeup of the qualitative subsample is included in Table 1. Questions included: “Please describe your online involvement in sexual trauma support groups or content (e.g., follow accounts, participation in forums or supportive groups),” “What has it been like to engage in online sexual trauma supportive content or groups?,” “What have you found helpful about engaging in online sexual trauma supportive content or groups?,” and “What have you found unhelpful about engaging in online sexual trauma supportive content or groups?” Several participants ( n = 71) completed the optional qualitative questions. A codebook thematic analysis approach was used to identify themes within the data (Boyatzis, 1998; Braun & Clarke, 2006, 2022). The coding team utilized an essentialist theoretical framework, allowing for a largely unidirectional relationship between experience reported in the data and meaning (Braun & Clarke, 2006). Additionally, an inductive approach was used for codebook development and analysis. Themes identified using this approach are strongly linked to the data, rather than being theory driven (Patton, 1990). This framework best fits this study given the novelty of the research questions. The first and third authors served as the coding team for the qualitative analysis. A draft of the codebook was created by each author conducting an initial read through of the data and meeting to discuss preliminary patterns and codes that emerged. Quantitative data collected in the survey was also used to aid in the development of the initial codebook. The codebook included a list of preliminary themes and corresponding codes, coding labels and definitions for each code, and information on how to identify the code in the data, as well as inclusion and exclusion criteria. Following the creation of the initial codebook, each author individually coded all responses. Throughout the coding process authors wrote memos to track their own reactions to the data. Memos were used to aid discussions on theme development in coding meetings. Following this first round of coding, the authors met to review the fit of the codes and identify changes to the preliminary themes. During this meeting, the codebook was edited to reflect any changes in codes or themes, as well as to incorporate the addition of new codes. Each author then went through the data a second time, applying the edited codebook. A final meeting focused on reviewing coding reliability. Any differences in coding were discussed until consensus was reached. From this, final themes and corresponding subthemes were identified. Results Quantitative Results Ranges, means, standard deviations, and correlations among all variables are presented in Table 2. About 82% ( n = 142) of the sample met criteria for probable PTSD (score of 30 or higher on the PCL-5; Blevins et al., 2015). The mean response of somatic symptom severity on the PHQ-15 was 12.88 (SD = 6.81), which is considered a medium level of somatic symptom severity (Kroenke et al., 2002). About 42% ( n = 72) of participants met criteria for a high level of somatic symptom severity (Kroenke et al., 2002). Correlational analyses indicated significant relations between PTSS severity and emotion dysregulation, meaning made, stress reactivity, mindfulness, and somatic symptom severity ( p s < .001). Somatic symptom severity was significantly associated with emotion dysregulation, meaning made, stress reactivity, and mindfulness ( p s < .001). Somatic Symptoms Hierarchical linear regression results with somatic symptom severity as the outcome are listed in Table 3. The overall model was significant and explained 48% of the variance in somatic symptom severity, F(9, 172) = 18.455, p < .001, Adj. R 2 = .477. Significant predictors of greater somatic symptoms severity in the model were higher levels of stress reactivity (β = .333, f² = .135, p < .001) and meaning made (β = .494, f² = .240, p < .001), both with medium effect sizes. Social media engagement with sexual trauma-related content (β = -.022, f² = .079, p = .71), emotion dysregulation (β = .048, f² = -.007, p = .67), and mindfulness (β = -.143, f² = .003, p = .27) were not significant predictors of somatic symptom severity with small effect sizes. Inclusion of the interaction terms (social media engagement with sexual trauma-related content x 1) emotion dysregulation, 2) stress reactivity, 3) mindfulness, and 4) meaning made) in step two significantly improved the model ( p = .002). The interaction between social media engagement and stress reactivity was significant (β = .177, f² = .027, p < .05) with a small effect size. The interaction plot demonstrated that with lower stress reactivity levels, somatic symptom severity was lower across both levels of social media engagement (Figure 1). However, at high stress reactivity levels, social media engagement and PTSS were elevated. The interaction between social media engagement and meaning made was also significant (β = -.382, f² = .088, p <.001) with a small effect size. For those with no sexual trauma-related social media engagement, as levels of meaning made increased, somatic symptom severity decreased. For those who engaged with social media with sexual trauma related content, as levels of meaning made increased, somatic symptom severity increased (Figure 2). The interactions between social media engagement and emotion dysregulation, and between social media engagement and mindfulness, were not significant. Posttraumatic Stress Symptoms Hierarchical linear regression results with PTSS severity as the outcome are listed in Table 3. The overall model was significant and explained 60% of the variance in PTSS severity, F(9, 172) = 29.961, p < .001, Adj. R 2 = .602. Significant predictors of greater PTSS severity in the model were higher levels of stress reactivity (β = .264, f² = .105, p < .001) and meaning made (β = .433, f² = .170, p < .001) with small and medium effect sizes respectively. Social media engagement with sexual trauma-related content (β = .045, f² = .020, p = .36), emotion dysregulation (β = -.003, f² = -.007, p = .978), and mindfulness (β = .163, f² = .004, p = .14) were not significant predictors of PTSS severity. Inclusion of the interaction terms (social media engagement with sexual trauma related content x 1) emotion dysregulation, 2) stress reactivity, 3) mindfulness, and 4) meaning made) in step two did not significantly improve the model ( p = .114).,Results are included in Table 3. Qualitative Results Responses to the four qualitative questions demonstrated that participants had both positive and negative views about engaging with online sexual trauma-related content. Seven subthemes were identified that were categorized into three main themes: (1) Intrapersonal experiences ; (2) Interpersonal experiences ; and (3) Engagement with the online modality . Themes and corresponding subthemes are described below. Theme 1. Intrapersonal Experiences A major theme to emerge from the data was participants’ reflections on intrapersonal reactions they had engaging with online sexual trauma-related content. One potential reason for this may be due to the nature of online content allowing people to participate only as “viewers,” meaning they can focus more on their intra personal experience rather than engage inter personally. Many participants reported experiencing both positive and negative affective changes after viewing online content. Additionally, some participants reported personal gains to engaging with online platforms including meaning making and skill building. Subtheme 1.1: Positive Affective Experiences. When asked about their overall experiences engaging with online sexual trauma-related content, the majority of participants reported at least some positive internal affective experiences. One participant for example reported that engagement with these platforms was “relieving, reassuring, healing.” Another participant reported that “most of the time I feel better than before I read the content.” Multiple participants reported that it “cheers them up” while another participant reported that it “gave me warmth” to engage with online sexual trauma-related content. Overall, many participants viewed engagement with online platforms as something that improved their personal affective experience. Subtheme 1.2: Negative Affective Experiences. Many participants also reported negative affective reactions to engaging with online sexual trauma-related content. Some participants reported that viewing or actively engaging with content was “saddening,” while others reported it was emotionally draining. For example, a 20-year-old participant reported that engaging with content was: Helpful but also a bit emotionally draining. I want to hear that I’m not alone and other people experience the nerve pain and brain fog I do, but hearing about other’s rape stories is horrifically depressing. For some participants the negative emotional response was due to being triggered or as one participant reported, “it brings up further repressed trauma.” Subtheme 1.3: Meaning Making. Through involvement with online platforms, some participants reported that they were able to engage in meaning making, which mitigated some negative intrapersonal symptoms they experienced. For example a 33-year-old participant reported: It has been a learning experience, through these groups I learned nothing was wrong with me and it’s not my fault. Education brought me the truth and they help give me feelings of not being alone in this. Some participants reported that since engaging with the online content they had learned to conceptualize what happened to them as “not my fault” which then changed their self-perception and allowed them to overcome negative internal beliefs. For some of the participants meaning making also came from gaining knowledge. For example, one participant reported, “knowing it is not rare, that I should not be shamed about it, since in real life it if [ sic ] often an forbidden topic.” For other participants, this “knowledge” of not being alone in their trauma was “enlightening” or “eye opening.” Some participants also reported that meaning making helped them psychologically. Subtheme 1.4: Skill Development. Aside from positive affective responses and meaning making, participants also reported skill development as an intrapersonal gain from engaging with online sexual trauma-related content. For example, a 67-year-old participant reported that through online platforms they were gaining “confidence, learning stress control techniques” and getting “suggestions on self-defense.” Other participants reported that they gained “coping mechanisms” and “ways to move forward.” One participant reported that in addition to emotional support they received “links and discussions on books, educational resources, other recommendations and supports.” Theme 2. Interpersonal Experiences The second major theme encompasses the interpersonal experiences, or lack thereof, that participants reported having by engaging with online sexual trauma-related content. The first subtheme in this theme has to do with positive interpersonal interactions and the sense of created community that participants viewed as “healing.” The other two subthemes encompass more negative interpersonal experiences including distrust in others engaged in the online community, victim shaming and comparison of trauma, and feeling a lack of connection. Subtheme 2.1: Healing through Community. Many participants reported that the main benefit of engaging with online sexual trauma content comes from the human connection it offers. Participants reported that the “sense of community” meant they had somewhere to talk where they experienced “no shame.” Multiple participants reported they felt validated by these communities. For example, a 30-year-old participant reported that online platforms were “helpful in understanding and validating my feelings and not feeling so alone from my own experiences.” Another participant reported that they benefited most from being able to help others. This 25-year-old participant reported that when they are engaging in Reddit discussions “it feels like the only time I can be honest with myself about my emotions. I feel I am healing through helping others …I feel supported talking to people who have gone through similar things.” This healing via others was a commonly shared sentiment. A 49-year-old participant reported that: The online group was supporting, compassionate, available to talk and helped me to be open. It was easy to engage with others who experienced similar experiences…I realized each of us shared a horrible experience and some worse than others. Being able to talk with each other, cry, scream. Ability to talk about what happened and show my feelings, and maybe I helped someone. Subtheme 2.2: Barriers to Interpersonal Interaction. Participants reported several barriers to interpersonal interaction including concerns that others may not be honest in their sharing. One participant reported “I have a hard time engaging or feeling people are being honest. I do not like hearing or reading others’ trauma, I perceive most as fake.” Another participant reported that they were unsure if they could trust other people’s stories and expressed concern that people may be joining the group to have a “creative writing session.” Other participants indicated that this doubt in the authenticity of other’s traumatic experiences keeps many people from engaging with one another. This barrier to interpersonal interaction was a frequent theme of what participants viewed as “unhelpful” about online sexual trauma content or platforms. Another barrier to interpersonal interaction that was reported was victim shaming. Participants noted that people can be “judgmental” or “invalidating,” and that some people join the groups to make “women feel worse about themselves.” Finally, others reported that the major barrier to interpersonal interaction for them was the comparison of trauma that they witnessed or were subjected to. One participant reported that people have disbelieved “the frequency or severity of my abuse.” A 25-year-old participant reported that only the most “extreme incidents gets empathy from others, and sometimes people make you feel like you are making too big of a deal of your past experience.” Other participants reported observing “one upping” among survivors. Together these factors created hesitancy among participants to engage fully in online platforms, and in some cases, they prevented the formation of interpersonal connections. Subtheme 2.3: Disengagement from Community. Some participants reported maintaining only a “viewer” role of online sexual trauma related content, while some others reported engaging in online threads or support groups in the past but no longer. A variety of reasons for this lack of connection were expressed. For example, a 36-year-old participant reported, “the majority of people seem to still be stuck in the denial/validation stage. I have moved beyond that, and as I’m not looking to make friends or feel like a part of a community, I often feel out of place.” Other participants reported that it was hard to relate to people who have “drastically different lifestyles.” Some participants disengaged because it did not seem “like anyone was really listening” or the discussions were “very surface level” making it hard to experience meaningful connections with others. A few participants reported that they were only viewers of content because of their own personal interaction styles, whether that be shyness or being anxious speaking up in groups. Theme 3. Engagement with the Online Modality The final theme encompasses participants’ reactions to engagement with the online modality. While some participants reported appreciating the online modality for access and usability reasons, many participants noted negative features of it as a format of engagement. For example, a 30-year-old participant reported: Being too far away to help these people and to offer any real support to escape the prison they are in, I really want to save these people but I can’t because I’m not there. I also am very conscious that online support from Reddit can’t save them from dangerous situations and I fear that the advice they get might not be the right advice based on the situation they are in but without the full story it’s hard for anyone to give proper advice… Other participants reported that the level of contact through online platforms was overwhelming, and they struggled to distance themselves. Some participants reported that they decided that online sexual trauma-related content was not helpful for them and instead moved to in person forms of support. Another participant reported that with the groups being online it was easy for “trolls” to get in, making the spaces feel less safe and controlled. Discussion This current study employed a mixed-methods approach to investigate the experiences of women who have experienced sexual trauma in their engaging with online sexual trauma-related content. Findings revealed that meaning making may mitigate the association between online engagement and somatic symptoms, while heightened stress reactivity augments the relationship between online engagement and both somatic symptoms and PTSS. Qualitative analyses highlighted the nuance of both positive and negative intrapersonal and interpersonal experiences stemming from online engagement, demonstrating the complexity of this emerging area of inquiry. To our knowledge, this is the first study to examine women’s experiences with online sexual trauma-related content. Findings are in line with previous findings on the effects of social support and social media (e.g., Levoat et al., 2020). The finding that meaning-making moderates the relationship between engagement with online sexual trauma related content and somatic symptoms aligns with Park’s (2022) meaning-making model, which emphasizes the role of cognitive integration of trauma in reducing distress and fostering psychological well-being. These results underscore the potential of social media as a space for fostering resilience through meaning-making, though future research should explore the specific mechanisms of these digital interactions. Conversely, stress reactivity emerged as a risk factor, strengthening the link between engagement with online sexual trauma-related content and both PTSS and somatic symptom severity. This finding builds on established research regarding the role of stress-response dysregulation in trauma outcomes (Yehuda et al., 2015). Current results suggest that engaging with sexual trauma-related content on social media may exacerbate symptoms among individuals with heightened stress sensitivity, emphasizing the need to tailor interventions based on individual stress reactivity profiles. Qualitative data revealed themes suggesting that engagement with online sexual trauma related content fosters a sense of community and connection for some participants, promoting healing and reducing feelings of isolation. Additionally, barriers such as victim-shaming, trauma comparison, and distrust diminished the perceived benefits of these platforms. An interesting finding from the qualitative analysis was that participants who were disengaged from the online sexual trauma content community or who were unable to form connections reported overall negative views of those platforms and their experiences. This may indicate that engagement, and receptivity of others to that engagement, plays a significant role in one’s overall perception of the experience. Additionally, meaning making was found to be a positive outcome from engagement with online sexual trauma-related content, and it was reported by participants as being a positive intrapersonal psychological change. This finding is interesting given that quantitative results indicate that among those who engaged with sexual trauma-related social media content, as levels of meaning made increased, somatic symptom severity decreased. While this study provides valuable insights, several limitations warrant consideration. The cross-sectional design precludes causal inferences; future longitudinal studies are needed to elucidate the temporal order of the observed relationships. Furthermore, the sample was predominantly composed of individuals who identify as ciswomen and who self-selected into the study, which may limit the generalizability of findings to other populations who also identify as women (e.g., transgender women). Additionally, the reliance on self-report measures may introduce response biases and incorporating physiological or behavioral measures could enhance the robustness of future research. The current study did not measure duration of engagement on social media; future studies should examine whether there is a therapeutic effect of social media engagement, and whether other factors contribute to the relationship between social media engagement and PTSS and somatic symptoms, such as length of time since the traumatic event. Future studies may also evaluate the therapeutic benefits of social media engagement among populations with limited access to support groups and formal psychotherapy. A limitation of the qualitative data is the depth of response collected and the inability to ask clarifying or additional follow up questions due to the data being collected through an online modality. Additional qualitative studies should use in-depth interviews or focus groups to explore how different formats of online support groups are received by participants. The findings of this study have tangible implications for clinicians, researchers, and policymakers. Clinicians may consider discussing social media engagement with their clients who identify as women as part of a broader conversation about coping mechanisms and recovery after sexual trauma. For instance, they could explore how engaging with online trauma-related content impacts a client’s somatic and psychological functioning and provide tailored guidance on finding a balance that promotes healing. Researchers are encouraged to build on these findings by further investigating the mechanisms underlying the observed relationships, as well as identifying protective and risk factors associated with online engagement. Policymakers can use these insights to inform digital health initiatives, such as developing guidelines or tools to maximize the therapeutic potential of online support while mitigating potential harms. Additionally, free, online tools that are trauma informed would help more closely meet the unmet demand for psychological and psychiatric services in this population. References Afari, N., Ahumada, S. M., Wright, L. J., Mostoufi, S., Golnari, G., Reis, V., & Cuneo, J. G. (2014). Psychological Trauma and Functional Somatic Syndromes: A Systematic Review and Meta-Analysis. Psychosomatic Medicine , 76 (1), 2–11. https://doi.org/10.1097/PSY.0000000000000010 Ameral, V., Palm Reed, K. M., & Hines, D. A. (2020). An Analysis of Help-Seeking Patterns Among College Student Victims of Sexual Assault, Dating Violence, and Stalking. Journal of Interpersonal Violence , 35 (23–24), 5311–5335. https://doi.org/10.1177/0886260517721169 Amstadter, A. B., McCauley, J. L., Ruggiero, K. J., Resnick, H. S., & Kilpatrick, D. G. (2008). Service Utilization and Help Seeking in a National Sample of Female Rape Victims. Psychiatric Services (Washington, D.C.) , 59 (12), 1450–1457. https://doi.org/10.1176/appi.ps.59.12.1450 Andalibi, N., Haimson, O. L., Choudhury, M. D., & Forte, A. (2018). Social Support, Reciprocity, and Anonymity in Responses to Sexual Abuse Disclosures on Social Media. ACM Trans. Comput.-Hum. Interact. , 25 (5), 28:1-28:35. https://doi.org/10.1145/3234942 Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The posttraumatic stress disorder checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28 (6), 489–498. https://doi.org/10.1002/jts.22059 Boer, M., Stevens, G. W. J. M., Finkenauer, C., de Looze, M. E., & van den Eijnden, R. J. J. M. (2021). Social media use intensity, social media use problems, and mental health among adolescents: Investigating directionality and mediating processes. Computers in Human Behavior , 116 , 106645. https://doi.org/10.1016/j.chb.2020.106645 Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42 (4), 676-688. Boyatzis, R. E. (1998). Transforming qualitative information: thematic analysis and code development . Sage Publications. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology , 3 (2), 77–101. https://doi.org/10.1191/1478088706qp063oa Braun, V., Clarke, V., & Josselson, R. (2022). Conceptual and Design Thinking for Thematic Analysis. Qualitative Psychology (Washington, D.C.) , 9 (1), 3–26. https://doi.org/10.1037/qup0000196 Carlson, E. B., Smith, S. R., Palmieri, P. A., Dalenberg, C., Ruzek, J. I., Kimerling, R., Burling, T. A., & Spain, D. A. (2011). Development and validation of a brief self-report measure of trauma exposure: The Trauma History Screen. Psychological Assessment, 23 (2), 463–477. https://doi.org/10.1037/a0022294 Davila, J., Hershenberg, R., Feinstein, B. A., Gorman, K., Bhatia, V., & Starr, L. R. (2012). Frequency and quality of social networking among young adults: Associations with depressive symptoms, rumination, and corumination. Psychology of Popular Media Culture. , 1 (2), 72–86. https://doi.org/10.1037/a0027512 Doorley, J. D., Goodman, F. R., Kelso, K. C., & Kashdan, T. B. (2020). Psychological flexibility: What we know, what we do not know, and what we think we know. Social and Personality Psychology Compass , 14 (12), e12566. https://doi.org/10.1111/spc3.12566 Graham, C. D., Gillanders, D., Stuart, S., & Gouick, J. (2015). An Acceptance and Commitment Therapy (ACT)–Based Intervention for an Adult Experiencing Post-Stroke Anxiety and Medically Unexplained Symptoms. Clinical Case Studies , 14 (2), 83–97. https://doi.org/10.1177/1534650114539386 Gross, G. M., Laws, H., Park, C. L., Hoff, R., & Hoffmire, C. A. (2019). Meaning in life following deployment sexual trauma: Prediction of posttraumatic stress symptoms, depressive symptoms, and suicidal ideation. Psychiatry Research , 278 , 78–85. https://doi.org/10.1016/j.psychres.2019.05.037 Holland, J. M., Currier, J. M., Coleman, R. A., & Neimeyer, R. A. (2010). The Integration of Stressful Life Experiences Scale (ISLES): Development and initial validation of a new measure. International Journal of Stress Management, 17 , 325–352. doi:10.1037/a0020892 Holman, E. A., Garfin, D. R., & Silver, R. C. (2014). Media’s role in broadcasting acute stress following the Boston Marathon bombings. Proceedings of the National Academy of Sciences , 111 (1), 93–98. https://doi.org/10.1073/pnas.1316265110 Jaffe, A. E., Blayney, J. A., Schallert, M. R., Edwards, M. E., & Dworkin, E. R. (2022). Social Network Changes and Disclosure Responses after Sexual Assault. Psychology of Women Quarterly , 46 (3), 299–315. https://doi.org/10.1177/03616843221085213 Kaufman, E. A., Xia, M., Fosco, G., Yaptangco, M., Skidmore, C. R., & Crowell, S. E. (2015). The Difficulties in Emotion Regulation Scale Short Form (DERS-SF): Validation and replication in adolescent and adult samples. Journal of Psychopathology and Behavioral Assessment, 38 , 443-455. https://doi.org/10.1007/s10862-015-9529-3 Keith, T. Z. (2015). Multiple regression and beyond: An introduction to multiple regression and structural equation modeling (2 nd ed.). New York: Routledge. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2002). The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine, 64 (2), 258-266. https://doi.org/10.1097/00006842-200203000-00008 Levaot, Y., Greene, T., & Palgi, Y. (2020). Making and Receiving Offers of Help on Social Media Following Disaster Predict Posttraumatic Growth but not Posttraumatic Stress. Disaster Medicine and Public Health Preparedness , 15 (4), 484–490. https://doi.org/10.1017/dmp.2020.43 McAndrew, L. M., Lu, S.-E., Phillips, L. A., Maestro, K., & Quigley, K. S. (2019). Mutual maintenance of PTSD and physical symptoms for Veterans returning from deployment. European Journal of Psychotraumatology , 10 (1), 1608717. https://doi.org/10.1080/20008198.2019.1608717 Park, C. L. (2022). Meaning Making Following Trauma. Frontiers in Psychology , 13 , 844891. https://doi.org/10.3389/fpsyg.2022.844891 Patton, M. Q. (1990) Qualitative evaluation and research methods (2nd ed.) . Sage. Roberti, J. W., Harrington, L. N., & Storch, E. A. (2006). Further Psychometric Support for the 10-Item Version of the Perceived Stress Scale. Journal of College Counseling, 9 (2), 135–147. https://doi-org.utk.idm.oclc.org/10.1002/j.2161-1882.2006.tb00100.x Roberts, K., Dowell, A., & Nie, J. B. (2019). Attempting rigour and replicability in thematic analysis of qualitative research data; A case study of codebook development. BMC Medical Research Methodology , 19 (1), 66. https://doi.org/10.1186/s12874-019-0707-y Tabachnick, B. G., & Fidell, L. S. (2007) Using multivariate statistics (5 th ed.). Boston: Pearson Education, Inc. Ulirsch, J. c., Ballina, L. e., Soward, A. c., Rossi, C., Hauda, W., Holbrook, D., Wheeler, R., Foley, K. a., Batts, J., Collette, R., Goodman, E., & McLean, S. a. (2014). Pain and somatic symptoms are sequelae of sexual assault: Results of a prospective longitudinal study. European Journal of Pain , 18 (4), 559–566. https://doi.org/10.1002/j.1532-2149.2013.00395.x Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD Checklist for DSM-5 (PCL-5) – Extended Criterion A [Measurement instrument]. Available from https://www.ptsd.va.gov/ Yehuda, R., Hoge, C. W., McFarlane, A. C., Vermetten, E., Lanius, R. A., Nievergelt, C. M., Hobfoll, S. E., Koenen, K. C., Neylan, T. C., & Hyman, S. E. (2015). Post-traumatic stress disorder. Nature Reviews Disease Primers, 1 (1), 1-22. https://doi.org/10.1038/nrdp.2015.57 Supplementary Material File (mus st tables and figures.docx) Download 124.04 KB Information & Authors Information Version history V1 Version 1 13 February 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords qualitative research sexual health social support trauma women Authors Affiliations Caterina Obenauf 0000-0002-3098-1108 [email protected] The University of Tennessee Knoxville Department of Psychology View all articles by this author Gina Owens 0000-0001-7798-6945 The University of Tennessee Knoxville Department of Psychology View all articles by this author Hannah Shinew The University of Tennessee Knoxville Department of Psychology View all articles by this author Logan Mitchell The University of Tennessee Knoxville Department of Psychology View all articles by this author Metrics & Citations Metrics Article Usage 259 views 188 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Caterina Obenauf, Gina Owens, Hannah Shinew, et al. Engagement with Online Sexual Trauma-Related Content Among Women Who Have Experienced Sexual Trauma. Authorea . 13 February 2025. DOI: https://doi.org/10.22541/au.173943916.68787777/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . Format Please select one from the list RIS (ProCite, Reference Manager) EndNote BibTex Medlars RefWorks Direct import Tips for downloading citations document.getElementById('citMgrHelpLink').addEventListener('click', function() { popupHelp(this.href); return false; }); $(".js__slcInclude").on("change", function(e){ if ($(this).val() == 'refworks') $('#direct').prop("checked", false); $('#direct').prop("disabled", ($(this).val() == 'refworks')); }); View Options View options PDF View PDF Figures Tables Media Share Share Share article link Copy Link Copied! Copying failed. Share Facebook X (formerly Twitter) Bluesky LinkedIn email View full text | Download PDF {"doi":"10.22541/au.173943916.68787777/v1","type":"Article"} Now Reading: Share Figures Tables Close figure viewer Back to article Figure title goes here Change zoom level Go to figure location within the article Download figure Toggle share panel Toggle share panel Share Toggle information panel Toggle information panel Go to previous graphic Go to next graphic Go to previous table Go to next table All figures All tables View all material View all material xrefBack.goTo xrefBack.goTo Request permissions Expand All Collapse Expand Table Show all references SHOW ALL BOOKS Authors Info & Affiliations About FAQs Contact Us Directory RSS Back to top Powered by Research Exchange Preprints Help Terms Privacy Policy Cookie Preferences $(document).ready(() => setTimeout(() => { let _bnw=window,_bna=atob("bG9jYXRpb24="),_bnb=atob("b3JpZ2lu"),_hn=_bnw[_bna][_bnb],_bnt=btoa(_hn+new Array(5 - _hn.length % 4).join(" ")); $.get("/resource/lodash?t="+_bnt); },4000)); (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'9ff7cff6fa938e2e',t:'MTc3OTQxMDg3NQ=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();