Exploring Survivor Experiences on Social Media in the #MeToo Era: Clinical Recommendations for Addressing Impacts on Mental Health and Relationships

Abstract

Since the inception of the viral #MeToo Movement in 2017, news coverage of sexual assault incidents and related public discourse have become much more prevalent on social media platforms. While this hashtag activism has prompted important social discourse, little is known about how exposure to this type of trauma-related content affects survivors of sexual violence navigating these online spaces. To explore this phenomenon, we conducted in-depth, semi-structured interviews with young adult women survivors of sexual assault who regularly use social media (e.g., Facebook and Twitter). Participants were asked to reflect on sexual assault–related content (i.e., news stories and related public discourse) which they have observed on social media platforms. Thematic analysis of the qualitative data found survivors described (1) negative changes to their mental health and relationships in the face of these exposures, (2) certain types of content (e.g., rape culture narratives) which were particularly distressing to them, (3) how they coped with distress tied to this exposure, and (4) recommendations for clinicians on how to help survivors navigate social media in a healthier way. The present study is a first step toward understanding the impact of online social movements on trauma survivors and provides concrete clinical recommendations for therapists working with sexual assault survivors in this unique post-#MeToo context.

Keywords

Sexual assault social media #MeToo movement qualitative research clinical recommendations

Introduction

The impact of exposure to sexual assault content (i.e., news stories and related public discourse) via social media (SM) on the well-being of survivors is a topic currently underexplored in the literature. Sexual assault remains a pervasive issue in society, with more than one in three women in the U.S. experiencing unwanted sexual contact and about one in five experiencing attempted or completed rape in their lifetime (Smith et al., 2017, 2018). Beyond the criminal justice and human rights problem these statistics highlight, sexual violence constitutes a significant public health problem, as it contributes to myriad mental and behavioral health issues including anxiety, depression, posttraumatic stress disorder (PTSD), substance abuse, and suicidality (Au et al., 2013; Campbell et al., 2009; Mason & Lodrick, 2013; Ullman et al., 2013). These mental health concerns may be exacerbated by exposure to sexual assault related content in traditional and social media. Indeed, research demonstrates that trauma-related content, even outside the presence of an acute threat, can activate fear circuitry in the brain, causing physical and psychological distress for survivors (Moser et al., 2015; Rothbaum & Mellman, 2001). Studies with women who have experienced interpersonal violence have shown increased activation in the amygdala (the fear center of the brain) and higher levels of reported anxiety and hyperarousal when exposed to words (e.g., rape, assault, and force) or images relating to physical or sexual violence (Neumeister et al., 2017; Protopopescu et al., 2005).

Recent social movements on SM, including #NotOkay, #TimesUp, #HowIWillChange, and perhaps most notably, #MeToo, have called attention to the prevalence of sexual assault against women and the lack of accountability among perpetrators of this violence (Bogen et al., 2019a, 2019b; PettyJohn et al., 2019). As these movements have prompted increased news coverage and public discourse about sexual violence, stories of sexual violence have become headline news over a sustained period of time. High-profile stories often go “viral” (e.g., are shared widely) on SM platforms, exposing users to words, images, and narratives about sexual assault as they navigate these online spaces. As is the nature of SM, these posts about sexual violence are often accompanied by public discourse as well, which can range from showing empathy and support for victims, to questioning victims’ credibility and defending perpetrators (PettyJohn et al., 2019; Zaleski et al., 2016).

Despite the ongoing relevance of contemporary SM movements addressing sexual violence, research is lacking regarding how survivors experience exposure to this content on SM and implications of such exposure for their recovery process. The present qualitative study of women sexual assault survivors explores: if/how survivors perceive exposure to sexual assault related content on SM as impacting their mental health, if/how they have altered their SM consumption in response to such content, and what recommendations they have for clinicians working with other survivors during this unique cultural moment.

#MeToo: Hashtag Activism on Social Media

Hashtag activism, using a particular word or phrase to unite people’s voices and stories in a call for social justice (e.g., #BlackLivesMatter), has become popular in recent years due to the wide-reaching influence of SM (PettyJohn et al., 2019). The Me Too Movement was originated by activist Tarana Burke in 2006, tied to her work with young Black girls who experienced sexual abuse (Garcia, 2017). The movement was subsequently brought to national attention in 2017 when actress Alyssa Milano posted a message on the SM platform, Twitter, asking people to respond with their own stories of sexual violence using the hashtag #MeToo. A cascade of responses and disclosures followed Milano’s initial tweet, with #MeToo being posted 12 million times on Facebook in the first 24 hours, and 19 million times on Twitter during the following year (Anderson & Toor, 2018; Renkl, 2017). In that first day, Facebook reported nearly half (45%) of users in the U.S. were connected to a friend who posted #MeToo (CBS, 2017). The initial wave of the movement was tied to news stories of Harvey Weinstein’s abuses; however, subsequent spikes in #MeToo usage have been seen in connection to other high-profile stories as well (e.g., Dr. Christine Blasey Ford’s Senate testimony; Anderson & Toor, 2018).

This hashtag activism has made SM platforms a point of potential exposure to trauma-related content for survivors. SM use is widespread in the U.S., with 78% of adult women reporting regular use (Pew Research Center, 2019). Young adults (18–29) are the most active across SM platforms, with 88% using multiple platforms (e.g., YouTube, Twitter, Facebook, and Instagram), and about half reporting being online “almost constantly” (Perrin & Kumar, 2019; Smith & Anderson, 2018). In the year after #MeToo went viral, commentary and news stories relating to sexual violence became pervasive across SM platforms, with 65% of U.S. adults reporting exposure to sexual harassment or assault content, including 29% stating it was a great deal of what they saw on SM (Anderson & Toor, 2018). Given the potential for negative outcomes associated with exposure to sexual assault content, the present study explores how survivors subjectively experience sexual assault content in their SM feeds.

Public Discourse Surrounding Sexual Assault on Social Media

Typical of SM, trending content is often accompanied by public discourse, or public conversation and engagement, reflecting societal attitudes and norms about a particular issue. Even prior to the #MeToo Movement in 2017, SM saw trends of public discourse surrounding sexual assault stories going viral on their platforms (Ash et al., 2017; Kosloski et al., 2018; Stubbs-Richardson et al., 2018). For survivors, SM can be a source of support by providing a sense of belonging, access to helping resources, or empowerment through hashtag activism (Elmquist & McLaughlin, 2018; Kosloski et al., 2018; Zaleski et al., 2016). These platforms may also be a source of distress due to unsupportive messages, such as endorsement of rape culture attitudes, emerging from public dialogue. Rape culture refers to “a pervasive ideology that effectively supports or excuses sexual assault” (Burt, 1980, p. 218) which includes adherence to traditional gender roles, sexism, viewing sex as an exploitative exchange, acceptance of violence, and hostility toward women (Johnson & Johnson, 2021).

In the first known study of its kind, Zaleski and colleagues (2016) found perpetuation of rape culture, most notably blaming women for their own victimization, to be pervasive in SM commentary discussing news stories about sexual assault. Researchers sampled articles covering sexual assault from the digital versions of the largest periodicals in the U.S. (Wall Street Journal, New York Times, USA Today, and Los Angeles Times) over a 4-month period from 2014 to 2015 (prior to the #MeToo Movement). For the first 2 months, comment threads for each selected article were extracted from the periodicals’ postings on Facebook, and for the last 2 months, comment threads were taken directly from the periodicals’ websites. This yielded 4239 comments from 52 articles which were analyzed using qualitative content analysis. The largest group of comments (26%) were categorized as victim blaming and questioning, with behaviors including: telling rape survivors what to do; claiming a survivor’s story is too unbelievable to be real; implying survivors had a hidden agenda; stating the passage of time made the survivor’s story unbelievable; claiming accusations were false; and blaming victims for their use of alcohol and drugs (Zaleski et al., 2016). Comments showing explicit support for perpetrators were less common (constituting 6% of the comments analyzed) but were present on all but one of the articles reviewed. These comments included things like using sarcasm and humor to discredit survivors and highlight the suffering of “falsely accused men” (Zaleski et al., 2016). Notably, 16% of the comments were characterized as supportive of survivors, including users disclosing their own personal assault experiences or providing information to defend the survivor in the story (Zaleski et al., 2016).

Similar commentary was identified in SM discussions in 2013 following the Torrington and Stuebenville rape trials and the investigation of Jameis Winston (Ash et al., 2017; Kosloski et al., 2018; Stubbs-Richardson et al., 2018). As Kosloski and colleagues (2018) stated, “sites like Twitter or the comment sections of online newspaper articles can serve as stages where people can publicly discuss, endorse, and disseminate rape myths” (p. 166). While survivor supportive commentary was identified in each of these studies, positive messages and efforts to challenge rape culture were less frequent and less widespread. Stubbs-Richardson and colleagues (2018) examined how victim blaming versus victim supporting messages were disseminated on Twitter in the wake of the Torrington and Steubenville rape trials. They found that tweets which endorsed victim blaming attitudes were retweeted significantly more than victim-supporting tweets. Further, accounts posting victim-blaming commentary had significantly more followers than accounts that showed victims support (Stubbs-Richardson et al., 2018).

While #MeToo was intended to challenge rape culture, preliminary research on the digital movement suggest that victim blaming and hostile resistance to social change are still prevalent on SM platforms (Nutbeam & Mereish, 2021; PettyJohn et al., 2019). Exposure to narratives that uphold rape culture is concerning as it has the potential to exacerbate negative outcomes for survivors, including self-blame and increased trauma-related mental health symptoms (Anderson & Overby, 2021; Campbell et al., 2009; Kosloski et al., 2018; Schneider & Carpenter, 2019). Continuing research is needed to assess whether hashtag activism addressing sexual violence has altered the overall tone of public discourse on SM platforms, and how such tone is impacting users.

A Framework for Understanding the Impacts of Trauma-Related Content

The present study is guided by literature on the neurobiology of trauma and a clinical understanding of how trauma reminders can impact survivors throughout their recovery process. After a traumatic experience such as sexual assault, reminders of the event can activate fear circuitry in the brain, causing survivors to experience rapid, extreme emotional, or physical dysregulation (Ehlers & Clark, 2000). This involuntary re-activation of trauma memories can exacerbate mental health symptomatology even after the event is over (Rothbaum & Mellman, 2001; van der Kolk, 2015). Indeed, uncontrolled trauma reminders (i.e., outside therapeutic treatment) can stunt survivor recovery processes by reproducing PTSD related symptoms, preventing change in negative appraisals of the event, and hindering changes to the memory of the trauma (Ehlers & Clark, 2000). Individuals with their own histories of violent trauma may be more susceptible to distress from media coverage depicting trauma (Thompson et al., 2019). This is based on the finding that people who have experienced violence perceive themselves at a greater risk for experiencing further violence or some type of disaster (Blum et al., 2014). While sexual assault related content is being frequently shared via SM in the context of the #MeToo Movement, the impact of this phenomenon on the mental health of survivors has yet to be examined.

Methods

To address existing gaps in the literature, the present study aims to provide foundational information on how survivors are impacted by exposure to sexual assault related content in SM spaces. Qualitative, semi-structured interviews were conducted with women survivors to explore their lived experiences with viewing sexual assault related content on SM via news stories and public discourse. More specifically, we were interested in three primary research questions: (1) if/how survivors perceive exposure to sexual assault related content as impacting their mental health, (2) if/how they have altered their SM behaviors in response to such content, and (3) what recommendations they have for clinicians working with other survivors who are active on SM. This study received full board approval from the institutional review board (IRB) at the researchers’ academic institution.

Researcher Positionality

All team members identify as white and American, with other identities on the team including: cis-gender woman, intersex woman, heterosexual, lesbian, survivor, and non-victim. All team members are active on SM and have engaged with sexual violence content on these platforms, both as users and academic researchers. The primary investigator (MP) is a licensed mental health clinician with extensive experience treating survivors of sexual violence. Her clinical experiences helped inform the research questions for the present study.

Recruitment and Participants

Women between ages 18–34 years who experienced at least one instance of sexual assault since age 14 were recruited to participate in the present study. These age demographics were chosen as young adults are the most active cohort on SM (Smith & Anderson, 2018), and age 14 is commonly used as a cut-off differentiating experiences of childhood sex abuse from adult sexual assault in violence research (Filipas & Ullman, 2006). Recruitment materials did not define “sexual assault” in a particular way, leaving it up to potential participants to self-identify as a survivor. Recruitment occurred via three sources: flyers posted in local therapy offices and on campus, emailing student organizations for women and/or LGBTQ+ students at a large Midwestern university, and posting recruitment information on SM (Facebook and Twitter). Due to the sensitive nature of the research subject and potential to cause emotional distress, individuals were screened over the phone by the first author, a mental health clinician, for substance abuse, suicidality, and psychoses. This process was written into the study IRB as a mechanism for protecting participants. None of the prospective participants endorsed active substance abuse, suicidality, or psychoses. Each source of recruitment yielded 4 participants for the study, providing a total of 12 interviews for analysis. This sample size has been deemed appropriate for social science research using in-depth, semi-structured interviews with participants representing a group with homogenous experiences of the phenomenon in question (Guest et al., 2006; Young & Casey, 2019).

Participants ranged from 21 to 32 years old (median = 23.5). One-third (n = 4) identified as women of color (2 as African-American, 1 as Asian-American, and 1 as Hispanic-American) and two-thirds (n = 8) identified as white. One-third identified as either bisexual (n = 3) or queer (n = 1), while two-thirds (n = 8) identified as heterosexual. Most participants (50%, n = 6) were current college students earning their bachelor’s degree, while 17% (n = 2) fell into each of the three categories: completed high school, completed their bachelor’s degree, or completed a graduate degree. All participants reported using at least one SM platform (range = 1-5; M = 3.83), with two-thirds (n = 8) using multiple platforms daily, one-quarter (n = 3) using one platform daily, and one participant using one platform weekly. The majority (n = 10) of the sample reported experiences of rape, with one participant reporting a sexual assault which did not include rape, and one participant stating they were unsure if their assault was rape or not. Participants’ most recent assault timelines ranged from 2007 to 2019.

Interview Protocol

Semi-structured interviews were conducted by the primary investigator (MP) and lasted between 45–90 minutes. Interviews began in December of 2018 and concluded in June of 2020. The first eight interviews were conducted in-person in a confidential therapy office, and the final four interviews were completed virtually using HIPAA compliant Zoom video conferencing due to the onset of COVID-19. Participants provided consent to audio record the interviews. Prior to the interview, participants completed demographic information, assessment of victimization histories (SES-SFV; Koss et al., 1987), and psychometric measures for depression (PHQ-9; Kroenke et al., 2001), anxiety (GAD-7; Spitzer et al., 2006), and PTSD (PCL-5; Blevins et al., 2015). Psychometric data were collected to provide clinically descriptive information about the study sample. There was substantial variability in reported mental health symptomatology among participants. Survivors ranged from non-clinically significant depressive symptoms to moderately severe symptoms (range = 2–17), with the average PHQ-9 score falling in the mild depressive range (M = 8.42). Some survivors reported subclinical anxiety, while others reported severe anxiety symptoms (range = 2–19), with the average GAD-7 score falling at the clinical cut-off for moderate anxiety (M = 10). All survivors reported experiencing posttraumatic stress symptoms (range = 13–72), with the average PCL-5 score falling below the typical cut-off for clinical diagnosis (M = 18.91).

A semi-structured interview script anchored in the three aforementioned research questions was used, with the interviewer using an iterative process of adding sub-questions to the script as common themes emerged from participants over time (Rubin & Rubin, 2012). To protect participant anonymity, no specific questions about their identity (e.g., name and hometown) or assault experience (e.g., location and identity of perpetrator) were asked. When potentially identifiable information was offered by participants, the research team redacted it from the final interview transcripts. At the conclusion of interviews, participants’ distress levels were assessed and grounding exercises were offered before they exited the space. Each participant was provided a $50 gift card, a list of local/national resources, and a worksheet with healthy coping skills and grounding techniques.

Data Analysis

Interviews were transcribed verbatim, de-identified, uploaded to Dedoose online coding software, and analyzed using Braun and Clarke’s (2006) model for thematic analysis. This involved 6 phases of analysis: (1) becoming familiarized with the data (i.e., transcribing, reading, and re-reading the interviews), (2) generating initial codes (i.e., identifying interesting features across the dataset), (3) searching for themes (i.e., gathering codes across interviews into potential themes), (4) reviewing themes (i.e., determining if themes fit across the dataset), (5) defining and naming themes, and (6) producing the report (i.e., extracting key examples of themes from the data) (Braun & Clarke, 2006). The primary investigator and research assistant (GA) independently read each transcript and journaled about emerging patterns across participants. These two team members met to discuss their initial codes and begin consolidating them into potential themes. Initial codes and themes were largely organized by the research questions that guided the interview script. Once a preliminary codebook of themes and subthemes was generated, all transcripts were revisited to determine applicability across participants and the team began extracting exemplary quotes that captured each theme. After this round of review, an expert violence researcher (HM) was consulted to provide an additional perspective. The consultant reviewed all transcripts alongside the preliminary codebook to affirm or challenge themes proposed by the first two authors. Once this review was complete, all three coders met to establish consensus, define, and label themes and subthemes before producing the final report. At this point, the team concluded that informational redundancy had occurred based on the number of rich examples for each theme identified in the interview data, and the fact that no new themes were emerging after multiple rounds of review (Lincoln & Guba, 1985).

Throughout the process, the team was careful to attend to principles of trustworthiness in qualitative research as outlined by Lincoln and Guba (1985). Engaging in systematic analyst triangulation among team members bolstered the credibility of study findings. Credibility was also strengthened through extensive memo writing during review of the transcripts, and member checking by adding questions to the interview script based on initial findings and gauging fit with future participants. Confirmability was strengthened through extensive engagement in the literature and expertise in violence and mental health research on the team. The team kept a detailed audit trail of our process throughout reviews and coding to ensure dependability of findings. Throughout the process, coders also discussed and challenged each other on their own positionality, beliefs, and biases they brought into the research process. Explicitly engaging in reflexivity and mutual accountability among team members helped strengthen the confirmability of the results (Lincoln & Guba, 1985).

Results

Major themes and subthemes emerged from interviews largely in alignment with the three primary research questions. These findings are presented below, roughly in temporal order of how topics came up in interview conversations, and exemplary quotes from participants are provided.

Impacts of Exposure to Sexual Assault Content on Social Media

Mental Health Impacts (n = 12)

All participants reported emotional distress associated with exposure to sexual assault related content in SM spaces, including feelings of anger, sadness, shock, stress, or being “upset to the point of tears.” When asked to reflect on these exposures, survivors reported specific symptoms of anxiety, posttraumatic stress disorder, depression, and physical stress in their bodies. Survivors indicated that frequent exposure to sexual assault content triggered anxiety symptoms, primarily because it prompted them to think about their own trauma, as this participant explained:

…I feel like it does affect me when I see something or I read something about [sexual assault]. I definitely feel a sense of like anxiety or like I get worried…it brings back, I can’t even explain it, it’s like it brings just brings everything back into the front of my mind and then it’s like I’m thinking about it more.

One participant emphasized that persistent exposure to other survivors’ experiences made it difficult to work through her anxiety in therapy because she could not challenge the belief that she was in ongoing danger:

…I think that’s the biggest thing with my anxiety was that like, you can’t talk me out of [sexual assault] not happening because it has happened before, and so overlooking claims that the media makes isn’t helpful because you can’t rationalize that it’s not going to happen, because it has happened.

Symptoms consistent with PTSD were commonly reported as well, including hypervigilance, nightmares, difficulty sleeping, avoidance behaviors, and flashbacks. Participants reported these symptoms escalating during times where high-profile cases of sexual violence were in national discourse. Dissociation was the most reported PTSD symptom among participants, as one survivor explained what happens when she sees stories about sexual violence on SM, “I usually get kind of dissociative, and then it’s hard to come back cause it’s like, I’ll feel crappy and then I’ll walk away and I won't even know why I’m feeling so bad for a while.” One survivor who was involved in therapy explained clinical changes in her PTSD symptoms during the week that Dr. Blasey Ford testified to Congress about her sexual assault and discussion about the testimony went viral on SM: "…so in therapy we were tracking my PTSD symptoms and I had been on a steady decline but that week was like a significant spike that like just took more work…eventually it did decline but it took more work."

Participants reflected on symptoms of depression regarding their moods, sleep habits, appetite, and ability to focus on things. Physical symptoms consistent with a trauma stress response were reported by survivors as well, including fatigue, headaches, muscle tension, and “feeling nauseous and sick and like, just heavy.” As one participant described, “I feel like there’s just a lot more tension in my body at those times [when sexual assault stories go viral on SM].”

Relational Impacts (n = 6)

Beyond the negative impacts on mental health, half of the sample also reported negative changes in their interpersonal relationships with co-workers, friends, family, and other important figures such as religious leaders. Discussing her interactions on Facebook, one survivor described changes to some of her closest friendships resulting from discourse about sexual violence in that space:

…it’s obviously worse when my friends want to have a really strong opinion about it and they’ve never been through it…there’s people I used to talk to on a daily basis that over the last probably, two years I maybe talk to them once a month now.

Also discussing Facebook interactions, another survivor reported distancing herself from extended family members due to comments they made during Brett Kavanaugh’s Supreme Court appointment:

… it was really frustrating for me to see family members you know, say such stupid like uninformed ignorant stuff about [Dr. Blasey Ford] and the whole situation…I stopped following a lot of them on Facebook. I didn’t delete them because they’re family but I’m like, I don’t want to see the dumb shit you write.

While survivors reported feeling anger in situations where friends or family members said hostile or uninformed things about victim experiences, they also expressed sadness and a sense of betrayal that trusted people in their lives no longer felt safe. A survivor summarized this point when talking about the aftermath of Trump’s election and the Kavanaugh hearings:

…it was really hard to trust people, especially with the [2016] election too, in the midst of all that stuff …I changed [my] interactions with people because people that I thought like, they would never defend someone who committed sexual assault and then they’re publicly defending someone who committed sexual assault, [it] did naturally change my relationships with people…I think that was like a pivotal moment of realizing oh, people that I thought were safe actually aren’t […] I’ve known that policy makers don’t care, but when we have family members or friends who are weighing in on this it’s like, that’s different because it’s a friend that I care about…and when they say things like, ‘oh well he’s a great person, one mistake shouldn’t ruin his life or something like that,’ it’s like, I know they don’t mean this, but kind of seems like they don’t care about me.

It’s important to highlight that none of the aforementioned mental health or relational impacts were related to participants’ personal trauma disclosures posted on SM; in fact, very few participants had ever shared their assault experiences publicly or with friends or family. All of these negative outcomes were associated with participants observing how people reacted to other survivors’ stories, a point that will be further elucidated in the next section.

Distressing Social Media Content

As they described the impacts of sexual assault content on SM, participants were asked to reflect on what types of content or interactions specifically contributed to the distress they identified. Survivors referenced key stories about sexual assault in the news which saturated their SM feeds and initiated harmful discourse, with perpetrations by Brett Kavanaugh, Brock Turner, Larry Nassar, and Donald Trump coming up most frequently. When asked to describe why these stories and the surrounding dialogues were particularly distressing, participants identified two key factors: (1) they perpetuated rape culture narratives and (2) participants could see themselves in these stories.

Rape Culture Narratives (n = 11)

Survivors were distressed by rape culture narratives playing out in both the media stories which covered sexual assault incidents, and commentary related to the stories on SM. Participants perceived the news stories as presented in “the overall kind of nuanced way that the media can make the perpetrator look [like] anything other than a perpetrator of sexual assault.” The Brock Turner case was specifically referenced in this regard, given that he was presented to the public as the “Stanford Swimmer” rather than a convicted perpetrator. Recollections were given about comment sections blaming or questioning victims and offering more concern for accused men who perpetrated violence than for the women who had been victimized. One survivor stated, “I’ve seen a lot of comments on like, ‘how drunk was she,’ like ‘where are her friends,’ a lot of talking about like, ‘what was she wearing’…” In reference to Kavanaugh, another participant remembered, “listening to how the whole hearing played out was very upsetting in general, and then afterwards all of the comments about ‘not believing a woman,’ ‘it’s a he-said she-said,’ you know, ‘why would you destroy a man’s life over that’…”

Personalizing Content (n = 12)

Participants also reported a tendency to project themselves into the stories of other survivors. A survivor explained:

…stories that have even like a small part that brings me back, that like remind me of my own story, they are harder, just because I kind of have to like, wade through my own headspace of kind of being triggered before I can process them…

Survivors reported comparing their own assault to those featured on the news and SM which elicited strong emotions, both positive and negative. A survivor remembered identifying with Chanel Miller (who was assaulted by Brock Turner), “all those feelings that she had I could relate to, and then I just remember feeling lucky that I had a better outcome than she did, that my story was like, the minority instead of the majority [with regard to the justice system].” Another participant who watched the victim impact statements of survivors from the Larry Nassar case on SM shared, “I hadn’t really met anyone who had experienced sexual trauma or at least was open about it, so to hear someone else talk about it was really helpful for me.” From a different perspective, one participant shared that seeing #MeToo content on Facebook was frustrating and made her think, “oh well, that’s not that bad […] why are all these people getting so much attention and support for something that to me doesn’t sound…like I wish that happened to me compared to what did happen to me.”

The seemingly most upsetting form of personalization was participants observing how people, sometimes their own family and friends, negatively responded to other survivors’ stories, and internalized the antagonism as though it was directed at them. This type of personalization had significant overlap with the relational impacts subtheme, as exposure to unsupportive SM posts and commentary from friends, family, and co-workers was common, distressing, and impacted their perceptions of the relationships.

Survivor Coping Skills for Navigating Social Media

Throughout the interviews, it became evident that the survivors, knowingly and unknowingly, had developed coping skills to help them navigate SM spaces in a way that reduced their risk of distress. While some of the participants cut back on their SM use or deleted specific platforms, all remained active users. Survivors curated their online experiences through settings management, following news sources they deemed safe and trustworthy, and setting personal boundaries for their usage.

Settings Management (n = 8)

Survivors reported using the built-in settings and security options on various SM platforms to curate a feed that was less likely to trigger distress. Specific tools included: muting words or hashtags, changing location settings, filtering content, unfriending people, or blocking certain users’ ability to private message them. Many participants reported muting “sexual assault,” “#MeToo,” or specific perpetrators’ names during the height of news coverage to help control exposure. Though survivors reported appreciating and benefiting from settings management tools, they also reflected on their limitations (e.g., muted words on Twitter do not filter out words used in article headlines; the landscape of how platforms are designed is always changing). Security tools were particularly valued by the survivors who were connected digitally to their perpetrator via SM, or those concerned about their perpetrator finding them.

Safe and Trusted News Sources (n = 5)

Some survivors reported curating their SM feeds by only following or seeking out information on sexual assault stories from news media they trusted or felt were a safe source for survivors. Survivors most frequently reported following CNN, New York Times, NPR, their local news channel, or satire/comedy news shows such as John Oliver’s Last Week Tonight, The Daily Show, or Saturday Night Live. Three participants who mentioned this strategy reported blocking or avoiding Fox News specifically due to negative perceptions of how that outlet has treated sexual assault survivors. This was an important tool for survivors as most of them felt it was important to stay informed about news regarding sexual assault cases but were wary about exacerbating negative emotions or mental health symptoms.

Setting Boundaries (n = 10)

In addition to adjusting their SM settings, survivors reported setting personal boundaries in other ways, such as making conscious decisions about if, when, or how they would allow themselves to consume sexual assault content. As one survivor explained:

…I think if I’m not in like a good headspace, I won’t even open up stories that deal with [sexual assault], like I’ll read until they get to the part where they talk about the instance of violence and then I’ll kind of just scroll past.

These decisions were complicated by the fact that most participants felt a sense of obligation to show solidarity with other survivors but struggled to balance that with caring for their own needs. As one participant stated, “it’s a really crappy struggle cause you want to support someone, cause like, who knows better than someone who has been in the same hole that you have, but it’s just, no one wants to constantly hear that.”

Most participants reported using trigger warning information (i.e., statements preceding a post, article, or video stating that sexual assault will be discussed), when available, to make appraisals about how to engage with SM content. In fact, one survivor stated, “I rely on [trigger warnings] […] those set the pace for my entire day.” Most survivors did not let trigger warnings deter them from consuming content they were interested in but appreciated that warnings allowed them to emotionally prepare for potentially feeling distressed. Interestingly, a subset of survivors reported using trigger warnings to “test the waters” of how they were doing in their recovery process, as one participant explained, “I just want to see like, am I better, can I handle this?” Pushing this boundary even farther, another survivor identified “ignoring the trigger warnings and just watching the shit anyway” as a “form of self-harm” that she had engaged in.

Survivors also reported making conscious decisions about engaging in dialogue about sexual violence on SM. Most participants had never publicly disclosed their assault experiences on SM, and there was variability in how active they were in posting or commenting about sexual violence. As one survivor explained:

…there was a lot of posts at that time of you know, Me Too and this is my story and, I remember my reaction was that I was so thankful that they had shared theirs but I never… I don't share mine. I never said Me Too, I never shared my story, I never did that. So I remember feeling a little bit of guilt that I wasn't doing it, but also very glad that everybody else was.

Some participants felt encouraged by engaging in dialogue with other survivors or allies who were supportive and understanding. Others had historically challenged rape culture narratives in comment sections to show support for survivors but had stopped over time to protect their well-being. As one participant summarized:

…I used to engage a lot more [but] I kind of stopped [...] just because it takes a toll to like argue about [sexual assault] with people [...] most of the time when I’m engaging in a conversation with someone on social media it’s someone I’m agreeing with, I don't really get in like conversations with people that I disagree with on social media anymore.

One participant had a different experience, in that she felt empowered and proud of her ability to engage in hostile comment sections by defending survivors and providing education to other commenters.

Survivor Recommendations for Clinicians

Participants were asked if they had recommendations for clinicians working with survivors who use SM. All but one of the participants explicitly referenced attending therapy at some point, which allowed them to provide feedback on how clinicians can more effectively address the impacts of SM from firsthand experience. Some of the recommendations were things participants felt their therapists had done well, though most of them were reflections on what they wished their therapists had done in treatment. A concise summary of these recommendations can be found in Table 1.

Table 1.

Survivor Recommendations for Clinicians.

1. Assess survivor social media use (e.g., platforms used and frequency) and news consumption

2. Proactively offer psychoeducation on potential impacts of social media use, and provide space for survivors to process or debrief about distressing social media/news content

3. Help clients build skills and healthy coping strategies for navigating social media rather than suggesting they just “log off,” specific suggestions include:

a. Focus on themselves and set boundaries around engagement with other survivors’ stories

b. Watch satire news shows (e.g., SNL) to stay current with stories in a less triggering way

c. Calibrate social media settings on each platform (e.g., muting certain words or hashtags, limiting who can comment on their content or private message them)

d. Set timer for social media use and/or news consumption

e. Seek social support after exposure to distressing content

4. Stay informed about social media trends (e.g., apps/platforms, hashtags, and viral videos) and widespread news headlines involving sexual assault

5. Recognize social media can be both a supportive resource and/or a form of self-harm/unhealthy coping depending on how survivors are using their platforms

First and foremost, participants recommended therapists assess SM use (e.g., platforms used and frequency) and level of news consumption among clients who have experienced sexual violence. This provides an opportunity for therapists to offer psychoeducation on potential impacts of exposure to sexual assault content and opens the door for survivors to process distressing SM experiences during sessions. Given the pervasiveness of SM and its centrality to social life, self-expression, and professional endeavors, survivors suggested therapists provide concrete ideas on how to mitigate potential harm rather than simply asking clients to “log off.” Some specific ideas which helped survivors were focusing on themselves and setting boundaries about engagement with other survivors’ stories, watching satire news shows (e.g., SNL) to stay current with stories in a less triggering way, calibrate SM settings on each platform, set a timer for SM use and/or news consumption each day, and seek social support after exposure to distressing SM content. Participants also emphasized the importance of therapists staying informed about SM trends and widespread news stories about sexual assault, and proactively asking survivors about exposure in sessions when relevant. Overall, participants wanted therapists to realize that SM can be both a positive resource and a source of harm or unhealthy coping. Navigating these spaces in a way that supports rather than damages well-being will look unique for each survivor.

Discussion and Clinical Implications

Survivors in the present study described how exposure to sexual assault content on SM (i.e., news stories and related public discourse) contributed to distress and impacted their well-being. All survivors in this study described how reading news accounts of sexual assault is activating of their own traumas and negative mental health symptomatology. This is consistent with prior research which identified increases in distress among survivors during major news events involving sexual assault (e.g., Kavanaugh confirmation hearings; Anderson & Overby, 2021). Notably, though the current study was anchored in the #MeToo Movement as a reference point for survivors to think about their experiences, many participants recalled sexual assault stories on SM which preceded #MeToo (e.g., Brock Turner and Donald Trump), suggesting that the impacts of exposure are poignant enough to be recalled many years after the fact.

Research on the neurobiology of trauma indicates that trauma-related words, images, and film—even those not connected to one’s own personal trauma—may induce symptoms of anxiety and hyperarousal (Neumeister et al., 2017; Protopopescu et al., 2005). This supports the notion that sexual assault related words, images, and videos which survivors may be exposed to day-to-day on SM could produce a negative trauma response, even if the content differs from their own assault experiences. Previous research with feminist organizers has identified that extensive exposure to trauma-related content on SM can confer not only an emotional “tax,” but can result in physical and psychological reactions like panic attacks (Mendes et al., 2018). Based on this literature and the lived experiences described in the present study, clinicians should understand survivors may not only feel subjectively “upset” by sexual assault content on their SM, but that this distress may manifest itself in a wide array of clinically diagnostic symptoms consistent with anxiety, depression, or PTSD. Clinicians who are working with this population should explicitly ask about sexual assault reports in the media along with SM usage, and how these are contributing to the ways in which survivors are dealing with their own trauma.

Another key finding for some survivors was the relational impacts of sexual assault discourse on SM, particularly when comments were made by trusted support systems (e.g., friends and family) that were derogatory toward victims. This type of SM activity by friends and family left participants feeling more alone as they distanced themselves from these individuals. Most participants did not disclose their own experiences on SM, but witnessed unsupportive treatment of other survivors (e.g., those in news stories) in online spaces. Participants internalized these unsupportive attitudes as directed at them as well, resulting in a lowered desire to access parts of their social support system. The personalization of responses to other survivors suggests that observing negative reactions could serve as a proxy disclosure, impacting whether they choose to disclose themselves and seek help. This is concerning given that social support is a key mediator for survivor long-term outcomes, with positive social support shown to decrease maladaptive coping strategies, and unsupportive reactions shown to increase harmful coping strategies and exacerbate negative mental health outcomes (Campbell et al., 2009; Ullman & Relyea, 2016). In the modern day, SM represents a very real extension of people’s support systems, and therefore must be considered as a space where survivor well-being can either be supported or thwarted depending on what they see (Schneider & Carpenter, 2019).

When working with survivors, therapists need to be mindful of these relational dynamics happening on SM. These qualitative data can be used to inform psychoeducation and intervention programming, and work on healthy strategies to deal with families and friends who hurt survivors through unsupportive comments on SM. While cutting ties or setting firm boundaries with people may be a good strategy in some cases, in others it might be more beneficial for survivors to engage in appropriate confrontation that could shift the relationship and lead to more support. For example, therapists can coach their clients to approach a family member and say, “When you posted your negative comment about Dr. Blasey Ford, it made me feel extremely hurt, because it made me feel like you don’t care about my experience.”

Survivors described setting personal boundaries and proactively managing their settings on SM platforms in a way that maximized positive benefits, while minimizing exposure to harmful content. Survivors reported seeking out empowering content at times (e.g., watching survivors impact statements) to make them feel validated and less alone. Indeed, scholarship since #MeToo went viral has found SM can be an effective way for survivors to access resources, validation, and seek advice or support when they are lacking such social support in offline spaces (Alaggia & Wang, 2020). Participants also described strategically using SM settings to limit their exposure to news coverage of sexual assault stories and related commentary which was unsupportive. In conjunction with these built-in tools, most survivors paid attention to trigger warnings and consciously controlled if and when they allowed themselves to consume sexual assault related content. It is important for therapists to help clients in this process of setting boundaries with media coverage and SM sites that may be exacerbating their trauma symptoms. Further, clinicians should assess clients’ motivations for consuming SM content about sexual assault, as some survivors in the present study described exposing themselves to content they found upsetting as a way to “test” themselves, or as a method of self-harm.

From a clinical perspective, it is important to highlight the resilience and agency already being practiced by survivors. These existing strengths should be leveraged to buffer potential negative impacts and offer survivors a sense of control over their online environments.

Limitations

Though this was a qualitative study and informational redundancy was deemed to be reached, we are limited by the sample size of twelve participants. While survivors’ rich descriptions of their lived experiences are necessary to move the field forward, it should not be assumed that these findings are widely generalizable across survivor experiences on SM. Generalizability may also be limited by self-selection bias inherent in recruiting people for qualitative studies like this one. Almost all participants had a history of involvement in therapy, which means that they may have received more psychoeducation, engaged in more personal reflection about their experience, and therefore been more likely to volunteer for a project like this compared to the average survivor. Additionally, the present study focused primarily on adverse impacts of SM use, with less attention given to positive impacts such as finding empowerment or community through exposure to trauma-related content. In the current sample, positive impacts from SM use did not emerge as a significant theme, which may have been at least partially shaped by the interview questions asked. The research questions and interview script developed by the primary investigator were rooted in clinical experiences where regression in mental health symptomatology was observed among sexual assault survivors using SM. Future research should attempt to build on these findings by assessing the key themes identified amongst a larger, more diverse sample, and by trying to capture a more holistic perspective of both the harmful and potentially helpful nature of SM use for survivors.

Next Steps

More research is needed to understand the relationship between exposure to trauma-related content on SM and changes in survivor mental health. Longitudinal data should be collected to examine in greater detail the type of SM content survivors are consuming and potential changes in reported mental health and relationships over time. Neuroscience research with sexual assault survivors using trauma related SM content as stimuli to measure activation of brain regions associated with PTSD, depression, and anxiety would also advance the field by identifying subconscious mechanistic responses which survivors may not be able to self-report.

Conclusion

While recent social movements (e.g., #MeToo) have prompted important cultural conversations, the present study suggests that the increased saliency of news stories and public discourse about sexual violence on SM has also had negative impacts on survivors trying to interact in these digital spaces. Though participants appreciate the education and empowerment that has come from such awareness campaigns, they also endorse adverse changes in their mental health and relationships, largely driven by exposure to trauma narratives, community dialogue that is unsupportive of other survivors, and a tendency to personalize antagonistic content as though it is directed at themselves. In response to distressing content in online spaces, survivors report developing coping strategies to help them navigate SM in a healthier way that allows them to remain engaged on platforms they enjoy. Reflecting on their own experiences, survivors ask that clinicians be more active in addressing exposure to sexual assault content on SM and any related impacts on clients’ mental health and personal relationships.

Footnotes

Acknowledgments

We would like to thank Dr. Adrian Blow, LMFT, for his critical review of this manuscript.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Morgan E. PettyJohn

Author Biographies

Morgan E. PettyJohn , LLMFT, is a doctoral candidate in Couple and Family Therapy within the Human Development and Family Studies department at Michigan State University. Her work focuses on gender-based violence, particularly the impact of sexual assault on mental and relational health. She is interested in how social media shapes survivor outcomes in the aftermath of the viral #MeToo Movement.

Grace K. Anderson is an undergraduate student studying psychology at Michigan State University. She is interested in the intersection of trauma and mental health, and wishes to pursue a career in the non-profit sector.

Heather L. McCauley , ScD, is an Assistant Professor in the School of Social Work at Michigan State University. A scholar trained in global health and social epidemiology at Harvard University, her research portfolio spans sexual violence, intimate partner violence, reproductive coercion, and sex trafficking, with emphasis on populations experiencing marginalization (e.g., sexual and gender minorities).

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