The ad wasn’t the usual Super Bowl fare. As images of the inside of a home ran onscreen, viewers heard the recording of a woman’s 9-1-1 call. She spoke as if she were ordering pizza, confusing the dispatcher, until he realized she was seeking help but unable to say so because of the person in the room with her. “When it’s hard to talk it’s up to us to listen,” a tagline at the end read.

The ad was part of a campaign by the group No More – a coalition of advocacy groups, foundations and corporations – to normalize discussion of domestic violence and sexual assault, the way previous campaigns did for AIDS and breast cancer. That challenge was underscored in a previous series of ads that showed NFL players on the verge of tears, struggling to get any words out. “Domestic violence and sexual assault are hard topics for everyone to talk about,” the wording on the screen read.

What the ads don’t show the audience is how to do so. Yes, it’s hard to talk about domestic violence and sexual assault. But what can make it easier for people to talk about it? And when someone opens up, what can listeners do?

These questions aren’t academic. It’s likely that most people who saw the ads know at least one person – probably many more – who experienced domestic violence or sexual assault.

Based on a 2011 survey conducted for the Centers for Disease Control and Prevention, researchers estimated that 19.3 percent of women in the U.S. have been raped in their lifetimes, and nearly 44 percent experienced other forms of sexual violence. Among men, they estimated 1.7 percent have been raped and 23.4 percent experienced other forms of sexual violence. Nearly one in three women have experienced physical violence by an intimate partner, as have more than one in four men.

“Despite the vast numbers impacted by these crimes, people are not talking about them,” said Virginia Witt, director of the No More campaign.

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In trying to make sexual assault and domestic violence more common topics of conversation, Witt’s organization will have to address two interconnected problems:

Often, people who experience trauma avoid talking about it unless they’re asked directly. Experts say many things keep people from coming forward: Many people who experience sexual assault or domestic violence believe they’re to blame, that it wouldn’t have happened if they’d done something differently. Some people fear no one will believe them, or they worry what the response will be if they tell.

And many people are reluctant to ask others about domestic violence, sexual assault or other traumatic experiences. Despite evidence linking exposure to trauma with a wide range of mental and physical health problems, even health care providers are often hesitant to ask patients about traumatic experiences. Some worry about not knowing how to help if an inquiry reveals a problem.

And some worry that simply asking about domestic violence, sexual assault or other traumatic experiences will remind someone of a painful experience and make things worse – something experts say is not the case. In fact, some have found that, in the right circumstances, some people who experienced trauma were relieved to have an opportunity to acknowledge it.

Misplaced taboos?

That’s what Vincent J. Felitti found when he and a colleague tried to determine how common adverse childhood experiences such as abuse and domestic violence were. Their study eventually became a landmark piece of research, but it almost didn’t happen: it took nearly nine months to get approval from an institutional review board because members worried that asking people about traumatic events could cause those who experienced them to decompensate or become suicidal.

They finally got approval – on the condition that one of the researchers carry a cell phone at all times, in case the questions triggered problems.

No one called. But Felitti and his colleagues received letters from study participants, many from elderly women.

“Thank you for asking,” one wrote. “I feared I would die and no one would ever know what had happened.”

Officials at Connecticut’s Department of Mental Health and Addiction Services also faced reservations when they started a pilot program to test the use of trauma-related questions with clients in 2006. Some practitioners worried the questions would offend the clients, said Julienne Giard, the department’s director of evidence-based practices.

Clients overwhelmingly had the opposite response.

“They’re validated,” Giard said. “’Finally, somebody’s asking me these questions that no one else will ask me, that I really need to talk about, these really important things that happened to me.’”

Starting a conversation

So how can people begin to talk about domestic violence and sexual assault? Here are some suggestions from experts.

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Discuss the statistics or news stories.

No More suggests starting a conversation by mentioning statistics, such as that one in three women and one in four men experience domestic violence at some point in their lives.

Since sexual assault and domestic violence are frequently in the news, Jennifer Marsh, vice president of victim services for the Rape, Abuse & Incest National Network, or RAINN, suggested using news stories as a starting point. Discussing the topics sensitively could make others feel comfortable talking about their own experiences, she said.

Discuss domestic violence and sexual assault with kids as part of conversations about appropriate behavior.

Jason Lang, a psychologist at the Child Health and Development Institute of Connecticut, recommends that parents include both topics in ongoing conversations about appropriate and inappropriate behavior – using language that’s suitable for their children’s ages.

“It’s not just to say ‘don’t do that’ but to have a discussion about what’s OK and what’s not, to really listen to the child’s thoughts, and help them express their feelings – and to let children know they can talk to the parent about difficult topics,” Lang said.

If you see something, speak up.

If you notice signs of domestic violence or sexual assault – such as injuries or sudden changes in behavior or functioning – consider asking how the person is doing and if there’s anything they need. Similarly, experts said, people should speak up if they hear someone talk about committing violence.

“The basic idea behind ‘If you see something, say something’ applies here,” Lang said.

You don’t have to know how to solve the problem to ask about it.

Often, people are hesitant to ask someone if they’re dealing with domestic violence because they don’t know what to do if the answer is yes, said Karen Jarmoc, CEO of the Connecticut Coalition Against Domestic Violence.

Her advice: You don’t have to solve the problem. Help could mean directing the person to the right resource, like the statewide domestic violence hotline.

If someone talks about experiencing sexual assault or domestic violence, listen and take them seriously. Don’t jump in with unsolicited suggestions.

The reaction of the first person someone tells about sexual assault can influence whether he or she tells anyone else, seeks services or reports what happened to authorities, Marsh said.

“Let the victim or survivor know that you believe them, you believe it happened, that what happened to them is not their fault and that they don’t have to go through this by themselves,” she said.

Although it’s natural for friends and family members to want to figure out how it could have happened or to try to fix things, Marsh said asking questions like, “Why were you there?” “What were you doing?” or “Why didn’t you run away?” could make a victim less likely to continue talking.

For victims, shame is often a major barrier to talking about domestic violence or sexual assault, said Patricia Wilcox, who leads the Traumatic Stress Institute at Klingberg Family Centers in New Britain. Many people think it wouldn’t have happened if they’d done something differently. So she said it’s important for people to avoid reinforcing those ideas.

The first step, Wilcox said, is to listen and offer validation. People often want to immediately make suggestions, but she said doing that before the person asks can shut down the conversation.

“Instead just validate. Say, ‘I understand, that must be difficult, that sounds like a real struggle,’” she said. “Comments that show you’re picking up on their emotions about the situation.”

Recognize that making changes can take time.

People experiencing domestic violence or who have been sexually assaulted might not be ready to discuss it or to make a change. Lang and Jarmoc recommend being patient and offering ongoing support.

“The person may say, ‘I’m fine, I’m OK,’” Jarmoc said. “But at the very least, you know that they know that they can come to you.”

Ask if the person wants assistance finding help.

There are local and national hotlines available for people who need help. Those include:

National Domestic Violence Hotline: 1-800-799-SAFE (7233)

National Sexual Assault Hotline: 1-800-656-HOPE (4673)

Teen Dating Violence Hotline: 1-866-331-9474 or text “loveis” to 22522

Connecticut Sexual Assault Crisis Services statewide hotline: 1-888-999-5545 for English; 1-888-568-8332 for Spanish

Connecticut Coalition Against Domestic Violence statewide hotline: 888-774-2900 for English; 844-831-9200 for Spanish

Arielle Levin Becker covered health care for The Connecticut Mirror. She previously worked for The Hartford Courant, most recently as its health reporter, and has also covered small towns, courts and education in Connecticut and New Jersey. She was a finalist in 2009 for the prestigious Livingston Award for Young Journalists, a recipient of a Knight Science Journalism Fellowship and the third-place winner in 2013 for an in-depth piece on caregivers from the National Association of Health Journalists. She is a 2004 graduate of Yale University.

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