Table 2.

Summary of themes from ‘3H’ activity examining impact of trauma on thoughts, emotions and behavior at first and last session

	BASELINE (n = 31)			FINAL SESSION (n = 19)
	Themes	Cases (n)	Illustrative quotes	Themes	Cases (n)	Illustrative quotes
Head (Thoughts)	Self-doubt, self-criticism, regret	29	“I blamed myself.” “I thought something was wrong with me.”	Less rumination, self-doubt, worry	13	“I have learnt not to overthink things.” “I don’t think about the trauma anymore.”
	Fear, mistrust	11	“I didn’t trust men.” “I thought the world was not safe.”	Positive thinking, hope, self-esteem	9	“I’m learning to love myself.” “There’s absolutely nothing wrong with me.”
	Persistent worry, rumination, wondering why	11	“I was always thinking too much.” “I would think ‘why me?’” “I asked questions that had no answers.”	Motivated for positive change, focused on future	8	“I’m thinking of how I can best take care of my health.” “I have learned avoidance can undermine HIV care.”
	Hurting self or others, aggression	8	“I thought of killing myself.” “I would have the desire to hurt others.” “I became very aggressive.”	Still ruminating, doubting self	5	“I still think a lot about the abuse from my ex-boyfriend.”
Heart (Emotions)	Sad, empty, unloved, hopeless	30	“I would feel sad all the time.” “I would hurt so much.”	Content, loved, healed, happy	17	“I now have peace within me.” “Less burdened by trauma.”
	Anger	21	“Angry at everybody.” “I would want to hurt them first instead of them hurting me.”	Confident, trusting, clear-headed	10	“I know that it happened, but I feel that it shouldn’t worry me.” “My confidence is back.”
	Fearful, nervous, no trust	18	“Scared that he might do it again.” “I couldn’t trust men, even my brother.”	Still sad, angry, fearful, ashamed	5	“I still feel angry” “I still blame my family.” “Still scared of men.”
	Guilt, regret, shame	13	“Felt like everybody knew what happened to me.” “I blamed myself.”
Hands (Behavior)	Damaged important relationships	23	“Relationship with my parents was compromised.” “Stopped phoning my family”	Seeking/ repairing relationships	12	“I changed the way I speak and talk with people.” “Now I know what kind of relationship I want to have.”
	General social isolation, distance	22	“I shut down and kept in the house, scared to be around people.”	Less reactive, less angry	10	“I no longer bully people and my temper is more manageable”
	Outward anger, temper, lashing out	16	“I find it difficult to control my temper and always lash out.”	Opening up, more trusting	8	“I’m learning to open up to people and learning to trust people.”
	Mistrust, suspicion of others	13	“I used to not trust people.” “Do not trust men.”	More goal-focused, motivated, active	8	“I work with determination and don’t put HIV in my way.” “I’m able to change the stressors that I have.”
	Blame others for not protecting her	9	“I would blame my family for not rescuing me.”

Note. n = number of cases where theme was present. ‘3H’ graphics used with permission from Sikkema et al. (2017).