In a room at Stanford University this summer, a group of undergraduate women watched a video of a man and a woman at a party. As the two move into a bedroom and things escalate sexually, the students were asked to call out warning signs as the situation became increasingly dangerous for the young woman.

The undergrads were participating in Flip the Script, a 12-hour interactive training that specifically teaches women how to respond to and prevent sexual assault, which is most often perpetrated by men they already know. According to the U.S. Department of Justice, one in four undergraduate women will experience sexual assault by the time they finish college.

In a field with little definitive evidence for what actually works to reduce sexual assault, Flip the Script has shown unusually encouraging results. A randomized controlled trial conducted in Canada found that women who completed the program were 46 percent less likely to be raped and 63 percent less likely to experience an attempted sexual assault.

Heartened by these results, Stanford School of Medicine researchers are piloting Flip the Script with small groups of undergraduate women, with the goal of eventually providing the training to all female students.

Flip the Script was developed by Charlene Senn, a psychology professor at the University of Windsor in Canada, in 2005. At the time, effective prevention efforts were few and far between and sexual violence rates committed by men against young women had remained "virtually unchanged," since the 1990s, she told the Weekly.

She created what was then called the Enhanced Assess, Acknowledge, Act program, based on research on rape and prevention education that indicated a practical training focused on college-aged women, who are among the most at-risk populations for sexual assault, could be more effective than traditional university prevention programs.

"Most sexual assaults are perpetrated by someone you know and ... they occur in social situations that most people don't consider dangerous," Senn said. "The shock and disbelief and the questioning of our own perceptions in those situations is really common. Those completely normal reactions to those unexpected situations can interfere and delay our acknowledgment of the danger and therefore our action."

Senn studied the impact of the program on first-year women at three different Canadian universities, comparing their rates of rape and attempted sexual assault to those of a control group of female students who were instead shown brochures on sexual assault. Senn found that only 22 women would need to take the program in order to prevent one additional rape from occurring within one year of participation. The study also found that Flip the Script significantly reduced self-blame in women who were raped after participating.

When Senn's study was published in The New England Journal of Medicine three years ago, Stanford researchers Clea Sarnquist and Mike Baiocchi took notice. The two had been studying sexual-assault prevention among young girls in Kenya and saw remarkable similarities between their work and Senn's, including the nearly 50-percent reduction rate.

Seeing a "huge potential opportunity," they reached out to Carley Flanery, director of Stanford's Office of Sexual Assault & Relationship Abuse Education & Response, known as the SARA office, to discuss bringing the program to campus, Sarnquist said. They successfully introduced it this spring and have been steadily recruiting female students, including transgender women, to participate in their own study of the program.

Over the course of two days, trained facilitators, who are Stanford graduate students, lead women through the program's four units: assess, acknowledge, act, and sexuality and relationships. The first two units focus on problem-solving strategies that will help women assess the risk of sexual assault by an acquaintance and learn how to "more quickly acknowledge the danger in situations that have turned coercive," Senn's study states.

Junior Blessing Edem, who participated in Flip the Script this summer, found this portion the most impactful — the "everyday things that you should notice or little things you can do to avoid putting yourself in dangerous situations," she said, like a guy who isolates you at a party or insists on hanging out in a room with the door closed.

"Those things were the things that really stuck because it's easy to overlook them," Edem said.

In the second day, the students move to action — including three hours of self-defense instruction — and a deeper understanding of personal and sexual boundaries. The self-defense is not martial arts. The techniques, both verbal and physical, are designed to empower women, teaching that "feeling able to say 'no' and to say 'stop ... I don't want that,'" is its own defense mechanism, Flanery said. Students walk through different scenarios — being pinned up against a wall or walking alone at night — to learn how to get out of an uncomfortable or dangerous situation safely.

The facilitators "encouraged us, if we're faced against a predator who's larger than us, that we're still capable of defending ourselves," said sophomore Hannah Kukurugya, who works in the SARA office and took the training this summer. "It's definitely empowerment through force and not being afraid to react in a situation as well."

The final unit is meant to get everyone on the same page about basic sexuality. To help students think about their own boundaries and desires, they fill out a grid that lists people across the top (friend, significant other, stranger) and different intimate acts, from holding hands to sex.

"Foundationally connected to that, understanding my own desires, wants and needs is couched in your rights, your autonomy to your body and another person's and that when you're engaging with another person that they have those same rights as well," Flanery said.

Flip the Script's ultimate goal, as the name implies, is to help women challenge the gender-based stereotypes that are entangled in sexual violence, Senn said. Stanford's advertising flyer for the program lists some of the stereotypes women are subject to: "Don't be bossy," "Smile and look pretty," "Be a good girl," "Don't make a scene."

The program's creator and the Stanford researchers anticipate a perception that exclusively teaching women how to prevent sexual assault is a form of victim blaming (though that is the very script the program aims to flip). The program repeatedly emphasizes that sexual assault is never the victim's fault and facilitators are trained to confront that belief if it arises. Both Senn and the Stanford researchers emphasize that Flip the Script as one piece of a larger puzzle to prevent sexual violence, not a silver bullet.

Flip the Script's approach is necessary in today's climate, the Stanford researchers argued, when there is still no solid research on how to stop men from perpetrating sexual violence or on the efficacy of bystander training, a focus of many universities' prevention efforts.

Baiocchi compares sexual-assault prevention to an infectious disease program and likens Flip the Script to a vaccine women have to take.

Vaccines "do inflict a little bit of a burden on the person who's going to take the vaccine but usually the pay-off is large," he said. "That's kind of where we're at in the state of science for sexual-assault prevention. It looks like this is a pretty good vaccine, and it seems to be having a big effect."

Kukurugya, for her part, found the single-gender focus problematic. Flip the Script is beneficial, she said, but not in isolation.

"I think it is beneficial to both educate women and men," she said.

The SARA office is developing a similar training for men and male-identifying students, Kukurugya said. Stanford also requires incoming students to complete an online training on consent, bystander prevention and healthy relationships; and offers Beyond Sex Ed, during which upperclassmen share their own stories about intimacy, among other prevention programs.

Stanford is now offering Flip the Script, which is included in the Centers for Disease Control and Prevention's 2016 sexual-violence prevention toolkit, as a one-unit course to encourage more participation. The researchers plan to follow participants through the end of their time at Stanford to evaluate the long-term impact. So far, 15 students have taken the training.

A small but growing number of colleges and universities have implemented Flip the Script, Senn said, including Florida Atlantic University and University of Iowa, at least five colleges in Canada and and others in Africa, New Zealand and Australia.

Sarnquist attributed the small number of participating schools in the United States to cost, institutional support and awareness.

This summer, Edem said she left the weekend program wanting other women on campus to sign up.

"They made it point to give you things that were practical, so it didn't seem like you had to do something completely out of character to defend yourself," she said. "Hopefully it's not something you'll have to use but, just in case, I think it's a good thing to have in your tool belt."