Cognitive Behavioural Therapy (CBT) for Domestic Violence

Impact on crime
Evidence quality 3
Effect
How it works
cog full Evidence quality 1
Mechanism
Where it works
where full Evidence quality 2
Moderator
How to do it
what full Evidence quality 2
Implementation
What it costs
cost empty Evidence quality 0
Economic cost
* This is based on the strongest scores from a number of systematic reviews

What is the focus of the intervention?

Cognitive behavioural therapy (CBT) for perpetrators of domestic violence makes cessation/ reduction of violence the primary focus of treatment. The reviews in this narrative focus upon males who have committed domestic violence against their female partners.

CBT addresses violence as a learned behaviour, and attempts to alter that behaviour. Some CBT programmes also consider emotional components of domestic abuse, such as jealousy or empathy, so are not only behavioural in their approach. CBT interventions aim to reduce repeat violence by perpetrators of abuse, as well as changing verbally abusive behaviours, and attitudes towards victims and violence. Some examples of CBT for couples are also mentioned.

This narrative is primarily based on one systematic review covering 6 studies. A second review (covering 8 studies) provides additional evidence in relation to the moderator and implementation sections below.

EFFECT

How effective is it?

There is some evidence that the intervention has reduced crime, but overall the intervention has not had a statistically significant effect on crime.

Review 1 estimated that, on average, those offenders receiving CBT had a 14% lower chance of reoffending than those in the control group. This effect was not statistically significant and was based upon evidence from 4 primary studies.

The review authors stated that although overall there was no clear evidence of an effect of CBT on levels of reoffending, one study showed a statistically significant decrease.

How strong is the evidence?

The review was sufficiently systematic that many forms of bias that could influence the study conclusions can be ruled out. 

The overall evidence is taken from a systematic review covering 6 studies (Review 1), which demonstrated a high quality design in terms of having a transparent and well-designed search strategy, featured valid statistical analysis and sufficient assessment of the risk of bias in the analysis. The review did not, however, explore the effect that differences in follow-up times or outcome measures could have upon the overall effect size.

Biases identified within the primary studies included small sample sizes, incomplete outcome data, the integrity of the treatment and a lack of consideration for the impact that attrition (i.e. non-completed treatment) within the studies may have had.  

MECHANISM

How does it work?

CBT programmes are believed to work by identifying thoughts and beliefs that precede violent behaviour and challenging the ways that perpetrators justify their violence after the event.

The aim is to interrupt the chain of events leading to physical abuse by changing the way that perpetrators think about violence and the circumstances leading to violence.

Review 1 also noted that support given to partners during couples’ CBT might enable them to report more violence, leading to increased reporting rates.

Review 2 noted that the CBT model is based on the assumption that violence is a learned behaviour, and that non-violence can also be learned. CBT promotes awareness of alternatives to violence by increasing communication skills, social skills training and teaching participants anger management techniques.

MODERATORS

In which contexts does it work best?

Review 1 mentioned a number of possible moderators that could impact upon the success of CBT interventions. These include differences in participant characteristics, whether participation was voluntary or mandatory, and the intensity or length of the programme. However none of these moderators have been tested.

Review 2 tested the effect of differences in experimental design and outcome reporting, finding that quasi-experimental studies which used police reports of recidivism had a lower effect size than those which used partner reports. However, this difference in effect size was not statistically significant.

IMPLEMENTATION

What can be said about implementing this initiative?

Review 1 noted that CBT can be delivered individually, as a couple or can be group based. It can also be implemented in a number of settings, including correctional facilities and the offender’s home or work place.

Within the sessions, group leaders teach a variety of skills to try to eliminate further violence towards women, including cognitive restructuring, empathy enhancement, communication skills, anger modification and jealousy management.

Review 2 added that the interventions with the largest effect sizes were those which had 16-week group therapies supplemented with participation retention techniques. These techniques included reminder phone calls and supportive handwritten notes after intake and missed sessions. This led to lower attrition rates.

Many domestic violence perpetrator programmes mix different theoretical approaches to include behavioural, cognitive, feminist and emotional approaches, making it difficult to identify which component of the programme is causing the effect. This review also noted that it was difficult to separate CBT programmes from others including Duluth approaches. While Review 1 includes programmes with a Duluth element or focus (Duluth techniques may include CBT, but focus upon feminist and anti-sexist content), Review 2 specifically separates these from the CBT interventions. However, when Review 2 compared the effect sizes between the CBT programmes and those employing the Duluth model, there was no significant difference between their effectiveness.

ECONOMIC CONSIDERATIONS

How much might it cost?

Neither review mentions costs (and/or benefits) and no formal economic analyses are provided. 

General considerations

• It is sometimes difficult to distinguish between different types of CBT programmes. Some CBT programmes may address patriarchal issues, while others tend to focus more on  the learned and reinforced aspects of violence.
• The two reviews are based on a very small number of studies. More research is needed in order to determine the effectiveness of CBT for domestic violence perpetrators.
• Many of the abusive and controlling behaviours associated with domestic violence, which can be worse than physical violence, do not fall into traditional crime categories. Therefore perpetrator programmes have the potential to influence outcomes other than physical re-assault.

Summary

There is some evidence that the intervention has reduced crime, but overall the intervention has not had a statistically significant effect on crime. CBT aims to alter the way in which domestic violence perpetrators view violence, alongside teaching them skills such as more effective communication and anger management.

More research is needed to determine the effectiveness of CBT for preventing domestic violence, and to identify in which contexts it may work best.

Ratings for Individual Reviews

Review 1

How it works
cog full Evidence quality 1
Mechanism
Where it works
where full Evidence quality 1
Moderator
How to do it
what full Evidence quality 1
Implementation
What it costs
cost empty Evidence quality 0
Economic cost

Review 2

How it works
cog full Evidence quality 1
Mechanism
Where it works
where full Evidence quality 2
Moderator
How to do it
what full Evidence quality 2
Implementation
What it costs
cost empty Evidence quality 0
Economic cost

Resources

Review 1: Smedslund, G., Dalsbø, T. K., Steiro, A., Winsvold, A. and Clench-Aas J. (2011) 'Cognitive behavioural therapy for men who physically abuse their female partner', Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD006048. DOI: 10.1002/14651858.CD006048.pub2

Review 2: Babcock, J. C., Green, C. E. and Robie, C. (2004) 'Does batterers' treatment work? A meta-analytic review of domestic violence treatment', Clinical Psychology Review, 23, 1023–1053

 
This narrative was prepared by UCL Jill Dando Institute and was co-funded by the College of Policing and the Economic and Social Research Council (ESRC).  ESRC Grant title: 'University Consortium for Evidence-Based Crime Reduction'.  Grant Ref: ES/L007223/1.

Uploaded on 21.09.15

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