Cognitive behavioural therapy for men who physically abuse their female partner

Abstract

In national surveys between 10 % and 34 % of women have reported being physically assaulted by an intimate male partner. Cognitive behavioural therapy (CBT) or programmes with elements of CBT are frequently used treatments for physically abusive men. Participants either enroll voluntarily or are obliged to participate in CBT by means of a court order. CBT not only seeks to change behaviour using established behavioural strategies, but also targets the thinking patterns and beliefs that are thought to contribute to violence. To measure the effects of CBT and similar interventions on men's physical abuse of their female partners. We searched the Cochrane Controlled Trials Register (CENTRAL), C2-SPECTR, MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Care Data/Social Care Online, Sociological Abstracts, Criminal Justice Abstracts, Bibliography of Nordic Criminology (all to late 2006), and SIGLE to 2003. Santé mentale au Québec was handsearched from 1976 to 2003 and reference lists of articles. We also contacted field experts and the authors of included studies. Randomised controlled trials (including cluster-randomised and quasi-randomised trials) of cognitive behavioural therapy with men who physically abuse their partners and reporting effects on continued violence. Two review authors independently assessed trial quality and extracted data. We contacted study authors for additional information. Six trials, all from the USA, involving 2343 people, were included. A meta-analysis of four trials comparing CBT with a no-intervention control with 1771 participants, reported that the relative risk of violence was 0.86 (favouring the intervention group) with a 95% confidence interval (95% CI) of 0.54 to 1.38. This is a small effect size, and the confidence interval is so wide that there is no clear evidence for an effect. One study (Wisconsin Study) compared CBT with process-psychodynamic group treatment and found a relative risk of new violence of 1.07 (95% CI 0.68 to 1.68). Even though the process-psychodynamic treatment did marginally better than CBT, this result is also equivocal. Finally, one small study (N = 64) compared a combined treatment for substance abuse and domestic violence (SADV) with a Twelve-Step Facilitation (TSF) group. An analysis involving 58 participants investigated the effect on reduction in frequency of physical violence episodes. The effect size was 0.30 (favouring TSF) with 95% confidence interval from -0.22 to 0.81. There are still too few randomised controlled effect evaluations to conclude about the effects of cognitive behaviour therapy on domestic violence.