Testing the effectiveness of a transdiagnostic treatment approach in reducing violence and alcohol abuse among families in Zambia: study protocol of the Violence and Alcohol Treatment (VATU) trial

J C Kane,F Melendez,P Bolton,S Skavenski Van Wyk,S Munthali,C K Danielson,S M Murray,L K Murray,P Chimponda

doi:10.1017/gmh.2017.10

Abstract

Violence against women and girls (VAWG) is an urgent global health problem. Root causes for VAWG include the individual- and family-level factors of alcohol abuse, mental health problems, violence exposure, and related adverse experiences. Few studies in low- and middle-income countries (LMIC) have assessed the effectiveness of psychological interventions for reducing VAWG. This randomized controlled trial, part of the What Works to Prevent Violence Against Women and Girls consortium, examines the effectiveness of a common elements treatment approach (CETA) for reducing VAWG and comorbid alcohol abuse among families in Zambia. Study participants are families consisting of three persons: an adult woman, her male husband or partner, and one of her children aged 8-17 (if available). Eligibility criteria include experience of moderate-to-severe intimate partner violence by the woman and hazardous alcohol use by her male partner. Family units are randomized to receive CETA or treatment as usual. The primary outcome is VAWG as measured by the Severity of Violence Against Women Scale, assessed along with secondary outcomes at 24 months post-baseline. Interim assessments are also conducted at 4-5 months (following CETA completion) and 12 months post-baseline. This ongoing trial is one of the first in sub-Saharan Africa to evaluate the use of an evidence-based common elements approach for reducing VAWG by targeting a range of individual- and family-level factors, including alcohol abuse. Results of this trial will inform policy on what interventions work to prevent VAWG in LMIC with local perspectives on scale up and wider implementation.

Highlights

RelaxationGetting active (GA) Thinking in a different way – part I and part II (TDW1 and TDW2) Talking about trauma memories (TDM) Live exposure SafetySubstance use element (SU)Safety and violence prevention Focus on obstacles to engagement Linking program to assisting with client’s problems Includes family when appropriate Program information Normalization/validation of current symptoms/problems Strategies to improve physiological stress Examples include: deep breathing, meditation, muscle relaxation, and imagery
This ongoing trial is one of the first in sub-Saharan Africa to evaluate the use of an evidence-based common elements approach for reducing Violence against women and girls (VAWG) by targeting a range of individual- and family-level factors, including alcohol abuse
In a multi-national study, Zambia, the location of the present study, was found in a multi-national study to have the highest percentage of ever married women reporting intimate partner violence (IPV) (48%) (Kishor & Johnson, 2004), and our own studies indicate that a substantial percentage of youth are exposed to a high number and wide range of violence experiences (Murray et al 2006, 2015)

Summary

Introduction

CETA is currently the only transdiagnostic model with two rigorous clinical trials in LMIC that each show strong effect sizes across a range of symptoms: (a) on the Thailand/Myanmar border with Myanmar refugees (N = 347; ES: 1.19 post-traumatic stress, 1.16 depression, 0.79 anxiety) (Bolton et al 2014) and (b) in Southern Iraq with survivors of conflict, torture, trauma, and ongoing stressors (N = 149; ES: 2.40 posttraumatic stress, 1.82 depression, 1.60 anxiety) (Weisz et al 2015) These findings provide some evidence of effectiveness for CETA with adults, as well as ability of lay providers to learn this type of modular, flexible approach.

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Discussion

Conclusion