Cognitive Behavioural Therapy to reduce domestic violence
Smedslund, et al. (2011) conducted a systematic review and partial meta-analysis of the literature on the use of Cognitive Behavioural Therapy (CBT) to reduce domestic violence. The review examined Randomised Control Trial studies conducted worldwide that explored the use of CBT with male offenders who have perpetrated intimate partner violence. From these, six studies met the inclusion criteria, with a total of 2343 participants, who had either attended treatment voluntarily or as part of a court order. Four of the studies compared the effect of treatment versus no treatment, whilst two studies compared the effectiveness of CBT in reducing violence compared with other forms of treatment. The reviewers found that the evidence is insufficient to draw firm conclusions. This report describes the findings of this review.
What is it?
Men’s violence against women is a significant problem worldwide. National surveys regularly suggest that between 10% and 30% of women report being assaulted by an intimate male partner (Smedslund, et al. 2011). The focus of Cognitive behavioural therapy (CBT) for perpetrators of domestic violence is either stopping or reducing violence. CBT aims to do this by changing how men think about violence and how they manage their emotions and behaviours. CBT challenges distorted thinking, learned behaviours and emotional responses that lead to violence, through a range of interventions that include cognitive skills training; anger management and conflict resolution skills.
Should it work?
CBT is the basis of many offender behavior programmes, drawing on well-established theory and practice, and is supported by a substantial body of research dating back to the 1970s (Lipsey et al., 2007). The evidence consistently shows it is one of the most effective approaches to reducing offending.
Does it work?
The review examined 2856 randomised controlled trials that evaluated the effects of CBT on men’s physical violence towards their female partners worldwide. Six relatively small trials with a total of 2343 participants met the inclusion criteria. The results from four of these trials, which compared men who received CBT with men getting no treatment, were combined. They did not conclusively show whether CBT was more effective than no treatment. The individual results of the other two trials, which compared CBT with another treatment, were also inconclusive. Overall, the evidence from the included studies is insufficient to draw any conclusions.
The authors stated that although overall there was no clear evidence of an effect of CBT on levels of reoffending, a single study showed a small statistically significant decrease in violence.
How strong is the evidence?
The review took a robust approach. The main criteria for inclusion was that it was all studies were randomised controlled trials, including quasi- and cluster randomized trials. Participants were men who had been physically violent towards their female wife, partner or ex-partner, who had participated in an intervention, voluntarily or as part of a court order, that was recognizably and described as cognitive behavioural therapy. The primary outcome studies was a reduction or cessation in violence.
The studies showed high quality of design with transparent and well-designed search strategies, robust statistical analyses and risk of bias assessment. Nonetheless, the review used a risk of bias assessment and found a high risk of bias among the included studies.
Is it worth it?
The review did not consider the cost of the treatment.
Can it be implemented?
The review describes the different kinds of treatments available, including on-to-one, couple and group treatments, and the settings in which they can be delivered, including in prison, and at the offender’s home or workplace.
What's missing from the evidence?
The reviewers found it hard to distinguish between the different types of CBT programmes studied, and the different theoretical underpinnings of the treatments. It was also difficult to differentiate between CBT and other similar treatments.
The review recommends testing the different moderators that could come into play in determining the effectiveness of CBT including participant characteristics, the length and intensity of the programme and the nature of participation.
Some studies have included female perpetrators of domestic violence, but none met the inclusion criteria for this review.