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Practice Profile

Interventions for Domestic Violence Offenders: Cognitive Behavioral Therapy

Evidence Ratings for Outcomes:

No Effects - More than one Meta-Analysis Crime & Delinquency - Violent offenses
No Effects - One Meta-Analysis Victimization - Domestic/intimate partner/family violence

Practice Description

Practice Goals/Practice Theory
Cognitive Behavioral Therapy (CBT) interventions for domestic violence offenders were developed by psychologists to treat violent behavior. These interventions approach violence as a learned behavior; thus, according to the CBT model of psychology, nonviolence can also be learned by domestic violence perpetrators. CBT attempts to change the behavior by identifying the thought processes and beliefs that contribute to the offenders’ violence. Physically abusive men are encouraged to think about and change their understanding of violence, examine the circumstances surrounding their violence, and disrupt the cognitive chain that leads to their commission of violent acts of domestic abuse. By demonstrating how offenders use violence as an anger outlet, obtain compliance from their victims, and empower themselves with a sense of control, therapists encourage change in perpetrators’ thoughts about violence while teaching them cognitive behavioral techniques such as communication skills, nonviolent assertiveness, social skills, and anger management. Usually, CBT models of treatment for domestic violence also address the emotions underlying the violent behaviors and the perpetrator’s attitudes toward women.

Target Population
The target population of CBT for domestic violence almost exclusively comprises male batterers. However, although not reviewed here, the principles of CBT interventions can be transposed to other treatment settings and offender types.

Practice Components
CBT is a form of psychotherapy that focuses on patterns of thinking and the beliefs, attitudes, and values that underlie that thinking. It is not a distinct therapeutic technique, but rather a general term for a classification of similar therapies. These specific approaches include rational-emotive behavior therapy, rational behavior therapy, rational living therapy, cognitive therapy, and dialectic behavior therapy. Participants in CBT programs learn specific skills that they can use to effectively solve daily problems and to achieve legitimate goals and objectives.

Structurally, CBT is often composed of six phases. These phases include 1) assessment, 2) reconceptualization, 3) skills acquisition, 4) skills consolidation and application, 5) generalization and maintenance, and 6) follow-up treatment. While the specific phases may differ from program to program, all CBT-based programs encourage participants to first develop their ability to recognize distorted or unrealistic thinking when it happens, and then to change that thinking to eliminate problematic behavior.

A typical CBT program is provided by trained professionals or paraprofessionals (Clark 2011). Licensed and certified therapists often deliver CBT programs in small-group settings and incorporate lessons and exercises involving role play, modeling, and demonstrations. Individual counseling sessions are also often part of CBT. Clients are given homework and actually conduct experiments on their own between sessions. Some of the specific therapeutic techniques used in CBT programs may include

  • Self-instruction using imagery, affirmations, or motivational self-talk
  • Coping techniques for negative thoughts
  • Relaxation techniques
  • Exposing the person to a fearful situation, gradually undoing the automatic negative response, and presenting a positive response
  • Role play
  • Graded task assignments
Additional Information
Another model of interventions targeted at domestic violence offenders is the Duluth Model (https://www.crimesolutions.gov/PracticeDetails.aspx?ID=17). There are a number of differences between interventions for domestic violence offenders that use CBT and interventions that use the Duluth Model. One main difference between the two types of interventions is in the theories underlying each. With CBT, violence is viewed as a learned behavior, which can be addressed by changing patterns of thinking and promoting and reinforcing nonviolent alternatives. The Duluth Model proposes that the principal cause of domestic violence is a social and cultural patriarchal ideology that historically has allowed men to control women through power and violence; the model does not assume that domestic violence is caused by mental or behavioral health problems, substance use, anger, stress, or dysfunctional relationships. The Duluth Model focuses on changing offenders’ dominant and controlling behaviors, to foster more egalitarian relationships. In addition, CBT is a therapeutic approach, whereas the Duluth Model is viewed as psychoeducational programming (Babcock et al. 2004; Arias, Arce, and Vilariño. 2013) However, the distinctions between the two models are often unclear (Babcock et al. 2004).

Meta-Analysis Outcomes

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No Effects - More than one Meta-Analysis Crime & Delinquency - Violent offenses
Looking at the results from five quasi-experimental studies that used police report data, Babcock and colleagues (2004) found no statistically significant effect on recidivism rates for domestic violence offenders who participated in cognitive behavioral therapy (CBT), compared with offenders who did not participate. Similarly, Smedslund and colleagues (2011) looked at results from four randomized trials and found no statistically significant effect on the likelihood that CBT participants would commit violence against their partners.
No Effects - One Meta-Analysis Victimization - Domestic/intimate partner/family violence
Looking at the results from three quasi-experimental studies that used partner reports of violence, Babcock and colleagues (2004) found no statistically significant effect on victimization rates of partners of domestic violence offenders who participated in CBT.
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Meta-Analysis Methodology

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Meta-Analysis Snapshot
 Literature Coverage DatesNumber of StudiesNumber of Study Participants
Meta-Analysis 11984 - 2003225536
Meta-Analysis 21996 - 200762343

Meta-Analysis 1
Babcock and colleagues (2004) examined the effect of cognitive behavioral therapy (CBT) interventions for male perpetrators of domestic violence. Their literature search identified studies that examined the effectiveness of three different types of interventions: Duluth Model, CBT, and others.

Their review focused on evaluations that measured violent recidivism of the perpetrator. A search of PsycINFO was conducted to identify all studies retrieved by entering the keywords ‘‘batterers’’ and ‘‘domestic violence,’’ and cross- referenced with terms, including ‘‘treatment’’ and ‘‘intervention.’’ This strategy yielded 68 empirical studies on the efficacy of batterers’ treatment programs. This number was further refined by using inclusion criteria that included 1) the presence of some form of comparison group of batterers, and 2) reliance on a victim report or police record as the index of recidivism. These criteria resulted in the identification of 22 studies (5 experimental and 17 quasi-experimental). Seven of the studies were unpublished, and 15 were published in peer-reviewed journals. These 22 studies provided 44 effect sizes in which various or multiple treatments were compared with each other and with comparison groups. There were 5,536 participants across the various treatment conditions in the reviewed studies. The authors did not present a demographic breakdown.

The outcomes of interest in this review were recidivism and victimization. Recidivism was considered any report of physical violence reported by the victims and/or domestic violence incidents reported by the police during the follow-up period. For the recidivism outcomes, the meta-analysis reported an effect size for five quasi-experimental CBT interventions (k = 5). For the victimization outcomes, the meta-analysis reported on three quasi-experimental effect sizes for CBT interventions (k = 3).

The authors used a hierarchical fixed effects analysis model, because of a non-significant overall Q statistic, with inverse variance weights. Moderator analyses were performed by quality of methods (experimental and quasi-experimental) and by treatment type (CBT interventions, Duluth Model, and other interventions). Additionally, effect sizes were broken down by police report (recidivism) and partner report (victimization) data. Effect sizes were calculated as Cohen’s d.

One potential limitation of the results from this meta-analysis is that 13 quasi-experimental studies used dropouts as a comparison group, which may have confounded the analysis by comparing the most motivated participants with the least. Therefore, some of the results of this meta-analysis should be interpreted with caution, particularly when they are dependent on the effects of quasi-experimental studies.

Meta-Analysis 2
Smedslund and colleagues (2011) examined the effects of cognitive behavioral therapy (CBT) on men who physically abused their female partners. Their literature search concentrated on interventions that have a clear CBT element.

To be included in the meta-analysis, the studies needed to meet the following criteria: 1) used randomized controlled trials, 2) used male participants who were physically violent toward a female partner, 3) used interventions that included a form of CBT recognizable by its description, and 4) measured outcomes on violent behavior toward the female partner. The literature search targeted randomized trials in eight different databases and repositories. The study authors also consulted field experts and authors and searched conference papers. Of the six randomized trials identified, four used a no-treatment control group, and the remaining two used “other treatment” as a comparison group.

The six trials used in the meta-analysis had 12 citations: five trials had been published in at least one peer-reviewed journal. The six trials accounted for 2,343 of the participants, and the four trials with no-treatment control groups comprised 1,771 participants. The authors did not provide a demographic breakdown of the total sample. For the purpose of this review, only the controlled trials with a no-treatment comparison group (k = 4) were considered, and the outcome of interest was violent behavior.

The authors reported effect sizes as relative risk scores with 95-percent confidence intervals. For the analysis of the trials with a no-treatment condition, a random effects model was used, due to statistically significant heterogeneity in the studies’ effect sizes.
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Cost

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There is no cost information available for this practice.
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Evidence-Base (Meta-Analyses Reviewed)

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These sources were used in the development of the practice profile:

Meta-Analysis 1
Babcock, Julia C., Charles E. Green, and Chet Robie. 2004. “Does Batterers’ Treatment Work? A Meta-Analytic Review of Domestic Violence Treatment." Clinical Psychology Review 23:1023–1053.

Meta-Analysis 2
Smedslund, Geir, Therese K. Dalsbø, Asbjørn Steiro, Aina Winsvold, and Jocelyn Clench-Aas. 2011. “Cognitive Behavioural Therapy for Men Who Physically Abuse Their Female Partner.” Cochrane Database of Systematic Reviews 3 (CD006048).
http://summaries.cochrane.org/CD006048/cognitive-behavioural-therapy-for-men-who-physically-abuse-their-female-partner
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Additional References

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These sources were used in the development of the practice profile:

Arias, Esther, Ramón Arce, and Manuel Vilariño. 2013. “Batterer Intervention Programmes: A Meta-Analytic Review of Effectiveness.” Psychosocial Intervention 22:153–60. (This meta-analysis was reviewed but did not meet CrimeSolutions.gov criteria for inclusion in the overall outcome rating.)

Clark, Patrick M. 2011. “Cognitive Behavioral Therapy: An Evidence-Based Intervention for Offenders.” Corrections Today 73(1):62–64.
https://ncjrs.gov/pdffiles1/nij/239776.pdf
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Related Programs

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Following are CrimeSolutions.gov-rated programs that are related to this practice:

Culturally Focused Batterer Counseling (Pittsburgh, PA) No Effects - One study
A cognitive–behavioral counseling program specifically designed for African American men arrested for domestic violence. The program is rated No Effects. The program had no significant impact on program completion or self-reported reassault rates. The study showed that men who participated in the culturally focused counseling option were twice as likely as men who participated in the racially mixed counseling option to be rearrested for domestic violence.
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Practice Snapshot

Gender: Male

Targeted Population: Serious/Violent Offender, Victims of Crime

Settings: Inpatient/Outpatient, Other Community Setting

Practice Type: Cognitive Behavioral Treatment, Conflict Resolution/Interpersonal Skills, Group Therapy, Individual Therapy

Unit of Analysis: Persons