How far does screening women for domestic (partner) - NIHR Health ...

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Review Question IV
cognitive therapy component before the exposure
therapy to establish whether the efficacy of the
intervention was affected by the order in which
the cognitive and exposure therapy components
were delivered. Women were referred from the
‘municipal centre for women’ and victim support
centres, by judges of domestic violence cases and
by housing advisors. Women in the intervention
group showed significant decreases in depression
and ‘maladaptation’ and significant increases in
self-esteem 2 months from baseline. Although
women in the intervention group had reductions
in PTSD symptoms post-treatment, these were not
significant when compared with the control group,
apart from negative cognitions. No differences
were found between the two intervention groups.
Studies included in our previous review
In our previous review 11 we examined two
randomised controlled trials of a psychological
intervention conducted by Kubany and
colleagues. 145,146 The intervention was based on
cognitive behavioural therapy and was targeted
at women survivors of partner violence who had
PTSD. Specifically, the intervention included
elements from existing treatments for PTSD,
feminist modules that focused on self-advocacy and
empowerment strategies, assertive communication
skill building, the managing of unwanted contact
with former partners, and identifying potential
perpetrators to avoid revictimisation. The two
evaluation studies, both randomised controlled
trials, found a sustained improvement at 3 and 6
months, respectively, in a range of mental health
measures including PTSD, depression and selfesteem.
In a randomised controlled study by Mancoske
and colleagues, women who contacted a partner
violence agency were provided with a rapid
response crisis intervention. 147 They were then
randomly assigned either to feminist-oriented
counselling or to grief resolution-oriented
counselling, both of which were provided over
eight weekly sessions by trained social workers
and included basic problem-solving and
psychoeducation. At the end of counselling, both
groups showed improvements over baseline in
self-esteem and self-efficacy, although these were
only significant for women who received grief
resolution-oriented counselling.
In a parallel group study of women resident in
a refuge or receiving refuge-associated services,
conducted by McNamara and colleagues, two
types of intervention were compared: individual
counselling versus case management. 148,149 When
assessed after three sessions, women in both groups
showed significantly improved life satisfaction
and coping ability compared with baseline values.
Additionally, women who had received individual
counselling showed a significantly greater increase
in global improvement scores than women in the
case management group.
Group psychological interventions
Studies published since our previous review
Gilbert and colleagues 150 conducted a pilot study
using a randomised controlled trial design to test
the feasibility, safety and short-term preliminary
effects of a relapse prevention and relationship
safety (RPRS) intervention in reducing drug use
and partner violence among women in methadone
maintenance treatment programmes (MMTPs);
the geographical region was not reported. The
RPRS intervention consisted of eleven 2-hour
group sessions and one individual session. The
intervention was tailored to the realities of lowincome,
African American and Latina women and
focused on the enhancement of self-worth, ethnic
pride and risk avoidance in the future. Materials
and exercises incorporated social cognitive skill
building. At the end of each session, participants
were asked to commit to specific skills practice
exercises between sessions. The control group
received an information session consisting of
a 1-hour didactic presentation of a wide range
of local community services that women in
MMTPs can access, tips on help-seeking, and a
comprehensive directory of local partner violence
services. At the follow-up assessment women in
the intervention group demonstrated reductions
in minor physical, sexual and/or injurious partner
violence in the past 90 days. They were also more
likely than women in the information group
to report a decrease in both minor and severe
psychological partner violence. Other changes in
abuse measures did not reach significance. Women
in the intervention group also demonstrated
decreases in depression at the 3-month followup.
Compared with women in the control group,
women in the intervention group were more likely
to report a decrease in having sex while high on
illicit drugs. Improvements regarding substance
use and PTSD after receiving the intervention did
not reach significance. No adverse events were
detected.
A cognitive behavioral therapy programme for
women referred from social services, counsellors
and the judiciary who displayed post-traumatic