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

DOI: 10.3310/hta13160 Health Technology Assessment 2009; Vol. 13: No. 16
stress symptoms but did not meet the diagnostic
criteria for PTSD was evaluated in a case–control
study by Arinero and Crespo conducted in an
urban setting in Spain. 151 The intervention,
administered in a health-care setting, included
psychoeducation, breathing controlling techniques,
self-esteem improvement procedures, cognitive
therapy, problem-solving and communication
skills training as well as specific strategies for
relapse prevention. Eight 90-minute sessions were
conducted with groups of 3–5 women. Women
in the intervention group, compared with the
waiting list control group, showed a decrease in
post-traumatic and depressive symptoms and an
improvement in adaptation levels up to 6 months’
follow-up. There were no significant changes in the
levels of self-esteem, although there may have been
a ceiling effect as self-esteem levels were already
high at the outset compared with other studies.
The authors point out that the effect sizes were not
as large as those in previous studies, such as that
of Kubany et al., 145 and suggested that this might
be because participants in their study had lower
(i.e. better) symptom scores at baseline, producing
a ceiling effect. There were significant decreases
in depression for the intervention group posttreatment;
the authors state this was still significant
at 6 months but no data were presented. The effect
size post-treatment was 0.95, and at the 1-month
follow-up it was 0.66, but effect sizes for the 3- and
6-month follow-ups were not presented.
A before-and-after study, conducted in Mexico by
Cruz and Sanchez, 152 assessed the effectiveness
of a group cognitive behavioural intervention
on promoting self-esteem, coping strategies
and assertiveness in abused spouses of problem
drinkers. The intervention comprised three
components: (1) identifying and correcting
cognitive biases and defective information; (2)
establishing emotional regulation strategies;
and (3) acquiring assertiveness skills. Women
received eighteen 150-minute weekly group
sessions. Women’s self-esteem was found to have
improved significantly from pre-test at the 3-,
6- and 18-month follow-ups, but not immediately
after the intervention. There were also significant
improvements in coping strategies at the 3-, 6-
and 18-month follow-ups. Women’s assertiveness
increased significantly from pre-test to the 3- and
6-month follow-up, but this was not sustained at the
18-month follow up.
Studies included in our previous review
Included in our previous review 11 was a parallel
group study by Cox and Stoltenberg 153 in which
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new refuge residents were recruited to a personal
and vocational group psychological programme
that included cognitive therapy, skills building
and problem-solving. The 16 Personality Factors
instrument (16PF) was administered to half of
the intervention group, which was then given full
feedback, creating two intervention subgroups.
The control group received normal refuge care,
which included weekly non-structured counselling
sessions. When assessed immediately after the
cessation of the intervention, both intervention
groups showed significant improvements over
baseline levels of self-esteem. However, all other
benefits over time, including anxiety, depression,
hostility and assertiveness, were limited to those
women who received the intervention without
any feedback from the 16PF. Neither of the two
intervention groups improved in terms of locus of
control. None of the outcome measures improved
over time for women in the control group.
Cognitive behavioural therapy was also the method
used by Laverde in a randomised controlled trial
in Columbia. 154 Abused women in the intervention
arm were given cognitive behavioural therapy, with
lectures and structured exercises. The women were
shown models of appropriate and inappropriate
behaviour in different situations, and this was then
followed by role play. Twenty 3-hour group sessions
were held over a period of 11 weeks. Abused
women allocated to the control condition attended
a support group; these sessions were unstructured
and aimed to discuss issues around partner
violence and to provide information about the
women’s legal rights and the availability of services.
It was found that the frequency and intensity of
abuse decreased markedly in both groups at 15,
30 and 45 days postintervention, but the numbers
were too small for any conclusions to be drawn.
Other benefits over time for intervention group
participants were also observed. In comparison
with their baseline scores, women in this group
significantly improved on several measures:
communication skills, handling of aggression,
assertiveness, and their feelings towards their
partners and the relationship, such as feeling less
sentimental. These improvements did not extend
to the control group, and significant between-group
differences were observed.
A psychoeducational group programme was
evaluated in a parallel group study by Limandri
and May. 155 The content of this programme
included information about partner violence,
safety planning, stress management, building selfesteem,
coming to terms with loss and grief, and
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