Long-Term Effectiveness of Trauma-Focused Therapy for Intimate Partner Violence Against Women: Effects on Posttraumatic Symptoms and Revictimization

Abstract

The current study aimed to test the clinical effectiveness in the mid- and long-term of two versions of a cognitive-behavioral therapy (CBT) tailored for intimate partner violence against women (IPVAW) and with a focus on trauma: (a) with the incorporation of positive memories evocation (CBT-M+); and (b) without such evocation (CBT). Ninety-one female survivors of IPVAW entered a randomized controlled trial comparing CBT (n = 41) and CBT-M+ (n = 50). Pretreatment, post-treatment, and 3-, 6-, and 12-month follow-up measures were obtained for: posttraumatic stress, anxiety, depression, self-esteem, impairment, and exposure to violence (psychological, physical, sexual, and injury). A total of 45.05% of women who entered treatment dropped out, without significant differences between treatments. Both treatments resulted in significant improvements along the follow-ups, with good effect sizes, for posttraumatic stress ( $η_{p}^{2}$ = 0.42), anxiety ( $η_{p}^{2}$ = 0.25), depression ( $η_{p}^{2}$ = 0.21), self-esteem ( $η_{p}^{2}$ = 0.33) and impairment ( $η_{p}^{2}$ = 0.28); group effect and time-group interactions were not significant. Both treatments significantly reduced the percentage of women diagnosed with posttraumatic stress disorder, while they also led to reductions in depression, low self-esteem, and impairment. In addition, CBT-M+ significantly reduced the percentage of women with anxiety problems. The presence of psychological (90%–52.5%), physical (82.5%–30%), and sexual (62.5%–15%) violence significantly decreased at 12 months for both treatments, while the decrease in injury was significant only for the CBT group. These results show that both versions of the treatment accomplished long-term effects, improving clinically and significantly women’s emotional state and reducing revictimization, with no differences between them. Moreover, these improvements were consolidated and even increased over time. The study therefore provides valuable information about the potential of this CBT for women’s overall recovery and healing.

Trial registration: ISRCTN Registry (ref. ISRCTN73702156) (https://www.isrctn.com/ISRCTN73702156)

Keywords

intimate partner violence against women trauma-focused therapy posttraumatic stress positive memories randomized controlled trial revictimization effectiveness

Get full access to this article

View all access options for this article.

References

Allard

C. B.

Norman

S. B.

Thorp

S. R.

Browne

K. C.

Stein

M. B.

(2018). Mid-treatment reduction in trauma-related guilt predicts PTSD and functioning following cognitive trauma therapy for survivors of intimate partner violence. Journal of Interpersonal Violence, 33(23), 3610–3629. https://doi.org/10.1177/0886260516636068

Beck

A. T.

Steer

R. A.

(1990). The Beck Anxiety Inventory. The Psychological Corporation.

Beck

A. T.

Steer

R. A.

Brown

G. K.

(1996). BDI-II. Beck Depression Inventory—Second Edition. Manual. The Psychological Corporation.

Bellot

Muñoz-Rivas

M. J.

Botella

Montorio

(2024). Factors associated with revictimization in intimate partner violence: A systematic review and meta-analysis. Behavioral Sciences, 14(2), 103. https://doi.org/10.3390/bs14020103

Boutron

Altman

D. G.

Moher

Schulz

K. F.

Ravaud

, & CONSORT NPT Group (2017). CONSORT statement for randomized trials of nonpharmacologic treatments: A 2017 update and a CONSORT extension for nonpharmacologic trial abstracts. Annals of Internal Medicine, 167(1), 40–47. https://doi.org/10.7326/M17-0046

Calvete

Corral

Estévez

(2007). Factor structure and validity of the revised conflict tactics scales for Spanish women. Violence Against Women, 13(10), 1072–1087. https://doi.org/10.1177/1077801207305933

Chu

Y. C.

Wang

H. H.

Chou

F. H.

Hsu

Y. F.

Liao

K. L.

(2024). Outcomes of trauma-informed care on the psychological health of women experiencing intimate partner violence: A systematic review and meta-analysis. Journal of Psychiatric and Mental Health Nursing, 31(2), 203–214. https://doi.org/10.1111/jpm.12976

Contractor

A. A.

Banducci

A. N.

Weiss

N. H.

(2022). Critical considerations for the positive memory-posttraumatic stress disorder model. Clinical Psychology & Psychotherapy, 29(1), 81–91. https://doi.org/10.1002/cpp.2599

Contractor

A. A.

Brown

L. A.

Caldas

S. V.

Banducci

A. N.

Taylor

D. J.

Armour

Shea

M. T.

(2018). Posttraumatic stress disorder and positive memories: Clinical considerations. Journal of Anxiety Disorders, 58, 23–32. https://doi.org/10.1016/j.janxdis.2018.06.007

10.

Crespo

Arinero

(2010). Assessment of the efficacy of a psychological treatment for women victims of violence by their intimate male partner. The Spanish Journal of Psychology, 13(2), 849–863. https://doi.org/10.1017/S113874160000250X

11.

Crespo

Antón

A.A.

Hornillos

(2025). Dropout From Trauma-Focused Treatment for Intimate Partner Violence Against Women. Clinical psychology & psychotherapy, 32(3), e70092. https://doi.org/10.1002/cpp.70092

12.

Crespo

Arinero

Soberón

(2021). Analysis of effectiveness of individual and group trauma-focused interventions for female victims of intimate partner violence. International Journal of Environmental Research and Public Health, 18(4), 1952. https://doi.org/10.3390/ijerph18041952

13.

Crespo

Gómez

M. M.

Soberón

(2017). EGEP-5. Evaluación global de estrés postraumático 5. [Global assessment of postraumatic stress 5]. TEA Ediciones.

14.

Crespo

Hernández-Lloreda

M. J.

Hornillos

Miguel-Alvaro

Sánchez-Ferrer

Antón

A. A.

(2024a). Evocation of positive memories as complement to trauma-focused cognitive–behavioural therapy for intimate partner violence against women. European Journal of Psychotraumatology, 15(1).https://doi.org/10.1080/20008066.2024.2419699

15.

Crespo

Miguel-Alvaro

Antón

A.A.

Hornillos

Sánchez-Ferrer

(2024b). Manual del programa MEMPOSITIV Tratamiento centrado en las memorias positivas para el trauma en violencia contra la mujer en la pareja. [Manual of the MEMPOSITIV Programme: a therapy focused on positive memories for trauma in Intimate Partner Violence Against Women]. Psicofundación. Retrieved from: https://drive.google.com/file/d/1AUPmuhWBxytJLoWRBOX2jIpLoZa5u_bv/view

16.

Crespo

Miguel-Alvaro

Hornillos

Sánchez-Ferrer

Antón

A. A.

(2022). Effect of adding a positive memories’ module in a trauma-focused cognitive-behavioural treatment for female survivors of intimate partner violence: Trial protocol. Trials, 23(1), 593. https://doi.org/10.1186/s13063-022-06540-1

17.

Daneshvar

Shafiei

Basharpoor

(2022). Group-based compassion-focused therapy on experiential avoidance, meaning-in-life, and sense of coherence in female survivors of intimate partner violence with PTSD: A randomized controlled trial. Journal of Interpersonal Violence, 37(7–8), NP4187–NP4211. https://doi.org/10.1177/0886260520958660

18.

Echeburúa

Corral

M. P.

(1998). Manual de Violencia Familiar. [Handbook on domestic violence]. Siglo XXI Ed.

19.

Echeburúa

Sarasua

Zubizarreta

(2014). Individual versus individual and group therapy regarding a cognitive-behavioral treatment for battered women in a community setting. Journal of Interpersonal Violence, 29(10), 1783–1801. https://doi.org/10.1177/0886260513511703

20.

Emirza

E. G.

Uzun

(2024). The effect of psychotherapeutic interventions on posttraumatic stress disorder symptoms, depression and self-esteem in women exposed to violence: A systematic review and meta-analysis. Current Psychology, 43, 26301–26316. https://doi.org/10.1007/s12144-024-06285-x

21.

Foschiera

L. N.

Dupont

M. F.

Habigzang

L. F.

(2022). Follow-up evaluation of psychotherapy protocols for women with a history of intimate partner violence: Scoping review. Trends in Psychology, 30(2), 261–282. https://doi.org/10.1007/s43076-021-00119-6

22.

Gallegos

A. M.

Heffner

K. L.

Cerulli

Luck

McGuinness

Pigeon

W. R.

(2020). Effects of mindfulness training on posttraumatic stress symptoms from a community-based pilot clinical trial among survivors of intimate partner violence. Psychological Trauma: Theory, Research, Practice and Policy, 12(8), 859–868. https://doi.org/10.1037/tra0000975

23.

Galovski

T. E.

Werner

K. B.

Weaver

T. L.

Morris

K. L.

Dondanville

K. A.

Nanney

Wamser-Nanney

McGlinchey

Fortier

C. B.

Iverson

K. M.

(2022). Massed cognitive processing therapy for posttraumatic stress disorder in women survivors of intimate partner violence. Psychological Trauma: Theory, Research, Practice and Policy, 14(5), 769–779. https://doi.org/10.1037/tra0001100

24.

IBM Corp. (2023). IBM SPSS Statistics for Windows, Version 29.0.2.0. IBM Corp.

25.

Johnson

D. M.

Zlotnick

Hoffman

Palmieri

P. A.

Johnson

N. L.

Holmes

S. C.

Ceroni

T. L.

(2020). A randomized controlled trial comparing HOPE treatment and present-centered therapy in women residing in shelter with PTSD from intimate partner violence. Psychology of Women Quarterly, 44(4), 539–553. https://doi.org/10.1177/0361684320953120

26.

Kessler

R. C.

Aguilar-Gaxiola

Alonso

Benjet

Bromet

E. J.

Cardoso

Degenhardt

de Girolamo

Dinolova

R. V.

Ferry

Florescu

Gureje

Haro

J. M.

Huang

Karam

E. G.

Kawakami

Lee

Lepine

J. P.

Levinson

. . . Koenen

K. C.

(2017). Trauma and PTSD in the WHO World Mental Health Surveys. European Journal of Psychotraumatology, 8(sup5), 1353383. https://doi.org/10.1080/20008198.2017.1353383

27.

Kip

Iseke

L. N.

Papola

Gastaldon

Barbui

Morina

(2023). Efficacy of psychological interventions for PTSD in distinct populations—An evidence map of meta-analyses using the umbrella review methodology. Clinical Psychology Review, 100, 102239. https://doi.org/10.1016/j.cpr.2022.102239

28.

Kubany

E. S.

Hill

E. E.

Owens

J. A.

Iannce-Spencer

McCaig

M. A.

Tremayne

K. J.

Williams

P. L.

(2004). Cognitive trauma therapy for battered women with PTSD (CTT-BW). Journal of Consulting and Clinical Psychology, 72(1), 3–18. https://doi.org/10.1037/0022-006X.72.1.3

29.

Labrador

F. J.

Rincón

P. P.

Estupiñá

F. J.

Crespo

de Luis

Fernández

(2009). Protocolo de atención psicológica a mujeres víctimas de violencia de género. [Protocol for psychological care for women victims of gender-based violence]. COP Madrid—Instituto de la Mujer.

30.

Larsen

D. L.

Attkisson

C. C.

Hargreaves

W. A.

Nguyen

T. D.

(1979). Assessment of client/patient satisfaction: Development of a general scale. Evaluation and Program Planning, 2(3), 197–207. https://doi.org/10.1016/0149-7189(79)90094-6

31.

McFarlane

Maddoux

Paulson

Symes

Jouriles

E. N.

(2020). An evidence-based assessment tool for estimating future post-traumatic stress disorder: A 7-year follow-up study. Journal of Women’s Health (2002), 29(4), 520–523. https://doi.org/10.1089/jwh.2019.7699

32.

Miguel-Alvaro

Gómez-Gutiérrez

M. M.

Hornillos

Hernández-Lloreda

M. J.

Crespo

(2023). Implementation and effects of the Broad-Minded Affective Coping (BMAC) technique: A pilot study. International Journal of Cognitive Therapy, 16(2), 266–284. https://doi.org/10.1007/s41811-023-00163-3

33.

Moreira

A. C.

Rocha

J. C.

(2022). Randomized controlled trial: Cognitive-narrative therapy for IPV victims. Journal of Interpersonal Violence, 37(5–6), NP2998–NP3014. https://doi.org/10.1177/0886260520943719

34.

O’Doherty

L. J.

MacMillan

Feder

Taft

Taket

Hegarty

(2014). Selecting outcomes for intimate partner violence intervention trials: Overview and recommendations. Aggression and Violent Behavior, 19(6), 663–672. https://doi.org/10.1016/j.avb.2014.09.010

35.

Orang

Ayoughi

Moran

J. K.

Ghaffari

Mostafavi

Rasoulian

Elbert

(2018). The efficacy of narrative exposure therapy in a sample of Iranian women exposed to ongoing intimate partner violence—A randomized controlled trial. Clinical Psychology & Psychotherapy, 25(6), 827–841. https://doi.org/10.1002/cpp.2318

36.

Perez

Johnson

D. M.

(2008). PTSD compromises battered women’s future safety. Journal of Interpersonal Violence, 23(5), 635–651. https://doi.org/10.1177/0886260507313528

37.

Pill

Day

Mildred

(2017). Trauma responses to intimate partner violence: A review of current knowledge. Aggression and Violent Behavior, 34, 178–184. https://doi.org/10.1016/j.avb.2017.01.014

38.

Ragucci

Dragan

Cuomo

Fagiolini

Pozza

(2024). Psychological interventions for post-traumatic stress disorder in women survivors of intimate partner violence: A systematic review and meta-analysis. Journal of Affective Disorders Reports, 17, 100802. https://doi.org/10.1016/j.jadr.2024.100802

39.

Rosenberg

(1965). Rosenberg Self-Esteem Scale (RSES) [Database record]. APA PsycTests. https://psycnet.apa.org/doi/10.1037/t01038-000

40.

Salinas

(n.d.). Números Aleatorios [Random numbers] [Software]. https://www.ugr.es/~jsalinas/Aleatorios.htm

41.

Sánchez-Ferrer

Antón

A.A.

Miguel-Alvaro

Crespo

(2025). Lessons to learn from pilot studies in clinical trials: the example of a trauma-focused treatment for female survivors of intimate partner violence. Counselling and Psychotherapy Research, 25(2), e12843. https://doi.org/10.1002/capr.12843

42.

Sanz

Navarro

M. E.

(2003). Propiedades psicométricas de una versión española del Inventario de Ansiedad de Beck (BAI) en estudiantes universitarios. [Psychometric properties of a Spanish version of the Beck Anxiety Inventory (BAI) in university students]. Ansiedad y Estrés, 9, 59–84

43.

Sanz

Perdigón

A. L.

Vázquez

(2003). Adaptación española del Inventario para la Depresión de Beck-II (BDI-II): 2. Propiedades psicométricas en población general. [Spanish adaptation of the Beck Depression Inventory-II (BDI-II): 2. Psychometric properties in the general population]. Clínica y Salud, 14, 249–280.

44.

Straus

M. A.

Hamby

S. L.

Boney-McCoy

Sugarman

D. B.

(1996). The revised Conflict Tactics Scales (CTS2): Development and preliminary psychometric data. Journal of Family Issues, 17(3), 283–316. https://doi.org/10.1177/019251396017003001

45.

Tarrier

(2010). Broad minded affective coping (BMAC): A “positive” CBT approach to facilitating positive emotions. International Journal of Cognitive Therapy, 3(1), 64–76. https://doi.org/10.1521/ijct.2010.3.1.64

46.

Ward

R.A.

(1977). Aging group consciousness. Implications in an older sample. Sociology and Social Research, 61, 496–519.

47.

White

S. J.

Sin

Sweeney

Salisbury

Wahlich

Montesinos Guevara

C. M.

Gillard

Brett

Allwright

Iqbal

Khan

Perot

Marks

Mantovani

(2024). Global prevalence and mental health outcomes of intimate partner violence among women: A systematic review and meta-analysis. Trauma, Violence, & Abuse, 25(1), 494–511. https://doi.org/10.1177/15248380231155529

48.

World Health Organization [WHO]. (2021). Violence against women prevalence estimates, 2018: Global, regional and national prevalence estimates for intimate partner violence against women and global and regional prevalence estimates for non-partner sexual violence against women. Author. https://apps.who.int/iris/bitstream/handle/10665/341337/9789240022256-eng.pdf?sequence=1

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.13 MB