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Psychological therapies for women who experience intimate partner violence
Open accessAbstract
BACKGROUND: Intimate partner violence (IPV) against women is prevalent and strongly associated with mental health problems. Women experiencing IPV attend health services frequently for mental health problems. The World Health Organization recommends that women who have experienced IPV and have a mental health diagnosis should receive evidence-based mental health treatments. However, it is not known if psychological therapies work for women in the context of IPV and whether they cause harm. OBJECTIVES: To assess the effectiveness of psychological therapies for women who experience IPV on the primary outcomes of depression, self-efficacy and an indicator of harm (dropouts) at six- to 12-months' follow-up, and on secondary outcomes of other mental health symptoms, anxiety, quality of life, re-exposure to IPV, safety planning and behaviours, use of healthcare and IPV services, and social support. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR), CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, and three other databases, to the end of October 2019. We also searched international trials registries to identify unpublished or ongoing trials and handsearched selected journals, reference lists of included trials and grey literature. SELECTION CRITERIA: We included randomised controlled trials (RCTs), quasi-RCTs, cluster-RCTs and cross-over trials of psychological therapies with women aged 16 years and older who self-reported recent or lifetime experience of IPV. We included trials if women also experienced co-existing mental health diagnoses or substance abuse issues, or both. Psychological therapies included a wide range of interventions that targeted cognition, motivation and behaviour compared with usual care, no treatment, delayed or minimal interventions. We classified psychological therapies according to Cochrane Common Mental Disorders's psychological therapies list. DATA COLLECTION AND ANALYSIS: Two review authors extracted data and undertook 'Risk of Bias' assessment. Treatment effects were compared between experimental and comparator interventions at short-term (up to six months post-baseline), medium-term (six to under 12 months, primary outcome time point), and long-term follow-up (12 months and above). We used standardised mean difference (SMD) for continuous and odds ratio (OR) for dichotomous outcomes, and used random-effects meta-analysis, due to high heterogeneity across trials. MAIN RESULTS: We included 33 psychological trials involving 5517 women randomly assigned to experimental (2798 women, 51%) and comparator interventions (2719 women, 49%). Psychological therapies included 11 integrative therapies, nine humanistic therapies, six cognitive behavioural therapy, four third-wave cognitive behavioural therapies and three other psychologically-orientated interventions. There were no trials classified as psychodynamic therapies. Most trials were from high-income countries (19 in USA, three in Iran, two each in Australia and Greece, and one trial each in China, India, Kenya, Nigeria, Pakistan, Spain and UK), among women recruited from healthcare, community, shelter or refuge settings, or a combination of any or all of these. Psychological therapies were mostly delivered face-to-face (28 trials), but varied by length of treatment (two to 50 sessions) and staff delivering therapies (social workers, nurses, psychologists, community health workers, family doctors, researchers). The average sample size was 82 women (14 to 479), aged 37 years on average, and 66% were unemployed. Half of the women were married or living with a partner and just over half of the participants had experienced IPV in the last 12 months (17 trials), 6% in the past two years (two trials) and 42% during their lifetime (14 trials). Whilst 20 trials (61%) described reliable low-risk random-sampling strategies, only 12 trials (36%) described reliable procedures to conceal the allocation of participant status. While 19 trials measured women's depression, only four trials measured depression as a continuous outcome at medium-term follow-up. These showed a probable beneficial effect of psychological therapies in reducing depression (SMD -0.24, 95% CI -0.47 to -0.01; four trials, 600 women; moderate-certainty evidence). However, for self-efficacy, there may be no evidence of a difference between groups (SMD -0.12, 95% CI -0.33 to 0.09; one trial with medium-term follow-up data, 346 women; low-certainty evidence). Further, there may be no difference between the number of women who dropped out from the experimental or comparator intervention groups, an indicator of no harm (OR 1.04, 95% CI 0.75 to 1.44; five trials with medium-term follow-up data, 840 women; low-certainty evidence). Although no trials reported adverse events from psychological therapies or participation in the trial, only one trial measured harm outcomes using a validated scale. For secondary outcomes, trials measured anxiety on
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“This is particularly important as most existing interventions for IPV survivors focus on safety and crisis management, and there is presently a lack of evidence-based psychological programs to support the long-term recovery of those who have been exposed to IPV, particularly coercive control (Hameed et al., 2020).”
From The Trauma and Mental Health Impacts of Coercive Control: A Systematic Review and Meta-Analysis (2024) · cites this paper as Hameed et al., 2020
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“traditional psychotherapy alone can show limitations such as moderate effect sizes as well as a lack of generalizability and endpoint improvement, depending on the target population.”
From The Groundswell Community Surf Therapy Intervention for At-Risk Women and Changes in Body Acceptance, Resilience, and Emotional Regulation (2024) · cites this paper as [18]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“involvement in mental health interventions can improve outcomes related to depression, PTS, and substance use problems [13,14]”
From Psychological Interventions for Survivors of Intimate Partner Violence in Humanitarian Settings: An Overview of the Evidence and Implementation Considerations (2022) · cites this paper as [13]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“The authors reported that all kinds of therapies based on five or more sessions, but no fewer, were effective in reducing depression, and anxiety to a lesser degree.”
From Comparison of two psychotherapies in cortisol response and their efficacy in reducing symptoms of anxiety and depression in women victims of intimate partner violence (2023) · cites this paper as Hameed et al., 2020
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“However, we took the decision to exclude domestic abuse interventions due to another Cochrane Review (Hameed 2020).”
From Psychosocial interventions for survivors of rape and sexual assault experienced during adulthood (2023) · cites this paper as Hameed 2020
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“However, evidence of the effectiveness of specific interventions for IPV exposed women in improving other negatively affected factors, such as quality of life or social support, are scarce (Hameed et al., 2020).”
From Comparison of two psychotherapies in cortisol response and their efficacy in reducing symptoms of anxiety and depression in women victims of intimate partner violence (2023) · cites this paper as Hameed et al., 2020
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In the citing paper
“Relative to intimate partner violence (IPV), sexual violence has received less attention in the research literature”
From Psychosocial interventions for survivors of rape and sexual assault experienced during adulthood (2023) · cites this paper as Hameed 2020
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Metadata
- Authors
- Hameed, M., O'Doherty, L., Gilchrist, G., Tirado-Muñoz, J., Taft, A., Chondros, P., Feder, G., Tan, M., & Hegarty, K.
- Affiliations
- The University of Melbourne (AU)
- Faculty of Health and Life Sciences; Coventry University; Coventry UK
- King's College London (GB)
- Municipal Institute for Medical Research (ES)
- La Trobe University (AU)
- University of Bristol (GB)
- Royal Women's Hospital (AU)
- ORCID
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2020-07-01
- Volume
- 2020
- Issue
- 7
- Pages
- CD013017-CD013017
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC7390063
- OpenAlex
- W2800022838
- Semantic Scholar
- 7a825353791c01d15a467e6fb6cb0ce01ae06402
- Cited by
- 146
- References
- 286
- Citations by year
- 2026: 21 · 2025: 22 · 2024: 32 · 2023: 34 · 2022: 21 · 2021: 12 · 2020: 4
- FWCI
- 2.55
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Pure (Coventry University) (publishedVersion, other-oa)
- Bristol Research (University of Bristol) (publishedVersion, other-oa)
- Minerva Access (University of Melbourne) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- La Trobe University
- Funders
- World Health Organization
- Topics
- Social Sciences › Health › Intimate Partner and Family Violence
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Sociology and Political Science › Stalking, Cyberstalking, and Harassment
- Keywords
- intimate partner violence, psychotherapy, women, depression, self-efficacy, treatment discontinuation, anxiety, quality of life, safety planning, substance abuse, common mental disorders, cognitive behavioral therapy, humanistic psychotherapy, integrative therapy
- MeSH terms
- Intimate Partner Violence, Adolescent, Adult, Aged, Aged, 80 and over, Anxiety, Depression, Female, Humans, Middle Aged, Patient Dropouts, Psychotherapy, Quality of Life, Safety, Stress Disorders, Post-Traumatic, Randomized Controlled Trials as Topic, Self Efficacy, Young Adult
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