“Strength at Home” Intervention to Prevent Conflict and Violence in Military Couples: Pilot Findings

Health Service Interventions for Intimate Partner Violence among Military Personnel and Veterans: A Framework and Scoping Review

IPV is a significant concern among active duty (AD) military personnel or veterans, and there is a need for initiatives to address violence perpetrated by such personnel, and IPV victimisation in military and veteran-specific contexts. The aim of this paper was to provide an overview of major IPV intervention approaches and evidence in military and veteran-specific health services. A scoping review was conducted involving a systematic search of all available published studies describing IPV interventions in military and veteran-specific health services. Findings were synthesised narratively, and in relation to a conceptual framework that distinguishes across prevention, response, and recovery-oriented strategies. The search identified 19 studies, all from the U.S., and only three comprised randomised trials. Initiatives addressed both IPV perpetration and victimisation, with varied interventions targeting the latter, including training programs, case identification and risk assessment strategies, and psychosocial interventions. Most initiatives were classified as responses to IPV, with one example of indicated prevention. The findings highlight an important role for specific health services in addressing IPV among AD personnel and veterans, and signal intervention components that should be considered. The limited amount of empirical evidence indicates that benefits of interventions remain unclear, and highlights the need for targeted research.

Systemic interventions for traumatic event exposure: A 2010-2019 decade review

Trauma exposure is a pervasive issue worldwide. People exposed to traumatic events may develop PTSD, depression, anxiety, and other mental health symptoms. Family and intimate partner relationship problems also are frequently associated with trauma exposure. The purpose of this study was to conduct a systematic research synthesis of the empirical evidence on systemic interventions for traumatic event exposure from 2010 to 2019. A search of peer-reviewed research resulted in 31 articles that met inclusion criteria and were included in this review. Systemic interventions were grouped by modality (e.g., parent-child, couple, group). The collective evidence was strongest for systemic youth-caregiver interventions, group, and couple treatment categories for traumatic event exposure. Youth-centered interventions that included various combinations of family member participation can be considered probably efficacious. Overall, results indicated that systemic interventions for traumatic event exposure were successful in reducing posttraumatic stress symptoms including PTSD, depression, and anxiety, and improving relational outcomes.

A Comparison of Group Anger Management Treatments for Combat Veterans With PTSD: Results From a Quasi-Experimental Trial

Difficulty controlling anger is a significant concern among combat veterans with posttraumatic stress disorder (PTSD), yet few controlled studies have examined the efficacy of anger treatments for this population. This study examined the effects of a group cognitive behavioral therapy (CBT) intervention compared with a group present-centered therapy (PCT) control condition in male and female combat veterans with PTSD. Thirty-six combat veterans with PTSD and anger difficulties began group treatment (CBT, n = 19; PCT, n = 17). Separate multilevel models of self-rated anger, PTSD symptoms, and disability were conducted using data from baseline, each of 12 treatment sessions, posttreatment, and 3- and 6-month follow-up time points. Significant decreases in anger and PTSD symptoms were observed over time, but no significant differences between CBT and PCT were observed on these outcomes. A significant interaction of therapy by time favoring the PCT condition was observed on disability scores. Gender differences were observed in dropout rates (i.e., 100% of female participants dropped out of CBT). Findings suggest that both CBT and PCT group therapy may be effective in reducing anger in combat veterans with PTSD. Results also highlight potential gender differences in response to group anger treatment.

A Dyadic Analysis of PTSD and Psychological Partner Aggression Among U.S. Iraq and Afghanistan Veterans: The Impact of Gender and Dual-Veteran Couple Status

Posttraumatic stress disorder (PTSD) symptoms have been repeatedly linked to intimate partner aggression (IPA), and previous research has suggested that this association may be stronger among veterans and men. However, few studies have examined veteran status and gender as moderators of the association between PTSD and psychological IPA, taking both partners' perspectives into account (i.e., within a dyadic framework). The current study aimed to address this limitation by using dyadic multilevel modeling to examine the association between PTSD symptoms and psychological IPA perpetration among a sample of 159 Operation Iraqi Freedom and Operation Enduring Freedom veterans and their partners (N = 318 participants). Findings revealed that both one's own and one's partner's PTSD symptoms were positively associated with greater psychological IPA. In addition, the effects of partner PTSD symptoms on psychological IPA perpetration differed across gender and veteran status. Results suggested that the association of partner PTSD and IPA perpetration may be stronger for male veterans than for female veterans. Findings from the current study are consistent with previous research showing associations between PTSD and IPA, and have clinical implications for treatment of PTSD and IPA among Operation Iraqi Freedom and Operation Enduring Freedom veterans.

A systematic review of interventions for supporting partners of military Veterans with PTSD

Introduction: Partners of military Veterans with post-traumatic stress disorder (PTSD) and other mental health difficulties can themselves develop difficulties with stress, well-being, and secondary trauma. Various interventions exist which involve partners of military personnel, but very few with an explicit focus on the partners’ well-being. This article aims to conduct a systematic review of these interventions and outline the range of interventions and the outcomes measured. Methods: We conducted a systematic literature search, from which 25 papers were reviewed. Papers were included if they described any form of intervention in which a partner was involved, where the Veteran was described as having PTSD, and where the aim of the intervention was aimed at least partly at improving the well-being of partners. Results: We found various types of interventions, such as group-based interventions, residential retreats, couples therapies, Internet-based interventions, and family-based interventions. Of the 25 studies reviewed, 21 reported on well-being outcomes, either via randomized controlled trials (RCTs), evaluations, or case studies. In most cases, interventions reported improvements in the well-being of partners, although there were very few controlled studies. Only a small number of interventions were aimed solely at partners. The most common feature of interventions was psychoeducation on topics such as communication, problem solving, and emotion regulation. Many papers described the advantages of group processes such as social support and normalization, gained from partners sharing experiences with one another. Discussion: A wide range of formats exist of interventions for improving the well-being of military partners. The literature would benefit from more robust experimental research into their effectiveness, and exploration of interventions aimed directly at the well-being of partners.

Cognitive behavioural group therapy for male perpetrators of intimate partner violence: a systematic review

BACKGROUND

Violence against intimate partners is a worldwide public health problem. Cognitive behavioural therapy delivered in a group format is widely used for the treatment of men's violent behaviour towards their female partners. A Cochrane review about the effectiveness of this therapy from 2011 revealed a lack of controlled studies. Our aim is to update the current evidence on the effectiveness of cognitive behavioural group therapy on men's violent behaviour towards their female partner.

METHODS

The Cochrane Library, the Campbell Collaboration Social, MEDLINE, PsychINFO, CINAHL, SCOPUS, Embase, Open Grey, Grey Literature Report, and Sociological Abstracts were searched for studies investigating the effectiveness of cognitive behavioural group therapy on intimate partner violence published in the period of January 1, 2010, to February 12, 2018. Manual searches were also performed to identify randomized and non-randomized controlled trials. Data extraction was done in duplicate. The primary outcome was the reduction in violent behaviour, and secondary outcomes were physical health, mental health, quality of life, emotion regulation, and substance use. Study quality was assessed with the Cochrane Collaboration's risk of bias tool and the Risk of Bias In Non-Randomized Studies of Interventions tool. A narrative summary was used to describe the review findings.

RESULTS

We identified six new studies that met the inclusion criteria: four randomized controlled trials and two non-randomized trials. Three of the randomized controlled trials found a reduction in intimate partner violence after treatment. The fourth randomized trial found that a subsample of responding partners reported a reduction in violence but no changes in the men's self-reported violence after treatment. No effect could be detected in the two non-randomized studies. Analysis of risk of bias revealed mixed results, indicating both strengths and weaknesses.

LIMITATIONS

Only a limited amount of studies which scored as "low quality" were available.

CONCLUSIONS

There is still insufficient evidence to confirm that cognitive behavioural group therapy for perpetrators of intimate partner violence has a positive effect. Future research should focus on randomized controlled studies distinguishing between convicted and non-convicted populations where violent behaviour is the primary outcome.

TRIAL REGISTRATION

CRD42016041493 .

Integrated treatment options for male perpetrators of intimate partner violence

ISSUES

Male-to-female intimate partner violence remains a worldwide public health issue with adverse physical and psychological consequences for victims, perpetrators and children. Personality disorders, addiction, trauma and mood symptoms are established risk factors for intimate partner violence perpetration and factor prominently into a recovery-oriented treatment approach.

APPROACH

We reviewed the partner violence literature for detailed reports of traditional as well as innovative, integrated treatment approaches. Empirically based recommendations for intervention programs and the policies that guide intervention efforts are offered.

KEY FINDINGS

Nascent research suggests that integrated treatment models utilising a holistic approach to account for psychological comorbidity and interventions that involve a motivational interviewing component appear promising in terms of significantly improving intimate partner violence treatment compliance and reducing subsequent acts of physical partner violence. Further, methodologically rigorous research is required to fully assess the benefits of traditional and integrated treatment options.

IMPLICATIONS

We have advanced several recommendations, including the development of and exclusive reliance upon empirically supported treatments, conducting a thorough risk and needs assessment of the offender and the immediate family to facilitate appropriate treatment referrals, integrating content to foster the offender's internal motivation to change maladaptive behaviours, and attempting to minimise offender treatment burdens through the strategic use of integrated treatment models.

CONCLUSIONS

Intimate partner violence is a complicated and nuanced problem that is perpetrated by a heterogeneous population and requires greater variability in integrated treatment options. [Crane CA, Easton CJ. Integrated treatment options for male perpetrators of intimate partner violence. Drug Alcohol Rev 2017;36:24-33].

Interventions to reduce intimate partner violence perpetration among people with substance use disorders

The social and economic cost of intimate partner violence (IPV) is exorbitant and highlights the need for policy reform as it pertains to IPV interventions at a global level. There are multiple variables associated with the aetiology of IPV and, hence, multiple treatment needs must be considered. Substance use is one of several factors likely to influence the occurrence of IPV, but often goes unaddressed in standard treatment approaches. This review will discuss several treatment models for substance using offenders of IPV, including Psycho-educational Models, Cognitive Behavioural Therapy, Couples' Treatments, Parenting Programmes, Integration of Care Models, and Pharmacotherapies. Clinical recommendations will be discussed. Treatment outcomes among substance using offenders of IPV may be improved by implementing changes in protocol that increase diagnostic evaluations, integrate care with evidence-based models, require limits to the number of offenders in a group, and require qualifications for clinicians who treat offenders (licensed and trained psychologists, social workers, and/or psychiatrists).

Intimate Partner Violence Between Male Iraq and Afghanistan Veterans and Their Female Partners Who Seek Couples Therapy

The current study has three aims: (1) to describe the frequency, gender differences, and agreement in couples' reports of male-to-female and female-to-male intimate partner violence (IPV) reported by male veterans and their female partners who were seeking couples therapy; (2) to describe the pattern of violence reported by these couples (e.g., one-sided, mutual) and determine if frequency of violence varied based on patterns; and (3) to examine whether frequency of violence or pattern of violence were associated with veteran diagnosis of posttraumatic stress disorder (PTSD). One hundred heterosexual couples (male Iraq/Afghanistan veteran, female civilian) seeking couples therapy at a Veterans Affairs (VA) clinic completed self-report measures of violence in their relationship. Almost all couples reported verbal aggression. Men reported perpetrating more frequent sexual coercion, and women reported perpetrating more frequent physical aggression. Correspondence in partners' reports of violence varied based on type of violence from high correspondence on verbal aggression to low correspondence on sexual coercion. Three patterns of violence were identified: verbally aggressive (n = 45), one-sided physically aggressive (n = 27), and mutually physically aggressive (n = 26). Mutually physically aggressive couples generally reported the most frequent violence. Frequency and pattern of violence were not associated with veteran diagnosis of PTSD. Findings underscore the need for clinicians to assess both partners for violence perpetration and the need for effective prevention strategies and treatments for IPV among veterans.

PREP for Strong Bonds: A review of outcomes from a randomized clinical trial

To help address the relationship needs of service members, there have been a number of programs offered within active duty and veteran contexts. One program, offered within the Strong Bonds portfolio delivered by Army Chaplains, is PREP for Strong Bonds (PREP = the Prevention and Relationship Education Program). PREP has a number of empirically based and tested variants. This article reviews the disseminated research regarding results from a large randomized clinical trial designed to test the effectiveness of PREP for Strong Bonds. From a sample of 662 Army couples drawn from two sites, outcome papers have focused on different subsamples, marital outcomes, follow up time points, and moderators. Reviewing these disseminated outcomes, we conclude that PREP for Strong Bonds has significant divorce reduction effects at one site; these divorce effects were found at both one and two years post intervention, and were moderated by factors such as minority status, economic strain, and cohabitation history of the couple. In terms of marital quality outcomes, some modest overall effects were found pre to post intervention, but there were no overall marital quality outcome effects two years post intervention. However, marital quality outcomes are significantly moderated by infidelity and cohabitation history, with couples reporting these risk factors showing greater positive marital quality outcomes. These results to date are discussed in terms of clinical and research implications as well as directions for future work, such as examining longer term preventative effects.

"Strength at Home" Intervention for Male Veterans Perpetrating Intimate Partner Aggression: Perceived Needs Survey of Therapists and Pilot Effectiveness Study

Veteran and active duty populations evidence higher rates of intimate partner aggression (IPA) than comparable civilian groups, perhaps due in part to their unique service-related experiences. IPA offender treatment programs that take military background into consideration are not widely available, and it is unclear to what extent there is a perceived need for them among clinicians who serve service members and Veterans. Strength at Home (SAH) is a promising 12-session cognitive-behavioral group intervention designed to address IPA perpetration in military populations. While clinical support for SAH is emerging, the extent to which service members and Veterans find it appropriate and helpful is not yet known. Goals of the current study were threefold: (a) assess the perceived need for a military-specific IPA program among Veterans Administration and community domestic violence (DV) program providers; (b) conduct a pilot study to examine the feasibility and preliminary effectiveness of SAH in a sample drawn from a diverse, multicultural community; and (c) conduct focus groups to obtain participant feedback on the SAH protocol. Findings from the provider survey suggested a need for specialty programs to treat military personnel who perpetrate IPA of mildtomoderate severity. Results of the SAH pilot study (n = 6) indicated decreased psychological aggression and increased anger control from baseline to 6-month follow-up. Focus group feedback indicated participants found the program to be helpful and appropriate across a wide variety of ethno-cultural variables. As more service members and Veterans of the Iraq/Afghanistan war era reintegrate into our communities, it will become increasingly important for providers in both private and public sectors of care to understand the unique needs of this treatment population, and to have access to effective IPA treatment programs.