Erika Lawrence, Ph.D. Director of Translational Science The Family Institute, Northwestern - PowerPoint Presentation

Erika Lawrence, Ph.D. Director of Translational ScienceThe Family Institute, Northwestern University If it IS Broke, Why NOT Fix It?Using ACT to Treat Intimate Partner Violence

Existing Theories and (Lack of) Effectiveness Existing theories guiding treatments Feminist/patriarchal theory: Duluth model Social learning theory: Cognitive-Behavior treatmentHundreds of peer-reviewed studies and meta-analyses 5% improvement at bestLimitations Target reasons for initial violence not violence maintenanceNarrowly focused on 1-2 contributorsAttempt to change thoughts and feelings in order to change behavior(Didactic and confrontational)

The New Intervention: ACTV Developed from 20+ years of basic biobehavioral research on development of violence Based on Acceptance and Commitment Therapy (ACT)Developed for mental health problems (Hayes, Stroshal, & Wilson, 1999)Success with substance abuse, smoking, other behavioral problems (e.g., Gifford et al., 2004; Wilson & Byrd, 2004) First time ACT applied to externalizing problemFirst treatment to focus on function rather than content of thoughts and emotions to reduce violence

Acceptance and Commitment Therapy (ACT) Avoidance vs. AcceptanceAvoiding internal experiencesCognitive (De)Fusion Believing/dominated by unhelpful thoughtsContact with Present MomentThoughts of past or future dominateSelf-as-ContextAttachment to unhelpful self-conceptsValuesUnclear values, living for avoidanceCommitted ActionPersistent inaction, impulsivity or avoidancePsychological (In) Flexibility(Hayes et al., 2006)

The New Intervention: ACTV Cognitive FusionCognitive DefusionBeing “hooked” by thoughts, rules and beliefs and letting them determine what you do in your life, even when they are not helpful in terms of moving you in the direction of your values and goalsStepping back from the thoughts, emotions, memories and body sensations that pose as barriers and noticing them as thoughts, emotions, memories, and body sensations that need not determine what you do Experiential AvoidanceEmotional Acceptance Escaping from, avoiding, or trying to control one’s own experience such as thoughts, emotions, memories, and body sensations Being willing to have whatever thoughts, emotions, memories, and body sensations show up when moving in a valued direction

Emotion Dysregulation (3) Psychological or Physical Aggression StimulusInterpersonal conflict(4) Escape or relief from aversive emotional arousal  (2) Emotions, thoughts, urges, bodily sensations   Applying the ACT Model to Violence

Achieving Change through Value-Based Behavior (ACTV)1Multiple Contributions to Violence Maintenance2ACT Processes: Awareness, Values3-4Barriers to Change: Substance Use; Mood, Anxiety & Stress Management5-8ACT: Emotion (Dys)regulation, Experiential Avoidance , Emotional Acceptance 9ACT Processes: Awareness, Values 10-13 ACT Processes: Cognitive Fusion to Cognitive De-Fusion 14 Multiple Contributions to Violence Maintenance 15 ACT Processes : Awareness, Values 16 Psychologically, Physically and Sexually Aggressive Behaviors 17-21 Practicing Behavioral Skills: Communication & Conflict Resolution Skills 22 ACT Processes: Awareness, Values 23-24 Barriers to Change: Effective Parenting; Employment & Financial Stress  

Achieving Change through Value-Based Behavior (ACTV)1Multiple Contributions to Violence Maintenance2ACT Processes: Awareness, Values3-4Comorbid Phenomena: Substance Use; Mood, Anxiety & Stress Management 5-8ACT: Emotion (Dys)regulation, Experiential Avoidance vs. Acceptance 9 ACT Processes: Awareness, Values 10-13 ACT Processes: Cognitive Fusion vs. Cognitive De-Fusion 14 Multiple Contributions to Violence Maintenance 15 ACT Processes : Awareness, Values 16 Psychologically, Physically and Sexually Aggressive Behaviors 17-21 Practicing Behavioral Skills: Communication & Conflict Resolution Skills 22 ACT Processes: Awareness, Values 23-24 Contextual Factors: Effective Parenting; Employment & Financial Stress  

Can DOC employees learn the concepts and techniques? Can these concepts and techniques be adapted to address IPV?Can this population learn the new concepts and techniques? Feasibility Testing

Findings (qualitative data from facilitators and participants): Participation and retention rates were higher in ACTV than TAUGroup facilitators able to learn the new conceptual model and employ the new techniques within the context of IPVParticipants were able to learn the new skills and implement them in their own lives when taught in the context of IPVQualitative data extremely positive Feasibility Testing

Efficacy Study Testing the ACT processes as applied to intimate partner violenceFeasibility and pilot studies with the Department of CorrectionsEffectiveness StudyTesting the full intervention through the Department of CorrectionsTwo Randomized Controlled Trials

Community volunteers in relationships ( N = 101)Criteria: 2 or more acts of physical aggression in 6 mos.Random assignment: 10-12 per group12 sessions of ACT or support/discussion control groupSelf-report questionnaires Efficacy: Do ACT Skills Reduce Aggression?

Do ACT Skills Reduce Psychological Aggression? MDEAS, 28 itemsACTPost Intercept: b = 1.15, SE = .68, t(97) = 7.43, p < .01 6 Mos. Intercept: b = 2.05, SE = .71, t(97) = 8.33, p < .01Slopes: b = 2.21, SE = .74, t(97) = 3.59, p < .05

Do ACT Skills Reduce Physical Aggression? CTS2, 12 itemsPost Intercept: b = 1.45, SE = .59, t(97) = 7.11, p < .016 Mos. Intercept: b = 2.21, SE = .65, t(97) = 8.19, p < .01Slopes: b = 2.35, SE = .89, t(97) = 6.22, p < .05 ACTControlCommunity couples

Do ACT Skills Account for Group Differences in Aggression? ACT or ControlAggressionACT SkillsPartial Mediation in Psychological AggressionDirect Effect: γ = -.0273, SE = .004, t(99) = -2.19, p < .05 With mediator: Z = 1.98, SE = .005, p = .08 Partial Mediation for Physical Aggression Direct Effect: γ = -.0362, SE = .006, t(99) = -3.39, p < .05 With mediator: Z = 1.67, SE = .005, p = .08

Efficacy Study Testing the ACT processes as applied to intimate partner violenceFeasibility and pilot studies with the Department of CorrectionsEffectiveness StudyTesting the full intervention through the Department of CorrectionsTwo Randomized Controlled Trials

Achieving Change through Value-Based Behavior (ACTV)1Multiple Contributions to Violence Maintenance2ACT Processes: Awareness, Values3-4Barriers to Change: Substance Use; Mood, Anxiety & Stress Management5-8ACT: Emotion (Dys)regulation, Experiential Avoidance , Emotional Acceptance 9ACT Processes: Awareness, Values 10-13 ACT Processes: Cognitive Fusion to Cognitive De-Fusion 14 Multiple Contributions to Violence Maintenance 15 ACT Processes : Awareness, Values 16 Psychologically, Physically and Sexually Aggressive Behaviors 17-21 Practicing Behavioral Skills: Communication & Conflict Resolution Skills 22 ACT Processes: Awareness, Values 23-24 Barriers to Change: Effective Parenting; Employment & Financial Stress  

Recidivism One Year Post-Treatment

Summary ACTV significantly reduces recidivism compared to standard treatment First IPV intervention to:Focus on function rather than content of thoughts/emotions Target reasons why violence continues rather than why some men become violent initially Conducted in collaboration with state policy makers or DOC Iowa became the 1 st state to disseminate a statewide, court-mandated, empirically supported intervention for IPV

What Are We Doing Now? Replicate and extend IA, MN, MO, AZ, IL, NYBogota, Colombia (Spanish language versions)Longer-term follow-up, level of riskTest change mechanisms; indirect outcomes for victims, relationships, children Educate stakeholders PEW Institute recognized for cost effectiveness and (actual) effectivenessAPA awarded Distinguished Contribution to Family Psychology Disseminating across the U.S. Adaptations Piloting BREAK - for adolescents in juvenile detention Piloting CERB – for college students who engaged in sexual misconduct

Thank you! Questions?“Far and away the best prize that life has to offer is the chance to work hard at work worth doing.”- Theodore Roosevelt