Erika Lawrence, Ph.D. Director of Translational Science

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

2. Existing Theories and (Lack of) Effectiveness • Existing theories guiding treatments • Feminist/patriarchal theory: Duluth model • Social learning theory: Cognitive-Behavior treatment • Hundreds of peer-reviewed studies and meta-analyses • 5% improvement at best • Limitations • Target reasons for initial violence not violence maintenance • Narrowly focused on 1-2 contributors • Attempt to change thoughts and feelings in order to change behavior • (Didactic and confrontational)

3. 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 problem • First treatment to focus on function rather than content of thoughts and emotions to reduce violence

4. Acceptance and Commitment Therapy (ACT) Contact with Present Moment Thoughts of past or future dominate Avoidance vs. Acceptance Avoiding internal experiences Cognitive (De)Fusion Believing/dominated by unhelpful thoughts Values Unclear values, living for avoidance Psychological (In) Flexibility Self-as-Context Attachment to unhelpful self-concepts Committed Action Persistent inaction, impulsivity or avoidance (Hayes et al., 2006)

5. The New Intervention: ACTV

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

9. Feasibility Testing • 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?

10. Feasibility Testing Findings (qualitative data from facilitators and participants): • Participation and retention rates were higher in ACTV than TAU • Group facilitators able to learn the new conceptual model and employ the new techniques within the context of IPV • Participants were able to learn the new skills and implement them in their own lives when taught in the context of IPV • Qualitative data extremely positive

11. Two Randomized Controlled Trials • Efficacy Study • Testing the ACT processes as applied to intimate partner violence • Feasibility and pilot studies with the Department of Corrections • Effectiveness Study • Testing the full intervention through the Department of Corrections

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

13. Do ACT Skills Reduce Psychological Aggression? ACT MDEAS, 28 items

14. Do ACT Skills Reduce Physical Aggression? Control ACT Community couples CTS2, 12 items

15. Do ACT Skills Account for Group Differences in Aggression? ACT Skills Aggression ACT or Control Partial Mediation in Psychological Aggression Direct 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

16. Two Randomized Controlled Trials • Efficacy Study • Testing the ACT processes as applied to intimate partner violence • Feasibility and pilot studies with the Department of Corrections • Effectiveness Study • Testing the full intervention through the Department of Corrections

18. Recidivism One Year Post-Treatment

19. 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 1st state to disseminate a statewide, court-mandated, empirically supported intervention for IPV

20. What Are We Doing Now? • Replicate and extend • IA, MN, MO, AZ, IL, NY • Bogota, Colombia (Spanish language versions) • Longer-term follow-up, level of risk • Test change mechanisms; indirect outcomes for victims, relationships, children • Educate stakeholders • PEW Institute recognized for cost effectiveness and (actual) effectiveness • APA 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

21. 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