The Efficacy of Cognitive Behaviour Therapy and Client Centred Therapy on Treatment of Depressive Symptoms Among Female Domestic Violence Survivors
CHAPTER ONE
Objective of the Study
The broad objective of the study was to examine the effectiveness of cognitive behavioral therapy among women exposed to domestic violence to mitigate the negative effects of domestic violence. The following were the specific objectives of the research:
- To examine the forms of domestic violence and how demographic variables influence the occurrence of domestic violence among the study sample;
- To examine the association of domestic violence with anxiety and depression among the study sample;
- To establish the efficacy of cognitive behavioral therapy in reducing levels of anxiety and depression among the intervention study sample;
- To explore the factors associated with the level of effectiveness of cognitive behavioral therapy between the intervention and non-intervention study samples; and
- To establish the impact of cognitive behavioral therapy on domestic violence among the study sample.
CHAPTER TWO
LITERATURE REVIEW
This chapter focuses attempts a conceptualization of the definition of domestic violence and an understanding of its prevalence. The chapter progresses to evaluate the various forms of domestic violence experienced by survivors as well as factors contributing to occurrence of domestic violence. In addition, the chapter explains the psychological effects of domestic violence and how they affect women.
Domestic Violence
Domestic violence, is also known as domestic abuse, wife beating, dating abuse, spousal abuse, family violence, and intimate partner violence (IPV). It is a pattern of behavior which involves the abuse by one partner against another in an intimate relationship such as cohabitation, marriage, dating or within the family sub-systems. Domestic violence includes physical hostility or assault which may involve one partner throwing objects, hitting, slapping, biting, shoving, restraining, battering or threating the other. Domestic violence also takes the forms of sexual abuse, controlling or domineering, stalking, intimidation, neglecting and economic deprivation (Dutton, 1994). It involves incidents of frightening behavior, violence or abuse be it sexual, psychological, physical, financial or emotional between adults who are or have been intimate partners or family members regardless of gender or sexuality. Studies have acknowledged violence as a result of interpersonal interactions of individual relationships and environmental factors (Heru, 2007). According to Heru (2007), many community and clinical studies have found that intimate partner violence is often two-sided or bidirectional, where each partner is both an aggressor (perpetrator) and a victim.
According to Ogbuji (2015), domestic abuse is any hurtful word or behavior from a spouse against his/her partner or children that is intentionally threatening and or inflicting pain. Domestic violence involves various aspects of human living such as physical, emotional, psychological, social, economic/financial, verbal, or spiritual. Feminist understandings shaped by the lived experiences of abused women and supported by research evidence have aided to develop conceptualization of domestic violence as physical force, physically injurious assault, coercive and controlling behaviors that cause psychological, interrelated range of abusive treatment, sexual or physical harm to the victim (Barnish, 2004). This definition concentrates largely on both genders, consistent with the evidence concerning main abuse trends.
The main research findings are to the extent dynamic in relation to domestic violence. They expound the theories, factors associated with vulnerability to victimization, perpetrator types, risk markers for perpetration, the harm done to women, and women’s reactions to domestic violence. However, some issues of terminology remain disputed if domestic violence should be a gender-specific or neutral referent encompassing all forms and incidents of abuse in all types of intimate relationships. The fact remains that abuse and violence have affected an individual in a trusting environment and relationship.
According to the United Kingdom criminal justice system, domestic violence is any assult between current and former partners in an intimate relationship. This kind of violence includes sexual, physical, emotional and financial abuse, and use of children (Barnish, 2004). Some organizations, including some police services and national probation services, incorporate abuse in other close relationships into their definitions. Police definitions generally limit their additional scope to violence towards adult family members, whereas definitions by probation and child protection services (CPS) includes child abuse, though the CPS limits its sphere of activity to criminal offences (Criminal Justice Trials Commission, 2015; Population Council, 2008).
The United States government has defined domestic violence as abusive behavioral patterns in a given relationship, deemed by one partner as a mileage to acquire or maintain power (social or political) and control over another intimate partner (Dutton, 1996). Anyone can experience domestic violence regardless of age, race, religion, sexual orientation, or gender and can take many forms, including physical abuse, sexual abuse, emotional abuse, economic, and psychological abuse (Violence Against Women, 2011).
CHAPTER THREE
RESEARCH METHODOLOGY
Introduction
In this chapter, we would describe how the study was carried out.
Research design
The study design that was followed in this research was guided by the work of Fisher and Garson (2010), which states that intervention studies, both experimental and quasi, have been invaluable sources of scientific information and knowledge. The study applied a mixed method approach of both quantitative and qualitative approaches, which complement each other in data collection and analysis as per the proposed objectives and hypotheses. The study used both cross-sectional survey method and a short-term longitudinal study designs for data collection. Quantitative approach was used to gather data for all the objectives while qualitative approach helped to gather data for objectives one, two and five. Quantitative data was gathered using structured questionnaires, administered self-report inventories, and by applying repeated measurement data collection methods.
CHAPTER FOUR
DATA PRESENTATION AND RESULTS
INTRODUCTION
This chapter analyses both the quantitative and qualitative data on the effectiveness of cognitive behaviour therapy (CBT) on treating women who have been exposed to domestic violence. The presentation was guided by the study objectives and the findings grouped accordingly.
Analysis of Quantitative Data
Forms of domestic violence
From the research, the participants had been exposed to different kinds of domestic violence, which left them with high levels of anxiety and depression. The types of domestic violence which these clients had experienced included: physical assault, sexual assault, psychological assault, economic assault, and use of children to control the other partner (see Table 3). Table 3 demonstrates in a detailed manner each category of domestic violence and the scores. Women who had been exposed to physical violence reported to have been hit by the perpetrator using a fist or other crude weapons.
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATIONS
Introduction
This section provides a summary of the main findings of the study as per the objectives. The study had five objectives: to examine the forms of domestic violence and how demographic variables influence the occurrence of domestic violence; to determine the association of domestic violence, anxiety and depression; to establish the efficacy of CBT in reducing the levels of anxiety and depression among the intervention group; to explore factors associated with the level of effectiveness of CBT between the intervention and non-intervention groups; and to establish the impact of CBT on domestic violence among the study population. The conclusion presented in this chapter was drawn from the findings of the research study. The recommendations have been offered to fill the gap on how to treat African women facing domestic violence using cognitive behaviour therapy. Finally, this chapter points to areas for possible further study.
Summary of Findings
The participants of the study understand the core issues and aspects of domestic violence. The participants are able to define domestic violence as physical, sexual, psychological and emotional abuse, financial coercion, verbal abuse and use of children to control a partner. The study shows that a majority of victims of domestic violence are women and children, and men are commonly the perpetrators of domestic violence. However, there are some cases where men fall victims of domestic and women are the perpetrators. Causes of domestic violence are mostly as a result of behavioral patterns of the perpetrators and victims and other social demographics. Occurrence of domestic violence leaves the victims with negative impacts, but when they attend CBT sessions the impacts reduce on a large scale. During CBT sessions, the therapist equips the victims with coping skills to deal with their domestic situations.
Forms of domestic violence and influences of social demographics
The study findings show that all the participants had been exposed to emotional and psychological abuse. The second common type of abuse among the participants is economic coercion, at 91.1%, where the victims said they are financially controlled and deprived by the perpetrators. Victims of
DV approached by the researcher had experienced physical violence at 88.9%. Sexual assault was reported by 77.8% while the use of children to control a partner was mentioned by 62.2% of the study participants. Furthermore, the study investigated how perpetration occurs as a result victimization. From the findings, 24.4% of the study participants become perpetrators as a result of victimization. This occurs in instances where there is physical assault and psychological and emotional abuse. The study shows that 75.6% of the participants are only victims of domestic violence and not perpetrators while 24.4% of the study participants are both perpetrators and victims.
Logistic regression analysis was used to establish the influence of demographic variables on the forms of domestic violence. In this analysis, emotional and psychological abuse was not included as a variable because all the participants experienced it. Six demographic variables that were used in the analysis include age, education level, marital status, number of children, and household income. The study shows that more than 70% of the total participants are between 18 to 50 years of age. The study also revealed that 48.9% of the participants had tertiary education levels while 33.3% had O-levels, while the rest had primary and below levels at an aggregate of 17.8 %. The study shows that there is a relationship between domestic violence and education because those with lower levels of education and performance experience higher levels of domestic violence.
On household income, the study findings show that domestic violence cut across all levels of economic status: high, middle or low household income. However, sexual abuse is influenced by the amount of household income. In regards to marital status, 46.7% of the participants are married, with 26.7% being single, 12% of the participants from the intervention group being separated and 15% of the participants from the non-intervention group being divorced. The findings indicate that married women are the ones who experience higher frequencies of domestic violence as compared to other marital statuses. From the research findings, there is a relationship between the number of children and domestic violence, because 73.3% of the participants had children.
In conclusion, the study shows that physical violence is not significantly influenced by any of the six demographic variables, p > .05. Sexual assault is significantly influenced by household income (χ2=10.13, p<.05). Financial control and deprivation is significantly influenced by the number of children that the victims have (χ2=4.368, p<.05). The use of children to control the partner is
significantly influenced by age (χ2=18.12, p<.01) and marital status (χ2=24.13, p<.01) at confidence level of 95%.
Association of domestic violence with anxiety and depression
Pearson’s correlation analysis was used to determine the association between anxiety, depression and exposure to domestic violence. The results of the study show that there is a strong positive and significant correlation between anxiety and depression (r=.715, p<.01). The study shows that anxiety has a significant positive correlation with sexual assault (r=.224, p<.05) and use of children (r=.227, p<.05). Similarly, depression has a significant positive correlation with physical assault (r=.302, p<.05), sexual assault (r=.392, p<.01) and use of children to control partners (r=.299, p<.05). Finally, the study shows a positive significant correlation between psychological assault with physical assault (r=.533, p<.01), psychological assault and economic coercion (r=.369, p<.05). Also, sexual assault has a positive correlation with physical assault (r=.347, p<.05) and economic coercion (r=.452, p<.01). However, anxiety has insignificant association with physical assault, sexual assault, psychological assault, economic coercion and the use of children to control a partner at p > .05.
Efficacy of CBT in reducing levels of anxiety and depression
Multivariate analysis of covariance (MANCOVA) was used to establish the efficacy of CBT in reducing anxiety and depression. The findings show that there was a decrease in anxiety and depression levels among the intervention group. On the first invitation, this group had a mean level of anxiety at M=19.8, SD=2.2 and an average level of depression at M=18.4 (SD=4.0). After undertaking CBT sessions, the means of anxiety and depression decreased to M=5.6 (SD=3.3) and M=6.1 (SD=3.4), respectively. On the other hand, the non-intervention group, on the first invitation, had their average anxiety levels at M=20.5 (SD=1.4) and depression at M=20.6 (SD=1.2). Since there was no CBT intervention for this group, on the last invitation their anxiety and depression levels had decreased to M=19.8 (SD=2.4) and M=19.7 (SD=2.4), respectively. The study reveals that the number of CBT sessions attended have a significant effect on anxiety and depression. The MANCOVA analysis show a significant decrease for the intervention group between the 10th – 14th sessions of CBT, for both anxiety (F (1, 85) = 165.45, p<.001) and depression (F (1, 85) = 77.20, p<.001). This shows that CBT is effective tool for reducing the levels of anxiety and depression.
Factors associated with effectiveness of CBT among the study sample
In arriving at the factors associated with effectiveness of CBT, the researcher measured reduction of the anxiety and depression levels. The reduction was computed by getting the difference between the levels at the first and the last session. The study findings show that several factors have direct and partial associations with effectiveness of CBT. The key factor is the number of CBT sessions the participants attend in order to significantly reduce anxiety (β=1.548, p<.01) and depression (β=1.226, p<.01). Other factors that have partial associations with effective CBT include education level, performance in primary school education, self-esteem and household income. The study shows that when tertiary education level victims are compared with primary education level victims, the latter have the least reduction in depression (β=-13.649, p<.05). Similarly, in terms of performance in primary school, the study shows that CBT is significantly effective in reducing the level of depression among women who are moderate performers in primary schools than those who are low performers (β=11.308, p<.05). Self-esteem has a partial association with CBT effectiveness because victims with moderate self-esteem experience a significant effect of CBT in reducing depression in comparison to victims with low self-esteem (β=4.353, p<.05). The last factor with partial influence on effectiveness of CBT in reducing anxiety is household income. The study findings reveal that victims having moderate income levels experience a significant effect of CBT in terms of reduced anxiety in comparison with victims of DV with low income levels (β=4.274, p<.05).
Impact of CBT in reducing negative effects of domestic violence
Cognitive behavioural therapy has both short-term and long-term impacts on the lives of people who have been exposed to domestic violence and have gone through therapy using it. The study reveals that participants attending CBT sessions experience positive cognitive and behavioral adjustments. Cognitive behavioral therapy has an impact in reducing the levels of anxiety and depression. The long-term impact of CBT on the participant is the ability to restructure the cognitive capabilities of the person. Therefore, despite the challenges and the negative impacts of domestic violence which the participants had gone through, they acquire coping mechanisms through CBT. These coping skills help them to approach and navigate their lives with positivity and healing.
Conclusion
The study’s main objective was to examine the effectiveness of cognitive behavioral therapy among women exposed to domestic violence to mitigate the negative effects of domestic violence within Kibra. The study had five objectives: to establish the forms of domestic violence among the study participants in order to tell the source of the problem and the influence of demographic characteristics in occurrence of domestic violence; to explore the association between domestic violence and anxiety and depression; to establish the efficacy of CBT in reducing the levels of anxiety and depression among the intervention group; to explore factors associated with the level of effectiveness of CBT between the intervention and non-intervention groups; and to establish the impact of CBT on domestic violence among the study population.
Chapter provides an introduction and background to the study. Chapter two provides a review of available literature. It also develops the conceptual and theoretical framework upon which the study is based. Chapter three addresses the methodology of the study. In chapter four, the researcher analyzes both the quantitative and qualitative findings. In chapter five, the researcher provides summary of the findings, recommendations and areas for further study.
The researcher had hypothesized that cognitive behavioral therapy would alleviate anxiety and depression among the intervention group. It was also assumed that victims receiving cognitive behavioral interventions would score low on the hospital anxiety depression scale (HADS) as compared to those victims in the non-intervention group. The study findings show that all the participants reached by the researcher had been exposed to physical violence, psychological and emotional abuse, sexual assault, economic coercion, the use of children to control a partner and verbal abuse. The six demographic variables influence domestic violence partially or significantly were found to be age, education level, marital status, number of children, and household income. The study also revealed that there is a strong positive and significant correlation between anxiety and depression but not domestic violence. The study revealed that CBT is an effective tool for reducing the levels of anxiety and depression. This was achieved in the attempt to identify the factors associated with the level of CBT effectiveness among the intervention and non-intervention groups, where CBT was found to be very effective on the intervention study group because they responded well to its treatment. The main factors which make CBT effective are the number of sessions participants attend.
In conclusion, CBT has positive impact in reducing, preventing, healing, and equipping victims of domestic violence with coping mechanisms so that they can live a better life. Therefore, the researcher achieved the objectives under study and gave appropriate recommendations on what should be done to curb and mitigate the problem of domestic violence in Calabar metropolis specifically and Kenya in general
Recommendations
- The study recommends that the community should be educated on how to overcome gender disparity between men and women especially in patriarchal societies.
- The study recommends that women should be empowered economically so as to reduce dependency on their husbands/partners who sometimes take advantage of their financial vulnerability and subject them to abusive treatment and relationships.
- The curriculum of learning institutions should be planned to accommodate life skills learning from as low as primary school, where the pupils and students are introduced early enough on how to use cognitive awareness to understand their irrational thoughts which lead to unbecoming behavioral patterns
- People should be well trained and adequately equipped with proper coping skills, especially communication and problem-solving skills so as to mitigate marital conflicts in marriage life.
- The study recommends that clients who require psychological therapy using CBT to attend a minimum of 14 to 16 sessions for CBT to be more effective.
- The government of Kenya, the county government, NGOs and other stakeholders should facilitate therapists to carry out CBT among people experiencing domestic violence without charging the victims. This will enable victims of domestic violence to access therapy without financial limitations.
The government of Kenya should enact stiffer penalties for all perpetrators of domestic violence by increasing the jail term and attendant fines.
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