At a glance

Intervention Therapeutic approaches such as cognitive behavioural therapy (CBT) and cognitive processing therapy (CPT) delivered in groups or individually

Key populations Adult victims and survivors of intimate partner violence or non-partner sexual abuse, who have post-traumatic stress disorder (PTSD) or trauma symptoms

Outcomes studied Gender-based violence, health, social and material support, wellbeing and emotions

Impact of the intervention Of the 6 studies, 3 outcomes received an effectiveness rating on our Effectiveness Estimate Tool

Australian Evidence 0 studies presented findings from Australia. 0 studies reported on the experiences of Aboriginal and Torres Strait Islander people

Risk of bias Of the studies with available quantitative data, we rated 3 as low or very low, 5 as moderate and 3 as high or very high risk of bias via our Risk of Bias tool

Intervention description

Therapy for victims and survivors with post-traumatic stress disorder (PTSD) aims to help this group to recover and heal from intimate partner violence and/or non-partner sexual violence.

Therapeutic approaches target participants who have been diagnosed with PTSD or PTSD symptoms, and generally follow a set program for a number of weeks that either uses cognitive behavioural therapy (CBT) or cognitive processing therapy (CPT) to change outcomes for victims and survivors.

This intervention is delivered by therapists and registered psychologists. Most interventions were delivered face-to-face in person, but some include online components.

Some studies combined therapy with standard services (e.g., usual shelter services) or other treatments (e.g., aerobic exercises).

Therapy sessions often cover: psychoeducation, normalising common reactions to trauma, cognitive restructuring, teaching skills to recognise and address symptoms (e.g., breathing techniques).

What does the intervention involve?

Where is the intervention set? Commonly delivered in women's shelters, crisis centres, and community mental health services

How is the intervention delivered? Most delivered the intervention in person. Some delivered it live online (video call/live chat)

How frequently is the intervention delivered? Studies varied in frequency, but most offered weekly sessions. The number of weeks ranges from 4 to 17

What resources and costs are involved? 0 studies comment on costs associated with the intervention

Theory of change

How is the intervention designed or theorised to work?

Many of the studies argue that given the connection between intimate partner violence and PTSD, incorporating a trauma- and violence-informed lens for victims and survivors has the potential to enhance the efficacy of existing therapies (e.g., CBT).

Trauma-focused CBT treatments, for example, are hypothesised to produce change via altering negative trauma-related cognitions.

Impact section coming soon

Effectiveness rating	Outcome	Description

Key Populations

Has the impact of this intervention been tested with certain key populations?

This review assessed the impact of the evaluation on adult victims and survivors who had experienced intimate partner violence and/or non-partner sexual violence. It was a condition of eligibility that these participants had also experienced PTSD or trauma symptoms.

The interventions were not targeted towards any specific cultural or ethnic groups.

Some studies included participants who were studying at university, parents, and had other mental illness (e.g., depression symptoms).

The table below gives an overview of whether or not the intervention was examined with some key populations. The inclusion of these populations was guided by the National Plan to End Violence against Women and Children 2022-2032 and the Australian National Research Agenda to End Violence against Women and Children: 2023-2028.

🔴 = no studies
🟡 = at least 1 study mentions that population, but effectiveness wasn't tested with that population
🟢 = at least 1 study tests effectiveness with the population

Population	What do we know about this group?	Degree of knowledge
Aboriginal and Torres Strait Islander communities	0 studies. The appropriateness of this intervention with this population has not yet been established. Therefore, we cannot confirm the applicability of this intervention to this population
Sexuality and gender diverse / LGBTIQA+	0 studies. The appropriateness of this intervention with this population has not yet been established. Therefore, we cannot confirm the applicability of this intervention to this population
Specific age groups (including older people, children and young people)	0 studies. The appropriateness of this intervention with this population has not yet been established. Therefore, we cannot confirm the applicability of this intervention to this population
Culturally and linguistically diverse (CALD) groups	0 studies. The appropriateness of this intervention with this population has not yet been established. Therefore, we cannot confirm the applicability of this intervention to this population
Migrants and refugees	0 studies. The appropriateness of this intervention with this population has not yet been established. Therefore, we cannot confirm the applicability of this intervention to this population
People with disability	0 studies. The appropriateness of this intervention with this population has not yet been established. Therefore, we cannot confirm the applicability of this intervention to this population

Key considerations

What do we know about the intervention in Australia?

• None of our included studies in this intervention review presented findings from Australia. Most studies were based in the United States, while some others were implemented in Canada, Spain and Portugal.

• While the intervention appears to be effective across a number of outcome measures, trialing it in Australia may answer important questions about its applicability for victims and survivors experiencing PTSD locally.

What should Australian stakeholders consider?

• All studies in this intervention review were implemented by trained therapists or psychologists over a number of weeks. This has implications for resourcing.

• None of the studies commented on information relating to the costs of the intervention, which is also important in considering implementation within Australia.

Included studies

Characteristics of primary studies included in the Intervention Review

Study and location	Design	Intervention	Sample	Risk of bias rating
Beck et al. (2016), United States	Single group pre-post study Qualitative data: No	Cognitive Trauma Therapy for Battered Women (CTT-BW)	N=14 women aged 25-55.	Mental health
Echeburúa et al. (2014), Spain	Quasi-experimental study Qualitative data: No	Combined individual and group cognitive behavioural therapy	N=116 women who had experienced intimate partner violence	Mental health, social and material support
Ferrari et al. (2018), United Kingdom	Randomised controlled trial Qualitative data: No	Specialist psychological advocate + usual care advocate support	N=263 women who had experienced intimate partner violence	Mental health, gender-based violence
Jackson et al. (2020), Canada	Qualitative study	Trauma and Violence Informed CBT	N=3 women who had experienced intimate partner violence	Parenting, mental health, wellbeing and emotions, social and material support
Johnson et al. (2011), United States	Randomised controlled trial Qualitative data: No	Helping to Overcome PTSD through Empowerment (HOPE)	N=70 women who had experienced intimate partner violence	Mental health, wellbeing and emotions, social and material support, gender-based violence
Johnson et al. (2016), United States	Randomised controlled trial Qualitative data: No	Helping to Overcome PTSD through Empowerment (HOPE)	N=60 women who had experienced intimate partner violence	Mental health
Moreira et al. (2020), Portugal	Randomised controlled trial Qualitative data: No	Manualised cognitive-narrative program for IPV victims	N=23 women who had experienced intimate partner violence	Mental health, wellbeing and emotions, social and material support, gender-based violence
Smith et al. (2014), United States	Quasi-experimental study Qualitative data: No	Cognitive behavioural therapy plus group aerobic exercise sessions	N=14 women who had experienced intimate partner violence	Mental health, gender-based violence

References and further reading

Included Studies

• Beck, J. G., Tran, H. N., Dodson, T. S., Henschel, A. V., Woodward, M. J., & Eddinger, J. (2016). Cognitive trauma therapy for battered women: Replication and extension. Psychology of Violence, 6(3), 368-377. https://psycnet.apa.org/doi/10.1037/vio0000024


• Echeburúa, E., Sarasua, B., & Zubizarreta, I. (2014). Individual versus individual and group therapy regarding a cognitive-behavioral treatment for battered women in a community setting. Journal of Interpersonal Violence, 29(10), 1783-1801. https://doi.org/10.1177/0886260513511703


• Ferrari, G., Feder, G., Agnew-Davies, R., Bailey, J. E., Hollinghurst, S., Howard, L., … Peters, T. J. (2018). Psychological advocacy towards healing (PATH): A randomized controlled trial of a psychological intervention in a domestic violence service setting. PLoS One, 13(11), e0205485. https://doi.org/10.1371/journal.pone.0205485


• Hassija, C., & Gray, M. J. (2011). The effectiveness and feasibility of videoconferencing technology to provide evidence-based treatment to rural domestic violence and sexual assault populations. Telemedicine and e-Health, 17(4), 309-315 https://doi.org/10.1089/tmj.2010.0147


• Iverson, K. M., Gradus, J. L., Resick, P. A., Suvak, M. K., Smith, K. F., & Monson, C. M. (2011). Cognitive–behavioral therapy for PTSD and depression symptoms reduces risk for future intimate partner violence among interpersonal trauma survivors. Journal of Consulting and Clinical Psychology, 79(2), 193-202. https://doi.org/10.1037/a0022512


• Jackson, K. T., Mantler, T., Jackson, B., Walsh, E. J., Baer, J., & Parkinson, S. (2020). Exploring mothers’ experiences of trauma and violence-informed cognitive behavioural therapy following intimate partner violence: A qualitative case analysis. Journal of Psychosomatic Obstetrics and Gynecology, 41(4), 308-316. https://doi.org/10.1080/0167482x.2019.1707799


• Johnson, D. M., Johnson N.L., Perez, S., Palmieri P.A., & Zlotnick, C. (2016). Comparison of adding treatment of PTSD during and after shelter stay to standard care in residents of battered women's shelters: Results of a randomized clinical trial. Journal of Traumatic Stress, 29(4), 365-373 https://doi.org/10.1002/jts.22117


• Johnson, D. M., Zlotnick, C., & Perez, S. (2011). Cognitive behavioral treatment of PTSD in residents of battered women's shelters: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 79(4), 542-551. https://doi.org/10.1037/a0023822


• Littleton, H., & Grills, A. (2019). Changes in coping and negative cognitions as mechanisms of change in online treatment for rape-related posttraumatic stress disorder. Journal of Traumatic Stress, 32(6), 927-935. https://doi.org/10.1002/jts.22447


• Littleton, H., Grills, A. E., Kline, K. D., Schoemann, A. M., & Dodd, J. C. (2016). The From Survivor to Thriver program: RCT of an online therapist-facilitated program for rape-related PTSD. Journal of Anxiety Disorders, 43, 41-51. https://doi.org/10.1016/j.janxdis.2016.07.010


• Moreira, A., Moreira, A. C., & Rocha, J. C. (2020). Randomized controlled trial: Cognitive-narrative therapy for IPV victims. Journal of Interpersonal Violence, 37(5-6), NP2998-NP3014. https://doi.org/10.1177/0886260520943719


• Smith, E. N., Rotunda, R. J., & Cosio-Lima, L. (2014). Cognitive behavioral therapy and aerobic exercise for survivors of sexual violence with posttraumatic stress disorder: A feasibility study. Journal of Traumatic Stress Disorders & Treatment, 4(1), 44713 https://doi.org/10.4172/2324-8947.1000136


• Weisholtz, D., Silbersweig, D., Pan, H., Cloitre, M., LeDoux, J., & Stern, E. (2021). Correlation between rostral dorsomedial prefrontal cortex activation by trauma-related words and subsequent response to CBT for PTSD. Journal of Neuropsychiatry and Clinical Neurosciences, 33(2), 116-123. https://doi.org/10.1176/appi.neuropsych.20030058

Additional resources and further reading

• Johnson, D. M., & Ceroni, T. L. (2020). Cognitive behavior therapy for PTSD. In L. F. Bufka, C. V. Wright, & R. W. Halfond (Eds.), Casebook to the APA Clinical Practice Guideline for the treatment of PTSD (pp. 47–67). American Psychological Association. https://doi.org/10.1037/0000196-003