The impact of an intervention program on abusive intimate behaviors, self-esteem, and self-concept of male perpetrators of intimate partner violence

Vol.:(0123456789)
Jou nal o Expe imen al C iminology
h ps://doi.o g/10.1007/s11292-023-09569-7
1 3
The impac o anin e en ion p og am onabusi e
in ima e beha io s, sel ‑es eem, andsel ‑concep o male
pe pe a o s o in ima e pa ne iolence
OlgaCunha1 · Te esaSil a2· TelmaCa a inaAlmeida3,4,5· SóniaCa idade2·
RuiAb unhosaGonçal es2
Accep ed: 10 Ap il 2023
© The Au ho (s), unde exclusi e licence o Sp inge Na u e B.V. 2023
Abs ac
Objec i es This s udy examines he e ec i eness o a mul imodal pe pe a o
in e en ion p og am (PIP) on in ima e pa ne iolence (IPV) pe pe a o s’
sel - epo ed abusi e beha io s, sel -es eem, and sel -concep .
Me hods A sample o 53 male IPV pe pe a o s, bo h cou - and sel - e e ed o a
communi y-based PIP, we e assigned o one o wo condi ions: in e en ion condi ion
(IC; n = 38) and wai ing lis con ol condi ion (WLCC; n = 15). Da a on sel - epo ed
in ima e iolence, sel -es eem, and sel -concep we e collec ed a baseline, pos - es ,
and 6-mon h ollow-up. The Reliable Change Index (RCI) was also compu ed.
Resul s A conside able pe cen age o IC pa icipan s end o subs an ially educe hei
abusi e beha io ( eo ending sel - epo ed a es we e 10.7% a pos - ea men and
12.5% a ollow-up). IC pa icipan s inc ease sel -es eem and sel -concep . Changes
we e main ained a ollow-up. Signi ican di e ences we e ound be ween he g oups,
wi h IC pa icipan s epo ing educ ions in abusi e beha io s, sco ing highe on sel -
es eem and sel -concep , and e ealing g ea e clinical changes han WLCC pa icipan s.
Conclusions These indings sugges ha mul imodal in e en ions imp o e
sel -es eem and sel -concep and educe IPV pe pe a ion.
* Olga Cunha
olga.cunha@uluso ona.p
1 Hei Lab: Digi al Human‐En i onmen In e ac ion Labs, Lusó ona Uni e si y, Rua Augus o
Rosa, 24, 4000-098Po o, Po ugal
2 Psychology Resea ch Cen e , Uni e si y o Minho, B aga, Po ugal
3 Egas Moniz School o Heal h andScience, Ins i u o Uni e si á io Egas Moniz (IUEM),
Capa ica, Po ugal
4 CiiEM – Cen o de In es igação In e disciplina Egas Moniz, IUEM, Capa ica, Po ugal
5 LabPSI – Labo a ó io de Psicologia Egas Moniz, IUEM, Capa ica, Po ugal
O.Cunha e al.
1 3
Keywo ds Sel -es eem· Sel -concep · Male pe pe a o s· In ima e pa ne iolence
(IPV)· Pe pe a o s in e en ion p og ams (PIPs)
In oduc ion
Pe pe a o in e en ion p og ams1 (PIPs) a e widely widesp ead and cons i u e a pop-
ula penal y measu e o in ima e pa ne iolence (IPV) pe pe a o s (e.g., Cunha &
Ca idade, 2023; Mu phy & Richa ds, 2022). The de elopmen o PIPs is ancho ed in
he high numbe o IPV pe pe a o s in ol ed in he jus ice sys em and on he a gumen
ha puni i e s a egies pe se, such as inca ce a ion, a e insu icien ly e ec i e wi h
pe pe a o s o IPV, as he ecidi ism a e emains high (Mu phy & Richa ds, 2022).
Wi hou a specialized in e en ion, men a e likely o epea abusi e beha io s in hei
cu en o u u e ela ionships (Mani a & Ma ias, 2016). Howe e , esul s conce ning
he e ec i eness o PIPs emain inconsis en and ambiguous and a e mainly ocused
on ecidi ism as he p ima y ou come a iable. Howe e , he li e a u e documen s he
impo ance o o he a iables being conside ed in PIPs, which may also impac ecidi-
ism a es. The p esen s udy ocuses, he e o e, on analyzing he impac o a ending a
PIP on sel -es eem, sel -concep , and sel - epo ed abusi e beha io s in in imacy.
Abusi e beha io and ecidi ism
Reducing u u e IPV inciden s is he cen al goal o PIPs, and o ha eason, s udies
ha e used ecidi ism and eo ense as ou come a iables o assess PIPs’ e ec i e-
ness (Tu y & Babins-Wagne , 2019; Velonis e al., 2016). Al hough ecidi ism can
be measu ed using di e en me hods (i.e., o icial eco ds, ic ims’ epo s, pe pe-
a o s’ sel - epo s; Tu y & Babins-Wagne , 2019), quasi-expe imen al s udies and
me a-analyses ocus almos exclusi ely on o icial da a and ic ims’ epo s, wi h a
small numbe o s udies using pe pe a o s’ sel - epo s.
Babcock and collabo a o s (2004) and Fede and Wilson (2005) ound ha PIPs
ha e a minimal impac on educing ecidi ism and u he eassaul , assessed h ough
o icial da a and/o ic ims’ epo s. Howe e , despi e he small e ec , Babcock and
colleagues (2004) concluded ha hese p og ams posi i ely impac abusi e beha io .
Gannon and associa es (2019), howe e , ound ha indi iduals who ecei ed special-
ized psychological ea men ha e a lowe ecidi ism a e (15.5%) han hose who
had no ecei ed ea men (24.2%). A ce and colleagues (2020), Cheng and asso-
cia es (2019), and Fe nández-Fe nández and collabo a o s (2022) no iced ha PIPs
we e, in gene al, e ec i e in dec easing IPV ecidi ism and gene al o ense ecidi-
ism when epo ed by he c iminal jus ice sys em, bu no when assessed by he ic-
ims. Howe e , he e s ill we e no s a is ically signi ican e ec s on ecidi ism educ-
ion. Simila esul s we e ound by Wilson and associa es (2021), who concluded a
modes bene i o he in e en ion in expe imen al s udies when o icial epo s we e
conside ed and no bene i when he ic im epo ed ecidi ism.
1 The mo e common denomina ion o in e en ion p og ams o indi iduals who pe pe a e in ima e pa ne
iolence is ba e e in e en ion p og ams. Howe e , hey may ca y di e en names, such as pe pe a o in e -
en ion p og ams, o ende in e en ion p og ams, o p og ams o men who ba e (Cunha & Ca idade, 2023).
1 3
The impac o anin e en ion p og am onabusi e in ima e…
As p e iously men ioned, ewe s udies ha e assessed ecidi ism using pe pe a-
o s’ sel - epo based on he a gumen ha sel - epo measu es o iolen beha io
p esen di e en me hodological limi a ions (e.g., social desi abili y; p opensi y o
minimize he impac o iolence; B oady e al., 2014). Howe e , s udies ha assess
eo ense h ough hese measu es gene ally ha e e ealed posi i e ou comes (e.g.,
Cunha & Gonçal es, 2015; Cunha e al., 2023; Lila e al., 2018). Fo example, a sys-
ema ic e iew ha examined he e ec i eness o cul u ally speci ic male PIPs ound
ha he wo s udies ha assessed ecidi ism h ough sel - epo s e ealed signi ican
educ ions in episodes o abuse (Sa yen e al., 2022). Cunha and Gonçal es (2015),
compa ing 26 indi iduals who a ended in e en ion wi h 19 indi iduals who did no ,
ound ha hose who a ended a PIP sel - epo ed signi ican ly less abusi e beha io s
han he con ol g oup. Lila and colleagues (2018), using a sample o 160 men con-
ic ed o in ima e pa ne iolence, sough o assess he impac o adding an indi idu-
alized mo i a ional plan (IMP) o a s anda d PIP (SPIP) on he le el o in e en ion
e ec i eness compa ed o he PIP alone. Resul s indica ed ha SPIP plus IMP pa ici-
pan s we e 1.79 imes less likely o pe pe a e ac s o physical iolence (assessed by
pe pe a o s’ sel - epo s). Mo e ecen ly, Cunha and associa es (2023), in an a emp
o assess he impac o he in eg a ion o Mo i a ional In e iewing Techniques (MIT)
du ing he in ake phase o a s anda d PIP (SPIP), ound ha , a pos - ea men , pa ici-
pan s sel - epo ed signi ican educ ions in IPV pe pe a ion.
Despi e he p e iously men ioned and he p oli e a ion o me a-analyses on PIPs’ e ec-
i eness, an ex ensi e deba e exis s abou wha “success” means ega ding IPV pe pe a-
o s’ ea men and how o assess i (Velonis e al., 2016). Velonis and associa es (2016)
assumed ha ocusing on ecidi ism o eassaul , dis ega ding he mechanisms unde ly-
ing change, migh be p oblema ic o di e en easons. Fi s , hey belie e ha o PIPs o
impac ecidi ism o eo ense, indi iduals need o achie e mo e immedia e changes in
a i udes, mo i a ions, and skills. Besides, e en i he p oximal ou comes a e achie ed,
o he ac o s un ela ed o PIPs may in luence ecidi ism o eo ense, such as he co-
occu ence o subs ance abuse o men al diso de s. Finally, ano he p oblem ela ed o
using ecidi ism o eo ense as he only ou come is ha de ini ions o hese ou comes
o en di e ac oss s udies limi ing compa isons (Velonis e al., 2016).
Because o such limi a ions, a mo e ecen end emphasizes he need o conside
mo e immedia e changes in a i udes, mo i a ion, and skills, as hey migh impac
ecidi ism/ eo ense (e.g., Misso e  al., 2019; Mu phy & Richa ds, 2022; Velonis
e al., 2016). Responsibili y assump ion (e.g., F iedman e al., 2022), a i udes owa d
iolence (e.g., Bowen, 2011; Cunha e al., 2023;Cunha & Gonçal es, 2015), and pe -
sonal and social skills (e.g., Cunha e al., 2023; Cunha & Gonçal es, 2015; Mu phy
& Richa ds, 2022) a e impo an indica o s o in e en ion success. Sel -es eem and
sel -concep (e.g., Lila e al., 2012; Papadakaki e al., 2009) ha e also been iden i ied
as isk ac o s o u u e iolence and should also be included as change indica o s.
Sel ‑es eem
Sel -es eem e e s o he deg ee o which he quali ies and cha ac e is ics con ained in
one’s sel -concep a e pe cei ed o be posi i e. Sel -es eem e lec s a pe son’s physical
O.Cunha e al.
1 3
sel -image, alues, and pe cei ed success, as well as how o he s iew and espond o
ha pe son (Ame icanPsychologicalAssocia ion [APA]2023a). Di e en esea che s
ha e linked sel -es eem and iolence pe pe a ion (e.g., Muslu e al., 2020; Papadakaki
e al., 2009). Howe e , esea ch on he ela ionship be ween sel -es eem and IPV is
ambiguous, and con o e sy ini ia es when in es iga ing which le el o sel -es eem,
ei he high o low, impac s iolen beha io . Li e a u e has con i med he connec ion
be ween low sel -es eem and inc eased IPV pe pe a ion (e.g., Echebu úa e al., 2009;
Lila e al., 2012; Loinaz e al., 2012; Papadakaki e al., 2009; Walke & B igh , 2009).
Fo example, Lila and colleagues (2012) ound ha pe pe a o s wi h low sel -es eem
showed highe le els o iolence minimiza ion. Echebu úa and associa es (2009) sug-
ges ed ha iolence ends o occu as a way o gain espec and conside a ion ha hey
do no achie e o he wise. Walke and B igh (2009) sugges ed ha highe sel -es eem
inc eases he isk o IPV, especially i high sel -es eem is no suppo ed by any e i-
dence ha he indi idual is success ul. Thus, any h ea o he sel -concep is aken
mo e se iously, and iolence is a way o each supe io i y. The au ho s also s a ed ha
in la ed sel -es eem in IPV pe pe a o s is, in ac , co e ing low sel -es eem. Schmid
(2020) ound ha indi iduals sco ing high on a oidan and anxious a achmen s yle
measu es we e mo e likely o expe ience low sel -es eem and pe pe a e IPV. Schmid
(2020) also sugges ed ha low sel -es eem alone may no be a s ong enough a iable
o s imula e iolence. Ins ead, he in e ac ion be ween low sel -es eem and o he nega-
i e emo ions may elici iolen beha io .
Despi e some con lic ing esul s, i is assumed ha sel -es eem is signi ican ly asso-
cia ed wi h IPV pe pe a ion, which should be acknowledged and add essed du ing he
in e en ion (McGinn e al., 2020; Schmid , 2020). Mo el and associa es (2003), when
wo king wi h men who we e ecei ing he apy o IPV, ound ha he enhancemen
o sel -es eem caused a educ ion in iolen beha io . The same pa e n was ound by
Mu phy and collabo a o s (2005). O he s udies also ound di e ences in sel -es eem
be ween men who a ended in e en ion and hose who did no . Fo example, Cunha
and Gonçal es (2015) and B oady and associa es (2014) ound signi ican inc eases
in men’s sel -es eem a e ea men . Mo e ecen ly, a s udy de eloped by Tu y and
Babins-Wagne (2019) examined clinical ou comes in a sample o 382 men and ound
ha pa icipan s showed conside able imp o emen s in e ms o sel -es eem a e ea -
men comple ion.
Al hough changes in sel -es eem ha e no been ye es ablished as a alid ou come
o ea men e ec i eness, he posi i e esul s ound and he link be ween low sel -
es eem and IPV pe pe a ion suppo he impo ance o including sel -es eem as an ou -
come measu e.
Sel ‑concep
Sel -concep is equen ly e e ed o as one’s desc ip ion and e alua ion o onesel ,
including psychological and physical cha ac e is ics, skills, and oles, con ibu -
ing o he indi idual’s sense o iden i y (APA, 2023b). The sel -concep is a ec ed
by he ela ionship be ween social iden i y, he pe cep ion o sel -e icacy, and
sel -image (Ma ens, 2021). Low sel -concep is associa ed wi h ange p oblems,
1 3
The impac o anin e en ion p og am onabusi e in ima e…
agg essi e beha io s (Copeland-Linde e al., 2010), and nega i e sel -pe cep ion,
which can con ibu e o IPV. On he con a y, a highly posi i e sel -concep (i.e.,
eeling aluable, accep ed, and wo h lo ing) was ela ed o lowe abusi e beha io s
in in imacy (Genç, 2021).
The li e a u e e ealed ha IPV pe pe a o s ha e un ealis ically high expec a-
ions o hemsel es. Acco ding o Vecina and colleagues (2016), IPV pe pe a o s
a e mo ally absolu is and highly sel -decei ed and ha e a e y s ong mo al sel -
concep , desc ibing hemsel es as loyal, ai h ul, and us wo hy. In his sense,
Vecina and collabo a o s (2016) hypo hesized ha IPV could be unde s ood, in pa ,
as a beha io associa ed wi h absolu e mo al belie s (mo al absolu ism) and sel -
decep ion. They sugges ed ha hose concep s ac oge he o p o ec one’s mo al
sel -concep and psychological well-being, especially when hey eel h ea ened, as
should be he case in he con ex o men con ic ed o IPV (Vecina e al., 2016). This
mechanism helps indi iduals main ain an adequa e sel -concep , p e en ing hem
om su e ing and opening hemsel es up o change (Ma zana e al., 2016). Empi i-
cal s udies showed ha men con ic ed o IPV ha e an absolu is concep ion o igh
and w ong, a high mo al sel -concep , and high le els o sel -decep ion media ing
be ween his ex eme mo al ision o he wo ld and hei high mo al sel -concep
(Vecina e al., 2015). Resul s e eal ha sel -decep ion ully media es mo al absolu -
ism and mo al sel -concep in IPV pe pe a o s. Thus, he mo e hey el igh abou
hei mo al belie s, he mo e hey decei ed hemsel es and el good abou hem-
sel es (Ma zana e al., 2016; Vecina e al., 2015, 2016).
Al hough, as a as we know, no s udies assessed he impac o PIPs on pe pe-
a o s’ sel -concep , some ecen ends sugges ha in e en ion should build new
p osocial sel -concep s wi h pe pe a o s o build mo e app op ia e sel -es eem
(McGinn e al., 2020) since sel -concep and sel -es eem a e ela ed cons uc s.
The cu en s udy
The p esen s udy assesses he e ec i eness o a cogni i e-beha io al in e en ion
p og am inco po a ing psychoeduca ional s a egies and Mo i a ional In e iew-
ing Techniques (MIT) in IPV pe pe a o s’ sel -es eem and sel -concep . This
s udy is o ele ance o di e en mo i es. Fi s , PIPs e ec i eness esul s emain
con o e sial (e.g., A ce e al., 2020; Babcock e al., 2004; Cheng e al., 2019;
Fede & Wilson, 2005; Fe nández-Fe nández e al., 2022; Wilson e al., 2021).
So, he assessmen o PIPs ha inco po a ed di e en echniques and app oaches
(i.e., mul imodal p og ams) is c ucial as esea ch has shown ha mul imodal p o-
g ams ha e a signi ican impac on pe pe a o s’ change (Ba es & G aham-Ke an,
2020; Cunha e al., 2023;F iedman e al., 2022; Mu phy & Richa ds, 2022). Sec-
ond, al hough mos s udies on he e ec i eness o PIPs ocus on ecidi ism o
eassaul educ ion as he majo ou come, ecen li e a u e emphasizes he need
o conside mo e immedia e a iables as hey migh impac ecidi ism/ eo ense
(e.g., Velonis e al., 2016). Fu he mo e, as a as we know, no s udies in Po ugal
ha e assessed he e ec i eness o PIPs inco po a ing cogni i e-beha io al ech-
niques, psychoeduca ional s a egies, and MIT on sel -es eem and sel -concep .

O.Cunha e al.
1 3
Thus, he p esen s udy aims o examine he e ec i eness o a mul imodal PIP—
he P omo ion and In e en ion P og am wi h Ba e e s (PPRIAC; Cunha & Gon-
çal es, 2015; Cunha e al., 2022; Cunha e al., 2023)—on IPV pe pe a o s’ in i-
ma e abusi e beha io s (sel - epo ed), sel -es eem, and sel -concep . We also
in ended o compu e he Reliable Change Index (RCI). We hypo hesized ha
PPRIAC could educe in ima e pa ne iolence epo ed by he pe pe a o and
inc ease sel -es eem and sel -concep . A e PPRIAC comple ion, pa icipan s a e
expec ed o dec ease hei (sel - epo ed) in ima e iolen beha io and see hem-
sel es as mo e wo hy, hus inc easing sel -es eem and sel -concep (as hese con-
cep s a e in e ela ed). I is also expec ed ha hese changes will be main ained a
ollow-up. The a gumen behind ou hypo hesis is ha as he indi idual inc eases
his capaci y o sel - egula ion and coping skills, his sel -es eem and sel -con-
cep will imp o e (Mu phy e al., 2005). Conside ing ha IPV pe pe a ion may
p oduce nega i e sel -e alua ions, indi iduals migh eel be e abou hemsel es
when hey a e able o egula e hei impulse o abuse.
Me hod
Pa icipan s
The sample comp ises 53 male pe pe a o s o IPV, bo h cou - and sel - e e ed o a
communi y-based PIP (Cunha & Gonçal es, 2015; Cunha e al., 2022; Cunha e al.,
2023). Inclusion c i e ia we e as ollows: (a) being an adul male; (b) ha ing pe -
pe a ed any ac o iolence agains a emale in ima e pa ne o ex-pa ne ; and (c)
being able o ead and w i e. Exclusion c i e ia we e: (a) ha ing a psycho ic diso -
de ; (b) ha ing cogni i e impai men ; (c) ha ing a psychological and/o pe sonali y
diso de ; and (d) ha ing a subs ance abuse diso de .
All he pa icipan s we e Caucasians and we e, on a e age, 43.68 yea s old
(SD = 11.29), anging om 23 o 63. Mos pa icipan s we e ma ied o cohabi a ed
wi h he ic im a he ime o he in e en ion (n = 27, 50.9%), wi h an a e age ela-
ionship leng h o 17.25yea s (SD = 11.96). Mos o hem comple ed he 4 h g ade
(n = 12, 22.6%) o he 6 h g ade (n = 19, 35.8%) o educa ion, belonged o a low
socioeconomic s a us (SES; n = 24, 45.3%), and almos hal we e employed (n = 26,
49.1%). Twen y (37.7%) pa icipan s we e cou - e e ed o he in e en ion, and
mos had no p e ious c iminal eco d (n = 49, 92.5%). The g oups we e simila in
all he sociodemog aphic and ju idical a iables. Table1 summa izes he main soci-
odemog aphic and ju idical a iables.
P ocedu es
The in e en ion was deli e ed a he Psychology Se ice o Uni e si y o Minho. Pa -
icipan s we e e e ed o he in e en ion by he cou , child p o ec ion se ices, ic im
suppo , amily suppo ins i u ions, o p oba ion se ices o we e sel - e e ed.
1 3
The impac o anin e en ion p og am onabusi e in ima e…
The po en ial pa icipan s we e subjec ed o a sc eening in e iew (see Fig.1). All
he p ocedu es we e explained o he pa icipan s and hei olun a y na u e. Those
who me he inclusion c i e ia we e in i ed o pa icipa e. Ten indi iduals declined
o pa icipa e in he s udy. Th ee did no mee he inclusion c i e ia: wo could no
ead and w i e, and one me he subs ance abuse c i e ia. Those who ag eed o pa -
icipa e signed he in o med consen and comple ed a se o psychological meas-
u es. No incen i es we e o e ed o he pa icipan s. Pa icipan s we e alloca ed o
he in e en ion condi ion (CI; n = 38), ha is, a g oup ha ecei es in e en ion,
and he wai ing lis con ol condi ion (WLCC; n = 15), ha is, a g oup ha is on a
wai ing lis and would ha e access o he in e en ion in one yea , acco ding o a 2:1
a io, in o de o e e al o he p og am.
Table 1 Sociodemog aphic and ju idical cha ac e is ics
To al sample IC (n = 38) WLCC
(n = 15)
M SD M SD M SD U p η2
Age 42.47 11.90 44.16 11.17 42.47 11.90 260.500 .628 .004
Rela ionship leng h 17.25 11.96 17.61 11.82 16.33 12.67 267.500 .729 .002
n%n%n%χ2pC ame ’s V
Ma i al s a us
Ma ied/cohabi a ion 27 50.9 19 50.0 8 53.3 1.288 .525 .156
Single 4 7.5 2 5.3 2 13.3
Di o ced/sepa a ed 22 41.5 17 44.7 5 33.3
Educa ion
4 h g ade 12 22.6 9 23.7 3 20.0 3.638 .457 .262
6 h g ade 19 35.8 12 31.6 7 46.7
9 h g ade 6 11.3 6 15.8 0 0.0
12 h g ade 11 20.8 7 18.4 4 26.7
G adua ion 5 9.4 4 10.5 1 6.7
SES
Low 24 52.2 15 48.4 9 60.0 .604 .739 .115
Medium 19 41.3 14 45.2 5 33.3
High 3 6.5 2 6.5 1 6.7
P o essional s a us
Employed 26 49.1 19 50.0 7 46.7 .049 .976 .030
Unemployed 17 32.1 12 31.6 5 33.3
Re i ed 10 18.9 7 18.4 3 20.0
Re e al sou ce
Cou - e e ed 20 37.7 14 36.8 6 40.0 .046 .831 .029
Sel - e e ed 33 62.3 24 63.2 9 60.0
P io con ic ions
Yes 4 7.5 4 10.5 0 0.0 1.708 .191 .180
No 49 92.5 34 89.5 15 100
O.Cunha e al.
1 3
Despi e he limi a ions o such a design, he choice o a wai ing lis design
assumed ha all illegible pa icipan s should bene i om he in e en ion p og am
while pe mi ing a non-in e en ion assessmen (Cunningham e al., 2013). In addi-
ion, we p e e ed a 2:1 a io o p o ide in e en ion o a highe numbe o indi-
iduals aking in o conside a ion he po en ial posi i e impac o such in e en ion
on ic ims’ sa e y. In bo h g oups, da a we e collec ed a h ee di e en momen s:
p e- es (i.e., a he beginning o he in e en ion), pos - es (i.e., a he end o he
in e en ion), and ollow-up (i.e., 6mon hs a e he end o he in e en ion). Each
pa icipan comple ed he ins umen s indi idually in a pape -and-pencil o ma ,
supe ised by a psychologis . In he IC, 10 pa icipan s d opped ou om he p e-
o pos - es and ou om he pos - es o ollow-up; in he WLCC, one pa icipan
d opped ou om he p e- o pos - es and wo om he pos - es o ollow-up. Da a
was collec ed in 2013 and 2014.
E hics p ocedu es conce ning anonymi y and da a p o ec ion es ablished by he
Po uguese legisla ion and Helsinki Decla a ion (Wo ld Medical Associa ion, 2013)
Assessed o eligibili y (n=66)
Assigned o condi ions (n=53)
Excluded (n=13)
10 declined o pa icipa e
3 no mee inclusion c i e ia
IC (n=38) WLCC (n=15)
Pos - es (n=28)
10 d opou
Pos - es (n=14)
1 d opou
Follow-up (n=24)
4 d opou
Follow-up (n=12)
2 d opou
Fig. 1 Flowcha o subjec s’ pa icipa ion
1 3
The impac o anin e en ion p og am onabusi e in ima e…
we e ollowed. The s udy was app o ed by he Subcommi ee on E hics o Social
and Human Sciences o he Uni e si y o Minho.
Measu es
The Ma i al Violence In en o y (IVC; Machado e  al., 2007) is a 21 i ems sel -
epo measu e o assess IPV pe pe a ion. IVC assesses physically abusi e, emo-
ionally abusi e, and coe cion/in imida ion beha io s. I ems a e sco ed on a 3-poin
scale (0 = ne e , 1 = once, 2 = mo e han once) and g ouped in o wo scales: Physical
Violence (e.g., pulling hai igh ) and Psychological Violence (e.g., p e en ing con-
ac wi h o he s). In he cu en sample, he in e nal consis ency o he o al scale
was 0.83 a he p e- es , 0.79 a he pos - es , and 0.83 a he ollow-up.
The Rosenbe g Sel -Es eem Scale (RSES; Rosenbe g, 1965; Po uguese e -
sion San os, 2008) is a 10-i em sel - epo scale o assess global sel -es eem. I ems
a e a ed on a 4-poin Like scale anging om 1 (s ongly disag ee) o 4 (s ongly
ag ee). The o al sco e anges be ween 10 and 40, wi h highe sco es meaning highe
le els o sel -es eem. RSES e ealed good psychome ic p ope ies (San os, 2008).
The cu en s udy’s in e nal consis ency was 0.84 on he p e- es , 0.81 on he pos -
es , and 0.88 on he ollow-up.
The Clinical Sel -Concep In en o y (ICAC; Se a, 1986) is a 20 i ems sel - epo
scale o assess indi idual adjus men and, mo e speci ically, he emo ional and social
aspec s o sel -concep . The i ems a e sco ed on a 5-poin Like scale ( om 1—I do
no ag ee o 5—I ag ee e y much), wi h a o al sco e anging om 20 o 100. The
highe he sco e, he highe he indi idual’s sel -concep . The ins umen comp ises
ou ac o s: Social Accep ance-Rejec ion; Sel -E icacy; Psychological Ma u i y;
and Impulsi i y-Ma u i y. The o iginal e sion e ealed good psychome ic p ope -
ies (Se a, 1986). The p esen sample ound an in e nal consis ency o 0.85 a he
p e- es , 0.75 a he pos - es , and 0.91 a he ollow-up.
A sociodemog aphic and ju idical ques ionnai e was used o collec da a on he
main sociodemog aphic (e.g., age, educa ional le el, ma i al s a us, socioeconomic
le el) and ju idical a iables (e.g., ecidi ism, e e al sou ce). This da a was col-
lec ed a he in ake and upda ed in he pos e io assessmen s.
The in e en ion p og am
The P omo ion and In e en ion P og am wi h Ba e e s (PPRIAC) was de eloped in
2010 o sel - o cou - e e ed adul he e osexual male pe pe a o s o IPV (Cunha
& Gonçal es, 2015; Cunha e al., 2022; Cunha e al., 2023) (NCT05484440).
PPRIAC adop ed a mul ile el, consis ing o 4 o 6 indi idual sessions o 60min
each and 18 g oup sessions (each las ing be ween 90 and 120min), and a mul imodal
app oach, using MIT (Mille & Rollnick, 2013), cogni i e-beha io al and psychoe-
duca ional echniques (Cunha & Gonçal es, 2015). The main goals we e (a) o s op
he abusi e beha io agains women, (b) o accep esponsibili y o abusi e beha io ,
(c) o change i a ional belie s and a i udes owa d IPV, (d) o p omo e espec o
women and heal hy ela ionships, (e) o acqui e pe sonal and social skills, and ( ) o
O.Cunha e al.
1 3
2015). None heless, i is impo an o s ess ha d opou occu ed mainly a he
beginning o he in e en ion when he he apeu ic ela ionship and g oup cohesion
we e no comple ely de eloped (e.g., Hend icks e al., 2006). The he apeu ic alli-
ance is impo an in pa ien s’ mo i a ion (Ilgen e al., 2006) and in p edic ing posi-
i e clinical ou comes (A di o & Rabellino, 2011). Thus, pa icipan s’ lack o mo i-
a ion and/o engagemen in he p ocess o change may lead hem o abandon he
in e en ion. Al hough PPRIAC includes MIT, pe haps some indi iduals need mo e
sessions o p omo e hei mo i a ion o change and engagemen wi h he in e en-
ion p ocess.
This s udy showed ha eo ense a es, assessed h ough pe pe a o s’ sel -
epo s, o IC we e 10.7% a pos - ea men and 12.5% a ollow-up, meaning ha
a conside able pe cen age o IPV pe pe a o s who a end in e en ion p og ams
end o subs an ially educe hei abusi e beha io (e.g., Cunha & Gonçal es, 2015;
Cunha e  al., 2023). Besides, when compa ing IC and WLCC, al hough WLCC
epo ed a signi ican dec ease in he pe pe a ion o IPV, IC showed s onge e ec
sizes and epo ed conside ably lowe eo ense a es, bo h a pos - es and 6-mon h
ollow-up, ollowing p e ious li e a u e (e.g., Cunha & Gonçal es, 2015; Cunha
e al., 2023; Lila e al., 2018; Sa yen e al., 2022). These esul s a e e en mo e in e -
es ing since, a pos - es and ollow-up, a conside able highe numbe o pa icipan s
we e in an in ima e ela ionship (70.8% s. 29.2%).
Pos - ea men sco es showed ha IC pa icipan s signi ican ly inc eased sel -
es eem and sel -concep , including he sel -e icacy subscale. These esul s we e
main ained a a 6-mon h ollow-up. Signi ican di e ences we e ound be ween he
g oups, wi h IC pa icipan s e ealing highe sco es bo h on sel -es eem and sel -
concep . Thus, he mul imodal in e en ion p og am seems p omising in imp o -
ing IPV pe pe a o s’ sel -es eem and sel -concep . These esul s a e o pa icula
in e es o di e en easons. Fi s , low sel -es eem has been linked o inc eased
IPV pe pe a ion (e.g., Echebu úa e al., 2009; Lila e al., 2012; Loinaz e al., 2012;
Muslu e al., 2020; Papadakaki e al., 2009) and sel -es eem enhancemen has been
associa ed wi h educ ions in iolen beha io (Mo el e al., 2003; Mu phy e al.,
2005). Second, IPV pe pe a o s end o ha e un ealis ically high expec a ions o
hemsel es, and IPV pe pe a ion seems o be associa ed wi h absolu e mo al belie s
and sel -decep ion (Vecina e  al., 2016). Thus, imp o emen s in sel -es eem and
sel -concep migh a ec IPV pe pe a ion. Some explana ions o his link could be
ad anced. Fi s , enhancing sel -es eem and sel -concep migh make he indi idual
less sensi i e o pe cei ed con lic as h ea ening sel -es eem, limi ing he in ensi y
o nega i e emo ions when sel -es eem a acks a e pe cei ed (Mu phy e al., 2005).
A e e se e ec o iolence on sel -es eem is also possible (Mu phy e al., 2005).
As he indi idual inc eases his capaci y o sel - egula ion and abili y o cope adap-
i ely and heal hily wi h con lic s and p oblems, his sel -es eem and sel -concep
di ec ly enhance (Mu phy e al., 2005). Since iolen beha io may p oduce nega-
i e sel -e alua ions, IPV pe pe a o s migh eel be e abou hemsel es when hey
success ully egula e he impulse o abuse. Howe e , u he s udies a e needed o
be e unde s and he mechanisms unde lying he ela ionship be ween sel -es eem,
sel -concep , and IPV.

1 3
The impac o anin e en ion p og am onabusi e in ima e…
Resul s also poin ed o signi ican clinical changes in IC, wi h a highe numbe
o indi iduals alling in he global imp o emen ca ego y a pos - es and ollow-
up. In con as , a simila numbe o indi iduals om WLCC ell in o he global
de e io a ion o no change ca ego ies. This pa e n was obse ed o sel -es eem
and sel -concep a he pos - es and o sel -es eem, sel -e icacy, and psychologi-
cal ma u i y (i.e., sel -concep ac o s) a he pos - es and ollow-up. Conce ning
sel -concep a ollow-up and social accep ance/ ejec ion and impulsi i y-ma u i y,
a pos - es and ollow-up, he e ec size was no s ong enough o dis inguish bo h
g oups in e ms o clinical change, bu he same dis ibu ion endency was obse ed.
The conside able numbe o indi iduals om WLCC alling in o he de e io a ion
ca ego y led us o ques ion he abili y o he adi ional jus ice sys em o ehabili a e
o bols e psychological and emo ional p ocesses ela ed o IPV pe pe a ion. Thus,
he ou comes ound in indi iduals who comple ed PPRIAC may sugges ha such a
p og am can be use ul in bu e ing his endency o ge wo se o e ime. Howe e ,
i is also impo an o s ess ha he absence o change and de e io a ion obse ed
in WLCC migh be an a i ac o he design used. Li e a u e men ions ha wai ing
lis designs may o e es ima e in e en ions’ e ec s because pa icipan s assigned o
WLCC appea o imp o e less (o no a all) han would be expec ed (Cunningham
e al., 2013).
Al hough PPRIAC does no comp ise a module on sel -es eem and sel -concep ,
he inc ease in sel -es eem and sel -concep obse ed in IC pa icipan s may be
a ibu ed o he ac ha PPRIAC p omo es emo ional (e.g., sel -con ol), communi-
ca ion (e.g., communica ional s yles), and social skills (e.g., decision-making, p ob-
lem-sol ing), which, in u n, may impac indi idual’s sel -es eem and sel -concep .
Li e a u e has e ealed ha social skills aining signi ican ly inc eases sel -es eem,
pe sonal adequacy, and adjus men and educes inapp op ia e beha io s (e.g., Chien
e al., 2003; Seema & Kuma , 2018).
Limi a ions and u u e implica ions
Al hough he p esen s udy p esen s impo an con ibu ions, some limi a ions should
be men ioned. Fi s , he p esen s udy uses a wai ing lis design. Al hough WLCC has
e hical ad an ages because i allows o he p o ision o ca e o pa icipan s who a e
seeking help, his ype o design may o e es ima e he in e en ion e ec s (Cunning-
ham e al., 2013). Thus, ou esul s should be in e p e ed wi h cau ion, conside ing he
design used. A second limi a ion is he lack o andomiza ion in alloca ing pa icipan s
o each condi ion. Fu he s udies should p i ilege andomized con ol ial designs o
be e e alua e he e ec i eness o he in e en ion. Thi d, ou sample is small, which
may ha e in luenced he s a is ical powe o he esul s, and he esul s ob ained, which
should be in e p e ed cau iously. Thus, a la ge sample is ecommended o u u e s ud-
ies. Fou h, his s udy was based on he pe pe a o s’ sel - epo o assess he di e -
en a iables which may ha e a ec ed he esul s. Since social desi abili y is equen
in pe pe a o s’ epo s (Du on & Hemphill, 1992), u u e s udies should include ic-
ims’ epo s, o icial da a, social desi abili y measu es, o lie scales. In addi ion, as
he ollow-up pe iod was small, a longe ollow-up should be conside ed o assess he
O.Cunha e al.
1 3
long- e m e ec o he in e en ion p og am. Finally, he need o mo e da a on o i-
cially epo ed ecidi ism also makes i impossible o ca y ou a mo e con ex ualized
analysis o he esul s o his a iable.
The de elopmen , implemen a ion, and e ec i eness assessmen o s a egies
o educe IPV a e c ucial, and in e en ions a ge ing he pe pe a o a e among he
mos popula . The p esen s udy e ealed ha indi iduals who a ended a mul imodal
in e en ion showed signi ican educ ions in he sel - epo ing o iolence agains he
in ima e pa ne and signi ican imp o emen s in sel -es eem and sel -concep , bo h a
pos - es and ollow-up. Compa ing IC and WLCC pa icipan s, he esul s showed sig-
ni ican ly mo e posi i e changes in pe pe a o s who a ended in e en ion han in pe -
pe a o s om WLCC.
In sho , esul s om his s udy seem o suppo ha PIPs ocused on dimensions
iden i ied as mechanisms unde lying IPV pe pe a ion and ecidi ism, such as sel -
es eem and sel -concep , may p oduce be e ou comes (Cunha & Gonçal es, 2015).
Besides, mul ile el (i.e., including bo h indi idual and g oup modali ies) and mul i-
modal (i.e., MIT, cogni i e-beha io al, and psychoeduca ional echniques) PIPs appea
o be e ec i e a educing sel - epo ed abusi e beha io and inc easing sel -es eem
and sel -concep .
Funding This s udy was conduc ed a he Psychology Resea ch Cen e (PSI/01662), School o Psychol-
ogy, Uni e si y o Minho, suppo ed by he Founda ion o Science and Technology (FCT) h ough he
Po uguese S a e Budge (UIDB/PSI/01662/2020). This s udy was also unded by he Founda ion o Sci-
ence and Technology – FCT (Po uguese Minis y o Science, Technology and Highe Educa ion), unde
he g an UIDB/05380/2020, and suppo ed by G an SFRH/BD/66110/2009 om he Founda ion o
Science and Technology (FCT) awa ded o he i s au ho .
Da a a ailabili y No a ailable.
Code a ailabili y No applicable.
Decla a ions
E hics app o al The p esen esea ch was app o ed by he Uni e si y o Minho E hics Commission. All
p ocedu es we e in acco dance wi h he e hical s anda ds o he ins i u ional e hics commission and wi h
he 1964 Helsinki decla a ions and i s la e amendmen s. The ial is egis e ed a ClinicalT ials.go wi h
he e e ence NCT05484440.
Consen o pa icipa e All pa icipan s we e in o med abou he con en and aims o he s udy and we e
in o med abou hei anonymi y and olun a y pa icipa ion. All pa icipan s signed an in o med consen .
Compe ing in e es s The au ho s decla e no compe ing in e es s.
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O.Cunha e al.
1 3
Publishe ’s no e Sp inge Na u e emains neu al wi h ega d o ju isdic ional claims in published maps
and ins i u ional a ilia ions.
Sp inge Na u e o i s licenso (e.g. a socie y o o he pa ne ) holds exclusi e igh s o his a icle unde
a publishing ag eemen wi h he au ho (s) o o he igh sholde (s); au ho sel -a chi ing o he accep ed
manusc ip e sion o his a icle is solely go e ned by he e ms o such publishing ag eemen and
applicable law.
Olga Cunha, PhD, is an assis an p o esso a he Facul y o Psychology, Educa ion, and Spo s, Lusó ona
Uni e si y, Po o, Po ugal, and a esea che a he HEI-Lab: Digi al Human–En i onmen In e ac ion
Labs.
Te esa Sil a, Mas e , is a esea che a Psychology Resea ch Cen e (CIPsi), B aga, Po ugal.
Telma Ca a ina Almeida, PhD, is an assis an p o esso a he Egas Moniz School o Heal h and Science,
Ins i u o Uni e si á io Egas Moniz (IUEM), Capa ica, Po ugal; and a esea che a CiiEM – Cen o de
In es igação In e disciplina Egas Moniz and a LabPSI – Labo a ó io de Psicologia Egas Moniz, IUEM,
Po ugal.
Sónia Ca idade, PhD, is an assis an p o esso a he School o Psychology, Uni e si y o Minho, B aga,
Po ugal, and a esea che a Psychology Resea ch Cen e (CIPsi).
Rui Ab unhosa Gonçal es, PhD, is an associa e p o esso a he School o Psychology, Uni e si y o
Minho, B aga, Po ugal, and a esea che a Psychology Resea ch Cen e (CIPsi).