Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA.
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA.
Soc Sci Med. 2021 Jan;268:113458. doi: 10.1016/j.socscimed.2020.113458. Epub 2020 Oct 17.
Despite well-established associations between alcohol use, poor mental health, and intimate partner violence (IPV), limited attention has been given to how psychological and behavioral interventions might prevent or treat IPV in low- and middle-income countries.
In a recent randomized controlled trial in Lusaka, Zambia, transdiagnostic cognitive-behavioral psychotherapy (the Common Elements Treatment Approach; CETA) demonstrated significant treatment effects on men's alcohol use and women's IPV victimization in couples in which hazardous alcohol use by the male and intimate partner violence against the female was reported. In this study, we sought to gain a more in-depth understanding of mechanisms of behavior change among CETA participants.
We conducted 50 semi-structured in-depth interviews and 4 focus groups with a purposeful sample of adult men and women who received CETA between April and October 2018. Transcripts were analyzed using an inductive constant comparison approach by a team of US- and Zambia-based coders.
Participants described interrelated mechanisms of change, including the use of safety strategies to not only avoid or prevent conflict but also to control anger; reductions in alcohol use that directly and indirectly reduced conflict; and, positive changes in trust and understanding of one's self and their partner. Several overarching themes also emerged from the data: how gender norms shaped participants' understanding of violence reduction strategies; the role of household economics in cycles of alcohol and violence; and, deleterious and virtuous intercouple dynamics that could perpetuate or diminish violence.
Results suggest important avenues for future research including the potential for combining CETA with poverty reduction or gender norms focused interventions and for incorporating cognitivebehavioral skills into community level interventions.
尽管酒精使用、心理健康状况不佳和亲密伴侣暴力（IPV）之间存在明确关联，但对于心理和行为干预如何在中低收入国家预防或治疗 IPV ，关注有限。
在赞比亚卢萨卡最近的一项随机对照试验中，跨诊断认知行为心理疗法（常见要素治疗方法；CETA）对报告男性危险饮酒和女性遭受亲密伴侣暴力的夫妇中男性的酒精使用和女性的 IPV 受害情况显示出显著的治疗效果。在这项研究中，我们试图更深入地了解 CETA 参与者的行为改变机制。
我们对 2018 年 4 月至 10 月期间接受 CETA 的成年男女进行了 50 次半结构式深入访谈和 4 次焦点小组讨论。美国和赞比亚的编码员团队使用一种归纳式恒比法对转录本进行分析。
参与者描述了相互关联的变化机制，包括使用安全策略不仅可以避免或预防冲突，还可以控制愤怒；减少酒精使用，这直接和间接地减少了冲突；以及对自我和伴侣的信任和理解的积极变化。数据中还出现了几个总体主题：性别规范如何影响参与者对减少暴力策略的理解；家庭经济在酒精和暴力循环中的作用；以及可能加剧或减少暴力的有害和良性夫妻间动态。
结果表明，未来的研究有重要的途径，包括将 CETA 与减贫或性别规范为重点的干预措施相结合的潜力，以及将认知行为技能纳入社区层面干预措施的潜力。
