CBT Therapy for Domestic Violence Victims: A Cognitive Science Approach

Introduction: The Scope of Domestic Violence in America

Millions of Americans become victims of domestic violence each year, and the problem is worsening due in large part to the mental health consequences of the ongoing COVID-19 pandemic, as well as an array of other existential threats facing humankind at present. These threats include, but are not limited to, global warming and related extreme weather events, an increasingly polarized American electorate, international terrorism, and even the risk of undetectable impacts from objects in outer space. It is little wonder that Americans are suffering from increased stress, anxiety, depression, and fear — but in far too many cases, these reactions have translated into domestic violence.

Although further research into this problem is needed to determine the full range of adverse effects caused by the ongoing COVID-19 pandemic, most experts agree that the current prevalence of domestic violence in general, and against women in particular, will continue to increase well into the foreseeable future. The overarching purpose of this paper is therefore to expand on a DMin project aimed at helping women survivors of intimate partner abuse reach an emotional and theological place wherein they will neither accept nor desire to remain in abusive relationships.

This paper seeks to equip intimate partner violence victims with assertive skills using cognitive-behavioral therapy (CBT) so they will no longer remain in or return to abusive relationships. The problem of women returning to or staying in abusive relationships — and suffering continued physical and mental violence resulting in injury and even death — demands urgent attention. This interdisciplinary paper also supports the DMin project by investigating how fields of study outside of theology intersect with and inform the project. Research drawn from disciplines beyond theology can enrich the scope, depth, and effectiveness of the project.

The above-stated purpose of this study is especially relevant today, as national prevalence rates of domestic violence have significantly increased during the ongoing COVID-19 pandemic. Many researchers suggest the problem will continue to intensify in the coming years. Even before the pandemic, domestic violence in the United States was already severe. It is estimated that every minute, approximately 20 Americans become victims of physical abuse by an intimate partner, meaning that about 10 million people in the United States are personally affected by domestic violence each year.¹

While precise current figures continue to be compiled, more than 20,000 telephone calls are placed to domestic violence hotlines across the country each day, making it clear that this is a significant public health threat that continues to intensify. Moreover, while many people consider domestic violence as being largely limited to female victims, Americans of all genders are at risk. Although women are far more likely to be victims of domestic violence, men are also victimized at alarming rates. For instance, while one in four women are victims of severe physical violence by their intimate partner, one in nine men also experience some type of physically violent attack — such as beating, burning, strangulation, shoving, slapping, and pushing — as well as other behaviors that may not be widely recognized as constituting "domestic violence."²

In addition, fully one in seven American women and one in 18 men report having been stalked by an intimate partner to the point where they experienced significant fear or believed their partner would attempt to harm or kill them.³ More troubling still, more than one-third (35%) of American households own at least one firearm — and most own several — meaning that there are approximately 242 million privately owned firearms in the United States, 72 million of which are handguns. Handguns are responsible for a disproportionate percentage of shootings, and the risk of homicide is increased five-fold in American households that contain any type of gun.⁴

Not surprisingly, about one in five domestic violence incidents involves some type of weapon, and here again women face significantly higher risk of gun-related violence. Although domestic violence has been shown to cause or exacerbate depression, anxiety, and suicidal behaviors in victims, only about one-third of victims ever seek medical care for injuries sustained from domestic violence.⁵ An exploration of this discipline and theory therefore adds to a greater understanding of the antecedents of domestic violence and the types of interventions most appropriate for addressing it. This field and theory were selected based on the significance of domestic violence as a major public health threat that demands additional scholarship to identify efficacious strategies. The findings that emerged from this study also help illuminate the extent of the problem and provide valuable benchmarks for further investigation.

In sum, public awareness of and efforts to eradicate domestic violence may have heightened in recent years, but the problem remains life-threatening for far too many victims — most especially women, who account for the majority of domestic violence targets. While the reasons women remain in abusive relationships are unique to each individual, the research that follows identifies some of the primary antecedents that exacerbate the complexity of this public health threat and underscores the timeliness and importance of identifying strategies to reduce the prevalence of domestic violence against women in the United States.

Interdisciplinary Theory: CBT as a Framework

The selected interdisciplinary theory for this study is based on cognitive science approaches for applying cognitive-behavioral therapy (CBT) to help victims of domestic violence. Although a number of different theoretical approaches are available for this purpose, a growing body of research confirms the efficacy of CBT-based interventions for domestic violence victims. While different CBT-based methods exist depending on the unique needs and circumstances of each victim, they all share defining characteristics that make CBT an especially valuable and potentially efficacious tool. As Berliner, Merchant, and Roberts explain, "CBT is based on a theory that thoughts, feelings and behaviors mutually influence each other. CBT-based treatments target: unhelpful thoughts; difficulty managing intense negative feelings; ineffective or problem behaviors. CBT-based treatments are effective for many clinical conditions and behavioral problems."⁶

Furthermore, various CBT-based interventions have frequently been used in cases of domestic violence, given their proven ability to treat both victims and offenders. Berliner and colleagues add that "CBT is the underlying theory for many effective therapies for common clinical conditions such as anxiety, depression, PTSD, and disruptive behaviors. Effective treatments for individuals who break the law or abuse their children are also typically CBT-based. There are a number of branded CBTs that target law-breaking behavior."⁷ Taken together, it is clear that CBT represents a useful interdisciplinary approach to helping female victims of domestic violence regain some normalcy in their lives and move beyond abusive relationships.

Biblical Foundations for Opposing Domestic Violence

The Holy Bible contains numerous references to violence of all types, including domestic violence, and it is not surprising that passages taken out of context can be interpreted in different ways. In some cases, such misinterpretations have been used to discourage women from reporting domestic violence to appropriate authorities or even to encourage them to remain in abusive relationships. As Moder (2017) observes, "Scripture is often used to keep women silent about their experiences of domestic violence, to urge them to stay with an abusive partner, and even to justify abuse. But the Bible is clear that God opposes those who oppress, marginalize, and abuse others."⁸

Notwithstanding the potential for misinterpretation and the overall patriarchal nature of many biblical traditions, the Holy Bible provides a number of valuable guidelines that are generally and specifically applicable to domestic violence. For example, Colossians 3:19 (ESV) clearly states: "Husbands, love your wives, and do not be harsh with them." Likewise, Psalm 11:5 (ESV) emphasizes that violent behaviors are offensive to God: "The Lord tests the righteous, but his soul hates the wicked and the one who loves violence." More directly, 1 Peter 3:7 (ESV) stipulates that husbands are to "live with your wives in an understanding way, showing honor to the woman as the weaker vessel, since they are heirs with you of the grace of life, so that your prayers may not be hindered."

As Moder (2017) further points out, "The Bible views all forms of domestic violence as sin."⁹ In support of this assertion, Moder cites Malachi 2:16–17 (NIV): "'The man who hates and divorces his wife,' says the Lord, the God of Israel, 'does violence to the one he should protect,' says the Lord Almighty. So be on your guard, and do not be unfaithful.'" Moder also cites Psalm 11:5 (NIV): "The Lord examines the righteous, but the wicked, those who love violence, he hates with a passion."

Furthermore, people are admonished in certain biblical passages to avoid behaviors such as verbal abuse, which is formally recognized as a component of domestic violence. Proverbs 12:18 (NIV) states in part, "The words of the reckless pierce like swords," and Proverbs 18:21 (NIV) declares that "The tongue has the power of life and death." Indeed, a biblical foundation counsels against responding with violence even when provoked in an intimate relationship, as expressed in Ephesians 4:26: "In your anger do not sin." This passage is especially relevant to domestic violence situations, which are always characterized by some degree of mutual anger.

While it is easy enough to cite selected Scripture in support of a given position, these passages represent nothing more than quaint platitudes unless they are genuinely taken to heart and rigorously applied in people's day-to-day lives.¹⁰ Because humans are sinful, frail, and weak by nature, rising to this level of piety is not only challenging — it may appear impossible without accepting Christ as Savior and grasping what that relationship demands. In this regard, Moder concludes that "God's heart is to deliver the abused (Psalm 5, 7, 10, 140; Acts 14:5) and to protect women by calling husbands to provide for the physical and emotional needs of their wives with sensitivity and gentleness, encouraging them to become all that God created them to be (Mark 10:42–45; Eph. 5:1–2; Eph. 6:21–29). Any form of abuse is unacceptable behavior and defies God's calling for Christ-followers to relate to each other in love."¹¹

Conclusion

It is reasonable to conclude that the biblical and theological foundations described above are not only relevant to the problem of women who are victims of domestic violence — they are also foundational to the solution. Complex problems, however, typically demand complex solutions, and the problem of domestic violence in the United States is certainly no exception. The research was consistent in showing that domestic violence remains a national public health threat that has consistently defied various solutions in the past. A major part of the problem is the patriarchal and masculine nature of American society, and the growing polarization of the nation's electorate over gender-based issues is evidence that this problem has not been resolved through legislation alone.

Despite some modest progress in addressing this dangerous threat prior to the ongoing COVID-19 pandemic, the prevalence of domestic violence has once again increased — notably, though the full scope of that increase has yet to be determined. Moreover, people are increasingly withdrawing from active participation in American society for numerous reasons. Some view others as potential disease vectors to be avoided, while others fear for their safety in an environment of escalating gun violence. In addition, the ongoing Great Resignation reflects a broader shift in which Americans who worked from home during the pandemic are realizing that the daily demands of commuting and office life are no longer absolute requirements for earning a meaningful living.

While the United States is not necessarily becoming a nation of hermits, people are far less willing to subject themselves to potential dangers inherent in everyday life. In this environment, the potential for unreported domestic violence intensifies, and the need to identify domestic violence victims and provide them with appropriate interventions — interventions that may well save their lives — should be a national priority. Yet, despite loud calls from women's advocates for timely and effective remedies, it remains far from one.

Finally, the research was also consistent in showing that the selected interdisciplinary field and theory are highly congruent with and foundational to the author's DMin project. Empowering victimized women who might otherwise remain in violently abusive relationships — relationships that can cause severe mental and physical harm, including death — represents an enterprise that is closely aligned with the subject and objective of the DMin project. As the World Health Organization and numerous domestic researchers have affirmed, addressing intimate partner violence requires sustained, multi-dimensional commitment from clinicians, communities, and institutions alike.