The Effect of Biofeedback on Intimate Partner Violence: Study Protocol for a Randomized Controlled Trial

Background: Studies on cognitive behavioral therapy (CBT) for intimate partner violence (IPV) offenders show small to no effects on recidivism. IPV-offenders may not fully benefit from CBT due to insufficient transfer and generalization from therapy to real-life situations. During CBT, patients are taught to detect bodily signals indicative of arousal. A possible reason that the transfer is insufficient might be that the arousal-provoking stimuli in therapy do not match the real-world provoking stimuli, and thus patients do not learn to sufficiently detect bodily signals preceding arousal in real-life. Recent research has shown that IPV-offenders differ in their psychophysiological reactivity depending on their main diagnosis. This might also have implications for learning transfer. We presume that IPV perpetrators cannot fully profit from CBT interventions in which self-control is taught from cognitive techniques instead of increasing physical awareness through biofeedback. In the present study we first want to test the hypothesis that biofeedback will increase awareness of bodily signals indicative of arousal. Second, we expect that the use of biofeedback will have beneficial effects on transfer to real-life situations resulting in a decrease of IPV. For this purpose, we developed a smartphone application, Good Reaction Is Prevention (GRIP), that when used in conjunction with a heart rate monitor measures heart rate variability and notifies users when a personal stress threshold is surpassed. Methods/design: The study takes place in an outpatient forensic treatment center. In a randomized controlled trial(N = 40) we compare a 9-week CBT-based program aimed at developing motivation and self-control where IPV offenders will be treated either with or without biofeedback. The primary outcome is change in frequency of IPV from pretest to posttest. Secondary outcomes are weekly self-report questionnaires on bodily sensations of anger and change in resting HRV-values between pre and post intervention. Discussion: To our knowledge, this is the first study to test the effects of a biofeedback application on IPV. This study will test a new intervention strategy which is expected to increase treatment effects by focusing on bodily awareness instead of cognitive processes.