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Continuous Intimate Partner Violence : Mental health consequences and feasibility of psychological interventions : the case of Iran

Continuous Intimate Partner Violence : Mental health consequences and feasibility of psychological interventions : the case of Iran

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ORANG, Tahereh, 2018. Continuous Intimate Partner Violence : Mental health consequences and feasibility of psychological interventions : the case of Iran [Dissertation]. Konstanz: University of Konstanz

@phdthesis{Orang2018Conti-43122, title={Continuous Intimate Partner Violence : Mental health consequences and feasibility of psychological interventions : the case of Iran}, year={2018}, author={Orang, Tahereh}, address={Konstanz}, school={Universität Konstanz} }

Orang, Tahereh Attribution-NoDerivatives 4.0 International 2018-08-27T08:56:03Z Continuous Intimate Partner Violence : Mental health consequences and feasibility of psychological interventions : the case of Iran 2018-08-27T08:56:03Z Intimate Partner Violence (IPV) against women is a pervasive worldwide phenomenon, with high prevalence in the patriarchal societies of the Middle East such as Iran. High incidence of IPV results in the high prevalence of mental health problems such as Post-traumatic Stress Disorder (PTSD) and depression. Not all women have the opportunity to escape violence, especially in low-to middle income countries, where lack of resources, social taboos, and fear of isolation and rejection lead abused women to keep silent and acquiesce to violence. Refusal to leave an abusive relationship is also frequent in modern societies and high-income countries, where social support and legal intervention are more widely available. The women affected might hope their partner will change or are constrained by their abusive partner's controlling tactics. Accordingly, a huge number of abused women remain unable to seek help and live under ongoing IPV for a prolonged period of time. The present thesis was developed to evaluate the feasibility and effectiveness of a culturally sensitive trauma-focused therapy, Narrative Exposure Therapy (NET), to meet the mental health needs of abused women with current experiences of ongoing IPV.<br /><br />We believe that individual psychotherapy is a feasible means of providing help within patriarchal societies. It has advantages over legal interventions and social support, in that it does not require structural reforms and fundamental sociopolitical changes, which take time and provokes resistance within a society. Psychotherapeutic interventions are not only capable of reducing pain and suffering among victims of ongoing IPV, but also might decrease violent occurrences within private households, raise awareness, and increase general public knowledge of IPV and its causes and effects. NET is an evidence-based therapeutic method that is capable of delivering exposure-based treatments to people from different cultural backgrounds. It is especially well-suited to the treatment of trauma-related symptoms among victims of chronic violence, which, at the same time, helps the patient to develop a testimony against human right violations in war-affected societies.<br /><br />Despite the urgent needs of continuously abused women, first-line IPV intervention programs have mostly been conducted in abused women who have taken refuge in domestic violence shelters or at least a temporary leave of their abusive partner. Therefore, mental health needs of abused women suffering from ongoing IPV has been neglected. To fill this gap in the literature, the present thesis investigates whether psychotherapy, particularly the exposure-based method of NET, in comparison to treatment-as-usual (TAU) interventions, reduces mental health problems and IPV occurrences in women living in a context of ongoing threat and violence in a Middle Eastern country such as Iran. In addition, there are questions of how abused women perceive IPV-related traumatic stressors, and whether IPV-affected women with mental health problems caused by continuous violence, show specific demographic and psychopathological characteristics. Therefore, we interviewed 47 married Iranian women currently suffering from threatening and violent living circumstances, of which 34 completed therapy sessions and 3- and 6-month follow-up diagnostic interviews.<br /><br />The results in the first article, which are in line with previous research, showed comorbidity of PTSD and depression, and a significant degree of relationship between PTSD and daily functioning impairment. Further, we found that only IPV experiences in the last year, rather than childhood abuse, IPV in past years of marriage, and additional lifetime traumatic events, significantly predicted PTSD variance among abused women living with an abusive partner. Further analysis of relationships between demographics and mental health symptoms revealed that a) abused women with higher PTSD symptoms used more psychopharmaceutical drugs, b) socially empowered women with high education and high financial competence suffered from high PTSD and depressive symptoms, and c) women with a non-drug-addicted abusive partner showed high symptoms of depression. Accordingly, in the first article we discuss the contribution of psychosocial factors to the expression of IPV consequences in abused women living in a context of continuous domestic violence in Iran. It is of particular interest to contrast these factors as they play out in a strongly patriarchal society with similar cases in less oppressive societies.<br /><br />The second article demonstrates the feasibility and effectiveness of NET in the reductions of PTSD, depression and perceived stress symptoms, in a comparison against TAU, in the context of ongoing IPV. These results, consistent with the previous results of exposure-based interventions among IPV-affected women, reveal that trauma-focused therapeutic methods not only enable abused women to distinguish between real dangers and overgeneralized trauma reminders to appropriately apply specific skills to each condition, but also reduce symptoms of numbing and avoidance, which, in turn might decrease the likelihood of re-victimization. Results showed that NET and TAU performed similarly in the reductions of IPV occurrences and daily functioning impairment, participants showed significant reductions in IPV experiences and disturbed functionality in 3- and 6-month follow-ups, regardless of the type of treatment. This finding fills the gap in the literature regarding the effectiveness of psychotherapy interventions in reduction of IPV experiences.<br /><br />The third article explores the hypothesis that abused women's subjective perceptions of most disturbing adversities do not precisely correspond to the current definition of traumatic stressors described in standard diagnostic categorizations such as DSM-5. The abused women investigated in the present study considered psychological abuse, continuity, and chronicity of IPV experiences as well as physical abuse as the most severe stressors leading them to develop PTSD symptomology. This is important because international standard diagnostic assessments have neglected these common sources of pain and suffering as traumatic stressors among victims of chronic violence. In addition, further exploratory examination of women's experience of psychotherapy under ongoing IPV reveals that psychotherapy even under unsafe condition of living with an abusive partner, is a pathway to self-growth, self-confidence, new life skills, and an integrated self.<br /><br />In sum, the present thesis shows that psychotherapy in general, and an exposure-based method such as NET in particular, can result in a reduction of psychological symptoms in victims living in a context of ongoing threat and violence. In addition, the present thesis emphasizes the need for reconsideration of current definitions of traumatic stressors in standardized diagnostic categorizations in order to include actual sources of pain and suffering among victims of chronic, intimate violence such as IPV. Orang, Tahereh eng 2018

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