Psychology of Violence © 2017 American Psychological Association

2019, Vol. 9, No. 3, 257–266 2152-0828/19/$12.00 http://dx.doi.org/10.1037/vio0000097

Evaluation of Acceptance and Commitment Therapy for Domestic

Violence Offenders

Amie Zarling Sarah Bannon

Iowa State University Stony Brook University

Meg Berta
Iowa State University
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Objective: There are currently few empirically supported batterer intervention programs (BIPs) for
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perpetrators of domestic violence. In practice, a combination of psychoeducation on power and control

dynamics (i.e., Duluth Model) and cognitive-behavioral therapy (CBT) techniques are widely used in
BIPs but produce limited effects on violent recidivism. Thus, the purpose of this study was to examine
the impact of an Acceptance and Commitment Therapy (ACT)-based program (Achieving Change
Through Values-Based Behavior [ACTV]; Lawrence, Langer Zarling, & Orengo-Aguayo, 2014) on
reducing new criminal charges 1 year postintervention compared with the traditional treatment (a
combination of the Duluth Model and CBT). Method: Administrative data were collected from a sample
of 3,474 men who were arrested for domestic assault and court-mandated to a BIP (nonrandomized either
ACTV or Duluth/CBT) from 2011 to 2013. Incidence and frequency of new criminal charges were
examined during the intervention time period as well as 12 months postintervention time period, and
analyses were completed for the entire intent-to-treat sample as well as treatment completers only.
Results: Compared with Duluth/CBT participants, significantly fewer ACTV participants acquired any
new charges, domestic assault charges, or violent charges. ACTV participants also acquired significantly
fewer charges on average in the 1 year after treatment than Duluth/CBT participants. This pattern of
results emerged for both treatment completers and noncompleters. ACTV had a significantly higher
dropout rate. Conclusions: This investigation provides preliminary evidence for the feasibility and
effectiveness of an ACT-based group for men who have been arrested for domestic assault.

Keywords: Acceptance and Commitment Therapy, intimate partner violence, domestic violence,
recidivism, treatment outcomes

Physical violence against women by a current or former roman-
tic partner, called intimate partner violence (IPV) or domestic
violence, is a major social and public health concern in the United
States. Initial police response and arrest is not enough to protect
victims from recurrence of abuse; thus, many states have mandated
participation in batterer intervention programs (BIPs) for men who
have been charged with assault against an intimate partner. Pro-
viding an alternative to incarceration, thousands of BIPs have been
implemented across the United States to improve victim safety and
prevent reoccurrence of violence. The current study aims to assess
the effectiveness of a new BIP in reducing domestic assault recid-
ivism.
Nationally, BIPs are generally group programs lasting an aver-
age of 30 weeks, with variation in factors such as session length
This article was published Online First March 20, 2017.
Amie Zarling, Department of Human Development and Family Studies,
Iowa State University; Sarah Bannon, Department of Psychology, Stony
Brook University; Meg Berta, Department of Human Development and
Family Studies, Iowa State University.
Correspondence concerning this article should be addressed to Amie
Zarling, Department of Human Development and Family Studies, Iowa
State University, Ames, IA 50011. E-mail: azarling@iastate.edu
257
and facilitator training (see Babcock et al., 2016 for a review).
Most current BIPs are based on feminist/patriarchal theory and the
Duluth Model, in which the primary origin of male-to-female
violence is conceptualized to be patriarchal ideology and societal
sanctioning of men’s power and control over women (Pence &
Paymar, 1993). The Duluth Model views men’s violence as “bat-
tering,” and in this conceptual framework, battering involves a
web of intentional tactics that create the man’s power and control
over a partner. The curriculum is instructive and aims to challenge
the denial or minimization associated with abusive behavior that is
common among court-ordered men. Psychoeducational techniques
are used to promote changes in attitudes via education and reso-
cialization. In addition, the Duluth Model is embedded in a larger
“coordinated community response” system that includes arrests for
domestic violence, sanctions against noncompliance to court or-
ders, support and safety planning for victims, and referral to other
agencies with collaborative approaches (e.g., family court, child
protection services, alcohol and drug treatment, mental health
treatment; Gondolf, 2007). Most Duluth Model programs also
incorporate a cognitive-behavioral therapy (CBT) approach to
treatment. CBT techniques focus on modifying faulty or problem-
atic cognitions, beliefs, and emotions to prevent future violent
behavior and include skills training such as anger management,
assertiveness, and relaxation techniques (Adams, 1988).
 258 ZARLING, BANNON, AND BERTA
Historically, Duluth/CBT programs have been the standard for
BIPs, and they continue to be a treatment of choice today (Barner
& Carney, 2011). Many states have guidelines governing the
content of BIPs, mandating that the programs adhere to these
models to be state certified or to receive state funding (e.g.,
Babcock & Taillade, 2000). In practice, the techniques used in
Duluth and CBT overlap substantially, and distinguishing between
the two is increasingly difficult. For example, the Duluth Model
incorporates several CBT strategies, such as changing core beliefs
associated with masculinity and patriarchy.
Most published studies have found that Duluth and CBT inter-
ventions result in limited reductions in rates of recidivism. A
meta-analysis of experimental studies conducted by Babcock,
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Green, and Robie (2004) demonstrated that, on average, a man
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who has been arrested, sanctioned, and completed an intervention
program (Duluth, CBT, or a combination of both) is just 5% less
likely to perpetrate physical aggression toward a female partner
than a man who has only been arrested and sanctioned. Recently,
Eckhardt and colleagues (2013) conducted a review of traditional
and alternative intervention programs for IPV perpetrators and also
found “equivocal results regarding [the programs’] ability to lower
the risk of IPV,” (p. 197). Some of these alternative treatments
identified in their review have demonstrated positive results, in-
cluding integrated substance abuse programs (Easton et al., 2007)
and programs utilizing a motivational enhancement/stages of
change model (Alexander, Morris, Tracy, & Frye, 2010; Scott,
King, McGinn, & Hosseini, 2011).
New approaches based on mindfulness principles have also
shown promise. For example, Tollefson and Phillips (2015) com-
pared a mind– body bridging (MBB) program to an eclectic com-
parison program in 90 men randomly assigned to groups. The
MBB group demonstrated lower (nonstatistically significant) prev-
alence of domestic assault charges at follow-up (4% vs. 9%).
Another mindfulness-based treatment, Acceptance and Commit-
ment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999), was
examined in a clinical sample of adults who had recently engaged
in aggression (Zarling, Lawrence, & Marchman, 2015). In this
study, 101 participants were randomly assigned to either a 12-
week ACT treatment group or a 12-week control group. The
control group utilized a support and discussion format with no
direct instruction or practice of behavioral change. Results showed
that the participants in the ACT group had significantly greater
declines in self-reported physical and psychological aggression 6
months posttreatment than participants in the control group. The
current study evaluates a new application of this ACT-based
program to a different population and setting.
Acceptance and Commitment Therapy
ACT builds on traditional CBT but emphasizes different pro-
cesses in behavior change (Hayes, Strosahl, & Wilson, 1999).
ACT aims to increase the ability to engage in valued behavior
independent of the internal experiences that may arise. In other
words, to be able to do what is important, even if psychological
barriers (e.g., anger, fear, lack of confidence, shame, etc.) are
present. Self-defeating and destructive behavior patterns are tar-
geted via generating opposing behavioral processes such as present
moment awareness, acceptance of difficult emotions or thoughts,
decrease in believability of (or attachment to) thoughts,
perspective-taking, identification of values, and committed action
in service of values. These processes are postulated to have an
impact on problematic behaviors in part though their reduction of
experiential avoidance.
Experiential avoidance is a key theoretical construct underlying
the ACT model, defined as the attempt to alter the form or
frequency of unwanted private events such as thoughts, feelings,
and physiological sensations (Hayes, Wilson, Gifford, Follette, &
Strosahl, 1996). Experiential avoidance is related to but distinct
from concepts such as emotion dysregulation and poor distress
tolerance. There is a significant body of literature indicating that
experiential avoidance contributes to the development, mainte-
nance, and exacerbation of emotional and behavioral problems,
and that ACT is known to produce improvements in these prob-
lems in part by decreasing experiential avoidance (e.g., Hayes,
Luoma, Bond, Masuda, & Lillis, 2006).
Experiential avoidance is also positively related to aggressive
behavior and relationship violence (Bell & Higgins, 2015; Reddy,
Meis, Erbes, Polusny, & Compton, 2011; Shorey et al., 2014). In
addition, many forms of psychopathology commonly associated
with IPV are characterized by the presence of experiential avoid-
ance, including borderline personality disorder (e.g., Chapman,
Specht, & Cellucci, 2005), posttraumatic stress disorder (PTSD;
e.g., Orcutt, Pickett, & Pope, 2005), and substance use (e.g.,
Forsyth, Parker, & Finlay, 2003). It has been hypothesized that
experiential avoidance may actually account for the relationship
between psychopathology and IPV (e.g., Tull, Jakupcak, Paulson,
& Gratz, 2007), and there is evidence that IPV is driven by a lack
of acceptance and an inability to tolerate emotional experiences
(e.g., Cohn, Jakupcak, Seibert, Hildebrandt, & Zeichner, 2010).
Finally, in the Zarling et al. (2015) study earlier described, reduc-
tions in aggression were mediated in part by reductions in expe-
riential avoidance. Thus, an ACT model of aggression posits that
the primary mechanism by which the treatment decreases aggres-
sion is by targeting and reducing experiential avoidance (e.g.,
Langer & Lawrence, 2010).
Achieving Change Through Values-Based Behavior
The state of Iowa Department of Corrections (DOC) recently
collaborated with researchers to develop a new BIP called Achiev-
ing Change Through Values-Based Behavior (ACTV; Lawrence,
Langer Zarling, & Orengo-Aguayo, 2014). ACTV is based heavily
on ACT principles with a focus on transferability to the commu-
nity correctional setting. ACTV was developed to fit the structure
of court-adjudicated treatment and can be facilitated by correc-
tional staff and utilized with open or closed groups. The ACT
processes are framed as skills that one can practice and learn
during and outside of group sessions. The primary goals are to
learn new ways of responding to cognitive and emotional experi-
ences and build patterns of behavior that promote effective, value-
based living.
In contrast to Duluth and CBT techniques focusing on psychoe-
ducation and directly changing the content of thoughts and emo-
tions, ACTV focuses instead on experiential learning and changing
one’s relationship with one’s thoughts and emotions. ACTV pro-
vides a series of innovative techniques that do not involve chal-
lenging thoughts or correcting cognitive distortions; alternatively,
ACTV aims to alter their function, how they are experienced, and
 ACT FOR DOMESTIC ASSAULT
how they influence other behavior. Whereas the Duluth/CBT cur-
riculum would focus on teaching the men to change the thoughts
they have about their female partners via cognitive reappraisal or
self-talk methods, ACTV focuses on teaching the men to choose
behavior that is values-consistent, even in the presence of those
thoughts. For example, Duluth/CBT might encourage replacing the
thought “She shouldn’t treat me this way” with a more positive or
egalitarian thought. In contrast, ACTV would encourage behaving
with respect toward one’s partner even when having the thought
“She shouldn’t treat me this way.” The primary difference between
these two program philosophies is that the ACTV model does not
teach or require that the content of participants’ thoughts have to
change for behavior to change, only the way that they respond to
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their thoughts.
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The ACTV program differs from traditional Duluth or CBT
programs in additional ways. It is important to note that ACTV
places participants’ personal values front and center, and values
are used as the motivator for behavior change. For example, men
who have been court-mandated often identify “freedom” as an
important value. Therefore, complying with probation and court
requirements and reducing criminal behavior are possible exam-
ples of behavior in service of that value. ACTV then involves skills
training in several areas to help make that valued behavior possi-
ble. Other CBT programs may seek to effect changes similar to the
ACT conceptualization of values, but they do not typically target
such changes as mediators of change or as outcomes (Plumb,
Stewart, Dahl, & Lundgren, 2009). Finally, the posture of the
ACTV facilitator is collaborative and nonjudgmental. Although it
is not unique to focus on a strong working relationship, ACTV
facilitators go beyond merely being empathetic and supportive by
embodying and modeling the ACT processes themselves. The
ACTV facilitator is “in the same boat” as the participants and does
not make assumptions about what is right or wrong; instead, they
focus on what works in terms of their values. This is consistent
with the success of helping and healing approaches for domestic
violence compared with psychoeducational approaches (Babcock,
Canady, Graham, & Schart, 2007).
The Current Study
The goal of the current study was to test the effectiveness of
ACTV, compared with Duluth/CBT, in reducing recidivism for
men court mandated to complete an intervention program after
being convicted of domestic assault. We defined recidivism as new
criminal charges in the 12 months after the program. The sample
includes 3,474 men who were assigned but not randomized to
either ACTV or Duluth/CBT from 2011 to 2013. We hypothesized
that ACTV would be more effective than Duluth/CBT in reducing
overall recidivism as well as domestic assault charges specifically.
Method
The Iowa State University Institutional Review Board approved
all study procedures. Several thousand male offenders are con-
victed of domestic assault each year in the state of Iowa and are
subsequently mandated to complete a BIP. For the BIP curriculum,
the Iowa DOC utilized the Duluth Model beginning in 1991 and
then incorporated additional CBT components in 1999. In 2009,
the DOC sought to improve outcomes of this program because
259
recidivism rates were only marginally improved due to treatment.
ACTV was developed as a collaboration between researchers and
the DOC and then was piloted in 2011. BIPs in Iowa have
comprised ACTV and Duluth/CBT since that time.
Treatment Groups
Both ACTV and Duluth/CBT entail 24 weekly sessions (1.5–2
h each). Participants were required to pay an average of $25 per
session, and participants could not officially complete the program
if they did not pay the full amount. Both ACTV and Duluth/CBT
were commonly co-led by one female and one male facilitator. All
groups were open with continuous enrollment. ACTV groups and
Duluth/CBT groups were equally likely to be in the morning or
evening. In general, only ACTV facilitators led ACTV and only
Duluth/CBT facilitators led Duluth/CBT. In one district, there
were four facilitators who led both ACTV and Duluth/CBT (i.e.,
they were trained in both interventions), but they transitioned to
only providing ACTV by 2012. The coordinated community re-
sponse model was retained and did not differ between groups.
Duluth/CBT. The traditional curriculum of the Duluth Model
(Pence & Paymar, 1993) was followed with additional CBT com-
ponents. Two primary teaching tools are used to frame how bat-
tering works: the Power and Control Wheel to describe battering
behaviors and the Control Log to challenge the belief systems that
support those behaviors. Change in behaviors is directly linked to
changes in one’s belief systems and worldview; thus, the focus is
on unlearning sexist attitudes and beliefs and holding the men
accountable for their behavior. In this program, traditional CBT
principles such as cognitive change and/or positive self-talk un-
derlie almost all activities and exercises (e.g., thoughts cause our
behavior and negative thoughts allow us to do hurtful things).
Other CBT techniques included goal-setting and skills practice.
Each session includes group discussions, video vignettes, and
role-playing.
ACTV. ACTV is divided into five modules (see Table 1). The
Big Picture/Core Skills sessions present the main concepts of the
curriculum, such as values identification, being in the present
moment, and increasing awareness of one’s behaviors. The Matrix
is an interactive exercise to help participants identify and discrim-
inate their experiences as sensory experiences or mental experi-
ences and their behavior as either in service of values (toward
moves) or away from unwanted mental experiences (away moves;
see Polk, Schoendorff, Webster, & Olaz, 2016 for more informa-
tion about the Matrix). The Matrix is an engaging and collabora-
tive approach used in all sessions to deliver concepts simply and
effectively, even when clients are resistant or unmotivated. The
Emotion Regulation and Cognitive Skills sessions introduce and
encourage practice of the ACT processes such as awareness of
sensory, cognitive, and emotional experiences; learning new re-
sponses to emotions; stepping back from unhelpful thoughts;
awareness of behaviors in service of values versus behaviors in
service of avoidance; and identifying steps for behavior change.
The Behavioral Skills sessions focus on practicing of communi-
cation skills related to interpersonal relationships. Finally, the
Barriers to Change sessions address environmental or life circum-
stances that can hinder successful behavior change.
General facilitator training. Before specific training in Du-
luth/CBT or ACTV, all facilitators of BIP groups are required to
 260 ZARLING, BANNON, AND BERTA

Table 1
Description of ACTV Sessions

Modules Description

Big Picture/Core Skills (seven sessions interspersed
throughout the 24 weeks)
Emotion Regulation Skills (four sessions)
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The goal of these sessions is for participants to develop an intrinsic motivation to change by
connecting with their own values. Mindfulness skills are introduced to help participants
notice their own behaviors within their relationships, the multiple contributors to these
behaviors, and to distinguish between behavior that is value driven and behavior that is in
service of experiential avoidance. Participants identify healthy and unhealthy relationship
behaviors and evaluate their own behavior and relationships in terms of their values.
These sessions explore the function of emotions and invite participants to notice how they
have tried to control or avoid unwanted emotions in their life and how workable or
unworkable these strategies have been in terms of their values. Acceptance or willingness
is introduced as a skill that involves noticing emotions as they arise and allowing them to
be there without trying to alter their form or frequency.

Cognitive Skills (four sessions) Participants learn how the mind produces many thoughts, and although we cannot control
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Behavioral Skills (five sessions)
Barriers to Change (four sessions)
all of them, we can notice them and step back from them. The goal is to create a useful
distance from thoughts (i.e., defusion) to allow more mindful choices and increased
behavior in service of one’s values. A key principle in these sessions is that we are in
control of our behavior no matter what thoughts we may have.
Participants learn and practice basic communication skills such as reflective and active
listening and how to communicate in an assertive and respectful way. They also learn and
practice appropriate conflict resolution skills and how to set and respect boundaries. All
of the skills from the previous sessions (e.g., mindfulness, acceptance, defusion, values)
are incorporated into role-playing and practice.
These sessions help participants identify potential barriers to engaging in value-based
behavior (e.g. substance abuse, mood and anxiety difficulties, parenting difficulties) and
offer strategies and outside resources to help overcome these barriers.

complete domestic violence awareness training. This 1-day train-
ing includes a review of several topics such as Iowa laws on
domestic violence, the dynamics of IPV, statewide BIP standards,
and victim safety. Facilitators of BIP groups were also trained in
motivational interviewing. After the training and certification pro-
cess, facilitators in most districts were observed and assessments
were completed periodically per the usual DOC procedures. As-
sessment included ratings of the facilitators’ (a) preparedness for
group, (b) ability to engage participants, (c) ability to work with
their cofacilitator, and (d) fidelity to their respective curriculum.
After assessment, constructive feedback was given.
Training in Duluth/CBT. This consisted of a 3-day training
led by a male and female facilitator as well as a victim’s advocate.
Prerequisites to the training included reading the Duluth Model
book (Pence & Paymar, 1993) and completing victim advocacy
training. The training included presentations on the power and
control wheel, male privilege, the importance of the offenders
admitting to their violence, characteristics of criminal thinking,
cognitive distortions, writing control logs, and critical thinking.
Trainees learned how to change men’s beliefs via psychoeduca-
tion, lecture, critical dialogue, and challenging participants’ beliefs
and thoughts. Emphasis was placed on holding men accountable
and actively countering denial and resistance. Training included
videos and in-person observation of current Duluth/CBT groups.
Trainees practiced facilitating sessions and received feedback.
Training in ACTV. This consisted of an initial 2-day training
in which two experienced ACT therapists introduced the ACT
model and demonstrated experiential exercises with trainee partic-
ipation. A second 2-day training included a refresher on the ACT
model and trainees practicing delivery of session material with
trainers giving feedback. Training requirements also included in-
person observation of current ACTV groups. ACTV training did
not include specific content on men’s power and control dynamics.
ACTV takes a broader view of the causes of violence and incor-
porates a discussion of many possible contributors to aggressive
behavior (e.g., childhood experiences, emotions, stress, etc.).
ACTV acknowledges that power and control motivations may
apply to some men, but it is not assumed that all men use violence
for that reason. ACTV facilitators are trained to model the behav-
iors they are trying to teach (e.g., support, respect, validation) and
not to lecture or “one-up” the participants. Finally, ACTV trainees
had an experienced supervisor/coach who observed sessions and
gave feedback while the trainees facilitated their first full 24
sessions.
Participants and Procedures
Study personnel obtained data from the Iowa DOC’s research
director. These records included men who were enrolled in BIP
from January 2011 to December 2013 and included 1,353 men
assigned to ACTV and 3,707 men assigned to Duluth/CBT. There
were more Duluth/CBT groups running than ACTV groups during
the time frame of 2011–2013. The men were not randomized to
groups; rather, following the procedures and policies in place
within the DOC, they chose groups based on scheduling and
availability. The men did not know which ones were ACTV and
which ones were Duluth/CBT. Men who had some combination of
ACTV and Duluth/CBT (n ⫽ 377 or 966 cases) during the study
time period were excluded from the analyses presented herein.
Finally, men whose intervention length exceeded 365 days were
omitted. This left 3,474 men that were included in the intent-to-
treat (ITT) analyses (2,631 in Duluth/CBT and 843 in ACTV). See
Table 2 for demographics of study participants. Participants were
either successfully discharged after completing the entire program
or they did not complete the program (see Table 3 for information
on completion rates and reasons for noncompletion). The treatment
 ACT FOR DOMESTIC ASSAULT 261

Table 2
History and Demographics

History/demographic All, N ⫽ 3,474 ACTV, N ⫽ 843 Duluth/CBT, N ⫽ 2,631

a
Criminal history
Charges before start date, M (SD) 2.32 (8.64), range: 0–176 2.52 (8.44), range: 0–94 2.25 (8.71), range: 0–176
Violent charges before start date, M (SD) 0.40 (1.68), range: 0–31 0.44 (1.73), range: 0–23 0.38 (1.66), range: 0–31
Domestic assault charges before start date, M (SD) 0.14 (0.68), range: 0–11 0.17 (0.78), range: 0–11 0.14 (0.65), range: 0–9
Age in years, M (SD) 33.45 (10.25), range: 18–72 33.37 (10.65), range: 18–70 33.48 (10.12), range: 18–72
Race, %
White 59.3 55.0 60.7
Black 22.0 26.7ⴱ 20.6ⴱ
Hispanic/Latino 6.3 6.3 6.3
American Indian 1.0 0.7 1.0
Asian 1.0 1.8 0.6
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No data 10.5 9.5 10.8

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Education level, %
⬍High school 19.9 20.0 19.8
High school 51.5 58.6 49.2
Some college 3.3 3.7 3.1
College or above 2.0 2.5 1.8
No data 23.4 15.2 26.0
Employment status, %
Full time 38.0 44.4ⴱ 36.0ⴱ
Part time 8.7 8.9 8.7
Student/unemployed 22.2 19.8 23.0
Unable to work 4.2 5.0 4.0
No data 26.9 21.9 28.4
Marital status, %
Single 44.6 49.6 42.9
Married 17.4 20.3 16.5
Divorced 9.9 11.2 9.5
Separated 1.8 1.7 1.8
Widowed 0.3 0.2 0.3
No data 26.0 17.3 28.9
a
Does not include the domestic assault charge that precipitated their BIP in the current study.
ⴱ
Significant difference between ACTV and Duluth/CBT at p ⫽ .05.

completers were defined as men who fulfilled program require-
ments (e.g., payment for sessions) and completed at least 24
sessions.
Coding criminal justice data. These data included computer
records regarding BIP start date (the date of the first session they
attended), end date (the date of their last session attended), com-
pletion status, and criminal charges up to 12 months postinterven-
tion. The scope of criminal charges obtained was only for state-
level offenses. Recidivism was defined as new charges, not
convictions, because this represents a more cautious court esti-
mate; the offender may not have been convicted of these charges
or may have eventually pled guilty to a lesser charge. Recidivism
was separated into three categories: any charge (including drug,
property, violent, and public order charges), domestic assault

Table 3
Completion Rates and Reasons for Noncompletion

All (%) ACTV (%) Duluth/CBT (%)

Completion status
Completers 70.1 61.1ⴱ 73.0ⴱ
Noncompleters 29.9 38.9ⴱ 27.0ⴱ
Reasons for noncompletion
Jail 2.4 4.6ⴱ 1.7ⴱ
Noncompliant/behavioral issues 20.9 27.0ⴱ 18.9ⴱ
Absconded 0.6 0.8 0.5
Death 0.3 0.4 0.2
Case/court discretion 0.9 0.8 1.0
Sentence discharged/revoked 0.9 0.6 1.1
Program change (program eliminated, referred to alt.,
transferred locations) 3.5 4.3 3.3
Other (inappropriate referral, ineligible, not admitted) 0.3 0.4 0.3
ⴱ
Significant difference between ACTV and Duluth/CBT at p ⫽ .05.
 262 ZARLING, BANNON, AND BERTA
charges, and any violent charge (including harassment, armed
robbery, assault, domestic assault, murder/attempted murder, and
stalking).
Data analysis. Analyses were completed using IBM SPSS
Statistics Version 21. Analyses were conducted with the full ITT
sample as well as separate analyses with only treatment com-
pleters. The ITT sample included all men in the sample (com-
pleters and noncompleters). Analyses examined both occurrence
(e.g., charged at least once ⫽ yes, received no charges ⫽ no) and
frequency of offending (the number of criminal charges). In re-
cidivism analyses, two separate time periods were investigated.
First, a set of analyses that assessed reoffending during the pro-
gram period (between the participant’s individual start date and
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end date). Second, a set of analyses that assessed reoffending in the
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1 year after the program (within 12 months of the intervention end
date). Comparisons between groups examining occurrence were
done using ␹2 tests as well as binary logistic regressions to retrieve
odds ratios (ORs). Comparisons between groups examining length
of time until reoffense were done using independent-sample t tests.
Continuous outcome variables (e.g., number of charges) were
analyzed using linear regression. Missing demographic data (see
Table 2) were handled using casewise deletion. No outcome data
were missing.
Results
For the ITT sample, demographic characteristics did not signif-
icantly differ between the men in Duluth/CBT and ACTV, with the
exception of race and employment status. Compared with Duluth/
CBT, ACTV had significantly more Black participants, ␹2(1) ⫽
14.27, p ⬍ .05, and significantly more participants who were
employed full time, ␹2(1) ⫽ 8.83, p ⬍ .05. The same was also true
for treatment completers. Thus, race and job status were entered as
covariates in all analyses. There were not significant differences
between groups on criminal history in either the ITT sample or
treatment completers. At the start of intervention, men in both
groups had an average of two previous charges, and 35% had a
previous domestic violence charge.
Overall, 70.1% of men successfully completed treatment during
the study period (see Table 3). In the Duluth/CBT group, 73%
Table 4
Percentage of Men Acquiring Charges in the ITT Sample and Completers Only
Outcome ACTV (N ⫽ 843), %
ITT sample
Any charge during treatment
Domestic assault charge during treatment
Any charge within 12 months of end date
Domestic assault charge within 12 months of end date
Any violent charge within 12 months of end date
ACTV (N ⫽ 515), %
Completers only
Any charge during treatment
Domestic assault charge during treatment
Any charge within 12 months of end date
Domestic assault charge within 12 months of end date
Any violent charge within 12 months of end date
ⴱ ⴱⴱ ⴱⴱⴱ
p ⬍ .05. p ⬍ .01. p ⬍ .001.
completed treatment, compared with 61.1% of the ACTV partic-
ipants. In addition, a ␹2 test yielded a significant difference,
␹2(1) ⫽ 33.01, p ⬍ .001, between group completion rates, indi-
cating that men in the ACTV condition were less likely to com-
plete treatment. Furthermore, a logistic regression conducted with
group (Duluth/CBT ⫽ 0, ACTV ⫽ 1) predicting treatment com-
pletion was significant (OR ⫽ 1.67, p ⬍ .001), indicating that men
enrolled in the ACTV group had lower odds of completing treat-
ment. Completers were also more likely to be older, White, em-
ployed, married, and more educated than noncompleters.
The average duration of program enrollment differed between
groups (i.e., days from start date to end date). For the ITT sample,
Duluth/CBT program enrollment duration was significantly longer
than ACTV program enrollment duration, t(3,472) ⫽ 11.48, p ⬍
.001, with Duluth/CBT participants being enrolled an average of
165 days and ACTV participants being enrolled an average of 130
days. A similar pattern emerged for the treatment completers, with
the average program length being 190 days and 167 days for
Duluth/CBT and ACTV participants, respectively, t(2,434) ⫽
7.89, p ⬍ .001.
Please see Tables 4 and 5 for results for the ITT sample and
treatment completers. For the ITT sample, ␹2 analyses indicated
that significantly fewer ACTV participants were charged within
the intervention time period compared with Duluth/CBT partici-
pants (11.9% vs. 16.3%; ␹2 ⫽ 9.76 (1), p ⬍ .01), and men in the
Duluth/CBT group had significantly higher odds (OR ⫽ 1.45, p ⬍
.001) of receiving any charges during this time period. ACTV
participants also acquired significantly fewer charges on average
than Duluth/CBT participants (0.20 vs. 0.34) during the interven-
tion time period, t(3,472) ⫽ 3.54, p ⬍ .001. However, the groups
did not differ on average number of domestic assault charges
during the intervention time period.
During the 12 months after the intervention, significantly fewer
ACTV participants were charged as compared with men who
participated in Duluth/CBT (21.3% vs. 27.9%; ␹2 ⫽ 14.26 (1), p ⬍
.001). In addition, a logistic regression revealed that group signif-
icantly predicted general reoffense 1 year posttreatment and indi-
cated that the odds of reoffending were higher (OR ⫽ 1.43 p ⬍
.001) for men in the ITT sample enrolled in the Duluth/CBT
Duluth/CBT (N ⫽ 2,631), % ␹2(df)
11.9 16.3 9.76 (1)ⴱⴱ
1.4 1.4 .014 (1)
21.3 27.9 14.26 (1)ⴱⴱⴱ
5.3 7.7 5.44 (1)ⴱ
7.6 12.1 13.37 (1)ⴱⴱⴱ
Duluth/CBT (N ⫽ 1,921), % ␹2(df)
6.4 12.3 14.49 (1)ⴱⴱⴱ
0.03 0.08 1.09 (1)
15.5 24.4 18.35 (1)ⴱⴱⴱ
3.6 7.0 7.26 (1)ⴱⴱ
5.2 10.9 14.75 (1)ⴱⴱⴱ
 ACT FOR DOMESTIC ASSAULT 263

Table 5
Summary of Regression Analysis for Treatment Group Predicting Types of Recidivism at 1 Year
Posttreatment in ITT Sample and Completers Only

ITT sample Completers only

b
Predictor B SE B e B SE B eb

Any offensea ⫺0.34ⴱⴱ 0.122 0.71 ⫺0.56ⴱⴱⴱ 0.16 0.57

Number of chargesb ⫺0.15 0.09 ⫺0.20ⴱ 0.09
Any DA offensea ⫺0.34 0.22 0.71 ⫺0.60 0.31 0.55
Number of DA chargesb ⫺0.02 0.03 ⫺0.03 0.03
Any violent offensea ⫺0.47ⴱⴱ 0.18 0.62 ⫺0.80ⴱⴱ 0.26 0.45
Number of violent chargesb ⫺0.08ⴱ 0.04 ⫺0.11ⴱ 0.04
a
Logistic regression with a binary treatment variable (0 ⫽ Duluth/CBT and 1 ⫽ ACTV) and covariates (race,
job status, and district) predicting a binary outcome (0 ⫽ no offenses and 1 ⫽ one or more offenses within 1
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year after completion of treatment). b Linear regression with a binary treatment variable (0 ⫽ Duluth/CBT and
This document is copyrighted by the American Psychological Association or one of its allied publishers.

1 ⫽ ACTV) and covariates (race, job status, and district) predicting number of offenses within 1 year of
treatment completion. DA ⫽ domestic assault.
ⴱ
p ⬍ .05. ⴱⴱ p ⬍ .01. ⴱⴱⴱ p ⬍ .001.

intervention. Significantly fewer ACTV participants had domestic
assault charges (5.3% vs. 7.7%; ␹2 ⫽ 5.44 (1), p ⬍ .05), and the
odds of being charged with domestic assault were higher (OR ⫽
1.48, p ⫽ .07) for Duluth/CBT participants. There were also
differences in incidence of all violent offenses, with 7.6% of men
in ACTV versus 12.1% of men in Duluth/CBT being arrested for
a violent charge (␹2 ⫽ 13.37 (1), p ⬍ .001). The odds of Duluth/
CBT participants being charged with a violent offense were higher
than for men in the ACTV group (OR ⫽ 1.68, p ⬍ .05).
Finally, in the ITT sample, ACTV participants received signif-
icantly fewer charges on average (0.53 vs. 0.74) in the 12-month
follow-up period than men who participated in Duluth/CBT,
t(3,472) ⫽ 3.24, p ⬍ .001, as well as fewer violent charges,
t(3,472) ⫽ 3.25, p ⬍ .001. ACTV participants did not significantly
differ from Duluth/CBT participants in average number of domes-
tic assault charges in the 12-month follow-up period, t(3,472) ⫽
1.81, p ⫽ .07.
For the analyses conducted with treatment completers only, a
similar pattern of results emerged, but with a smaller percentage of
men reoffending in each category for both treatment groups. Anal-
yses revealed that significantly fewer men in ACTV reoffended
during the intervention time period compared with men who
participated in Duluth/CBT (6.4% vs. 12.3%; ␹2 ⫽ 14.49 (1), p ⬍
.001), and men in the Duluth/CBT group had higher odds (OR ⫽
1.98, p ⬍ .01) of receiving any charges during this time period.
ACTV participants also acquired significantly fewer charges on
average (0.09 vs. 0.23) during the intervention time period than
Duluth/CBT participants, t(2,434) ⫽ 3.84, p ⬍ .001. Domestic
assault charges did not differ between groups during the interven-
tion time period for completers.
During the 12 months after the intervention, significantly fewer
ACTV completers were arrested as compared with men who
completed Duluth/CBT (15.5% vs. 24.4%; ␹2 ⫽ 18.35 (1), p ⬍
.001). Logistic regression revealed that group significantly pre-
dicted general reoffense 1 year posttreatment for completers, in-
dicating that the odds of reoffending were higher (OR ⫽ 1.73, p ⬍
.001) for men in the Duluth/CBT intervention. Compared with
Duluth/CBT completers, significantly fewer ACTV completers
had domestic assault charges (3.6% vs. 7.0%; ␹2 ⫽ 7.26 (1), p ⬍
.01), and the odds of being charged with domestic assault were
higher (OR ⫽ 1.94, p ⬍ .05) for Duluth/CBT completers in the 12
months after the intervention. Significantly fewer ACTV com-
pleters had violent offenses overall (5.2% vs. 10.9%; ␹2 ⫽ 14.75
(1), p ⬍ .001), and the odds of being charged with a violent offense
were significantly higher (OR ⫽ 2.34, p ⬍ .001) for Duluth/CBT
completers during this time period.
Finally, for completers, ACTV participants received signifi-
cantly fewer charges on average during the 12-month follow-up
(0.34 vs. 0.59) than men who participated in Duluth/CBT,
t(2,434) ⫽ 3.67, p ⬍ .001. ACTV completers were also charged
with fewer violent offenses on average (0.08 vs. 0.19) than Duluth/
CBT participants, t(2,434) ⫽ 3.41, p ⬍ .001. However, the dif-
ference in average number of domestic assault charges (0.10 for
Duluth/CBT vs. 0.06 for ACTV) was not quite significant between
groups, t(2,434) ⫽ 1.89, p ⫽ .06.
Discussion
Researchers have indicated that traditional interventions for
domestic violence offenders, called BIPs, have a small impact on
recidivism rates (Babcock et al., 2004). Traditional BIPs most
commonly utilize the Duluth Model and CBT techniques. ACTV
is a new BIP developed for the correctional setting based on
empirical evidence regarding this population as well as the prin-
ciples and techniques derived from ACT. Departing from the
tenets of the Duluth Model and CBT, which focus primarily on
psychoeducation, cognitive restructuring, and issues of power and
control, ACTV is an acceptance and mindfulness-based interven-
tion focused on increasing psychological flexibility via experien-
tial learning. This is the first study of ACTV for domestic violence
offenders and one of very few studies that have compared two
active BIPs.
Results of the current study supported our hypotheses and were
promising in terms of the potential for ACTV to reduce recidivism
for domestic violence offenders. Comparing recidivism rates be-
tween ACTV and Duluth/CBT 1 year postintervention, ACTV
participants were significantly less likely to be arrested for any
charge, domestic assault charges, and any violent charges. More-
over, compared with Duluth/CBT, ACTV participants had signif-
icantly fewer charges than Duluth/CBT participants on average.
 264 ZARLING, BANNON, AND BERTA
However, there were no differences between groups in average
number of domestic assault charges, indicating that when ACTV
participants did reoffend, they received a similar number of
charges as Duluth/CBT reoffenders. This pattern of results was
similar for the ITT sample and treatment completers.
The overall effect sizes for the primary recidivism outcomes
between ACTV and Duluth/CBT were in the small range (Cohen’s
d ⫽ .21–.47); however, these effect sizes represent the magnitude
of the difference between these two active treatments. Because of
the lack of a no-treatment comparison group, these effects sizes
underestimate treatment effects. For example, the small effect
sizes for BIPs that have been reported in meta-analyses are typi-
cally comparing Duluth and CBT to no-treatment control condi-
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tions. Therefore, although this study is preliminary, the current
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results are relatively positive for ACTV given the general marginal
impact of traditional BIPs in reducing domestic assault recidivism
(e.g., Babcock et al., 2004).
An obvious question is why an ACT-based intervention ap-
peared to have such an effect. There are several hypotheses to
consider. First, one possibility is that ACTV targets processes that
relate directly to decreases in aggressive behavior. Data have not
supported the theoretical tenets (e.g., patriarchal attitudes; Smith,
1990; Sugarman & Frankel, 1996) and treatment components (e.g.,
cognitive restructuring; e.g., Feder & Forde, 2000) of Duluth and
CBT models for BIPs. It is possible that the theory of change
underlying ACTV—that a reduction in experiential avoidance
leads to decreased aggression—and the associated techniques are
responsible for the positive behavior changes reflected by these
outcome data. This is an important question for future research.
A second possibility is that the flexibility of ACTV is more
suited to the heterogeneity of this population compared with the
one-size-fits-all model of traditional interventions. As noted by
Cantos and O’Leary (2014), there is substantial evidence to sug-
gest that men who engage in IPV represent a heterogeneous group
and, in turn, there is very little evidence to justify the current
practice of mandating all perpetrators to interventions addressing
power and control issues. By design, ACTV facilitators do not
make a priori assumptions about the causes of any one person’s
violent behavior; rather, they encourage the offenders notice and
identify the antecedents and consequences of their own individual
behavior while using the offenders’ personal experiences as fodder
for group discussion and skills training.
Third, the ACTV facilitator stance may have enhanced out-
comes. This is an interesting possibility in light of the fact that
facilitators in both conditions had training in motivational inter-
viewing, which has been associated with positive treatment out-
comes for BIPs (e.g., Kistenmacher & Weiss, 2008; Taft, Murphy,
Elliott, & Morrel, 2001). Given that the motivational interviewing
approach supports change that is in line with a person’s own
values, it may be better supported and utilized within the context
of the ACTV curriculum.
Finally, ACTV’s ability to significantly reduce violent recidi-
vism in general (instead of only domestic assault) compared with
Duluth/CBT was unexpected. Violent recidivism includes domes-
tic assault charges as well as child abuse, harassment, armed
robbery, stalking, assault, and willful injury. The skills training
included in ACTV is flexible and can be applied to all areas of the
participants’ lives, including but not limited to relationships with
one’s intimate partners. Therefore, it is possible that the broader
focus of ACTV has a greater impact on the participants’ behavior
repertoires such that they are able to apply new skills to a wider
array of situations.
Dropout/Attrition
The overall intervention noncompletion rate of approximately
30% in the current study is consistent with previous studies in-
volving domestic violence interventions that range from 22% to
78% (e.g., Jewell & Wormith, 2010). However, of interest in the
current study is the higher rate of noncompletion for men who
were assigned to ACTV (39% for ACTV and 27% for Duluth/
CBT). When looking at only those who did not complete because
of noncompliance or behavioral issues (a definition of dropout
commonly used in other studies), the dropout rate is 27% for
ACTV and 19% for Duluth/CBT. To further investigate this issue,
the authors obtained data from the DOC from more recent years
2014 –2015. These data indicated that the ACTV noncompletion
rate was 31% in 2014 –2015 (compared with 39% in 2011–2013).
This suggests that the attrition in ACTV may be explained by the
early implementation phase and the trial and error that occurred
during the ACTV roll out. Regardless, the higher dropout rate of
ACTV participants warrants further investigation in future studies.
Strengths and Limitations
This study has several methodological strengths. First, multiple
controls were put in place, such as equal number of sessions and
session length per intervention group, equal number of facilitators
per group, same treatment setting, same referral procedures (i.e.,
court mandated), and participants’ blindness to condition. These
controls address prior methodological concerns raised in the liter-
ature such as reliance on waitlist or no-treatment control groups
(Eckhardt et al., 2013). Second, the study was conducted in col-
laboration with the DOC across the entire state of Iowa, allowing
for the development of a treatment program uniquely tailored to
the agency’s needs and providing us with access to a large and
representative sample. Third, DOC employees, not research assis-
tants, were successfully trained in delivering ACTV, further en-
hancing the external validity of these findings and speaking to the
feasibility of implementing such an intervention in a real-world
setting. Fourth, the use of charges instead of convictions as the
outcome variable, the inclusion of multiple types of offenses in
addition to domestic violence charges, the relatively long recidi-
vism time frame (1 year instead of 3 or 6 months utilized in most
studies; Arias, Arce, & Vilariño, 2013), and the analysis of com-
pleters and noncompleters (see Eckhardt et al., 2013 for examples)
provides a more conservative and robust estimate of the findings.
Nevertheless, the results of this preliminary evaluation should
be interpreted in light of several limitations. First, as in many
real-world studies, it was not possible to randomly assign partic-
ipants to ACTV or Duluth/CBT because of scheduling complexi-
ties. Instead, participants were assigned to intervention groups
based on their availability and the groups offered during those
times. Although we controlled for factors that differed between
groups (i.e., race and employment status), nonrandom assignment
still leaves the possibility that the groups might have differed in
ways that could impact the results. Second, it is important to note
that recidivism data only indicate involvement with the law at the
 ACT FOR DOMESTIC ASSAULT
state level (not nationally), rendering it possible that some reoff-
enses were missed. However, there is no reason to expect different
rates of mobility between groups. Third, only administrative data
were examined in the current study. It will be important for future
studies to include self-report and victim reports because these data
will enhance our knowledge about treatment effectiveness. For
example, it is unknown which men were still in a relationship with
the victim (or a new partner) during the intervention or follow-up
period. Of note, data on processes related to mechanisms of change
and mediators of treatment outcome, such as experiential avoid-
ance and emotion dysregulation, will be particularly helpful in
determining why ACTV works.
Fourth, the lack of formal fidelity and competency measures
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make it impossible to determine whether ACTV and Duluth/CBT
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facilitators were fully adherent to their respective treatment man-
uals and protocols. Best efforts were made to control for this
common problem by providing structured training in the delivery
of each program before the study. According to DOC policy, all
facilitators were deemed competent in their respective intervention
before facilitating groups, and most received periodic assessments
of their performance. Finally, analyses for the completers (i.e., the
subsample of men who completed treatment) may be biased in
favor of ACTV because of the much higher rate of dropout in that
condition and the fact that most dropout reflected behavioral
noncompliance. However, participants who dropped out of ACTV
did not have higher rates of previous criminal charges at pretreat-
ment than participants who dropped out of Duluth/CBT, suggest-
ing that they were not more problematic cases at the outset.
Research Implications
More rigorous studies of ACTV are necessary, and some are in
progress. In addition to replicating the current findings in an
experimental design, as well as confirming that ACTV’s dropout
rate has stabilized at a lower level, several other research questions
will need to be addressed. Specifically, future research should
determine for whom and why ACTV is most effective. There is a
consensus that individuals resort to violence for different reasons
and have differing levels of risk, and these factors impact treatment
outcome (Cantos & O’Leary, 2014). Thus, examining moderators
of treatment outcome should be tested by future research. More-
over, as mentioned earlier, it will be important for future research
to examine the underlying theory of change and mechanisms of
treatment outcomes. Likewise, the present results do not provide
information as to which components of the ACTV program pro-
duce effects. Component analysis studies could elucidate the active
ingredients of the treatment program. Finally, the focus is on male
offenders in this study because they are disproportionately repre-
sented among cases coming into the system; thus, they appear to be
the most relevant for initially informing judicial decision-making.
However, the ACTV curriculum is gender neutral and is currently
being piloted with female offenders.
Clinical and Policy Implications
Historically, BIPs have had little measureable impact on domes-
tic violence recidivism, and more effective interventions are
needed. The current study indicates that ACTV is a hopeful direc-
tion in terms of feasibility, dissemination, and effectiveness spe-
265
cifically for domestic violence and more generally for violent
crime. If the current results are replicated in more rigorous studies,
then ACTV has potentially large implications for further develop-
ment of integrated justice and intervention services to address
violent recidivism. ACTV is also relevant philosophically as a
contrasting form of intervention that happens to be consistent with
shifts occurring in the criminal justice system toward empirically
supported practices (Andrews & Bonta, 2010). Indeed, correc-
tional treatments are often built upon nonscientific and “common
sense” theories of criminal behavior and a focus on punishment,
leading to programs that do not reduce recidivism. ACTV joins
other recent efforts to promote and disseminate empirically sup-
ported treatments, including CBT and ACT, in correctional sys-
tems (see Tafrate & Mitchell, 2013 for a review). Finally, based on
the success of ACTV, the Iowa DOC has recently adopted the title
“Iowa Domestic Abuse Program (IDAP)” to replace the previous
term Batterer Intervention Program. The change represents a shift
from a pejorative label on individuals to a focus on the behavior
being targeted.
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Received June 1, 2016
Revision received January 6, 2017
Accepted February 3, 2017 䡲