- Research
- Open access
- Published:
Women’s experiences of changes in related men’s impulsivity and domestic violence following men’s participation in the ReINVEST clinical trial
BMC Public Health volume 25, Article number: 2945 (2025)
Abstract
Background
Impulsivity, a behaviour often associated with reactive violence to perceived provocation or stress is a key risk factor for Domestic Violence (DV) perpetration. This study explores the experiences of women on related men’s changes in impulsivity and DV following men’s participation in the ReINVEST clinical trial that investigated whether the commonly used antidepressant sertraline would reduce impulsivity and domestic violence.
Methods
The study conducted in-depth interviews with 27 women ex(partners) and family members living in New South Wales, Australia. Critical Realism and Self-Determination Theory (SDT) underpinned the analysis and interpretation of findings.
Results
Most women (92.3%, n = 24) reported some or significant changes in impulsivity and DV or intimate partner violence (IPV) following the participation of related men in the trial. Many changes were reported at the individual (e.g., self-regulation), partner or family (e.g., feeling safer), and social levels (e.g., employment). Analysis using critical realism and SDT identified three themes (Determination to change, Enabling environment, and Continuum of changes) that illustrated the underlying mechanisms and causal explanations of the changes women experienced among themselves and the trial participants.
Conclusions
The experiences of women revealed the benefit of antidepressant sertraline in reducing impulsivity and DV or IPV when supported with other interventions (e.g., counselling and follow-up support by clinicians). The behaviour change processes described using critical realism and Self-Determination Theory (SDT) demonstrated the potential of SDT-grounded approaches in reducing impulsivity and its associated effects on intimate partner violence (IPV) or domestic violence (DV).
Trial registration
Australian New Zealand Clinical Trials Registry, ACTRN12613000442707, registered on 18/04/2013.
Introduction
Domestic violence, impulsivity, and violence
Domestic violence (DV) is a global health problem and a fundamental violation of human rights. DV involves physical, sexual, emotional/psychological, financial, social, and spiritual abuse occurring within various interpersonal relationships across all demographics [1]. The term DV is often used interchangeably with intimate partner violence (IPV). However, the latter refers to violence in romantic relationships between current or former intimate partners [2]. More broadly, violence can be defined as:
‘the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either result in, or has a high likelihood, of resulting in injury, death, psychological harm, mal-development or deprivation’ [3].
Both violence and DV have profound physical, mental, social, and economic impacts on individuals and communities. Globally, violence has been reported as one of the leading causes of death among people aged 15–44, with estimates indicating 20–40 hospitalised injuries for every person killed by violence [2]. Similar patterns are observed in DV. The Lancet’s global and regional estimates for IPV reported that 27% of women aged 15–49 have experienced physical or sexual intimate partner violence in their lifetime [4]. Reports from Australia reveal an increasing trend of violence and DV. For instance, between 2010 and 2019, the number of individuals incarcerated for violent offences increased by 49% [5]. Meanwhile, prevalence data show that over 2.7 million women and 1.1 million men have experienced DV since the age of 15 [6]. Although many incidents go unreported, and thus official figures likely understate the true extent of violence [7] - these data still highlight the magnitude of DV and the pervasive harm it inflicts and underscore the need for effective prevention and intervention strategies.
Domestic violence (DV) or intimate partner violence (IPV) is associated with impulsivity. A recent review defines impulsivity as an “individualized, normative, and multidimensional pattern of human decision-making behavior characterized by free will and insufficient reasoning due to the diminished reasoning process.” [8]. In the context of violence, impulsivity is often associated with reactive violence, which is an immediate response to perceived provocation or stress [9]. Impulsive, hyperactive, and inattention symptoms have been reported as risk factors for DV or IPV [10,11,12], and higher traits of impulsivity were observed among perpetrators convicted of DV or IPV [13, 14]. The link between impulsivity and violence is often mediated by neurocognitive, socio-economic, and psychopathological factors such as substance abuse, aggression, psychological abuse of victims, lack of premeditation, marital dissatisfaction, and residing in a disadvantaged neighborhood [15,16,17].
Interventions to address impulsivity and domestic violence or intimate partner violence
Different interventions have been implemented to address impulsivity and its associated outcomes with violence and DV or IPV. Interventions for the prevention of IPV have historically focused on law enforcement and psychotherapeutic measures [18], with a recent review indicating the effectiveness of small-group counseling, economic empowerment, community mobilization, and IPV screening and referral [19]. It was recognized long ago that services for the prevention of IPV or DV are inadequate without the involvement of perpetrators. Thus, there have been efforts towards working with men, who statistically perpetrate the majority of DV and IPV [20, 21]. Notably, interventions for women victims and survivors of IPV that included men were more effective than interventions for women only [19]. Perpetrator-centered interventions can be targeted at reducing impulsivity or the actions of the person of interest which, depending on specific behaviours (e.g., substance abuse), can vary greatly. For example, psychological interventions, including emotional regulation training and problem-solving strategies, and cognitive boosting interventions, particularly goal management training, have shown positive results in reducing impulsive choice and urgency [22, 23].
Arguably, randomized controlled trials (RCTs) provide the strongest empirical evidence [24]. There has been a proliferation of RCTs aimed at reducing impulsivity and the actions of IPV perpetrators, as well as related outcomes. Despite preliminary and experimental nature of available studies and differences in sample size, combined interventions (pharmacological combined with non-pharmacological) have shown promising results. For example, one RCT on the treatment of aggression with fluoxetine, an antidepressant, combined with alcohol treatment and cognitive behaviour therapy was effective in reducing aggression and partner abuse [25]. Similarly other RCTs have reported the effectiveness of adding an individualised motivational plan to IPV perpetrator interventions resulting in reduced physical violence and recidivism [26, 27]. However, effectiveness of perpetrator-focused interventions for IPV have generally remained inconclusive reporting mixed outcomes depending on the behaviour of perpetrator, and type, number and duration of interventions considered [28,29,30].
The ReINVEST intervention
ReINVEST stands for REducing Impulsivity IN Repeat ViolEnt Offenders Using a Selective Serotonin Reuptake Inhibitor (SSRI). It represents a randomized placebo-controlled double-blind clinical trial that investigated whether the commonly-used SSRI antidepressant sertraline, when administered to highly impulsive men with histories of criminal violence, would reduce impulsivity and violent offending (including domestic violence). The scientific rationale for this investigation was based on the known neurobiology of impulsive violence, where a strong relationship was found between aggression, impulsivity, and serotonergic dysfunction [31]. Findings from a 2010 open label trial that preceded the ReINVEST trial showed reductions in impulsivity (35%), irritability (45%), anger (63%), assault (51%), verbal-assault (40%), indirect-assault (63%), and depression following treatment with SSRI [32]. Following the award of a National Health and Medical Research Council partnership grant and funding from Justice Health New South Wales, participants in the ReINVEST program were recruited between 2013 and 2021. The study successfully screened 1,738 men for suitability, and 630 were randomized to receive either active (sertraline) or placebo treatment. In addition to providing sertraline as per the trial protocol, the trial included strong counseling support and regular follow-up with trial participants.
Purpose of the study
Recent studies showed that including women - whether victim-survivors or observers - is vital to understanding the effectiveness of violence prevention and intervention programs [33, 34]. Their unique perspectives often reveal daily shifts in men’s behaviour, highlight how changes may (or may not) take hold in real life, and underscore victim-survivor safety needs. However, many programs and studies remain solely perpetrator-focused, risking an incomplete picture of intervention outcomes. Given that women can provide first-hand insights into both the strengths and limitations of men’s behaviour change, their inclusion is essential for a more holistic and victim-survivor centered approach.
Building on this recognition, the purpose of this study was to explore how women - whether (ex)partners or other female relatives - experienced and observed changes in men’s impulsivity and domestic violence following men’s participation in the ReINVEST clinical trial. By including women’s voices, this study captures the perspectives of those who directly witnessed or were affected by men’s violent or aggressive behaviour. The study was poised to answer the following research questions: What were the impacts of the intervention? And what factors brought these changes about?
Methodology
Philosophical grounding and theoretical framework
This study is underpinned by critical realism, which posits that observable data (the empirical level) arise from underlying events (the actual) and deeper causal mechanisms (the real) [35, 36]. By acknowledging the conditions that produce observed phenomena, critical realism goes beyond simple cause-and-effect explanations. It employs analytic tools such as abduction (recontextualizing findings through theory) and retroduction (uncovering essential prerequisites for the phenomenon) [35, 36]. This approach has been successfully applied to thematic analysis in qualitative research and is suitable for explanatory qualitative research, where the aim is to produce causal explanations [37, 38]. This makes critical realism an appropriate choice for our explanatory aim: to explore the causal mechanisms behind the ReINVEST trial’s impact on impulsivity and domestic violence outcomes.
The study employed self-determination theory (SDT) to describe causal explanations and underlying mechanisms and substantiate the claims made in the analysis. SDT is a theory of human behaviour and motivation where behaviour is described as “a function of the conscious or nonconscious reasons or motives that organise it” [39]. Unlike other theories where motivation is considered a unitary phenomenon (i.e., the strength and amount of motivation to effect behaviour), SDT sees motivation as an ‘autonomy-control continuum’ to describe the extent to which behaviour and performance are intrinsically and extrinsically motivated. The theory is primarily used to analyse how socio-contextual factors drive behaviour and performance through fulfilling the psychological needs of competence, autonomy and relatedness [39, 40]. In SDT, autonomy is “the need to self-regulate one’s experiences and actions” and competence refers to people’s “basic need to feel effectance and mastery” while relatedness is the feeling of being socially connected [39]. SDT has been applied in different contexts, including schools and learning, workplace, sport and exercise, and to psychopathological conditions such as obsessive-compulsive personality, conduct disorders, and antisocial personality [39].
Inductive reasoning and applying abductive and retroductive processes in search of the prerequisites for the phenomenon led to the choice of this theory (see steps v and vi of the analysis section). The theory’s focus on behaviour and motivation, the factors used to analyse changes in behaviour (i.e., socio-contextual factors), and its applications to psychopathological conditions are congruent with the nature of impulsivity (as a human decision-making behaviour), its mediators (neurological, socio-economic and psychopathological factors) and the interventions used to address it (i.e., emotional regulation, problem-solving, and cognitive boosting).
Sampling and recruitment
A convenience sample of participants’ (ex)partners and family members was used to recruit interviewees. The research team approached trial participants who were still engaged with their ReINVEST clinician. The recruitment process involved clinicians asking ReINVEST participants to invite their (ex)partners or family members (women) to participate in the study. Interviewees were reimbursed $75.
Twenty-seven women participated in the interviews, representing 25 ReINVEST participants (100% of whom were men). The women varied in age, living situations, backgrounds, and their relational connections to the men. Although interviewees could identify as Aboriginal or Torres Strait Islander, not all were asked every demographic question. Because Aboriginality did not arise in discussions or relate to a specific focus of the research question, the authors opted not to further incorporate Aboriginal or Torres Strait Islander status.
Data collection procedures
Interviews were conducted by telephone between March and April 2022. The study also utilised a steering committee of experts including those with lived experience of DV to establish the study protocols.
Two interviewers conducted the interviews. Initially, a ReINVEST trial clinician completed three interviews while a research assistant observed. The clinician then observed the research assistant conduct two interviews to ensure standardisation. The research assistant then independently completed the remaining 22 interviews.
Interviews began with consent discussions and were fully recorded. The interviews collected data on the impacts, opinions, and other contextual information relevant to the ReINVEST intervention from the interviewees’ perspective. Although variation was present, these interviews were semi-structured and followed an interview schedule (Supplementary Material 1: Interview Guide). Input on the interview schedule was provided by a women’s advisory group, which included victim-survivors and other stakeholders. The interviews lasted, on average, 40 min (20–80 min) and were audio-recorded following receipt of written and verbal informed consent from participants. Interviewees were offered the opportunity to be debriefed by a ReINVEST clinician after the interview or at any time. Interviewees were also provided with contact details for support services. At the end of the interviews, Interviewees were invited to join a monthly all-women Zoom group to discuss these topics and debrief. An independent company transcribed this data in a simple, verbatim style before the data was migrated to NVivo for analysis.
Data analysis
The critical realist approach to thematic analysis [37, 38] was used to guide the analysis process. These approaches provided accessible steps for applying critical realist philosophy to qualitative data analysis, with a particular inclination towards the steps proposed by Fryer [37]. However, these steps were not strictly followed for two reasons. Firstly, the authors preferred to allow a natural flow of the analysis process, and secondly, there were elements in both Fryer [37] and Wiltshire and Ronkainen [38] approach that the authors raise some issues. For example, in Fryer [37] approach, themes are considered as causal explanations, which was not evident in our analysis. We retained the meaning of themes as housing codes and organising concepts [41] whereas causal explanations are best described using the themes collectively further substantiated by claims made from available evidence and relevant theory.
Analysis of the experiences of interview participants, the events that produced these experiences and the underlying mechanisms that caused the events were conducted simultaneously during the analysis. The analysis was inductively driven, first describing participants’ experiences through an iterative process of developing codes and organising themes while simultaneously recontextualising participants’ experiences using theoretical terms relevant to assigned codes and searching for theories that best explain the underlying mechanisms that were constructed from the data through the standardisation and growing pattern of assigned codes.
In summary, the analysis process included the following six steps: (i) de-identified transcripts were first migrated to NVivo version 14 for analysis and checked for completeness and consistent file names, (ii) the first author randomly selected and skim-read three transcripts from partner, mother and daughter interviewees to gather initial thoughts and make a decision on how to start coding the transcripts. The author also created a file named ‘notes from transcripts’ and started taking notes of observations from reading and coding of the transcripts, (iii) initial categories were developed using question topics from the interview guide (such as changes, motivation, medication, perception about trial, etc…). This helped to keep a bigger picture of the issues discussed while trying to relate and subset descriptive codes within the categories, (iv) re-reading and coding of transcripts continued with further standardisation of the codes. This involved ensuring that the codes captured diverse views of participants that surfaced as the reading of additional transcripts continued and simultaneously checking relevant terms used in the literature to confirm the authenticity of the descriptions applied or the terms used as latent codes. This process also involved conceptualising the relationships between codes and categories leading to the drafting of sub-themes and themes and establishing stratified levels of participants’ experiences, the events leading to these experiences and the underlying mechanisms that cause the events, (v) draft sub-themes and themes developed and the initial categories in step iii kept changing as informed by the coding process. The author also started to search for relevant theories that can explain the phenomenon while consolidating the possible causal explanation which could answer the research question, (vi) themes and sub-themes were further refined, schematic description developed, and the most suitable theory was chosen to anchor causal explanations to the available evidence and substantiate the claims made in the analysis.
The steps mentioned above were not wholly linear; particularly steps iii to vi involved an iterative process of going back to initially developed codes and organising themes, revisiting, refining and standardising these until the best possible representation of participants’ experiences and the phenomenon studied was achieved and the research question answered through an iterative process of the authors’ understanding and description of data, confirming and revisiting of such description using available literature and theory while ensuring validity.
Assessing and ensuring validity
Assessing and ensuring validity of the findings was undertaken in conjunction with the iterative process of developing codes and themes and establishing causal explanation throughout the analysis process. The authors implemented different strategies to ensure descriptive validity (how well the authors’ description of themes/sub-themes correspond to factual information) and interpretive validity (how well the analysis interpreted participants’ experiences) of study findings. Strategies included (i) re-reading of a section of a transcript while paying adequate attention to participants’ words including the tones expressed through their words, (ii) re-examining the context in which an interviewee responded to a question to avoid misinterpretation of their thoughts. This required consideration of the type of questions asked and situating a response within a larger section of the transcript both before and after the specific text was coded/interpreted, (iii) tallying verbatims from multiple interviewees to voice participants’ own words and ensure that their ideas and meanings are adequately and accurately interpreted, and (iv) comparing participants’ opinions between different sections of a transcript to capture its logical flow and avoid confusion in interpreting their perspectives.
Results
Participant characteristics
A total of 27 women representing 25 ReINVEST trial participants (14 Active treatment and 11 Placebo) participated in the interviews including 15 partners/spouses, 2 ex-partners, 8 mothers, 1 mother-in-law and 1 daughter of trial participants. One interview representing on trial participant was not included in the analysis due to use of interpreter. Partners and ex-partners had a median relationship length of 6 years (and a range of 1.5 to 25 years, n = 12) with trial participants. Most (88%, n = 15) relationships included children and 60% of these children were living with either one or both of their parents. Most (73%, n = 11) partners were living together at the time of the study. Seven women identified as Indigenous.
Themes
Three themes and several sub-themes were constructed through the analysis (Table 1). Figure 1 describes relationships between the themes. Supplementary Material 2 provides details of the themes and sub-themes.
Theme 1: determination to change
This theme captured women’s perception of trial participants’ primary motivation to participate in the intervention (ReINVEST clinical trial) and acquire a sense of purpose to make changes in their own lives and the lives of their partner and/or family. It also includes their perceived lack of competence in acting on their motivation.
Motivation
Most women interviewed (80%, n = 20) reported that trial participants were determined to change to better themselves before enrolling in the ReINVEST clinical trial. The women described different types of motivation.
For example, some trial participants were reported as being frustrated with their undesirable and consequential past self, had had enough of it, and were ready to change (reflective motivation). Some women described that the trial participants were looking more into themselves and finding a way to ‘become a better person’.
“I think he was fed up being in and out of jail.” (PID 4).
“…he has just made it to a point in his life where, okay I have had enough of this, it’s definitely not working…” (PID 9).
“He was open-minded, and he was open to it, to make a better person of himself.” (PID 17).
For others, the women indicated that the motivation for trial participants to change behaviour was linked to their close relationships and the parental responsibility of protecting and caring for significant others (relational motivation).
“That’s all he wants in life, to be the best dad he can be…” (PID 17).
[Partner speaking on behalf of trial participants] “…I’m going to do everything I can to make sure that I keep my family together.” (PID 9).
Some women noted that other trial participants did not initially seem motivated to change until their personal circumstances gave them a ‘wake-up call’ or a ‘turning point’ (circumstantial motivation).
“I think it was just a big wake-up call, what he’s going through at the moment…” (PID 19).
“The fact that he ended up in gaol for domestic violence recently on myself and a good friend of mine, I think that was his turning point, because that did wake him up and he did say to me, once he got out that it did scare him.” (PID 2).
A few women (15.4%, n = 4) also observed that several trial participants were not necessarily motivated to join the intervention but were either mandated or had other reasons to do so (legal or enforced motivation).
Interviewee: Well he had to join it. (PID 18)
Facilitator: Oh okay. So it was court ordered?
Interviewee: Yeah.
“The thing is that if he had done it, he could get his fines paid off.” (PID 14).
Women commonly reported that trial participants had more than one motivation to participate in the trial and commit themselves to change. For example, trial participant related to PID 9 had enough of their past and had also parental responsibility, and trial participant related to PID 13 was frustrated with their past self and was also mandated to change for the better.
“…he has just made it to a point in his life where, okay I’ve had enough of this, it’s definitely not working, I need help, I’m going to accept the help, I’m going to ask for the help and I’m going to do everything I can to make sure that I keep my family together.” (PID 9).
Facilitator: What was his motivation for participating? Did he see that there was a problem or was he kind of forced into it?
Interviewee: Bit of both, I think. (PID 13)
Perceived lack of competence
While most trial participants were motivated to change, there was a clear perception of constrained personal resources to make the change happen. They desperately needed help which they were ready to accept as long as it moved them toward their better selves.
“…he has just made it to a point in his life where, okay I’ve had enough of this, it’s definitely not working, I need help, I’m going to accept the help, I’m going to ask for the help….” (PID 9).
“I think that he needed that help, help him.” (PID 4).
Determination to change summary
The different types of motivation described above shows that motivations to join the trial and change one’s behaviour occurred as a continuum both in terms of the level of internalisation of how trial participants valued and were convinced of the change needed, and the variety of underlying reasons for their motivation. Such a continuum aligns with existing literature and theory on ‘taxonomy of human motivation’ where motivation is portrayed as a non-unitary phenomenon from no motivation and extrinsic motivation through to intrinsic motivation [40, 42].
The women reported that trial participants’ proactive evaluation of their past selves, readiness to let it go, and recognition of their social responsibility were primary. This demonstrated that trial participants may have had a sense of purpose and personal endorsement of the change needed in their behaviour. However, the fact that few participants were mandated to change their behaviour or did not necessarily have intrinsic motivation to join the trial highlights not all participants were in congruence with the required change. This is expected to result in different outcomes for the intervention (see Theme 3).
Even though women recognised trial participants’ determination to change, they acknowledged that the men often lacked the capacity to make this change happen and they required support to build their competence. Supporting a person’s competence to change behaviour provides efficacy to achieve desired goal or intended behaviour change. It can further facilitate internalisation of the motivation and result in the change needed [40]. The women not only bore witness to this but were active agents in being part of this change, as seen below in their role in the environment of the men.
Theme 2: enabling environment
Here we discuss women’s description of the conditions that built on trial participants’ motivation and facilitated the changes on the men and their partners or family. Women talked of the elements of the intervention and context as possible mediators of the changes they experienced.
The intervention
Women referred to the trial from two sides: the medication and the trial clinician’s counselling and support.
The benefits from the medication were described mainly through the changes experienced (Theme 3). However, some women saw the medication as helping to build trial participants’ motivation thus boosting their competence to change and engage in other programs.
“He is trying to change to be a better person. Hopefully, the medications just helping him to doing that.” (PID 24).
“I think maybe the medication is probably helping him stick on that [motivation to change], that straight and narrow. I don’t know” (PID 19).
Women spoke highly of the continuous counselling and support provided by trial clinicians during the intervention. They reported that the intervention was (i) agile, hands-on and friendly, (ii) supporting and engaging family members, and (iii) building respectful rapport.
Agile, hands-on and friendly
Women felt that ReINVEST supports were readily available and suited to their needs and the needs of their partner, son or father in a comfortable setting. They had a person to listen to and help with their concerns and the difficulties they and the men were going through.
“She [clinician] is so helpful. We can ring her at any time with anything and she’ll just– like she’ll help us with whatever she can and…like help us with whatever situation it is that we can– we’re going through.” (PID 1).
“It is just a more one-on-one approach, you’re able to actually sit down and have these talks and express whatever feeling or worry you’ve got, where in other situations you probably can’t.” (PID 16).
Supporting and engaging family members.
During the intervention, trial participants’ family members were proactively supported and engaged. Trial clinicians were inclusive, regularly checking on the wellbeing of partners, mothers and daughters of trial participants and helping them manage difficult circumstances.
“Just on face-to-face catch-ups she [clinician] doesn’t just talk to Mark [de-identified] she talks to both of us.” (PID 16).
“She [clinician] always asks how I’m doing. When dad was incarcerated she was ringing me up and checking up on me.” (PID 24).
Building respectful rapport.
Trial clinicians had close relationships with trial participants, and they did not judge the person and their family based on their criminogenic history. They treated and supported them with due respect.
“No one judges you, they don’t judge our family, they don’t look at us and think that we’re just another number or something. We’re actually real people and we do make mistakes…” (PID 9).
“…so we’ve got all of these people looking at us and they’re like he’s a bad [parent], you’re this, you’re that. Then we’ve got someone that’s actually read over everything and listened to our side of the story. We can tell that she [clinician] knows we’re not taking shit. She reads it from our view” (PID 19).
Context
Women’s support to their partners, sons and fathers and other contextual conditions contributed to facilitating the changes women experienced among trial participants.
Women’s support and assertiveness.
As partners, mothers and daughters of trial participants, women provided companionship while building the men’s confidence and supporting them to adhere to taking their medication. Some women reported becoming more assertive during the intervention period.
Women took an active role in the lives of these men, were active in appointments, offered them care, and provided the direct support trial participants needed to benefit from the trial (companionship).
“I’ve always been very much involved in all of it as well, to try and help him stay out of trouble…” (PID 19).
“…I know pretty much everything about it [trial]. I’ve been his carer from the very start.” (PID 24).
The women provided a positive push for trial participants to take the next step while correcting them when things were going in an undesired direction (confidence building).
“Since he’s moved back in, he’s still a little sloppy with a few things, but I’m hoping if I kind of push him a little bit more and go, well, come on, you’ve got this, it will improve.” (PID 2).
“…trying to be that person that’s [unclear], that’s not the right decision, come on let’s go and do something to take your mind off it.” (PID 19).
Women’s support also included helping these men comply with the medication, take these on time and avoiding possible skips (medication adherence support).
“The last couple of years I’ve been - I’ve set it up for him so that you can see where he’s at every day and he can just take it every day.” (PID 10).
Some women became more assertive, respecting and standing up for themselves, setting clear boundaries of their needs and interests and what they are able to allow in their relationship (becoming assertive).
“But I’ve also improved myself and I feel like I don’t have to take the kind of stuff he gives out.” (PID 10).
“Now, that I’m getting to the point where I’m standing up or myself, I don’t think he’s used to me standing up for what I deserve.” (PID 2).
Individual and social contextual conditions.
Trial participants were involved in complementary programs and services (e.g. anger management course, working with probation and parole, continuing a previously discontinued counselling support), and women felt that these programs had a synergistic effect with the medication received from ReINVEST.
“But he also did an EQUIPS course too, which went a long good with the medication.” (PID 14).
“…I think when we look at John [de-identified] from 12 months to now it’s been a combination of a lot of things as to why he’s where he is now.” (PID 7).
The programs and services helped trial participants gain experience, learn from like-minded individuals and manage their anger.
“I guess it [anger management course] just makes the men look at it from our side maybe. Or someone that’s looking in on what’s happening and then they can hear it from somebody else.” (PID 26).
“But doing those courses also opened his mind on how to react in situations that are not under his control.” (PID 9).
Some women attributed the changes to the men’s maturity as they assumed parental responsibility or quit some risky behaviours or undesired relationships.
“So I put it down to this trial and David [de-identified] both growing up and realising they’re a parent now and they’ve got a responsibility.” (PID 25).
“…he doesn’t go out with his mates anymore since he stopped drinking.” (PID 18).
Enabling environment summary
Participants enrolled in the clinical trial had, for the most part, a determination to change their behaviour (see Theme 1) and received multiple levels of support creating an enabling environment to make the change happen. Support from the intervention and other complementary programs and services constituted a community or social-level support for participants where the medication from the trial was building their motivation and enabling the changes experienced. Trial clinicians’ agile, friendly, inclusive, and respectful counselling and continuous follow-up provided a sense of worth and relatedness. The support from the intervention also had a synergetic effect on other skill-enhancing programs and services received during the intervention period, which further facilitated the changes. At the partner or family level, trial participants received caring and confidence building support from their women which helped to boost their competence and relationships and to continue taking their medication to change their behaviour. Individually, participants assumed maturity and parental responsibility and quit undesirable relationships and risky behaviours that women believed was contributing to the changes they experienced. These multiple level supports confirm women’s perception that the medication worked along with other influencing conditions in realising the changes they experienced among trial participants.
Theme 3: continuum of changes
This theme details the range of changes women experienced at the individual (trial participant), partner or family, and social levels following the participation of the men in the ReINVEST trial.
Women reported a continuum of changes in the men from none or minimal, to some and significant (Fig. 2).
The words of women made it clear that trial participants changed over the course of the intervention (Table 2).
Changes were reported at the individual (trial participant), partner or family and social levels with changes at the individual level often leading to changes at the partner/family and social levels. Women expressed many of the changes they observed in the men. Trial participants were able to self-regulate, exercise their responsibility and take care of their family. Women reflected some changes in themselves and their family as a result of the men’s involvement in the trial. There were also some changes beyond the trial participant and their immediate family, including employment and re-establishing social networks (social level changes) (Table 3).
Continuum of changes by treatment condition
Unblinded supplementary analysis of the continuum of changes women experienced among trial participants showed that the two study participants who reported no or minimal change (refer to Fig. 2) had their (ex)partner in the Placebo treatment condition while most of the women (61%) who indicated significant change had their ex(partner), son or father in the Active treatment condition (Table 4).
Continuum of changes summary
Underpinned by participants’ determination to change (Theme 1) and further supported by the trial’s enabling environment (Theme 2), this theme elaborated on the specific changes observed among participants, their partner or family and beyond. It was evident to observe that the changes among trial participants were leading to a continuum of changes experienced among partners or family and social levels demonstrating a multistage level impact of the intervention. There was, for the most part, significant approval by women of the changes they witnessed among the men particularly regarding their behaviour becoming stable and regulated further restoring relationships, making women feel safer and charting a new way for a positive, purposeful, and less turbulent family life. The findings also showed that changes were uneven with few women reporting none or minimal changes in their men and their relationships.
Discussion
Women who participated in this study reported changes in related men’s impulsivity and domestic or intimate partner violence following participation of men in the ReINVEST trial. As (ex)partners, mothers and daughters of trial participants, women experienced changes at individual (trial participant), family/partner, and social levels. Based on the analysis approach employed in this study, below we described the causal explanations and underlying mechanisms of the changes experienced. We further elaborated the findings in light of current evidence and future work on impulsivity and domestic or intimate partner violence.
Underlying mechanisms and causal explanations
Most women who participated in this study indicated that their related men were determined to change their behaviour before they were recruited by the trial. Determination to change behaviour was expressed as a combination of reflective, relational and circumstantial motivations. Through these motivations, trial participants exercised a proactive evaluation of their past selves and were ready to let that self go while recognising their social responsibility and demonstrating a sense of purpose and personal endorsement of the change needed in their behaviour. This shows that trial participants had autonomy, “the need to self-regulate one’s experiences and actions” where “one’s behaviours are self-endorsed, or congruent with one’s authentic interests and values” [39]. When motivation to change behaviour takes an autonomous form, there is a tendency to act, often referred to as “organismic supports for acting” in Self-determination Theory [40]. Autonomy is also considered a critical element for internalisation where a new behaviour becomes integrated within oneself gaining an inward worth in a person [40]. The mechanism through which autonomous motivation improves self-regulation is also supported by neurological processes where autonomous motivation has been shown to elicit increased brain sensitivity to self-regulation failure resulting in improved performance [43]. Furthermore, mounting evidence shows the determining role of autonomous motivation in behaviour change interventions such as smoking cessation and promoting healthy behaviours in affective disorders, attention deficit hyperactivity disorder (ADHD), and posttreatment depression severity [44,45,46,47].
We claim that the Intervention and Context described under the Enabling Environment theme provide the causal explanations for the continuum of changes women experienced among trial participants. While trial participants were determined to change their behaviour, they had lacked competence and were in need of help. Women’s caring and confidence building support and trial participants’ involvement in other programs (the Context) boosted trial participants’ confidence to change behaviour and improved their relationship with their partners. The medication and trial clinician’s agile, friendly, inclusive, and respectful counselling and follow-up support (the Intervention) gave trial participants a sense of worth and motivation to make positive changes in their life. For example, women clearly reflected the importance of the medication in building trial participants’ confidence to change their behaviour.
“I think it[medication] just gave him a belief within himself that he can be something”. (PID 7).
“He is trying to change to be a better person. Hopefully, the medications just helping him to doing that”. (PID 24).
Given some of the positive changes reported by women whose men were in the Placebo treatment arm of the trial, it is possible that expectancy effects may have also played a role.
Other findings arising from the trial found benefits in terms of reduced domestic violence in those on the trial compared to a control group who satisfied all inclusion and exclusion criteria but did not proceed to randomisation. Participants who had a longer engagement with ReINVEST also had fewer offences [48].
These change processes represent fulfilment of mutually reinforcing psychological needs for autonomy, competence and relatedness which have been extensively confirmed to facilitate improved performance or behaviour change [39, 40]. Perceived competence is a key target to focus on for promoting behaviour change and relatedness is a strong predictor of relationship outcomes [49, 50]. People are likely to adopt a goal or new behaviour when they feel that they have the necessary knowledge and skills (i.e. competence) to achieve the goal as actions that support competence enable the internalisation of changes needed [40]. Similarly, the internalisation of changes needed for a goal or new behaviour can be further enhanced by activities that support “a sense of belongingness and connectedness to the persons, group, or culture disseminating a goal” [40].
What the findings mean for current evidence on impulsivity and domestic or intimate partner violence
Women reported changes in both the men’s impulsivity (e.g., self-regulation and making positive decisions) and partner relationships (including lessened domestic/intimate partner violence). Positive changes were attributed to the support the men received during the intervention period. The women were convinced that the pharmacotherapy (sertraline) worked along with other supports including trial clinicians’ counselling, partners’ support and SSRI ‘enabled’ skill-building programs trial participants were able to access and complete once they were on the trial.
Existing evidence on the impacts of different interventions on impulsivity is mixed and inconclusive warranting further research. While there are studies showing the effectiveness of some interventions such as emotional regulation training, goal management training, and cognitive-behavioural therapy, the evidence including from systematic review and meta-analysis of RCTs is either limited to some interventions or the findings are preliminary and experimental lacking translation to clinical practice [22, 23, 51, 52]. Our findings provide preliminary insight into future research indicating that a combination of interventions targeted at men with a similar profile to the current study can be effective in reducing impulsivity.
Baseline characteristics of trial participants represented in the interviews were similar with the whole trial sample (Supplementary Material 3). However, women’s reports indicating improvements in participants’ impulsivity and related behaviours appeared, at first glance, different from the main quantitative psychometric findings of the ReINVEST trial. The main trial’s analysis during the double-blind phase did not detect statistically significant between-group differences (sertraline vs. placebo) on standardized measures of impulsivity. However, interpretation of these specific quantitative comparisons is limited by high participant attrition (> 50%) during the double-blind phase, which threatened the internal validity and statistical power for detecting changes in these self-reported impulsivity measures. It is noteworthy that reductions in impulsivity were observed during the initial 4-week single-blind run-in phase of ReINVEST, where all participants received sertraline. Furthermore, similar reductions were demonstrated in an earlier open-label pilot trial of sertraline in a comparable population [32]. Therefore, the positive changes reported by women in this qualitative study might reflect these initial drug effects observed pre-randomization or potentially capture genuine changes during the double-blind phase that the attrition-affected quantitative analyses lacked sensitivity to differentiate between groups. Additional factors contributing to the apparent discrepancy likely include other methodological differences, such as the specific sample characteristics (partners vs. participants, relationship status differences between samples) and partners observing broader behavioural patterns potentially influenced by the combination of medication and psychosocial support received within the trial. Further possible explanations were released as a separate methodological paper [53].
The positive changes in partner relationships (including lessened domestic/intimate partner violence) found in this qualitative study align with the overall quantitative results of the trial where administering SSRI showed a 21% reduction in domestic violence at 24 months post-randomisation [48]. Moreover, the combined effect of interventions claimed by women in the current study corresponds with existing evidence on IPV perpetrators. In an RCT by George, Phillips [25] the use of SSRI in conjunction with alcohol treatment and cognitive-behavioural therapy was found to be effective in reducing anger and physical aggression among alcoholic perpetrators of IPV. Several other studies including a systematic review of RCTs have also demonstrated the added benefit of incorporating additional activities (e.g., individualised motivational plans) into IPV perpetrator interventions in reducing IPV recidivism and treatment dropout, and increasing motivation to change and treatment adherence [27, 54,55,56,57].
Women provided companionship, confidence building and medication adherence support to the men and contributed their share to the positive changes in impulsivity and domestic or intimate partner violence reported in the current study. The inclusion and empowerment of women in IPV prevention can be viewed from two aspects. Firstly, including victim’s perspectives in the evaluation of domestic violence prevention programs not only provides a holistic view of how success or response should be measured for a meaningful relationship and lasting positive change but also avoids the one-size-fits-all response of prosecuting perpetrators and sheltering victims and thus addresses women’s varying needs [34, 58]. Secondly, risks to IPV have moved from a single factor to multi-level causes that include individual, immediate family, and societal issues [59]. However, the unequal position of women in a relationship is recognised as a significant structural precipitator of IPV thus the need to empower women [60]. While ReINVEST’s support to trial participants’ partners was not necessarily designed as a way of empowering the women and that we cannot claim the impact of such an intervention, women reported that they became assertive in their relationship and that this contributed to an ‘empowered’ negotiating space. There is evidence that women’s psychological need fulfilment for autonomy, competence and relatedness is protective against IPV perpetration by men [61].
Implications
The analysis process employed in the current study revealed a ‘natural’ fit of SDT in describing the change process observed among trial participants confirming the potential of SDT grounded approaches in reducing impulsivity and associated effects on IPV or DV. While SDT has not been specifically applied in impulsivity control, there is strong evidence in relevant fields that supports our claim on its potential. SDT-based theoretical framework has been able to provide strengths-based approach to the aetiology, treatment and positive behavioural outcomes in Attention-Deficit Hyperactivity Disorder (ADHD) offering a shift from the long held deficit oriented and ‘motivationally hedonistic’ mental health approach to the disorder [62]. SDT has also been used in interventions targeted at improving intimate relationships and reducing IPV. The role of autonomy, competence and relatedness has been indicated in optimal intimate relationship development and functioning [49, 63] and in preventing IPV perpetration by men [61].
In-depth exploration of the changes in impulsivity and DV or IPV presented in the current study testify the benefit of including women’s perspectives in interventions targeting related men. When supported with rigorous research design and analysis, women’s perspectives offer holistic insights into the causes and prevention mechanisms of men’s behaviour associated with DV or IPV.
Limitations
The findings in the current study are based on the analysis of a subset of the ReINVEST trial participants. Most women who participated in the interviews represented trial participants who had been in intimate relationships for a median of 6 years and had children. Thus, the claims made in the analysis apply to this specific group of population and cannot be generalised to all types of impulsive men in different settings and jurisdictions.
The reporting by women of the changes in impulsivity, IPV or DV and other impacts of the ReINVEST trial on their men has limitations similar to other proxy reporting. Women as partners, mothers, grandmothers or daughters of trial participants might not fully understand the changes that occurred among trial participants for reasons of communication barriers with their men, sensitivity of issues discussed, recall bias and other factors. This could result in (i) under or over-reporting of changes experienced or (ii) incorrect reporting of the presence or absence of changes among trial participants.
While unblinded supplementary analysis of the findings based on active and placebo treatment conditions of represented trial participants offered some insights (Table 4), the small sample size limited the ability to draw concrete conclusions from the comparative data. However, the reporting of some or significant changes by women whose related men were in the Placebo treatment condition suggests that expectancy effects may have influenced the results associated with the medication. Further limitations have been detailed in another publication [53].
Conclusions
Most women who participated in this study reported positive changes in the men’s impulsivity and DV or IPV following participation of their partner, son or father in the ReINVEST trial. The findings showed that treatment with SSRI coupled with counselling and follow-up support by clinicians, and women’s companionship, confidence building and medication adherence support to their impulsive men resulted in a continuum of changes among impulsive men and their partners. The behaviour change processes described using Self-Determination Theory (SDT) also revealed the potential of SDT-grounded approaches in reducing impulsivity and associated effects on IPV or DV.
Data availability
Data used for the purpose of this study are transcripts from individual interviews. Privacy of participants will be compromised if these data are shared publicly.
References
Australian Institute of Health. and Welfare Family, domestic and sexual violence: Australian Institute of Health and Welfare; 2024 [Available from: https://www.aihw.gov.au/family-domestic-and-sexual-violence
Krug EG, Mercy JA, Dahlberg LL, Zwi AB. The world report on violence and health. Lancet. 2002;360(9339):1083–8.
World Health Organisation. Definition and typology of violence, WHO.: 2002 [Available from: https://www.who.int/groups/violence-prevention-alliance/approach
Sardinha L, Maheu-Giroux M, Stöckl H, Meyer SR, García-Moreno C. Global, regional, and National prevalence estimates of physical or sexual, or both, intimate partner violence against women in 2018. Lancet (London England). 2022;399(10327):803–13.
Australian Bureau of Statistics. Prisoners in Australia Australian Bureau of Statistics; 2019 [Available from: https://www.abs.gov.au/statistics/people/crime-and-justice/prisoners-australia/2019
Australian Bureau of Statistics Personal Safety, Canberra A. Australian Bureau of Statistics 2021-22 [Available from: https://www.abs.gov.au/statistics/people/crime-and-justice/personal-safety-australia/latest-release#violence
Australian Bureau of Statistics. Defining the Data Challenge for Family, Domestic and, Sexual Violence ABS. Website2013 [Available from: https://www.abs.gov.au/statistics/people/crime-and-justice/defining-data-challenge-family-domestic-and-sexual-violence/latest-release
Al-Hammouri MM, Rababah JA, Shawler C. A review of the concept of impulsivity: an evolutionary perspective. Adv Nurs Sci. 2021;44(4).
Meidenbauer KL, Choe KW, Bakkour A, Inzlicht M, Meidenbauer ML, Berman MG. Characterizing the role of impulsivity in costly, reactive aggression using a novel paradigm. Behav Res Methods. 2024;56(2):690–708.
Buitelaar NJL, Posthumus JA, Buitelaar JK. ADHD in childhood and/or adulthood as a risk factor for domestic violence or intimate partner violence: A systematic review. J Atten Disord. 2016;24(9):1203–14.
Fang X, Massetti GM, Ouyang L, Grosse SD, Mercy JA. Attention-deficit/hyperactivity disorder, conduct disorder, and young adult intimate partner violence. Arch Gen Psychiatry. 2010;67(11):1179–86.
Shorey RC, Brasfield H, Febres J, Stuart GL. The association between impulsivity, trait anger, and the perpetration of intimate partner and general violence among women arrested for domestic violence. J Interpers Violence. 2010;26(13):2681–97.
Romero-Martínez Á, Lila M, Moya-Albiol L. The importance of impulsivity and attention switching deficits in perpetrators convicted for intimate partner violence. Aggress Behav. 2019;45(2):129–38.
Stanford MS, Houston RJ, Baldridge RM. Comparison of impulsive and premeditated perpetrators of intimate partner violence. Behav Sci Law. 2008;26(6):709–22.
Stuart GL, Holtzworth-Munroe A. Testing a theoretical model of the relationship between impulsivity, mediating variables, and husband violence. J Family Violence. 2005;20(5):291–303.
Vogel M, Van Ham M. Unpacking the relationships between impulsivity, neighborhood disadvantage, and adolescent violence: an application of a neighborhood-Based group decomposition. J Youth Adolesc. 2018;47(4):859–71.
Siever LJ. Neurobiology of aggression and violence. Am J Psychiatry. 2008;165(4):429–42.
Barner JR, Carney MM. Interventions for intimate partner violence: A historical review. J Family Violence. 2011;26(3):235–44.
Alsina E, Browne JL, Gielkens D, Noorman MAJ, de Wit JBF. Interventions to prevent intimate partner violence: A systematic review and Meta-Analysis. Violence against Women. 2023;30(3–4):953–80.
Turner W, Morgan K, Hester M, Feder G, Cramer H. Methodological challenges in Group-based randomised controlled trials for intimate partner violence perpetrators: A Meta-summary. Psychosoc Interv. 2023;32(2):123–36.
Harvey A, Garcia-Moreno C, Butchart AJGWHO. Department of Violence, Prevention I, Disability. Primary prevention of intimate partner violence and sexual violence: Background paper for WHO expert meeting May 2–3, 2007. 2007;2.
Martínez-Loredo V, Fernández-Hermida JR. Impulsivity-targeted selective preventive interventions and treatments in addictive behaviors. Revista de psicología clínica Con Niños. Y Adolescentes. 2019;6(3):1–7.
Anderson AC, Youssef GJ, Robinson AH, Lubman DI, Verdejo-Garcia A. Cognitive boosting interventions for impulsivity in addiction: a systematic review and meta-analysis of cognitive training, remediation and Pharmacological enhancement. Addiction. 2021;116(12):3304–19.
Barton S. Which clinical studies provide the best evidence? The best RCT still Trumps the best observational study. British Medical Journal Publishing Group; 2000. pp. 255–6.
George DT, Phillips MJ, Lifshitz M, Lionetti TA, Spero DE, Ghassemzedeh N, et al. Fluoxetine treatment of alcoholic perpetrators of domestic violence: a 12-week, double-blind, randomized, placebo-controlled intervention study. J Clin Psychiatry. 2011;72(1):60–5.
Lila M, Gracia E, Catalá-Miñana A. Individualized motivational plans in batterer intervention programs: A randomized clinical trial. J Clin Psychol. 2018;86(4):309–20.
Expósito-Álvarez C, Roldán-Pardo M, Gilchrist G, Lila M. Integrated motivational strategies for intimate partner violence perpetrators with substance use: A randomized controlled trial. Psychosoc Interv. 2024;33(3):187–200.
Stephens-Lewis D, Johnson A, Huntley A, Gilchrist E, McMurran M, Henderson J, et al. Interventions to reduce intimate partner violence perpetration by men who use substances: A systematic review and Meta-Analysis of efficacy. Trauma Violence Abuse. 2019;22(5):1262–78.
Karakurt G, Koç E, Çetinsaya EE, Ayluçtarhan Z, Bolen S. Meta-analysis and systematic review for the treatment of perpetrators of intimate partner violence. Neurosci Biobehav Rev. 2019;105:220–30.
Sousa M, Andrade J, de Castro Rodrigues A, Caridade S, Cunha O. The effectiveness of intervention programs for perpetrators of intimate partner violence with substance abuse and/or mental disorders. A Systematic Review. Trauma Violence Abuse. 2024;25(5):4188–203.
Krakowski M. Violence and serotonin: influence of impulse control, affect regulation, and social functioning. J Neuropsychiatry Clin Neurosci. 2003;15(3):294–305.
Butler T, Schofield PW, Greenberg D, Allnutt SH, Indig D, Carr V, et al. Reducing impulsivity in repeat violent offenders: an open label trial of a selective serotonin reuptake inhibitor. Australian New Z J Psychiatry. 2010;44(12):1137–43.
McGinn T, Taylor B, McColgan M. A qualitative study of the perspectives of domestic violence survivors on behavior change programs with perpetrators. J Interpers Violence. 2019;36(17–18):NP9364–90.
Westmarland N, Kelly L. Why extending measurements of ‘success’ in domestic violence perpetrator programmes matters for social work. Br J Soc Work. 2013;43(6):1092–110.
Bhaskar R. A realist theory of science. Routledge; 2013.
Danermark B, Ekström M, Karlsson JC. Explaining society: critical realism in the social sciences. Routledge; 2019.
Fryer T. A critical realist approach to thematic analysis: producing causal explanations. J Crit Realism. 2022;21(4):365–84.
Wiltshire G, Ronkainen N. A realist approach to thematic analysis: making sense of qualitative data through experiential, Inferential and dispositional themes. J Crit Realism. 2021;20(2):159–80.
Ryan RM, Deci EL. Self-determination theory: basic psychological needs in motivation, development, and wellness. Guilford; 2017.
Ryan RM, Deci EL. Intrinsic and extrinsic motivations: classic definitions and new directions. Contemp Educ Psychol. 2000;25(1):54–67.
Braun V, Clarke V. Thematic analysis: A practical guide. Sage. 2021.
Howard JL, Gagné M, Bureau JS. Testing a continuum structure of self-determined motivation: A meta-analysis. Psychol Bull. 2017;143(12):1346–77.
Legault L, Inzlicht M. Self-determination, self-regulation, and the brain: autonomy improves performance by enhancing neuroaffective responsiveness to self-regulation failure. J Pers Soc Psychol. 2013;105(1):123.
Morsink S, Van der Oord S, Antrop I, Danckaerts M, Scheres A. Studying motivation in ADHD: the role of internal motives and the relevance of self determination theory. J Atten Disord. 2021;26(8):1139–58.
Vancampfort D, Madou T, Moens H, De Backer T, Vanhalst P, Helon C, et al. Could autonomous motivation hold the key to successfully implementing lifestyle changes in affective disorders? A multicentre cross sectional study. Psychiatry Res. 2015;228(1):100–6.
Vancampfort D, Moens H, Madou T, De Backer T, Vallons V, Bruyninx P, et al. Autonomous motivation is associated with the maintenance stage of behaviour change in people with affective disorders. Psychiatry Res. 2016;240:267–71.
Williams GG, Gagné M, Ryan RM, Deci EL. Facilitating autonomous motivation for smoking cessation. Health Psychol. 2002;21(1):40–50.
Butler T, Akpanekpo E, Knight L, Robledo K, Greenberg D, Ellis A, Allnutt S, Wilhelm K, Jones A, Scott R, Ton B, Grant L, Mitchell P, Tynan R, Jones J, Villa D, Chappell D, Dixon C, Churchill A, Gebski V, Keech T, Schofield PW. ReINVEST - A randomised clinical trial of Sertraline for impulsive violence. Unpublished manuscript. 2025.
Patrick H, Knee CR, Canevello A. Lonsbary C. The role of need fulfillment in relationship functioning and well-being: a self-determination theory perspective. J Pers Soc Psychol. 2007;92(3):434.
Sheeran P, Wright CE, Avishai A, Villegas ME, Rothman AJ, Klein WMP. Does increasing autonomous motivation or perceived competence lead to health behavior change? A meta-analysis. Health Psychol. 2021;40(10):706.
Aguilar-Yamuza B, Trenados Y, Herruzo C, Pino MJ, Herruzo J. A systematic review of treatment for impulsivity and compulsivity. Front Psychiatry. 2024;15.
Khalifa NR, Alabdulhadi Y, Vazquez P, Wun C, Zhang PJFP. The use of combined cognitive training and non-invasive brain stimulation to modulate impulsivity in adult populations: a systematic review and meta-analysis of existing studies. Front Psychiatry. 2024;15:1510295
Thain E. You think that, again, that’s the medication: reflecting on qualitative methods for interviewing family members of violent and impulsive men in an intervention trial. Qualitative Res Psychol. 2023;20(3):471–501.
Santirso FA, Gilchrist G, Lila M, Gracia E. Motivational strategies in interventions for intimate partner violence offenders: A systematic review and meta-analysis of randomized controlled trials. Psychosoc Interv. 2020;29(3):175–90.
Lila M, Expósito-Álvarez C, Roldán-Pardo M. Motivational strategies reduce recidivism and enhance treatment adherence in intimate partner violence perpetrators with substance use problems. Front Psychiatry. 2025;16:1538050.
Pinto e Silva T, Cunha O, Caridade S. Motivational interview techniques and the effectiveness of intervention programs with perpetrators of intimate partner violence: A systematic review. Trauma Violence Abuse. 2022;24(4):2691–710.
Soleymani S, Britt E, Wallace-Bell M. Motivational interviewing for enhancing engagement in intimate partner violence (IPV) treatment: A review of the literature. Aggress Violent Beh. 2018;40:119–27.
Messing JT, Ward-Lasher A, Thaller J, Bagwell-Gray ME. The state of intimate partner violence intervention: progress and continuing challenges. Soc Work. 2015;60(4):305–13.
Stith SM, Smith DB, Penn CE, Ward DB, Tritt D. Intimate partner physical abuse perpetration and victimization risk factors: A meta-analytic review. Aggress Violent Beh. 2004;10(1):65–98.
Jewkes R. Intimate partner violence: causes and prevention. Lancet. 2002;359(9315):1423–9.
Petit WE, Knee CR, Hadden BW, Rodriguez LM. Self-determination theory and intimate partner violence: an APIM model of need fulfillment and IPV. Motivation Sci. 2017;3(2):119–32.
Champ RE, Adamou M, Tolchard B. Seeking connection, autonomy, and emotional feedback: A self-determination theory of self-regulation in attention-deficit hyperactivity disorder. Psychol Rev. 2023;130(3):569.
Knee CR, Hadden BW, Porter B, Rodriguez LM. Self-Determination theory and romantic relationship processes. Personality Social Psychol Rev. 2013;17(4):307–24.
Acknowledgements
The authors would like to thank Bianca Ton, Andrea Lee and trial clinicians for their support during data collection and interview of study participants.
Author information
Authors and Affiliations
Contributions
AKH conceptualized write up of the manuscript, conducted data coding and analysis and drafted the manuscript. ET, SC and TB contributed to conceptualization, methodology and result interpretation and reviewed the manuscript. PS and LK contributed to result interpretation and manuscript revision.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
The University of New South Wales granted ethics approval for the study (HC17771). Written and verbal informed consent was obtained from all participants prior to interviews. The study adhered to the Declaration of Helsinki.
Consent for publication
Not Applicable.
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
About this article
Cite this article
Hagos, A.K., Thain, E., Cox, S. et al. Women’s experiences of changes in related men’s impulsivity and domestic violence following men’s participation in the ReINVEST clinical trial. BMC Public Health 25, 2945 (2025). https://doi.org/10.1186/s12889-025-24056-6
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s12889-025-24056-6