The Importance of Maintaining an Evidence-based Approach in CBT


In October 2021, The British Association of Behavioural and Cognitive Therapists’ (BABCP) published a piece in CBT Today by the founders of the ‘Women and Gender Minorities Equality Special Interest Group’ (WOMGENE). It suggested that implementing the following five recommendations would reduce violence against women, as follows:

“Five things you can do to help end violence against women and girls:

  1. Acknowledge and understand how sexism, male dominance and male privilege lay the foundation for all forms of violence against women.
  2. Examine and challenge individual sexism and the role that you play in supporting men who are abusive.
  3. Recognise and stop colluding with other men by getting out of socially defined roles and take a stance to end violence against women.
  4. Remember that silence is affirming. When you choose not to speak out against men’s violence you are supporting it.
  5. Educate and re-educate sons and other young men about their responsibility to ending men’s violence against women (”

As CBT is an evidence-based intervention that considers evidence both for and against ideas, I thought it would be prudent to present some of the research that contradicted the recommendations to the BABCP and its readership. Below is the response article I sent to the BABCP in November 2021. After three months it appears unlikely that this response will be accepted for publication in CBT Today, therefore I am publishing the full unedited version here below.

The original article

Incorporating accuracy and evidence to reduce violence engaged in by men.

The October edition of CBT Today ran an article called We cannot do this alone. This article was produced by the founders of the Women and Gender Minorities Equality Special Interest Group (WOMGENE). The article indicates that the authors, have themselves, experienced violence from men and I want to thank them for sharing. It can’t have been easy to express your frustration with the current situation. 

Most law abiding citizens, both men and women, want a reduction in violence engaged in by men. Women compose the vast majority of victims of sexual violence and domestic abuse, while men constitute most of the victims of murder and violence in public spaces (Office of National Statistics, 2020; Office of National Statistics, 2021a, 2021b).

The previous article made 5call to actions’ that claim, if adopted, would help end violence towards women and girls.With such a serious issue such as male violence, we want to make sure that the suggestions we propose, as a professional body, are effective and do not have an adverse impact on other populations that we may need to treat. 

As we are responsible practitioners I am excited to have the opportunity to examine the article’s suggestions for validity and to have the opportunity to incorporate contrary evidence so our thoughts and theories on the issues can develop further. 

As to be solution focused, I will examine the call to action for its evidence base and logical consistency. In its assertions and how successful it would be in reducing violence against women. I have done this, in part, through use of CBT techniques. As a number of premises were proposed along with recommendations this initial response article will address the first call to action. Future articles will explore the subsequent recommendations.

To make accurate, balanced descriptions regarding the world around us, it is necessary to consider the evidence both for and against a belief. I believe the original article explored some of the evidence for the recommendations and these articles can explore some of the evidence against it. Together we can come to a balanced position.

  1. “Acknowledge and understand how sexism, male dominance and male privilege lay at the foundation for all forms of violence against women.”

CBT therapists in general are wary of global beliefs, therefore, attributing sexism, male dominance and male privilege as the foundation of allviolence against women should warrant our attention.

Is it possible to imagine a setting where a male might use violence against a female and they are not in the dominant or privileged position? For example, an elderly man with severe physical and learning difficulties hitting their female carer?I am sure the reader can consider the men they have supported in the past and recognise that though men are frequently in the dominant position, due to their on average greater strength and economic power, there will be many instances when these generalisations do not apply.

In addition to this, women are now able to put themselves in authoritative positions where they are more likely to experience violence, such as the police and front line army positions. They will likely experience some violence that many of their male counterparts would have encountered for exactly the same reasons. As women were previously barred from these roles due to sexism then some of the violence these individuals will experience will have been due to a reduction in sexism. It would be wrong for us to deny women these roles however it does question if every violent experience a woman faces has sexism, male dominance and male privilege at its foundation.

So, if not all, what is the appropriate word? A lot? Some? The majority? Or would a percentage be more appropriate and if so how would it be quantifiable and measurable? How will we know what percentage of violence women are experiencing is due to reasons other than sexism, male dominance and male privilege? This nuance is important if we want to develop SMART goals as a society and as a professional body. 

Then we need to consider if a reduction in the imbalance of privilege would necessarily lead to a reduction of violence. For example in relationships where the average societal privilege, dominance or sexism differential is more equal, such as same sex relationships, would we see a decrease in intimate partner violence (IPV)? Though hard to measure the research suggests that IPV within gay and lesbian relationship may be either equal to or greater than heterosexual relationships (Messinger, 2011; Rollè et al., 2018; Turell, 2000). Reasons for violence in these relationships may be different to heterosexual relationships and rigourus research with and regarding perpetrators of IPV must be the foundation of any intervention recomended to reduce it.

As professionals, we shouldconsider whether a significant proportion of men who engage in violence to either men or women actually come from underprivileged backgrounds. Including early life exposure to interpersonal violence (Kar, 2019), drug and alcohol dependence (Parrott et al., 2003) and mental health problems (Scott et al., 2020). These possible contributing factors do not excuse the behaviour, or negate the need to do something about it, though they may lead to meaningful early identification and treatment models that might improve outcomes.

The previous article suggested that getting men to Acknowledge and understand how sexism, male dominance and male privilege lay at the foundation for all forms of violence against women will help end violence against women. Thissuggestion has been trialled and is continued to be used via the Duluth model. The Duluth Model was succinctly summarized by Bates et al (2017), researchers at the University of Cumbria and Central Lancashire.

“The Duluth Model was established in the United States in 1981 as an intervention derived from the Duluth Domestic Abuse Intervention Project [DAIP] (Pence & Paymar, 1993). The Duluth model curriculum was developed by activists within the battered women’s movement and five battered women (Pence & Paymar, 1993) who believed domestic violence was caused by men’s patriarchal ideology. The Duluth derived program therefore focused on re-educating partner violent men. Re-education (rather than treatment) was deemed appropriate as men’s violence to their intimate partners was understood as not “stemming from individual pathology, but rather from a socially reinforced sense of entitlement.” (Paymar & Barnes, ND). Using the “Power and Control Wheel” was central as partner violence was understood as being motivated men’s need for power and control over women. Women’s aggression was understood as self defensive.“ (Bates et al., 2017, p.3)

To consider if this approach is substantially more useful than any other we can look at three literature reviews. A 2004 meta-analysis of 22 separate domestic abuse programs showed that though the Duluth Model did have a small effect size it did not significantly differ from any other treatment model offered (Babcock et al., 2004). Babcock et al (2004) concluded that the treatments had “minimal impact on reducing recidivism beyond the effect of being arrested”.

A 2005 meta-analytic review of 10 court-mandated batterer programs which frequently used the Duluth Model did “not provide confidence that these programs will be found to be effective” (Feder and Wilson, 2005 p.258) and recommended the criminal justice system look for alternative interventions to address the problem of domestic violence .

A 2013 meta-analytic review of 19 research articles by Arias et al. (2013) concluded “On the whole, the treatment of batterers had a positive but non statistically significant effect. As for some specific treatments, it may also have had considerably negative effects both in ORs [official report] and CRs [couples reports]” (p.158) and “The lack of a significant treatment effect in the Duluth Model and CBT Programmes corroborated the findings of Babcock et al. (2004)” (Arias et al., 2013, p.158-159)

A disappointing feature found in Arias et al.’s (2013) study was that when efficacy of an intervention was examined by an external researcher, they were more likely to find a negative outcome of the intervention. Though this was not confirmed as causal, the author noted that the continuity of some of these programs was dependent on positive outcomes.

Bates et al (2017) of Cumbria and Central Lancashire University go further with their criticism of the Duluth Model and state that “Research has been consistent that such approaches [Duluth and Duluth/CBT hybrids] are not effective” p3. Attributing the models failing due to not accounting for emotional dysregulation, bidirectional IPV as well as social, developmental and biological contributors to IPV.

The limits of the Duluth model’s theoretical, rather than evidenced based, approach towards gendered violence was eventually recognised by one of the founders Ellen Pence. 

“Speaking for myself, I found that many of the men I interviewed did not seem to articulate a desire for power over their partner. Although I relentlessly took every opportunity to point out to men in the groups that they were so motivated and merely in denial, the fact that few men ever articulated such a desire went unnoticed by me and many of my coworkers. Eventually, we realized that we were finding what we had already predetermined to find” (Pence, 1999, p 29)

Pence (1999) noted that societies unwillingness to support and believe abused women, led to a gendered based counter belief that was just as unhelpful.

“For more than a decade, the DAIP and shelter advocates reacted to the constant undercurrent of “women are liars” by arguing that “women are saints”. In many ways, we turned a blind eye to some women’s use of violence, their drug use and alcoholism, and their often harsh and violent treatment of their children. There did not seem to be a way to acknowledge these problems and still argue that this was a deeply gendered issue and that women were being subjected to repeated acts of intimidation and coercion very different from what men were experiencing as a group within marriages.” (Pence, 1999, p 30)

The above are selective quotes from Pence’s later work and she maintained many of the beliefs around power structures that favoured men. I would encourage you to read the original document if you have the time.

Unfortunately the relationship between critical academic researchers and activist based interventions appears to have soured. Bates et al. (2017) found that some domestic violence perpetrator programs that take a particular ideological, usually feminist oriented, position are now suspicious of researchers attempting to scrutinise treatments and refused to engage in her research.

Based on the academic literature I found, getting men to Acknowledge and understand how sexism, male dominance and male privilege lay at the foundation for all forms of violence against women is a key component of the Duluth Model and its efficacy at reducing violence by men towards women is contested.

The causes and prevention of men turning violent is a serious matter and we should use every evidence-based tool at our disposal to engage with them, recognise the causes and petition those in power to implement interventions that work. Theories are a very useful place to start, however, if their efficacy is not clear or is not verifiable then we are to explore alternative theories, collect different information and consider that our theory may have been wrong or create an incomplete picture of the situation.

I found writing this article enlightening and during the course of it recognised that even in academia there are biases on both sides with vested interests in being right. The evidence and arguments I have proposed here are selective. I would encourage the reader to explore the range and often contradicting evidence themselves. 

What is required to reduce male violence will unlikely have a ‘one size fits all’ solution and will require honest engagement with all of the evidence available. It may require us to move away from the clear perpetrator/victim narrative, if we are to engage with and meet the needs of those at increased likelihood of becoming violent.

I look forward to reviewing the other recommendations of the founders of WOMGENE in my subsequent articles. If you have any thoughts regarding this response please e-mail me at


Arias E, Arce R and Vilariño M (2013) Batterer intervention programmes: A meta-analytic review of effectiveness. Psychosocial Intervention. DOI: 10.5093/in2013a18.

Babcock JC, Green CE and Robie C (2004) Does batterers’ treatment work? A meta-analytic review of domestic violence treatment. Clinical psychology review 23(8): 1023–1053.

Bates EA, Graham-Kevan N, Bolam LT, et al. (2017) A review of domestic violence perpetrator programs in the United Kingdom. Partner abuse 8(1). Springer: 3–46. Accessed:

 Office for National Statistics (2020) Homicide in England and Wales. Available at: (accessed 5 April 2021).

Feder L and Wilson DB (2005) A meta-analytic review of court-mandated batterer intervention programs: Can courts affect abusers’ behavior? Journal of Experimental Criminology. DOI: 10.1007/s11292-005-1179-0.

Kar HL (2019) Acknowledging the victim to perpetrator trajectory: Integrating a mental health focused trauma-based approach into global violence programs. Aggression and violent behavior 47: 293–297.

Messinger AM (2011) Invisible victims: same-sex IPV in the National Violence Against Women Survey. Journal of interpersonal violence 26(11): 2228–2243.

Parrott DJ, Drobes DJ, Saladin ME, et al. (2003) Perpetration of partner violence: effects of cocaine and alcohol dependence and posttraumatic stress disorder. Addictive behaviors 28(9): 1587–1602.

Pence E (1999) Some thoughts on philosophy. Coordinating community responses to domestic violence: Lessons from Duluth and beyond: 25–40.

Rollè L, Giardina G, Caldarera AM, et al. (2018) When Intimate Partner Violence Meets Same Sex Couples: A Review of Same Sex Intimate Partner Violence. Frontiers in psychology 9: 1506.

Scott K, Oliver CL and Cheng P (2020) Perpetrator mental health: depression and suicidality as risk factors for domestic homicide. Preventing Domestic Homicides. DOI: 10.1016/b978-0-12-819463-8.00007-1.

Office for National Statistics(2021a) Nature of sexual assault by rape or penetration, England and Wales . Available at: (accessed 19 April 2021).

Office for National Statistics.(2021b) The nature of violent crime in England and Wales – . Available at: (accessed 10 May 2021).

Turell SC (2000) A Descriptive Analysis of Same-Sex Relationship Violence for a Diverse Sample. Journal of family violence 15(3): 281–293.

The views written are that of the Author’s and do not represent their employer or any of their registering bodies”

By Rory Laing

Rory is the proud father of two boys aged 1 and 5. He trained as a Social Worker, receiving his MA at the University of York in 2014. He subsequently completed his PGDip in Cognitive Behaviour Therapy at the University of Surrey and is currently studying for his PHD.

If you are a CBT therapist that is registered with the BABCP, please join me to ensure practice is rooted in evidence. Join me in establishing a Special Interest Group that is dedicated to defending evidence-based enquiry in CBT, both in the therapy room, and within our profession please contact me via

One comment

  1. The Duluth Model is propaganda as so many of these gender feminist contributions are. We have known this for 50 years. We put up with these malcontents to humor them because we do not want them acting out their histrionics on the rest of us. We thought it was better to patronize them publicly, and then do what we knew works in our own clinical practices. Now, unfortunately, we can no longer humor them because they have become dangerous. In actuality we were wrong 50 years ago. They were always dangerous.

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