Development and implementation of self-supportive intervention on post-traumatic stress symptoms and quality of life among battered wives of Madhya Pradesh, India: A pilot study

Introduction

The state of women who are victims of intimate partner violence is denoted by the word ‘battering’. This kind of violence against women is considered a worldwide health issue (Habigzang et al., 2018). Intimate partner violence which affects millions of women throughout the world every year can take the form of physical, sexual, or psychological harm (Liu et al., 2020). Intimate partner violence (IPV) is a serious form of abuse that affects both urban and rural parts of India, with negative consequences for the woman’s mental and physical health and a lower quality of life (Achchappa et al., 2017). According to the World Health Organization, approximately one-quarter of women will be subjected to experience severe physical and psychological violence during their lifetime by an intimate partner, such as being slammed, hit, or beaten (Breiding et al., 2014). As the country with the second-largest population in the world, India records many intimate partner violence cases across the country (Shubina, 2015).

Women who have been experiencing battering have various mental health issues than non-victims, including post-traumatic stress disorder. Increased physical, psychological, and social morbidity have been related to intimate partner violence, causing battering to be the most significant cause of female injuries (Shubina, 2015). According to Tirone and his colleagues (2021), among battered women, post-traumatic stress disorder is one of the most frequently diagnosed mental health conditions. The reenactment of traumatic events through recollections and dreams is a common sign of PTSD. Flashbacks and nightmares typically leave victims overly stirred, easily startled, and quick to anger as a result of which they are continually re-traumatized (APA, 2013). Further, the previous study suggests that traumatic relationship experiences can impact an individual’s personality, coping mechanisms, strength, and empowerment (Jojo & Sathiyaseelan, 2019). Furthermore, women who have been abused have been found to have chronic post-traumatic stress disorder, with symptoms continuing even after the assault has stopped.

In the context of India, due to many reasons such as fear, shame, and lack of understanding, victims of battering may not report these abuses. Moreover, women are impaired by loneliness, cultural differences, and inadequate information of services available to protect the rights and safety of women (White & Satyen, 2015). Women’s sorrow is exacerbated by a strong patriarchal household structure in which they have little control, limited opportunities for education, and unemployment. Thus, being a ‘good wife’ and ‘good mother’ is crucial and deeply ingrained in the minds of Indian women, which might make these women more vulnerable to ongoing battering, and most women who experience battering do not seek help outside their families (Evans et al., 2020). The cross-sectional data from India show a strong association between battering and self-reported post-traumatic stress disorder among battered women. Furthermore, battering leads to suicide; therefore, the need for psychological interventions is recommended (Malhotra & Shah, 2015).

Based on these findings, the current study developed a self-supportive intervention (SSI) program to lessen the symptoms of post-traumatic stress and to improve the quality of life among battered wives in India by combining mindfulness-based cognitive and emotional processing theories. Self-support is viewed as a tool that people can use to address their own challenges in daily life and advance their own growth (Das et al., 2020). A pilot study was conducted on the newly created SSI program to measure its viability and effectiveness.

Methods

Results

The goal of the current study was to target post-traumatic symptoms and quality of life among abused wives by developing a self-supportive intervention program that incorporated mindfulness-based theory and emotion processing theory. The newly designed self-supportive intervention program was assessed for its content and suitability in clinical practice by six specialists currently employed in mental health facilities and other associated medical and counseling sectors. The expert group consisted of one clinical psychologist, two family counselors, one psychiatrist, and two social work directors. The evaluators were given an adapted version of a standardized evaluation instrument created and used by the United States Agency for International Development (2006) to evaluate the content and validate its appropriateness in clinical practice. The evaluators were requested to validate the entire program and its suitability in clinical practice. One of the evaluators stated that the facilitator should be aware of the confidentiality of personal difficulties when administering it in group settings. If any of the participants inquire about counselling for personal clarification, that should be facilitated for them. The Self-Supportive Intervention (SSI) program received an overall grade of “A” from the experts, demonstrating its soundness, applicability, and viability. We carried out an inter-rater reliability test to ascertain the inter-rater dependability of the expert’s evaluation of the SSI program. The results indicated that the SSI program scored an inter-rater coefficient Alpha Value of .845 and an intra-class correlation coefficient value of .859. It shows that various factors of the SSI program were highly reliable and consistent. The six modules and their goals are listed in Table 1 for the Self-Supportive Intervention Program.

Table 2 displays the pretest-posttest mean scores and standard deviation values of the participants of the pilot study in terms of post-traumatic stress symptoms measured by the post-traumatic symptoms scale interview version for DSM-5 (PSS-I-5) and Quality of Life measured by the World Health Organization Quality of Life (WHO-QOL-BREF). The results showed that after the intervention program, the participant’s level of post-traumatic stress symptoms reduced, and their Quality of Life increased.

Table 2 also shows the paired sample t-test result of the variables. The pilot study demonstrated that after five weeks, a twice-weekly SSI intervention program resulted in a statistically significant decrease in the participants’ post-traumatic stress symptoms and increased Quality of Life. The total PSS-I-5 scores between the pre-test and post-test varied significantly (t=27.813; p=.001) and all the sub-variables of Quality of Life. The pretest and posttest scores in psychological (t=-31.231; p=.001), physical (t=-18.358; p=.001), social (t=-16.432; p=.001), environmental (t=-14.600; p=.001) and total scores of WHOQOL-BREF scale (t=-32.284; p=.001) also shown a substantial difference.

Ten battered wives who took part in the 11-week-long six-modular self-supportive program reported happiness and appreciation for participating in the pilot study. Furthermore, participants qualitatively reported improved mindful attention, improved quality of life and decreased symptoms of posttraumatic symptoms. One participant said that “The program significantly helped in my return to mental tranquility. I felt as though I were carrying a large stone in my chest. I was so sad, but now I’m joyful and free.” Another said; “It was really moving for me to realize the meaning and purpose of life. I’ll live and love my life.” All these results showed that the SSI program impacted participants’ lives and was an effective program to improve battered wives’ Quality of Life and reduce post-traumatic stress symptoms.

Discussion

The pilot study of the SSI program was a six-modular intervention program adopting mindfulness-based cognitive theory and emotion processing theory. This intervention program sought to evaluate its viability and determine its effects on the participants’ symptoms of posttraumatic stress and enhancing quality of life, as they performed all of the activities in each module. The current study’s results were supported by a previous study, stating traumatic relationship experiences might affect a person’s personality, coping skills, strength, and sense of empowerment (Jojo & Sathiyaseelan, 2019). In this perceptive, the newly developed self-supportive intervention results statistically supported and validated battered women’s quality of life and sense of empowerment by reducing the PTSD symptoms. An earlier study demonstrated that domestic violence is a serious public health issue that necessitates handling measures (Habigzang et al., 2018). Furthermore, intervention has severe influence on women’s ability to establish and maintain relationships, avoid social isolation, increase their self-acceptance and access social support (Jonker et al., 2019). According to American Psychological Association, due to flashbacks and nightmares, victims are regularly retraumatized, which causes them to be quickly startled, overly sensitive, and easily enraged (APA, 2013). The outcome of this intervention strongly suggests that the self-supportive intervention program is effective and has met the goals of the program. The findings of the pilot study support the assessments and evaluations made by the six mental health specialists, demonstrating the scientific validity of the self-supportive intervention program.

To ensure the homogeneity of the research circumstances, we thoroughly analyzed the demographic profile of the participants before the pilot-test. The results showed that the participants had frequently been battered and severely suffering from posttraumatic stress symptoms and had a need for supportive intervention as early as possible. Previous research supports that mindfulness-based cognitive techniques give relief from stress and foster a nonjudgmental awareness of one’s mental processes. By doing so, one can create a positive, healthy attitude toward the surroundings and develop the necessary coping mechanisms for dealing with difficult emotions (Tomfohr et al., 2016). The participants were able to admit that they lack the ability to significantly alter their environment, but they also learnt to be more accepting of their limitations and the realities of life after the program.

Conclusion

The Self-Supportive Intervention program had a significant positive effect on participants and it improved the quality of life among female victims of domestic violence by decreasing post-traumatic stress symptoms. Furthermore, the concepts and design of this program are reliable, feasible and effective for evaluating a larger population of female victims of domestic violence who have been suffering from posttraumatic stress symptoms. The findings of this research will be valuable for mental health professionals, particularly psychiatrists and clinical psychologists to recognize women’s post-traumatic stress symptoms in the early stage.