"Interaction Between Self-Efficacy and Domestic Violence: Real World Applications" by Catherine Baz

Interaction Between Self-Efficacy and Domestic Violence: Real World Applications

Catherine Baz, University of Massachusetts Dartmouth



Abstract: This paper explores the interaction between self-efficacy and domestic violence across the lifespan, and throughout the stages of domestic violence relationships. Survivors of domestic violence often experience PTSD; this can hinder survivors from leaving, as well as impact their current and future relationships. Self-efficacy helps survivors manage PTSD symptoms, and reduces trauma-related shame (DeCou et al. 2015, DeCou et al. 2019). Self-efficacy also protects against resource loss which exacerbates PTSD symptoms and decreases an individual's ability to recover from trauma and leave an abusive relationship (Walter et al. 2010, Lerner & Kennedy, 2000). Research suggests that fostering self-efficacy in survivors of domestic violence helps in recovery, and is crucial to sustaining independence after leaving an abusive relationship. This paper reviews relevant literature, and discusses implementation of self-efficacy in the form of a resource manual for domestic violence survivors who are leaving their abuser. The manual was created to foster the development of self-efficacy in its users through the ease of use, successful attempts at getting help on their own, and increased self-reliance.


Keywords: Domestic violence, self-efficacy, coping self-efficacy, childhood abuse, sexual assault, interventions, resource gain, resource loss



Introduction


Self-efficacy has been defined as an individual’s sense of agency and perception of their ability to perform certain actions, alongside the cognitive awareness that these actions can be performed successfully (Bandura et al, 1999). Self-efficacy has also been defined as the sense that one has the sole authorship over one's actions, thoughts, and emotional experiences, that one has both volition and control over one’s behavior, and lastly that one is the architect of one’s intentions and plans. The definition of self-efficacy describes a state that is in direct opposition to the feelings that arise from PTSD and trauma. Abuse takes away an individual's control, autonomy and robs them of being the architect of their own plans (Lerner & Kennedy, 2000). The relationship between self-efficacy and abuse is important, as self-efficacy acts as a protective factor from PTSD symptoms despite the severity of abuse, as well as mitigating the effect of trauma related shame on PTSD symptoms (Diehl & Prout, 2002, DeCou et al. 2019, DeCou et al. 2015).


Self-efficacy supports the maintenance of personal resources, which are key in leaving an abusive relationship and recovering from PTSD (Walter et. al, 2010, Lerner & Kennedy, 2000). Trauma affects an individual's self-efficacy across a lifetime, from childhood into adulthood. Victims of childhood sexual abuse and childhood physical abuse are more likely to experience secondary victimization, which can exacerbate and maintain symptoms of PTSD (Walter et. al, 2010). For this reason, it is vital to understand the interaction between abuse and self-efficacy, to lower PTSD symptoms, and support survivors in leaving and maintaining healthy future relationships. Through gaining this understanding, we can create interventions to support victim self-efficacy, increase self-efficacy. These interventions help create an upward spiral of resource gain, rather than the downward spiral caused by resource loss and PTSD which is common when leaving an abusive relationship (Sullivan, 2017, Johnson & Zlotnick, 2009).


Effects of Abuse on Childhood Self-Efficacy


Childhood sexual abuse compromises the victim's sense of self-efficacy due to PTSD resulting from the abuse. Symptoms of PTSD interfere with exercising self-efficacy and include decreased self-awareness, hypervigilance, poor interpersonal relations, and poor self-image. Beginning in middle school, maltreated children show lower self-efficacy than non-maltreated peers; self-reporting they are less competent than non-maltreated peers (Diehl & Prout, 2002). As children age their cognitive gains allow them to assess their internal traits, making these formative years key to the development of strong self-efficacy. Abuse of a child, whether it is sexual, physical, and/or psychological disrupts the development of the child's self-perception. During these formative milestones, an abused child’s focus is on surviving external threats instead of developing the self-awareness to tend to their own needs, thoughts, and desires (Harter, 1999)


Childhood sexual abuse shifts a child’s locus of control from internal to external (Diehl & Prout, 2002). The locus of control is the degree to which an individual believes that they, as opposed to external forces, have control over the outcome of events in their lives. This is demonstrated by cognitions of adults who have been sexually abused as children. Women who suffered sexual abuse as children are more likely to blame themselves for negative events, in addition to attributing causes external to themselves for positive events (Paunovic, 1998). Sexually abused children self-report reduced interpersonal trust, self-blame for negative events, and a sense of being different from non-abused peers (Mannarino et al., 1994).


High levels of self-efficacy have been shown to correlate with better emotional health, while lower levels have been shown to correlate to less effective emotional regulation skills (Saarni, 1999). Emotional regulation is the ability to control one’s subjective experience of emotion, especially its intensity and duration, in addition to being able to express the emotion to another person. Emotional regulation contributes to individuals' overall sense of self-efficacy, and sexually abused children are less likely to use their emotional-regulation skills effectively (Saarni, 1999). Two main types of emotional-regulation strategies are problem-solving strategies and emotion-focused strategies. Problem-solving strategies include solace seeking, and help-seeking, activities that actively attempt to respond to what is causing the emotional disturbance. Whereas emotion-focused strategies use distraction and avoidance. These emotion-focused strategies are similar to the symptoms experienced by individuals with PTSD, as they involve disassociation of the self from the situation (Saarni, 1999).


This phenomenon was investigated by Walter et. al (2010) who investigated the role of childhood abuse and subsequent PTSD on later resource loss. Trauma in childhood disrupts the ability to learn the resource acquisition process, and PTSD inhibits healthy emotional regulation that leads to avoidance of resource networks (Walter et al., 2010). When individuals cannot develop and maintain a resource pool they are more vulnerable not only to stress but resource loss. Over time resource loss reduces an individual's ability to cope and thrive after trauma, as resources include; interpersonal resources such as assistance from friends and coworkers, family resources such as help with tasks at home, and material resources like food and shelter. This resource loss has been shown to predict the development and maintenance of PTSD (Walter et. al, 2010). Low self-efficacy in individuals with PTSD leads to a more limited ability to obtain, foster, and protect resources, as these require self-efficacy in many different areas. PTSD symptoms may be perceived by the individual experiencing them, as a failure to effectively manage their own emotions, lowering their self-efficacy. Childhood abuse is positively related to both PTSD symptoms and later resource loss (Walter et. al, 2010). It is important to note that PTSD symptoms were shown to be negatively correlated to self-efficacy, and positively correlated with resource loss. This suggests that self-efficacy acts as a protective factor against resource loss after the experience of childhood abuse. Negative effects from PTSD such as resource loss may be mitigated by protective self-cognitions including self-efficacy. These findings suggest that fostering protective self-cognitions in women with PTSD following childhood abuse may be critical to the prevention of later resource loss (Walter et al, 2010).


Effects of Abuse on Adult Self-Efficacy


Resource loss may occur through an individual's inability to maintain a resource network, but also through negative social reactions to an individual's sexual assault and PTSD symptoms. Negative social reactions to disclosure of sexual assault are associated with deleterious outcomes for survivors, including an increase in PTSD symptoms, and lower perceived control after trauma. These reactions and the subsequent outcomes lead to lowered self-efficacy, which hinders individuals from thriving. Survivors of trauma often experience trauma-related shame, which is defined as “a negative evaluation of the self in the context of trauma with a painful affective experience, and a behavioral tendency to hide and withdraw from others to conceal one’s own perceived deficiencies” (DeCou et al, 2019). This is notably a predictor of PTSD symptoms.


A protective factor against trauma-related shame is trauma coping self-efficacy, which is an individual's perception of their ability to manage the demands of recovery after trauma. Self-efficacy is extremely important in symptom management of PTSD, and trauma recovery. These results emphasize the importance of psychotherapeutic interventions that directly address shame and coping self-efficacy. Interventions that foster coping self-efficacy are important in the treatment of PTSD not only to reduce PTSD symptoms but also due to their ability to counterbalance trauma-related shame. Such interventions may be of particular importance to survivors who have experienced negative social reactions to their sexual assault (DeCou et al., 2019).


Domestic violence coping self-efficacy has been shown to moderate the association between severity of partner violence and PTSD symptoms. Recent partner violence had a significant association with PTSD symptoms, this association was moderated by domestic violence coping self-efficacy. Participants with the lowest levels of domestic violence coping self-efficacy had the highest levels of PTSD symptoms (DeCou et al, 2015). In the same study, this interaction was also found in individuals with average levels of domestic violence coping self-efficacy. Domestic coping self-efficacy was also shown to be a protective factor against the symptoms of PTSD even in light of recent partner violence.


When women are faced with the difficult process of leaving a violent relationship, self-efficacy moderates PTSD symptoms, and helps women navigate the complex nature of escape. High self-efficacy is needed to overcome the barriers of the external environment, family and social role expectations, psychological consequences of violence, and lasting effects from childhood abuse and neglect (Lerner & Kennedy, 2000). Self-efficacy in battered women is integral to their readiness to seek change, as individuals undertake changes they feel confident they can manage but avoid those they believe exceed their coping abilities. Self-efficacy is also viewed as essential to the maintenance of action, which is especially important when leaving a domestic violence situation as many battered women return to abusive relationships after leaving them due to unforeseen hardships.


Lerner and Kennedy’s 2000 study examined 191 women in different stages of an abusive relationship. They found that women who had most recently left a violent relationship reported the highest level of trauma symptoms, as well as the most significant difference in functioning. This group may be the most psychologically vulnerable, and in most need of interventions that foster a sense of self-efficacy to help mitigate the effects of PTSD. Emotion-focused coping was found to have a meaningful inverse correlation to self-efficacy. The strongest temptation to return to the relationship was reported by women using emotion-focused coping (Lerner & Kennedy, 2000). When assisting women who are in this difficult process, fostering self-efficacy can decrease the temptation to return due to an increase in situational self-efficacy, or the feeling they are equipped to overcome the barrage of challenges they face in leaving a domestic violence relationship.


Unfortunately, the nature of PTSD decreases the protective factor of self-efficacy, especially as PTSD symptoms lead to resource loss, poor coping skills, and potential revictimization. The development of survivor self-efficacy is vital in all stages of abuse; to enable women to leave, foster their determination to stay out of the relationship, and ensure that they will not re-enter an abusive relationship. To best support individuals with PTSD from domestic violence, there must be an understanding of this interplay, to foster the health of their relationship with themselves and others.


Correlation between resources and domestic violence


The societal context of domestic violence must always be considered. The “universal risk theory”, which is popular in feminist literature, obscures class issues related to domestic violence against women through an overfocus on gender (Evans, 2005). The universal risk theory states that all women are at risk of being victimized due to their gender. Evans (2005) puts forth that the universal risk theory is an incorrigible proposition because it is contradicted by empirical evidence to the contrary and because many of its supporting studies lack solid methodological and/or conceptual foundations. It has been consistently shown that class in addition to gender, predisposes women to a higher rate of violence than gender alone. In Australia, for example, women in poverty are more than seven times more likely to be killed by a partner or ex-partner than women from a higher socioeconomic area (Evans, 2005).


Not only are women in poverty more at risk for violence, but they also face additional barriers to receiving help. Poverty and class limit mobility within a culture due to a lack of resources, along with other hidden barriers such as shame and stigmatization. Income-assisted single mothers with cumulative trauma and PTSD are more exposed to social strain and deteriorated personal and interpersonal agency (Samuels-Dennis et. al, 2010). While the mothers' neighborhood of residence was not shown to mediate the relationship between cumulative trauma and PTSD, the mother's personal resources were. This shows that despite difficult circumstances when a mother in need is given the lifeline she needs to access resources, she can increase her self-efficacy and decrease the PTSD symptoms holding her back. This study is especially relevant as the women we work with are often made single mothers by their decision to leave their partners, and many of the women we work with are receiving assistance from the government or seeking it.


Development of a Resource Manual for Survivors of Domestic Violence


Women’s economic resources not only affect their mental health but also mediate the relationship between the severity of intimate partner violence and health outcomes (Ford-Gilboe et. al, 2009). As discussed in the literature review above, providing women with resources allows them to gain skills in self-efficacy, which leads to an increased sense of self and future ability to access resources. To that end, we developed a simple, easy-to-use resource manual to enable survivors of domestic violence to access the resources they needed to gain and maintain independence from their abuser. The simplicity of use will lead to women’s confidence in their abilities to access resources on their own and begin the upward positive spiral of resource gain. The manual was created to foster the development of self-efficacy in its users, through ease of use, successful attempts at getting help on their own, and increased self-reliance. The manual was created to suit the needs of the clients served by the Domestic Violence Clinic, a legal services center at Northeastern University, located in Boston, Massachusetts. Services listed were tailored to past client needs and created to suit the most common client the clinic served. Clients of the clinic are almost exclusively female, victims of intimate partner violence, who are working with the clinic to receive free legal services such as restraining orders, enforcement of restraining orders, criminal interventions, and violence prevention. The majority of the population lives in the greater Boston area, although there are clients outside of this area. Manual covered accessible resources across three counties in Massachusetts; Suffolk, Bristol, and Middlesex. These locations were chosen based on where the majority of the clientele were located. Obstacles clients commonly face include housing instability, food insecurity, and poverty.


As each client will have different needs at different times, the areas the manual covered were purposefully all-encompassing. The manual was designed so a woman could use it throughout the entire process of gaining independence. There are resources for when a woman very first leaves her partner; such as emergency housing. As well as resources for when she has been away from her partner for a longer period of time such as; food banks, government assistance, extended housing, clothing, furniture.


According to best practices established for service providers assisting women who were suffering domestic violence during COVID-19, the manual was made to be accessible virtually and discretely (Slakoff et al, 2020). The manual was created on Google Drive, which was accessible through the internet, and could also be made available in print. The manual was broken down into categories of needs that may arise for survivors of violence while leaving; food, shelter, clothing, furniture, and legal aid. Each section was broken down by county, and then further broken down by town. This was alphabetized, for ease of reference while using the manual. A woman could look through to find her town, or even use the search feature if reading the manual online. Each resource was listed, as well as possible limitations with each resource. For example, food resources that were restricted to serving a certain area were clearly labeled, as well as resources that could only be accessed a certain number of times per month. For the longevity of the manual, a link to the website was added, as well as a phone number, so users of the manual can call or look online to double-check the information listed.


The population of women the Domestic Violence Clinic at Northeastern works with have many complex needs. It is vital to consider the factors that may predispose some of the clients to a greater likelihood of violence. When creating the resource manual for the Domestic Violence Clinic at Northeastern, we kept women’s independence at the forefront of our minds. The goal was to create a manual that would not only help women short-term but also lead to long-term positive outcomes. To do so we considered the needs of the majority of our clients, as well as best practices for providing services to domestic violence victims. This manual was designed to help overcome obstacles to help-seeking, support interagency coordination, expand client knowledge about family services, and were used in conjunction with safety planning (Hamby & Turner, 2015).


The World Health Organization in the World Report on Violence and Health states that poverty is the greatest risk factor for all forms of relationship violence (Evans, 2005). This leaves individuals who are already low in resources, such as the women served by Northeastern, especially vulnerable when leaving a partner due to violence. Interventions are needed for these women to support their already diminished resources.


Women who have suffered abuse have diminished capacity to access resources and need support to ensure that they do not incur further resource loss (Lee & DePrince, 2017). This is why we have created a resource guide for survivors of domestic violence that they can access themselves. Interventions that help survivors increase executive function and self-efficacy support women's efforts to access resources independently (Lee & DePrince, 2017, Lerner & Kennedy, 2000). The goal of domestic violence programs is not only to protect survivors and their children from future harm but also to contribute to their long-term well-being (Sullivan, 2017).


The Domestic Violence Clinic at Northeastern already provides immediate protection to survivors through their legal assistance in attaining restraining orders (209A) as well as victims of sexual assault in harassment order cases (258E). Restraining orders in Massachusetts provide survivors with a broad range of relief, including no contact conditions, home surrenders, child custody, and child support. The Domestic Violence Clinic at Northeastern recognized a larger need for community support clients could access themselves. Providing resources to survivors of abuse creates a positive upward spiral where the resources gain leads to more positive social and emotional well-being over time (Sullivan, 2017). Women who worked with advocates for 10 weeks continued to show improvement even two years later compared to women in a control condition (Sullivan, 2017). This resource manual works in accordance with the goals of treatment in domestic violence programs, as set by Sullivan (2017) in The Social and Emotional Well-being Framework. Firstly, the manual increases survivors’ and their children's sense of self-efficacy as well as their hope for the future. Secondly, the manual directly increases survivor access to community resources, opportunities, and support including social support. These steps allow the program to repair resource loss from domestic violence, as well as instigate resource gains from working with supports.


Conclusion


Abuse directly affects individuals' self-efficacy across the lifespan (Diehl & Prout, 2002). There is a known downward bi-directional spiral between loss of resources and PTSD (Johnson & Zlotnick, 2009). Resource loss contributes to the development of PTSD, where then the PTSD symptoms lead to further resource loss and an exacerbation of symptoms. This can result in diminished functioning in multiple spheres, which makes it harder to establish safety or independence from the abuser. PTSD severity, independent of intimate partner violence, is significantly related to poorer social adjustment, less effective use of community resources, and greater loss of personal and social resources. The implementation of supportive services to women leaving abusive relationships, as well as the design and implementation of a resource manual, sought to combat these effects through the conservation of resources theory. This states that gaining resources creates a positive spiral where improvements result in more positive social and emotional well-being over time (Sullivan, 2017).


The trauma - PTSD process is a complex one that is determined not only by a woman’s experiences but by the availability or accessibility of personal, health, and social resources (Samuels-Dennis et al., 2010). Health outcomes of women who have left abusive relationships must be understood in the context of the woman’s resources. Women’s current personal, social, and economic resources exerted direct positive effects on their mental and physical health. All of these resources together mediated the relationship between the severity of past intimate partner violence and current health (Ford-Gilboe et al., 2009). The creation of a resource manual to be implemented in a local domestic violence legal clinic seeks to increase self-efficacy incurred from abuse, and create resource gain. While the manual was created and implemented, we do not yet have data on the efficacy of its use. Further research is needed to study the effects of implementing our resource manual on clients.


References


Bandura, A., Freeman, W. H., & Lightsey, R. (1999). Self-efficacy: The exercise of control. Journal of Cognitive Psychotherapy, 13(2), 158–166. https://doi.org/10.1891/0889-8391.13.2.158


Decou, C. R., Lynch, S. M., Cole, T. T., & Kaplan, S. P. (2015). Coping Self-Efficacy Moderates the Association Between Severity of Partner Violence and PTSD Symptoms Among Incarcerated Women. Journal of Traumatic Stress, 28(5), 465–468. https://doi.org/10.1002/jts.22034


Decou, C. R., Mahoney, C. T., Kaplan, S. P., & Lynch, S. M. (2019). Coping self-efficacy and trauma-related shame mediate the association between negative social reactions to sexual assault and PTSD symptoms. Psychological Trauma: Theory, Research, Practice, and Policy, 11(1), 51–54. https://doi.org/10.1037/tra0000379


Diehl, A. S., & Prout, M. F. (2002). Effects of Posttraumatic Stress Disorder and Child Sexual Abuse on Self-Efficacy Development. American Journal of Orthopsychiatry, 72(2), 262–265. https://doi.org/10.1037//0002-9432.72.2.262


Evans, S. (2005). Beyond gender: Class, poverty and domestic violence. Australian Social Work, 58(1), 36–43. https://doi.org/10.1111/j.0312-407x.2005.00182.x


Ford-Gilboe, M., Wuest, J., Varcoe, C., Davis, L., Merrit-Gray, M., Campbell, J., & Wilk, P. (2009). Modelling the effects of past Intimate Partner Violence and current resources on women's health after leaving an abusive partner. Social Science and Medicine, 68, 1021–1029. https://doi.org/10.1037/e518032013-001


Hamby, S., Finkelhor, D., & Turner, H. (2015). Intervention following family violence: Best practices & helpseeking obstacles in a nationally representative sample of families with children. Psychology of Violence, 5(3), 325–336. https://doi.org/10.1037/e529382014-216


Harter, S. (1999). The construction of the self. New York; Guilford Press.


Johnson, D. M., & Zlotnick, C. (2009). HOPE for battered women with PTSD in domestic violence shelters. Professional Psychology: Research and Practice, 40(3), 234–241. https://doi.org/10.1037/a0012519


Lee, M. S., & DePrince, A. P. (2017). Impact of executive function on efficacy obtaining resources following intimate partner violence. Journal of Community Psychology, 45(6), 704–714. https://doi.org/10.1002/jcop.21887


Lerner, C. F., & Kennedy, L. T. (2000). Stay-Leave Decision Making in Battered Women: Trauma, Coping, and Self-Efficacy. Cognitive Therapy and Research , 24(2), 215–232. https://doi.org/10.1023/A:1005450226110


Mannarino, A., Cohen, J., & Berman, S. (1994). The children's attributions and perceptions scale: A new measure of sexual abuse-related factors. Journal of Clinical Child & Adolescent Psychology, 23(2), 204–211. https://doi.org/10.1207/s15374424jccp2302_9


Paunovic, N. (1998). Cognitive factors in the maintenance of ptsd. Scandinavian Journal of Behaviour Therapy, 27(4), 167–178. https://doi.org/10.1080/02845719808408511


Saarni, C. (1999). The development of emotional competence. Guilford Press.


-Dennis, J. A., Ford-Gilboe, M., Wilk, P., Avison, W. R., & Ray, S. (2010). Cumulative Trauma, Personal and Social Resources, and Post-Traumatic Stress Symptoms Among Income-assisted Single Mothers. Journal of Family Violence, 25(6), 603–617. https://doi.org/10.1007/s10896-010-9323-7


Slakoff, D. C., Aujla, W., & PenzeyMoog, E. (2020). The role of service Providers, technology, and mass media when home isn't safe for intimate partner Violence Victims: Best practices and recommendations in the era of COVID-19 and beyond. Archives of Sexual Behavior, 49(8), 2779–2788. https://doi.org/10.1007/s10508-020-01820-w


Sullivan, C. M. (2017). Understanding How Domestic Violence Support Services Promote Survivor Well-being: A Conceptual Model. Journal of Family Violence, 33(2), 123–131. https://doi.org/10.1007/s10896-017-9931-6


Walter, K. H., Horsey, K. J., Palmieri, P. A., & Hobfoll, S. E. (2010). The role of protective self-cognitions in the relationship between childhood trauma and later resource loss. Journal of Traumatic Stress. https://doi.org/10.1002/jts.20504