Metacognitive Interpersonal Therapy for Male Intimate Partner Violence Perpetrators With Personality Disorders

ConditionsIntimate Partner Violence Personality Disorders

Trial statusNot yet recruiting

Trial phaseNot applicable

Trial typeInterventional

Biological sexMale

Age18+

SponsorHugo César Vicente

About this trial

This study evaluates the preliminary efficacy of MIT-MDO-PT, the European Portuguese cultural and linguistic adaptation of Metacognitive Interpersonal Therapy for Male Domestic Offenders (MIT-MDO), in adult men under judicial supervision for intimate partner violence (IPV) offences who meet criteria for a personality disorder. MIT-MDO-PT is an individual psychotherapy of 24 weekly 50-minute sessions delivered over approximately six months in four phases (case formulation and metacognitive assessment; mentalization and affect regulation; memory rescripting and shame transformation; consolidation and relapse prevention). The study uses a preregistered nonconcurrent multiple-baseline single-case experimental design across participants (target N = 5-7; enrolment ceiling 7): each participant completes a baseline phase with weekly monitoring (target of five data points), and treatment onsets are fixed a priori and staggered by at least three weeks between participants to provide internal experimental control without randomization. Primary outcomes are self-reported IPV perpetration (Revised Conflict Tactics Scales, CTS2), metacognition (Metacognition Self-Assessment Scale, MSAS) and personality pathology (Personality Inventory for DSM-5, PID-5), assessed at baseline (T0), after sessions 8 (T1), 16 (T2) and 24 (T3) and at 8-10-week follow-up (T4), with weekly monitoring of IPV (CTS2 physical assault and psychological aggression subscales) and psychological distress (CORE-10) throughout baseline and treatment. Where available, partners are assessed independently by a hospital victim-support service at T0 and T3 (Danger Assessment-5, CTS2 partner version, Psychological Maltreatment of Women Inventory-Short Form). Outcome assessment at T0, T3 and T4 is performed by an assessor independent of the therapist. Objectively recorded violence-related incidents (police or judicial occurrences, breaches notified by the supervising services, hospital safety-protocol activations) are collected as a secondary outcome. Analyses are conducted per participant (reliable change index, percentage of non-overlapping data, non-overlap of all pairs, Tau-U, structured visual analysis), with study-level conclusions based on replication across participants. Treatment fidelity is monitored through structured session notes and blind rating of 20% of sessions. The study is preregistered on the Open Science Framework (osf.io/wqpnc; protocol update v3.1, September 2026) and has a favourable opinion from the Ethics Committee of the University of Beira Interior, subject to the formal authorizations of the referring institutions.

Eligibility criteria

This trial does not accept healthy volunteers

Qualifiers

Male, aged 18 years or older

Under judicial supervision (e.g., suspended sentence, provisional suspension of proceedings, or other court-ordered measure) for intimate partner violence offences, referred by the Directorate-General for Reintegration and Prison Services (DGRSP) or by the Hospital Beatriz Ângelo victim-support service

Personality disorder confirmed by the SCID-5-PD (at least one diagnosis) AND elevation of at least one PID-5 domain (T-score >= 60, Portuguese norms)

Current or recent intimate partner violence perpetration

Disqualifiers

Psychopathy, operationalised as antisocial personality disorder confirmed by the SCID-5-PD together with a total score of 70 or above on the Self-Report Psychopathy Scale - Short Form (SRP-SF, European Portuguese version), administered at screening only to candidates meeting antisocial personality disorder criteria; clinical indicators from the screening interview and the referral file (generalised instrumental violence, absence of remorse and of affective bonding) are recorded as supporting information

Active psychosis or severe cognitive impairment

Imminent risk of harm to the victim requiring immediate protective intervention

Substance dependence requiring concurrent intensive treatment

Trial design

Design model

Single group

Treatments tested in this trial

Metacognitive Interpersonal Therapy for Male Domestic Offenders, Portuguese adaptation (MIT-MDO-PT)
Behavioral
Manualised individual psychotherapy (24 weekly sessions, 50 minutes, approximately 6 months) adapted to European Portuguese from MIT-MDO. Phase I (Sessions 1-8): shared case formulation and metacognitive assessment; Phase II (Sessions 9-16): mentalization and affect regulation; Phase III (Sessions 17-21): memory rescripting and shame transformation; Phase IV (Sessions 22-24): consolidation and relapse prevention. Delivered by a psychologist trained in MIT (Levels I-III) under weekly clinical supervision by the model developer. Fidelity: structured session notes (100% of sessions) and blind rating of 20% of sessions with the MIT-MDO-PT Session Fidelity Checklist; adherence threshold \>= 80%.

Treatment groups

7 Participants

are divided into 1 treatment group

Group A: MIT-MDO-PTExperimental treatment 1 intervention

Trial outcomes

Primary outcomes

Change in self-reported intimate partner violence perpetration (CTS2)

Revised Conflict Tactics Scales (CTS2), perpetration scales (physical assault, psychological aggression, sexual coercion, injury); European Portuguese version. Metric: reliable change index (RCI, Jacobson \& Truax) between T0 and T3; \|RCI\| \>= 1.96 indicates reliable change; decrease = improvement.

Time frame

Baseline (T0) and end of treatment (T3, after Session 24, approximately 6 months after treatment onset)

Change in metacognition (MSAS)

Metacognition Self-Assessment Scale (MSAS; Pedone et al., 2017; European Portuguese version: Faustino et al., 2021; 18 items; total score and four factor scores: self-reflexivity, critical distance, mastery, understanding other minds). Metric: RCI between T0 and T3 on the total score (\|RCI\| \>= 1.96; increase = improvement). Factor scores reported descriptively.

Time frame

Baseline (T0) and end of treatment (T3, after Session 24, approximately 6 months after treatment onset)

Change in personality pathology (PID-5)

Personality Inventory for DSM-5 (PID-5), adult form, five domain scores (T-scores, Portuguese norms). Metric: RCI between T0 and T3 per domain (\|RCI\| \>= 1.96; decrease = improvement). Facets reported descriptively.

Time frame

Baseline (T0) and end of treatment (T3, after Session 24, approximately 6 months after treatment onset)

Secondary outcomes

Weekly intimate partner violence monitoring series (CTS2 subscales)

Sum of CTS2 physical assault and psychological aggression subscales (act counts, 1-week recall), self-completed by the participant on a secure platform before each session, collected weekly throughout baseline (Phase A) and treatment (Phase B). Metrics: percentage of non-overlapping data (PND \>= 70%) and non-overlap of all pairs (NAP \>= 0.66) between Phase A and Phase B, Tau-U (uncorrected as main index; trend-corrected as sensitivity analysis) with 95% CI, baseline-to-treatment rate difference, plus structured visual analysis following a named protocol (level, trend, variability, immediacy, overlap, consistency). Reported by partner-exposure stratum (cohabiting, regular contact, no contact).

Time frame

Weekly from start of baseline (target of five weekly points) through Session 24 (approximately 7-8 months per participant)

Weekly psychological distress (CORE-10)

CORE-10 total score collected weekly throughout Phases A and B. Metrics: PND, NAP and structured visual analysis, Phase A versus Phase B.

Time frame

Weekly from start of baseline (3-5 weeks) through Session 24 (approximately 7-8 months per participant)

Maintenance of gains at follow-up (CTS2, MSAS, PID-5)

RCI between T0 and T4 on the CTS2, MSAS total score and PID-5 domains; maintenance supported when \|RCI\| \>= 1.96 with no reliable deterioration between T3 and T4.

Time frame

Baseline (T0) and follow-up (T4, 8-10 weeks after Session 24)

Change in global psychological distress (CORE-OM)

Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), total score, Portuguese version. Metric: RCI T0-T3 (\|RCI\| \>= 1.96; decrease = improvement).

Time frame

Baseline (T0), 8 weeks (T1), 16 weeks (T2), 24 weeks (T3, end of treatment) and 32-34 weeks (T4, follow-up) after treatment onset

Other outcomes

Working alliance (WAI-SR)

Working Alliance Inventory - Short Revised (WAI-SR), total score; descriptive process variable.

Time frame

Weeks 4, 8, 12, 16, 20 and 24 after treatment onset (Sessions 4, 8, 12, 16, 20 and 24)

Empathy (IRI)

Interpersonal Reactivity Index (IRI), subscale scores, Portuguese version; descriptive process variable.

Time frame

Baseline (T0), 8 weeks (T1), 16 weeks (T2), 24 weeks (T3, end of treatment) and 32-34 weeks (T4, follow-up) after treatment onset

Treatment fidelity index (TFI)

Percentage of protocol-required elements implemented per session, rated blindly by an independent rater on 20% of sessions with the MIT-MDO-PT Session Fidelity Checklist; inter-rater reliability (ICC) on 10% of rated sessions; participant mean \>= 80% required for inclusion in primary efficacy analyses.

Time frame

Throughout treatment (24 weekly sessions, approximately 6 months)

Partner danger assessment (DA-5) - safety screening

Danger Assessment-5 (DA-5), administered first at each partner assessment by hospital victim-support staff; an elevated score triggers the hospital safety protocol. Descriptive reporting.

Time frame

Baseline (T0) and 24 weeks after treatment onset (T3, end of treatment)

Sponsors and contacts

Click on the lead sponsor to view all of their trials.

Hugo César Vicente

Lead sponsor

University of Beira Interior

Sponsor institution

Source ClinicalTrials.gov

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