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. Author manuscript; available in PMC: 2024 May 1.
Published in final edited form as: Psychol Violence. 2022 Dec 1;13(3):258–266. doi: 10.1037/vio0000458

Preliminary Efficacy of a Web-Based Alcohol and Emotion Regulation Intervention on Intimate Partner Aggression Among College Women

Cynthia A Stappenbeck 1, Julia F Hammett 2, Natasha K Gulati 3, Debra Kaysen 4
PMCID: PMC10919120  NIHMSID: NIHMS1882012  PMID: 38463200

Abstract

Objective.

Intimate partner aggression (IPA), encompassing psychological and physical aggression, is a public health concern due to its high rates among young adults. Research and theory connect heavy drinking and emotion regulation (ER) difficulties to IPA and highlight their potential role in reducing IPA. A web-based intervention combining alcohol reduction strategies with ER skills demonstrated initial efficacy at reducing heavy drinking and improving ER abilities among college women with sexual assault victimization histories.

Method.

The present study represents a secondary analysis of this brief web-based intervention to evaluate its preliminary efficacy on IPA. The sample comprised 200 heavy drinking college women with histories of sexual assault victimization randomized to an assessment only control or the intervention consisting of 14 brief online alcohol reduction and ER skill building modules administered daily over a two-week period. The analytic sample included 103 women who reported their psychological and physical IPA at both the 1- and 6-month follow-up surveys.

Results.

After controlling for alcohol use, repeated measures mixed models examining changes from baseline to 6-month follow-up by condition revealed a significant time-by-intervention interaction effect on psychological IPA. Women who received the intervention had a significant decrease in psychological IPA from baseline to 6-month follow-up; there was no change in psychological IPA among women in the control condition. There was no significant effect of the intervention on physical IPA.

Conclusion.

Reducing alcohol use and improving ER skills may be beneficial in helping women cope with relational conflict, thereby decreasing their use of psychological IPA.

Keywords: Intimate partner aggression, Brief intervention, Alcohol use, Emotion regulation

Introduction

Rates of intimate partner aggression (IPA) perpetration are high among young adults in the US. Between 20% and 37% of dating relationships involve physical aggression (i.e., a physical attack such as hitting, slapping, or punching; Bell et al., 2007; Silverman et al., 2001). Rates of psychological IPA, sometimes referred to as verbal aggression, are even higher, with 70–90% of dating relationships involving this form of aggression (e.g., manipulation of a partner via intimidation, verbal attacks, shaming; Neufeld et al., 1999; Shorey et al., 2008). Although women tend to sustain more injuries as a result of IPA compared to men (Archer, 2000), numerous studies have found no difference in rates of psychological and physical aggression perpetration for both men and women (Shorey et al., 2008; Stappenbeck & Fromme, 2014). Results of laboratory- and event-based research on alcohol’s acute effects on aggression have consistently demonstrated that alcohol intoxication increases aggressive behavior generally (Gallagher et al., 2014; Giancola & Corman, 2007; Neal & Fromme, 2007; Quinn et al., 2013) and IPA specifically (Eckhardt et al., 2021; Rothman et al., 2012; Shorey, Stuart, McNulty, et al., 2014; Shorey, Stuart, Moore, et al., 2014; Stappenbeck, Gulati, & Fromme, 2016). Indeed, 30–50% of IPA incidents involve alcohol (Reingle et al., 2014; Shorey et al., 2011; Stappenbeck, Gulati, & Fromme, 2016), and IPA incidents are more likely to occur and are rated as more severe when one or both partners consumed alcohol (Graham et al., 2011; Testa et al., 2003).

The I3 Model (Finkel, 2011, 2014; Finkel & Eckhardt, 2013) provides a theoretical framework to help explain the causal link between alcohol intoxication and IPA. This model posits that the likelihood of IPA is related to three factors: instigation (i.e., experiences that increase one’s urges to aggress), impellance (i.e., dispositional factors that strengthen urges to aggress), and inhibition (i.e., one’s ability to resist or override urges to aggress). The ability to access and use one’s inhibitory capabilities is impacted by disinhibitory factors, including heavy drinking. Emotion regulation (ER) has emerged as an inhibitory factor, with ER deficits consistently and robustly associated with IPA, particularly in the context of other risk factors for IPA such as heavy drinking (Neilson et al., 2021). Indeed, ER difficulties have been shown to moderate the association between heavy drinking and IPA such that the positive relation between heavy drinking and IPA was stronger for those with greater impulse control difficulties and more limited access to ER strategies (Stappenbeck, Davis, et al., 2016). Importantly, both research and theory suggest that interventions which bolster inhibition have high potential to reduce IPA.

Despite the fact that IPA is a widespread problem with significant public health impacts, empirically supported interventions for IPA are limited, often lengthy (e.g., lasting up to as many as 20 sessions), and resource intensive (e.g., require in-person sessions facilitated by a licensed and trained therapist) making their broad dissemination difficult (Easton & Crane, 2016; Marchiondo, 2015; Stover et al., 2009). Additionally, existing IPA interventions often do not adequately address risk factors that serve to maintain IPA, such as heavy drinking and ER deficits (Easton & Crane, 2016; Marchiondo, 2015). In support of targeting heavy drinking to reduce IPA perpetration, treatments for substance misuse that do not directly target IPA have nevertheless shown reductions in IPA perpetration (Stuart et al., 2003; 2009). These promising findings suggest that existing interventions that bolster inhibition through reductions in heavy drinking may be useful for reducing IPA, particularly if they also address other inhibitory factors associated with IPA, such as ER deficits. Additionally, because of the potential public health benefit of broad dissemination, interventions that overcome some of the barriers to dissemination identified in traditional IPA interventions may be especially advantageous.

A recently developed web-based alcohol intervention, RELATE (Regulating Emotions and Lowering Alcohol use Training Experience), attempts to bolster inhibition by administering a combination of alcohol reduction strategies as well as regulatory skills targeting ER and distress tolerance (Gulati et al., 2021). This intervention has shown initial efficacy in reducing heavy drinking and improving ER and distress tolerance abilities compared to an assessment only control condition (Stappenbeck et al., 2021). Notably, this intervention was developed and evaluated in a sample of heavy drinking college women with histories of sexual assault victimization not selected based on a history of IPA. However, a few studies have shown connections between earlier victimization experiences and subsequent IPA perpetration. In one such study, childhood sexual abuse (in addition to psychological and physical abuse occurring during childhood) was associated with subsequent IPA perpetration among men and women (Li et al., 2020). In another study, women’s sexual assault victimization earlier in college was associated with later IPA perpetration (Graves et al., 2005). Sexual assault victimization has been linked to ER difficulties and increased heavy drinking (Lindgren et al., 2012; Thomson Ross et al., 2011; Walsh et al. 2012). Individuals with histories of sexual assault victimization may exhibit intense emotional reactions and have difficulty managing emotional arousal (Charak et al., 2018; Marx et al., 2005; Walker et al., 2021). Moreover, individuals with less access to adaptive ER strategies may consume alcohol to self-medicate distress which tends to lead to increased heavy drinking over time (Khantzian, 2003). Consistent with the I3 model, reduced inhibition through ER difficulties and heavy drinking increase risk for IPA perpetration and may, at least in part, explain the association between prior victimization experiences and subsequent IPA perpetration.

Thus, the combination of specific skills administered (alcohol reduction, ER, and distress tolerance) in RELATE may be helpful for reducing IPA in a sample of heavy drinking women with sexual assault victimization histories through bolstered inhibition, suggested by the I3 model to help an individual override an urge to aggress. Specifically, alcohol reduction strategies may decrease one’s drinking, thereby reducing disinhibition and the subsequent impact on one’s inhibitory abilities. Improving ER skills may increase one’s ability to override an aggressive urge by modifying one’s emotional response or reaction, particularly when one’s emotional response is ineffective or inappropriate given the situation. Finally, improving distress tolerance skills may help an individual overcome an aggressive urge in situations when one has limited ability to control or change the situation or their internal experience, and therefore, tolerating the distress is the most adaptive strategy. Importantly, RELATE is brief and delivered online with minimal required resources and therefore, if efficacious in reducing IPA, has the potential to be broadly disseminated and overcome several barriers with existing intervention approaches.

Present Study

The present study represents a secondary data analysis of RELATE to evaluate the preliminary efficacy of this web-based intervention to reduce IPA compared to an assessment only control condition. Heavy drinking college women with sexual assault victimization histories (N = 200) were recruited and asked to complete baseline, 1-month, and 6-month follow-up surveys that included assessments of their IPA along with 14 daily diary assessments. During daily dairy, women randomized to the intervention condition received a brief alcohol reduction or regulatory (e.g., ER, distress tolerance) skill module each day based on their daily diary responses. Women randomized to the assessment only control condition completed questionnaires but did not receive any skill modules. We hypothesized that women who received the intervention would demonstrate decreased psychological IPA (hypothesis 1) and physical IPA (hypothesis 2) from baseline to follow-up relative to those in the assessment only control condition.

Method

Participants

A sample of 200 college women (MAge = 20.9, SD = 2.8) were recruited from a large metropolitan university in the Pacific Northwest United States. Eligible participants were women ages 18 or older who reported a lifetime history of attempted or completed oral, vaginal, or anal rape, engaged in at least two heavy drinking episodes in the past month, and consumed an average of seven or more standard drinks per week in the past month. The majority of women identified as White (69.0.0%). The remaining women identified as Black/African American (1%), Asian (13.5%), Native American (1.0%), and Multiracial/Other (15.5%). Ten percent of women identified as Hispanic. At baseline, 25.5% of women were in their first year of college, 21.0% were in their second year, 23.0% were in their third year, 26.0% were in their fourth year, and 4.0% were in their fifth year or higher.

Procedure

All procedures were approved by the university’s Institutional Review Board and registered at ClinicalTrials.gov [NCT03111056]. Names and contact information of female students were obtained from the university registrar’s office. College women were randomly selected from a registrar list to receive an email seeking participation in a study on emotions and behaviors. Interested individuals read an information statement about study procedures and completed a web-based screening survey to determine eligibility. Eligible participants were then directed to an online baseline survey in which they provided electronic consent and completed a battery of questionnaires including surveys assessing their alcohol use and IPA. They received a $30 Amazon gift card for completing the baseline survey.

Next, participants were randomized into either the intervention or assessment only control condition (see Intervention Description section). For 14 consecutive days, individuals in both conditions received a link to a brief daily monitoring survey. After each daily survey, individuals in the intervention condition were presented with a 5–10-minute online skill module. After the daily monitoring period, all participants were emailed follow-up surveys at one month and six months posttreatment assessing their alcohol use and IPA. Participants also completed a survey immediately post-treatment, but because this was limited to the period of time while completing the intervention, it was not included in these analyses. Both 1- and 6-month follow-up surveys took approximately 1–2 hours to complete and participants were paid $40 to Amazon for completing each. Individuals also received a bonus $25 Amazon gift card if they completed at least seven of 14 daily monitoring surveys and all follow-up surveys.

Measures

Demographics

During the screening survey, participants reported demographic information including age, race, sorority status, employment status, and relationship status.

Lifetime Sexual Assault Victimization

The Traumatic Life Events Questionnaire (TLEQ; Kubany et al., 2000) was administered at screening and used to assess eligibility. Four behaviorally specific items measured sexual abuse perpetrated by someone close in age as well as by someone at least 5 years older before they were age 13. Participants were also asked how often they had experienced unwanted sexual contact between ages 13 and 18, and after age 18. Follow-up items asked whether attempted or completed oral, vaginal, or anal penetration occurred (0 = No, 1 = Yes). Participants were considered to have a lifetime history of sexual assault victimization if they reported ever experiencing attempted and/or completed penetration at any age.

Alcohol Use

The Daily Drinking Questionnaire (DDQ; Collins et al., 1985) assessed standard drinks consumed each day in a typical week during the past month and was administered at screening and all follow-up surveys. A sum score was created to reflect the total number of weekly drinks. A single item from the National Institute on Alcohol Abuse and Alcoholism Recommended Alcohol Questions (National Institute on Alcohol Abuse and Alcoholism, 2003) assessed heavy episodic drinking frequency (i.e., four or more drinks within a two-hour period) in the past month on a scale of 0–30 times and was used to determine eligibility.

Intimate Partner Aggression

During the baseline, 1- month, and 6-month follow-up surveys, psychological and physical IPA perpetration were assessed with the Psychological Aggression and Physical Assault Subscales of the Revised Conflict Tactics Scales (CTS-2; Straus et al., 1996), respectively. Examples of items assessing psychological IPA included insulting or swearing at a partner, shouting or yelling at a partner, and stomping out of the room after an argument. Examples of items assessing physical IPA included throwing something at a partner, twisting a partner’s arm or hair, and pushing or shoving a partner. Participants were asked to indicate the number of times the event occurred in the past year at baseline, in the past month at 1-month follow-up, and in the past five months at 6-month follow-up (0 = This has never happened; 1 = Once; 2 = Twice; 3 = 3–5 times; 4 = 6–10 times; 5 = 11–20 times; 6 = More than 20 times). Items were recoded to the midpoint to attain frequency, with 0 = 0, 1 = 1, 2 = 2, 3 = 4, 4 = 8, 5 = 15, and 6 = 25. Items were then summed to yield overall psychological and physical IPA frequency scores.

Due to low base rates in IPA frequency (particularly physical IPA) that may be difficult to capture within a 1-month time frame, and to evaluate potential decreases in IPA frequency from baseline to follow-up on equivalent time frames, we combined the 1- and 6-month follow-up surveys to capture IPA that was reported in the full 6-month follow-up period. Then, baseline responses for the past year were divided in half. This resulted in one baseline psychological IPA, one baseline physical IPA, one follow-up psychological IPA, and one follow-up physical IPA score, each assessing the frequency of acts of IPA over the preceding 6-month period.

Intervention Description

For an in-depth description of the intervention, including information on pilot testing and qualitative feedback, please see Gulati et al., 2021. Although all participants received 14 daily monitoring surveys, only individuals in the intervention condition received a brief, 5–10-minute skill module each day for 14 days immediately following each daily monitoring survey. Skill modules consisted of seven alcohol reduction skills and seven regulatory skills targeting both ER and distress tolerance. Consistent with the I3 model for aggression perpetration, these skills are thought to bolster inhibition thus improving one’s ability to resist an urge to aggress. The specific skill module received on a certain day was tailored based on participants’ same-day reports: If participants reported high willingness to drink that day, they were shown an alcohol reduction module. If they reported high intensity of negative emotions, they were shown a regulatory skill module. Finally, if both willingness to drink and intensity of negative emotions were high, they were shown a skill they had not previously seen at random. Once participants received all alcohol reduction skill modules, then regardless of their daily reports they were provided a regulatory skill module and vice versa. If a participant missed a daily monitoring assessment, they were presented with two skill modules each subsequent day until they caught up or until the conclusion of the monitoring period. Women in the intervention condition completed an average of 10.0 (SD = 4.8) out of the 14 possible modules (Stappenbeck et al., 2021).

All skill modules were administered through Qualtrics survey software, were mobile compatible, and included a short video providing an overview of the skill and interactive exercises designed to promote learning and personalization of delivered content. Skill modules integrated with participants’ survey data, allowing for skill module material to reference participant input (e.g., daily drinks, intensity of emotion). Images and hyperlinks to resources were also included to promote engagement. After each skill module, participants were instructed to practice new material with individually generated examples.

Alcohol Reduction Skill Modules

The intervention consisted of seven alcohol reduction skill modules emphasizing cognitive behavioral strategies for decreasing alcohol consumption (Cronce & Larimer, 2011; Larimer & Cronce, 2007, Monti et al., 2002) that have demonstrated effectiveness among young adults (Dimeff & McNeely, 2000; Neighbors et al., 2004; Walters et al., 2007; Weitzel et al., 2007). Alcohol reduction skill modules included: 1) Alcohol Health and Norms to provide psychoeducation about alcohol’s impact on behavior and present normative feedback on participant alcohol use; 2) Protective Behavioral Strategies to reduce negative consequences related to alcohol use (e.g., arrange a sober ride or use a rideshare); 3) Managing Negative Thinking to restructure and challenge unhelpful appraisals related to alcohol using the ABC Model (Ellis, 2008); 4) Drink Refusal Skills to learn to refuse alcohol in high-risk situations; 5) Seemingly Irrelevant Decisions to understand how choices may inadvertently lead to heavy alcohol use; 6) Analysis of Triggers to identify and modify cues for heavy alcohol use; and 7) Sources of Support to engage social networks and community resources for alcohol use and distress.

Regulatory Skill Modules

Seven regulatory skill modules targeting ER and distress tolerance strategies were adapted from Dialectical Behavior Therapy (DBT; Linehan, 1993, 2014). ER skill modules included: 1) Labeling Emotions to provide psychoeducation about naming and understanding the function of emotions; and 2) Opposite Action to change unwanted or ineffective emotions by acting opposite of an emotion’s action urge. Distress tolerance skill modules included: 3) Cope Ahead to cope effectively with an upcoming distressing situation through problem solving, mental rehearsal, and relaxation techniques; 4) STOP to navigate a crisis situation by stopping, taking a step back, observing, and proceed mindfully; 5) Pros and Cons to evaluate short- and long-term benefits and costs of a crisis urge or difficult situation; 6) Radical Acceptance to reduce distress and suffering by accepting reality; and 7) Half-Smiling and Willing Hands to reduce distress and suffering by accepting reality with the body.

Data Analytic Strategy

Stata 15.1 (Stata, 2017) was used for all analyses. Bivariate associations were evaluated via correlations between all primary study variables at baseline. To evaluate treatment effect from baseline to follow-up in psychological and physical IPA perpetration, we examined separate multilevel linear mixed-effects models for each outcome.

Given the repeated measures, we fit two-level random-intercept models with an independent covariance structure between the random effects. Of primary interest was a condition (control vs. treatment) X time (baseline vs. follow-up) interaction to evaluate potential change in outcomes from baseline to follow-up, with condition and time both considered categorical predictors. Each model controlled for the number of drinks participants consumed per week and either the number of daily monitoring surveys completed (control condition) or the number of intervention skill modules completed (intervention condition) as a proxy for treatment dose. We examined pairwise comparisons to elucidate all treatment X time effects.

Missing Data and Attrition

Of the 200 women included in the study, 168 (84.0%) completed the 1-month follow-up data and of those 140 (83.3%) provided data on IPA. Additionally, 143 (71.5%) completed the 6-month follow-up and of those 128 (89.5%) provided data on IPA. The final sample for analysis is composed of the 103 women (51.5%) who provided IPA data at both the 1-month and 6-month follow-up. Missing data were primarily due to attrition and lack of IPA data. Differences in drinking and IPA at baseline between participants who completed the two follow-up surveys (51.5%, n = 103) and those who did not (48.5%, n = 97) were examined. Participants who completed both follow-up surveys and participants who did not complete both follow-up surveys did not differ in their baseline levels of psychological IPA perpetration, M(completed) = 5.91, SD = 9.47 vs. M(not completed) = 4.36, SD = 6.66, t(197) = 1.33, p = .19; physical IPA perpetration, M(completed) = 0.95, SD = 3.17 vs. M(not completed) = 0.33, SD = 0.76, t(197) = 1.86, p = .06; drinks per week, M(completed) = 14.50, SD = 8.04 vs. M(not completed) = 15.42, SD = 7.25, t(198) = 0.85, p = .40; and whether or not they had a history of childhood sexual abuse, χ2(1) = 0.34, p = .56. Of the participants who completed both follow-up surveys, 27/103 (26.2%) endorsed a history of childhood sexual abuse and of the participants who did not complete both follow-up surveys, 22/97 (22.7%) endorsed a history of childhood sexual abuse. However, participants who completed both follow-up surveys reported more severe sexual assault victimization history at baseline (M = 28.97; SD = 17.02) than those who did not complete both follow-up surveys (M = 24.26; SD = 13.78), t(190.61) = −2.15, p = .03.

Power Analyses

Post-hoc Monte Carlo simulation analyses were conducted to determine whether the current analyses were adequately powered to detect medium (Cohen’s f = 0.25) main and interaction effects of time and condition on IPA. Results of the simulations indicated that a sample size of 103 participants would yield power of .71 to .72. Moreover, simulations showed that with an alpha = .05 and power = .80, effects of size f = .28 could be detected.

Results

Women included in the current study (N =103) were on average 21.02 years old (SD = 3.4). Seventy-one (68.9%) women identified as White, 16 (15.5%) identified as Asian, 11 (10.7%) identified as Multiracial, one (1%) identified as Native American, and 4 (3.8%) identified as another ethnicity or were missing data on this variable. Eight women (7.8%) indicated they were Hispanic. Sixty (58.3%) women reported they had pledged a sorority, 66 (64.1%) women were employed full- or part-time, and 45 (43.7%) were currently in a romantic relationship at baseline.

At baseline, 75.7% of the women included in the current sample reported that they had engaged in at least one act of psychological IPA during the past 6 months and 51.5% reported that they had engaged in one or more acts of psychological IPA between baseline and 6-month follow up. Furthermore, 30.1% of women reported that they had engaged in at least one act of physical IPA during the past 6 months at baseline and 12.6% reported that they had engaged in one or more acts of physical IPA between baseline and 6-month follow up. Descriptive statistics for study measures for the full sample as well as split by condition can be found in Table 1. Women in the treatment group had significantly higher levels of both psychological and physical IPA at baseline. As shown in Table 2, there were significant positive correlations for baseline and follow-up measures of number of drinks per week and psychological IPA. Moreover, higher baseline psychological IPA was related to higher baseline physical IPA and higher baseline physical IPA was related to higher follow-up psychological IPA.

Table 1.

Descriptive Statistics of the Full Analytic Sample and Comparison by Condition

Variable Full Sample (n = 103) Treatment Group (n = 45) Control Group (n = 58) t
M SD M SD M SD
Number of modules/daily surveys completed 11.19 3.47 12.00 3.20 10.57 3.57 2.11*
Baseline Drinks per Week 14.50 8.04 15.36 9.57 13.84 6.63 0.95
Follow-up Drinks per Week 8.50 8.86 8.09 7.10 8.83 10.07 0.42
Baseline Psychological IPA 5.91 9.47 8.76 12.16 3.70 5.92 2.77*
Follow-up Psychological IPA 3.75 7.00 3.91 8.39 3.62 5.76 0.21
Baseline Physical IPA 0.95 3.17 1.68 4.49 0.39 1.31 2.08*
Follow-up Physical IPA 0.83 3.28 0.80 3.04 0.84 3.48 0.07
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*

p < .05

Note. IPA = Intimate Partner Aggression, M = Mean, SD = Standard Deviation.

Table 2.

Bivariate Correlations of Key Study Variables

Key Variables 1 2 3 4 5 6 7
1. Number of modules/daily surveys completed --
2. Baseline Drinks per Week −.10 --
3. Follow-up Drinks per Week .07 .40** --
4. Baseline Psychological IPA −.08 .11 .10 --
5. Follow-up Psychological IPA −.14 .10 .09 .35** --
6. Baseline Physical IPA −.07 .09 −.04 .68** .20* --
7. Follow-up Physical IPA <−.01 −.13 .05 .07 .38** .06 --
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**

p < .01,

*

p < .05

Note. IPA = Intimate Partner Aggression.

To examine hypothesis 1, that women who received the intervention would demonstrate decreased psychological IPA from baseline to follow-up relative to those in the assessment only control condition, there was a statistically significant condition X time interaction for psychological IPA perpetration (b = −4.62, p = .01; see Figure 1) after controlling for the number of drinks participants consumed per week and number of daily surveys or modules completed. Pairwise comparisons showed that women in the treatment condition had significantly higher levels of psychological IPA at baseline compared to women in the control condition (z = 5.49, p < .01). Although levels of psychological IPA did not differ for women in the treatment condition compared to women in the control at follow-up (z = 0.87, p = .59), women in the treatment condition experienced a significant decrease in psychological IPA from baseline to follow-up (z = −4.38, p < .01), whereas there was no change in psychological IPA among women in the control condition (z = .23, p = .85). Specifically, an examination of marginal means showed that women in the treatment condition started with a mean psychological IPA level of 8.78 (Std. Err. = 1.22) at baseline, which decreased to 4.39 (Std. Err. = 1.22) at follow-up. In comparison, women in the control condition had similar mean psychological IPA levels at baseline (M = 3.29, Std. Err. = 1.05) and at follow-up (M = 3.53, Std. Err. = 1.06).

Figure 1.

Figure 1.

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Change from Baseline to Follow-up in Psychological Aggression by Condition Based on Predictive Margins With Error Bars Representing 95% Confidence Intervals

To examine hypothesis 2, that women in the intervention would demonstrate decreased physical IPA from baseline to follow-up relative to those in the assessment only control condition, the intervention X time interaction was not statistically significant for physical IPA perpetration (b = −1.28, p = .14) after controlling for the number of drinks consumed per week and number of daily surveys or modules completed. Results of all multilevel linear mixed-effects models and planned pairwise comparisons are summarized in Table 3.

Table 3.

Results of the Multilevel Linear Mixed-Effects Models and Planned Pairwise Comparisons Examining Change Over Time by Condition and Differences Between Treatment and Control Conditions

Model Parameters Psychological IPA Physical IPA
Coef. Std Err z p Coef. Std Err z p
  Constant 6.26 2.43 2.57 .010 0.61 0.91 0.67 .504
 Drinks per Week 0.06 0.07 0.95 .343 0.03 0.03 0.94 .345
 Number of modules/daily surveys completed −0.33 0.19 −1.75 .079 −0.05 0.07 −0.79 .427
 Condition 5.49 1.60 3.43 .001 1.33 0.64 2.08 .037
 Time 0.23 1.25 0.19 .852 0.58 0.58 1.00 .317
 Condition X Time −4.62 1.84 −2.51 .012 −1.28 0.86 −1.49 .137
Contrasts
 Follow-up vs. Baseline: Control 0.23 1.25 0.19 .852 0.58 0.58 1.00 .317
 Follow-up vs. Baseline: Treatment −4.38 1.47 −2.99 .003 −0.70 0.67 −1.03 .301
 Treatment vs. Control: Baseline 5.49 1.60 3.43 .001 1.32 0.64 2.08 .037
 Treatment vs. Control: Follow-up 0.87 1.60 0.54 .586 0.05 0.64 0.08 .937
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Note. Coef. = Coefficient, Std Err = Standard Error, IPA = Intimate Partner Aggression.

Discussion

The current study aimed to evaluate the preliminary efficacy of a brief, web-based intervention to reduce psychological and physical IPA compared to an assessment only control condition. Designed to address the specific needs of heavy drinking college women with sexual assault victimization histories, RELATE uniquely combines ER and distress tolerance skills along with strategies known to reduce alcohol use. Although this intervention was not originally developed to reduce IPA perpetration, the specific skills targeted in this intervention were hypothesized to be helpful for reducing IPA through bolstered inhibition – a component of the I3 model of aggression perpetration – via decreased drinking and increased ability to override aggressive urges. Indeed, in support of our first hypothesis, that there would be a decrease in psychological IPA for women who received the intervention relative to control, we found significant reductions in psychological IPA perpetration from baseline to 6-month follow-up among women in the treatment condition, and no changes in psychological IPA perpetration among women in the control condition. However, we failed to support our second hypothesis, that physical IPA would decrease for women who received the intervention relative to control, as there were no changes in physical IPA perpetration among either those in the treatment or control group.

Consistent with our first hypothesis, patterns of change evidenced positive treatment effects for psychological IPA perpetration. Specifically, there were significant declines of about 50% in psychological IPA from baseline to 6-month follow-up for women in the treatment condition, whereas there were no changes for women in the control condition. These findings are in line with theoretical approaches (e.g., I3 Model; Finkel, 2007, 2014; Finkel & Eckhardt, 2013) and prior research (e.g., Fruzzetti & Levensky, 2000; Neilson et al., 2021; Stappenbeck et al., 2016; Waltz, 2003) linking the current treatment targets (alcohol use, ER, and distress tolerance) and IPA. In fact, a prior evaluation of this intervention (see Stappenbeck et al., 2021) showed a reduction in heavy drinking and improvements in ER and distress tolerance skills. Thus, when confronted with situations that may have otherwise led to psychological IPA, women in the treatment condition may have bolstered inhibition and therefore been better able to effectively overcome aggressive urges due to decreased drinking and improved ER and distress tolerance abilities, resulting in reductions in psychological IPA following the intervention.

It is notable that women in the intervention condition started out at higher levels of psychological IPA at baseline than those assigned to control, which may have contributed to greater reductions in IPA over time because there was more room for improvement among these women. More research is needed to evaluate these patterns, potentially over longer follow-up periods, to examine whether these declines will be maintained over longer time intervals such that those who receive the intervention would eventually have significantly lower levels of psychological IPA perpetration compared to those in the control condition.

Contrary to our second hypothesis, we did not find a significant intervention-by-time interaction effect for physical IPA perpetration. This absence of a treatment effect may be related to the overall low base rate of physical IPA (less than one act, on average, during the past 6 months at baseline and follow-up) in the current sample of women, who were not selected to be a high-risk sample with regards to IPA perpetration). Future research with higher-risk samples is needed to examine the potential usefulness of RELATE for reducing physical forms of IPA, as even small reductions in physical IPA outcomes could have implications for broad population-based improvements given a low-resource intervention with potential for broad dissemination.

Limitations

Although this study evidences several strengths, including the evaluation of an innovative web-based intervention using longitudinal, 6-month follow-up data, the current results should be interpreted in light of some limitations. First, our inclusion criteria limit generalizability of the current findings to heavy drinking college women with sexual assault victimization histories. Thus, it is unknown whether results would generalize, for example, to individuals without significant histories of trauma exposure. Second, women were not specifically sampled for IPA perpetration; thus, it remains unclear whether similar treatment effects would be observed among individuals engaged in higher levels or more severe forms of IPA, among male perpetrators of IPA, among older adults, or among groups of more diverse backgrounds, which should be evaluated in future studies. Third, we did not assess relationship status at all timepoints of the study and cannot know whether IPA decreased because women left relationships characterized by IPA. Although we might assume that relationship dissolution would be similar between those in the control and intervention conditions as a function of random assignment to condition, it may be that participating in the intervention encouraged more women to end relationships that involved aggression. Potential dissolution of these relationships may therefore explain the decrease observed in psychological IPA among women who received the intervention and thus could be a potential positive outcome of the intervention that should be explored in future research.

Finally, retention was relatively low in the larger study from which these data were drawn, and when limiting the sample to only women who provided IPA data at both the one-month and the six-month follow-up assessments, the final sample for analysis was roughly half of the full sample. Although we had ample procedures in place to attempt to maximize retention (e.g., reminder emails, phone calls, and texts), the attrition observed may be due to factors related to studying college populations, such that some women may have graduated by the time follow-up assessments were administered and some may have been unavailable due to summer or semester breaks. Additionally, low retention may have been due to sample characteristics selected for in this study (e.g., heavy drinking); however, there were no differences in any of the variables of interest (drinking, IPA) at baseline between women who provided data at the two follow-up assessments and those who did not.

Future Research Directions

Additional research using larger and more diverse samples specifically selected to be higher-risk for IPA perpetration, and not limited to those with sexual assault victimization histories, is needed to support the present findings. Although it may prove unnecessary, future adaptations of this intervention could consider whether the addition of content that directly addresses IPA strengthens outcomes. Finally, this intervention was delivered to only one individual within a dyad and would not directly impact their partner’s behavior. To the extent that aggression occurring within one’s romantic relationship is bidirectional and/or in response to a partner’s aggressive behavior, future adaptations could be developed and evaluated with couples to more directly address aggressive patterns that may otherwise be maintained by a partner’s behavior.

Clinical Implications

Findings support prior research and are consistent with the I3 model of aggression perpetration concluding that alcohol use and ER difficulties are associated with IPA, and that bolstering inhibition reduces IPA. Consistent with prior research (Stuart et al., 2003; 2009), reductions in psychological IPA were observed even though IPA was not directly targeted as part of the intervention. If replicated, these results have important clinical implications for how to intervene to reduce IPA, particularly for individuals at risk for perpetrating psychological IPA. Specifically, these individuals may benefit from learning strategies to reduce their alcohol consumption and improve their regulatory abilities by providing skills targeting ER and distress tolerance. Importantly, results also highlight that these skills can be delivered via a web-based intervention through the use of mobile devices which decreases potential barriers to dissemination and implementation and significantly increases available intervention options for individuals at risk for IPA. The fact that this web-based intervention is brief, requires few resources, and thus can be widely disseminated underscores its potential for making a significant public health impact and improving the lives of individuals who experience IPA at high rates.

Acknowledgments

Manuscript preparation was supported by grants from the National Institute of Alcohol Abuse and Alcoholism: K08AA021745 (PI: Stappenbeck), R01AA027994 (PI: Stappenbeck), and F31AA028144 (PI: Gulati). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Alcohol Abuse and Alcoholism.

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