Studies focusing on cognitive-behavioral approaches in the treatment of batterers are extensive in the international literature. According to a review by Voith et al. (2020), some of these interventions show positive results in emotional regulation strategies, cognitive restructuring, and aggression reduction, demonstrating better outcomes compared to other therapeutic models (Arce et al., 2020). However, other studies show no significant differences between the intervention group and control group, demonstrating minimal results in recidivism (Babcock et al., 2004) or inconclusive findings regarding effectiveness (Smedslund et al., 2011).

Among the articles selected in the integrative review, Cortez et al. (2005) conducted a group intervention with a cognitive-behavioral focus. The results showed improvements in the couple’s adjustment and an impact on the recurrence of violent behavior, as reported by the participant, their partner, and through monitoring of new reports. It is important to consider the difficulties and biases related to the sensitive nature of violence data and potential reliability issues regarding clients’ self-reporting. However, this Brazilian experience, involving seven men with a history of aggression, conducted through eight weekly sessions lasting two hours each, provides a possible framework for addressing the issue of IPV. Among the strategies most used in the treatment of domestic violence are relaxation exercises, psychoeducation, analysis of the family of origin, assessment of the impact of violence on the family, violence accountability, marital dynamics, examination of beliefs about gender roles, anger control strategies, identification of “hot and cold” thoughts, role play, social skills and assertiveness training, feedback, follow-up, and maintenance of gains. During the intervention, the main strategies used were taking responsibility for aggressive behavior (restructuring behavioral patterns that externalize responsibility), anger control (through self-observation and breathing techniques), timeout (leaving the environment where there is potential for aggressive behavior), assertiveness training, and role-playing (acting out scenes and analyzing strategies).

In another article included in the literature review, Padovani and Williams (2002) conducted a case study based on cognitive-behavioral therapy. A 52-year-old man, who engaged in physical violence in his marital relationship and in external settings, displayed a low frustration threshold and impulsive behavior. Among the strategies adopted, cognitive restructuring, anger management, relaxation exercises, and timeout stood out. Two months after treatment completion, improvements were identified in communication, anger management, and in the flexibility of legitimizing beliefs. Additionally, according to the patient, no new aggression was committed against the partner.

However, data from literature indicate that cognitive-behavioral therapy does not yield satisfactory results when applied to personality disorders, refractory cases, processes involving the limbic system (Smedslund et al., 2011), or with aggressors who have higher emotional and physiological activation (Voith et al., 2020). This indicates that cognitive-behavioral strategies may have positive results for batterers with lower emotional activation. Nevertheless, in aggressors with a higher degree of impulsivity, emotional activation, and generalization of violent behavior, the results may be limited (Karakurt et al., 2019; Nesset et al., 2020), indicating that strategies and techniques focused solely on cognition may not be effective for all types of aggressors.

Other Brazilian studies that analyzed aggressors’ profile focused on the identification of Early Maladaptive Schemas (EMS) (Borges & Dell’Aglio, 2020; Paim & Falcke, 2016), which are deeply ingrained structures correlated with the limbic system, developed at a young age, shaped by temperament, environment, and unmet emotional needs. Most studies indicate a connection between intimate partner violence and schemas belonging to the domain of disconnection and rejection. In other words, they are individuals with a history of fragile bonds in the family of origin, unstable, insecure, with an impaired sense of belonging, with a disconnected view of themselves and others, sensitive to rejection and abuse (Borges & Dell’Aglio, 2020; Paim & Falcke, 2016). A recent meta-synthesis (Pilkington et al., 2021) observed a correlation between IPV and the mistrust and abuse schema, corroborating the findings of Brazilian studies. These results imply the need for the inclusion of therapeutic strategies with a cognitive-behavioral approach that address the traumatic content of memories developed at a young age.

Based on a socio-historical perspective, Reflective Groups propose an intervention based on the perceptions of gender stereotypes identified in those who perpetrate violence against women, understanding that patriarchal ideologies legitimize and encourage violence. The rigid normative masculine discourse, therefore, would have a direct impact on the perpetration of violence (Mistura, 2015; Scott, 2018).

In an article selected in the integrative review (Rovinski et al., 2018), the authors used the Rorschach Test with 31 men who were convicted due to IPV, assigned to participate in reflective groups. The results indicated that these men have a distorted (egodystonic) perception of violent behaviors. The participants’ accounts demonstrated a tendency to downplay violent behavior and not recognize it as such.

Rovinski et al. (2018) based their study on the narratives of seven participants who were indicted under the Maria da Penha law (Brazilian federal law on domestic violence against women), using semi-structured interviews to study their historical representations and interrelationships. Although voluntary, the male participants could have their sentences reduced if they were convicted. A total of 16 weekly sessions were conducted, each lasting two hours. The themes were based on the Maria da Penha law, such as illnesses, masculinity, gender roles, violence in interpersonal relationships, family, and work. Spontaneous topics that emerged in the group dynamics were also addressed. Among the observed benefits, greater flexibility in understanding gender roles, the denaturalization of the role of violence against the intimate partner, and strategies for conflict prevention and resolution were noted from participants’ narrative analyses. This framework of progress assessment deserves attention, as it is important to highlight the potential biases, especially the potential sentence reduction that participation could entail. These factors may have influenced the discourse and the conclusions of the study itself, considering that the only effectiveness criterion was the perpetrator’s self-report. Other studies also highlight the importance of using reflective groups in the treatment of batterers (Prates & Andrade, 2013; Scott, 2018). However, the results were obtained through the analysis of participants’ discourse, without, for example, interviews with their partners or a longitudinal control to verify recidivism, which may reduce the reliability of the results regarding the reduction of violence practiced by these participants.

An important aspect to be observed in these studies is the inclusion criteria. In Mistura’s study (2015), the participants were primary male offenders, characterized by threats or minor injuries, without psychiatric disorders or substance use. Holtzworth-Munroe and Meehan (2004) characterized typologies among batterers by assessing their frequency and intensity, generalization of violent acts, and presence of psychopathologies. Aggressors who meet the inclusion criteria listed by Mistura (2015) can be referred to as “exclusive family members”. In many cases, these aggressors resolve their violent behavior without any therapeutic intervention, indicating that it would be questionable to apply the same approach to cases with more severe episodes of violence (Karakurt et al., 2019; Voith et al., 2020).

Research on cultural determinants adopt an androcentric/patriarchal perspective that legitimizes various forms of violence against women. The stereotyped and rigid gender belief that positions women as inferior and submissive contributes to intimate partner violence (Saffioti, 2001). Based on this social distortion, the misogynistic violent relationship, of the superiority of men and objectification of women, legitimize violence as an act of correction towards the partner, blaming her and often understanding that the violence exerted was in defense of a prevailing moral status (Lamoglia & Minayo, 2009).

One of the articles obtained in this review was by Lamoglia and Minayo (2009). This study conducted a qualitative and quantitative analysis of 1,000 complaints registered at a police station between 1997 and 2001, cross-referencing documentary data with couples’ statements at the service counter. It was found that 53% of the complaints were due to physical injury, 39% due to threats or attempted homicide, and 8% due to defamation and insults. Most physical aggressions targeted the female partners’ faces. Among the reasons for the complaints, 45% reported that the men displayed a posture of control, domination, and aggression even after the relationship had ended, 36% did not have a specific reason, and 14% because the female partners did not wish to maintain the relationship.

In a cross-sectional study in primary care (Schraiber et al., 2012), also obtained in the review, 789 men aged 18 to 60 years participated, with 775 having had a partnership at some point between 2002 and 2004. Among the data, the level of education stands out, with 65.5% of the participants presenting five to 11 years of education. Also, most of these men (52.1%) had committed some form of violence, with a higher prevalence of psychological and physical violence during the study period. These participants also reported victimization in intimate relationships, with 14.2% of them reporting experiencing some form of violence, with psychological violence being the most frequent. Regarding the perception of violence, 67.2% of the aggressors did not consider themselves violent, and 31.3% demonstrated a significant degree of generalization of violent behavior outside of the romantic relationship, consistent with the “generalized violent” typology described by Holtzworth-Munroe and Meehan (2004).

Cultural aspects, such as placing blaming and social pressure on women in romantic relationships, play an important role in the reporting of IPV (Edwards & Dardis, 2020). In general, these elements act as inhibitors of disclosure, whether through formal or informal channels. As a result, cases where male aggressors are not reported by their female partner are common (Padovani & Williams, 2002). Therefore, official data on violence should be interpreted with caution, considering that cultural variables are often not the focus of study for government agencies. It is possible to hypothesize that cultural variables are essential for understanding the underreporting of IPV.

Among the variables that influence intimate partner violence, jealousy, anxiety, and alcohol use have shown to have a significant impact. In a probabilistic cluster sample, Oliveira et al. (2009) conducted home interviews with 1,631 individuals over 18 years old to estimate the occurrence of IPV in the past 2 years and explore possible associations with alcohol use and sociodemographic variables. In the sample, 41.2% were men, 5.0% admitted to perpetrating violence, and 6.1% of women reported experiencing some form of IPV. Interestingly, in the same study, age was found to be correlated with the profile of the perpetrator, with higher prevalence among those aged 30 to 39, followed by 18 to 29. However, international literature indicates a decrease in aggression with increasing age, suggesting possible regional differences or characteristics specific to this sample (O’Leary & Woodin, 2005). Nevertheless, caution must be exercised when making these comparisons due to the methodological differences between these studies, as the Brazilian study had a cohort design while the American study had a longitudinal design, making it difficult to compare these data.

Another finding from the study by Oliveira et al. (2009) indicated that alcohol use was associated with both the victimization (18.2%) and perpetration (15.9%) of IPV. Binge drinking was a predictor of higher frequency of victimization and perpetration. Women reported more frequently that alcohol was involved in the aggression, stating that during an episode, either no one or only the man had consumed alcohol. Regarding substance use, Padovani and Williams (2011), in a study with 40 individuals, including 20 aggressors, found that only the perpetrators reported current or past use of illicit substances. In cases where the perpetrator has abusive use of psychoactive substances, intervention targeting addictive behavior becomes necessary. Despite these data, a recent meta-analysis indicated that the differences in methods and measurements of alcohol and substance use across the literature makes it challenging to establish a clear relationship (Bacchus et al., 2018). Research utilizing validated measures adapted to the Brazilian context can help clarify the role of alcohol and illegal substances in IPV.

Analyzing the relationship between jealousy, anxiety, and intimate partner aggression, Priolo-Filho et al. (2019) found differences between groups in a sample of 40 men with similar sociodemographic measures, 20 with a history of aggression towards their partners and 20 without a history. Aggressors reported higher scores on the Jealousy Scale, particularly in the categories of pain and anger. In the aggressor group, 85% reported perceiving their partners to have higher levels of jealousy, while in the non-aggressor group, this rate was 20%. Regarding anxiety, 95% of the control group did not show significant scores on the Beck Anxiety Inventory (BAI), while in the aggressor group, 40% had mild anxiety, 15% had moderate anxiety, and 10% had severe anxiety. These findings are consistent with those obtained by Lamoglia and Minayo (2009), which indicate that jealousy and alcohol use preceding aggression rank third among the reasons reported by women for filing complaints. Most interventions available in the literature include some degree of elements aimed at controlling anxiety through cognitive techniques (Karakurt et al., 2019). However, meta-analyses on the subject have not identified anxiety as a variable that affects IPV, especially due to the diversity of measurements, like what occurs with alcohol and substance use (Bacchus et al., 2018).

Interventions focused on the specific needs of Brazilian perpetrators, through more detailed screening and the use of specific techniques, can offer more effective treatment (Priolo-Filho et al., 2019). Programs that include specific treatment for alcohol and other drugs and IPV have shown good effectiveness (Klostermann et al., 2010; Kraanen et al., 2013). In general, these programs have a semi-structured, flexible format based on cognitive-behavioral strategies with approximately 16 sessions. The female partner is also encouraged to participate in the first psychoeducation meeting on Lenore Walker’s “Cycle of Abuse”, and subsequently, psychoeducation techniques, motivational interviewing, anger management, tracking diaries, homework assignments, and strategies to deal with the perpetrator’s desires are used. The goal is abstinence from substances, although controlled use is an accepted goal; however, regarding aggressive behavior, cessation is the only accepted outcome (Klostermann et al., 2010; Kraanen et al., 2013). In the national context, understanding the expressions, functions, and consequences of these behaviors should be a priority for professionals working in the prevention and intervention of IPV. The lack of research on these topics has been one of the barriers to the implementation of interventions that can positively affect these variables.

Padovani and Williams (2011) observed that 90% of aggressors had a history of childhood abuse, with the father being the most common perpetrator. In contrast, 45% of non-aggressors experienced abuse. Among inappropriate parenting styles, the aggressor group had higher scores in neglect, inconsistent punishment, excessive control, and overprotection. A similar difference is observed in exposure to IPV during childhood, with 45% of aggressors and 15% of non-aggressors having a history of this form of victimization. Childhood intrafamilial violence, both as a victim and a witness, predicts marital violence (Kimber et al., 2018), and inappropriate parenting practices are an important variable in violence perpetrated by male batterers (Padovani & Williams, 2011).

In Stenzel’s (2019) article, three individuals imprisoned under the Maria da Penha law were evaluated through interviews and the Rorschach method, two of whom had murdered their partners. Difficulties in managing tensions and stress and a repertoire of conflict resolution based on aggression were identified. When analyzing their backgrounds (Stenzel & Lisboa, 2019), family patterns characterized by abuse, physical and psychological violence, helplessness, and trauma were identified.

Considering these characteristics in the aggressors’ life histories, Voith et al. (2020) emphasize the importance of investigating and intervening in the traumas experienced by these men as a possible pathway to preventing future violence against their current partners. New strategies based on investigations into life histories that address trauma and beliefs that affect the occurrence of violence, as well as elements that can modify rigid beliefs associated with violent behavior, can also be highlighted (Karakurt et al., 2019).