Metacognitive Interpersonal Therapy for Male Intimate Partner Violence Perpetrators With Personality Disorders (MIT-MDO-PT)

Adult men under judicial supervision for intimate partner violence with a personality disorder receive 24 individual weekly 50-minute sessions of MIT-MDO-PT after a baseline phase with weekly monitoring (target of five weekly data points; minimum of three only under imminent risk). Treatment onsets are fixed a priori and staggered by at least three weeks between participants (nonconcurrent multiple-baseline design).

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%.

• MIT-MDO
• Terapia Metacognitiva Interpessoal para Agressores de Violência Doméstica

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.

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.

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.

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).

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

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.

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

Inventory of Interpersonal Problems - 32 items (IIP-32), total score. Metric: RCI T0-T3 (|RCI| >= 1.96; decrease = improvement).

Difficulties in Emotion Regulation Scale, Portuguese version (EDRE), total score. Metric: RCI T0-T3 (|RCI| >= 1.96; decrease = improvement).

Short UPPS-P Impulsive Behavior Scale (SUPPS-P), total and facet scores, Portuguese version. Metric: RCI T0-T3 (|RCI| >= 1.96; decrease = improvement).

Toronto Alexithymia Scale - 20 items (TAS-20), total score, Portuguese version. Metric: RCI T0-T3 (|RCI| >= 1.96; decrease = improvement).

Test of Self-Conscious Affect (TOSCA-3), shame-proneness and guilt-proneness scales. Metric: RCI T0-T3 (|RCI| >= 1.96).

Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD): number of personality disorder diagnoses met. Descriptive reporting only (no inferential threshold).

CTS2 partner version (CTS2-P) and Psychological Maltreatment of Women Inventory - Short Form (PMWI-SF), administered exclusively by hospital victim-support staff. Metric: per-informant change classification and dyad-level concordance category with perpetrator report (descriptive); ICC(2,1) exploratory only if at least 5 complete dyads.

Per-participant visual analysis of the MSAS trajectory (T0-T2) and the weekly CTS2 monitoring series, classified as temporal precedence present, absent or indeterminate. No formal mediation model (N = 5-7).

Objectively recorded events, independent of self-report: new police or judicial occurrences for violence, breaches of the judicial measure notified by the Directorate-General for Reintegration and Prison Services, and activations of the hospital safety protocol. Counts per participant and per phase (baseline, treatment, follow-up), reported descriptively without a formal hypothesis. Any incident meeting the a priori definition of a serious adverse event is reported to the Ethics Committee and triggers the study-level stopping rule.

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

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

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.

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.

Number of MIT-MDO-PT sessions attended by each participant, out of 24 scheduled sessions. Descriptive reporting per participant; completion defined as attendance at 20 or more sessions.

Number of participants enrolled per month during the enrolment window (January to June 2027), by referral pathway. Descriptive reporting.

Percentage of scheduled assessment occasions (T0 to T4 and weekly monitoring points) completed by each participant. Descriptive reporting.

Number of participants for whom the partner completed both partner assessments (T0 and T3) with the hospital victim-support service. Descriptive reporting.

Number of participants who discontinued the intervention before Session 24, classified by reason for discontinuation (e.g., withdrawal of consent, breach of judicial measure, relocation, exclusion for safety). Descriptive reporting.