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A multi-site randomized controlled trial of a cognitive skills programme for male mentally disordered offenders: social–cognitive outcomes

Published online by Cambridge University Press:  16 August 2011

A. E. Cullen*
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK
A. Y. Clarke
Affiliation:
South London and Maudsley NHS Trust, London, UK
E. Kuipers
Affiliation:
Department of Psychology, Institute of Psychiatry, King's College London, London, UK Biomedical Research Centre for Mental Health at the Institute of Psychiatry, King's College London and the South London and Maudsley NHS Foundation Trust, London, UK
S. Hodgins
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK Département de Psychiatrie, Université de Montréal, Montréal, Canada Department of Psychiatry, Heidelberg University, Heidelberg, Germany
K. Dean
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK South London and Maudsley NHS Trust, London, UK
T. Fahy*
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK South London and Maudsley NHS Trust, London, UK
*
*Address for correspondence: A. E. Cullen and T. Fahy, Department of Forensic and Neurodevelopmental Sciences (Box P023), Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. (Email: alexis.cullen@kcl.ac.ukorthomas.fahy@kcl.ac.uk)
*Address for correspondence: A. E. Cullen and T. Fahy, Department of Forensic and Neurodevelopmental Sciences (Box P023), Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. (Email: alexis.cullen@kcl.ac.ukorthomas.fahy@kcl.ac.uk)

Abstract

Background

Cognitive skills programmes have been associated with improvements on psychometric measures and reductions in antisocial behaviour in mentally disordered offenders (MDOs). However, to date there have been no randomized controlled trials (RCTs) of such programmes with this population. In the first RCT of a cognitive skills programme with MDOs we aimed to determine if participation in the Reasoning and Rehabilitation (R&R) programme was associated with improvements in social–cognitive skills and thinking styles.

Method

A total of 84 men with a primary diagnosis of psychotic disorder and a history of violence were recruited from medium-secure forensic units and allocated to receive R&R (n=44) or treatment as usual (TAU; n=40). At baseline and post-treatment interviews, participants completed questionnaires to assess social problem-solving, criminal attitudes, anger experience, blame externalizing and perspective-taking. Researchers were not blind to group status.

Results

The R&R group demonstrated significant improvements on measures of social problem-solving relative to the TAU group, some of which were maintained at 12 months post-treatment. Only half of those allocated to receive R&R completed the full programme. In post-hoc analyses programme completers showed improvements in social problem-solving at the end of treatment and changes in criminal attitudes at 12 months post-treatment.

Conclusions

Among male MDOs, R&R participation was associated with improvements in social–cognitive skills, some of which were maintained for up to 12 months post-treatment. Our finding that programme completers do better may reflect pre-treatment patient characteristics. This study establishes that multi-site RCTs can be conducted in medium-secure forensic units.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2011

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References

Ashford, JB, Wong, KW, Sternbach, KO (2008). Generic correctional programming for mentally ill offenders: a pilot study. Criminal Justice and Behavior 35, 457473.Google Scholar
Bateman, AW, Tyrer, P (2004). Psychological treatment for personality disorders. Advances in Psychiatric Treatment 10, 378388.Google Scholar
Batson, A, Gudjonsson, G, Gray, J (2010). Attribution of blame for criminal acts and its relationship with psychopathy as measured by the Hare Psychopathic Checklist (PCL-SV). Journal of Forensic Psychiatry and Psychology 21, 91–101.Google Scholar
Berman, AH (2005). The Reasoning and Rehabilitation program: assessing short- and long-term outcomes among male Swedish prisoners. Journal of Offender Rehabilitation 40, 85–103.Google Scholar
Beven, JP, O'Brien-Malone, A, Hall, G (2004). Using the Interpersonal Reactivity Index to assess empathy in violent offenders. International Journal of Forensic Psychology 1, 3341.Google Scholar
Brennan, PA, Mednick, SA, Hodgins, S (2000). Major mental disorders and criminal violence in a Danish birth cohort. Archives of General Psychiatry 57, 494500.Google Scholar
Clarke, AY, Cullen, AE, Walwyn, R, Fahy, T (2010). A quasi-experimental pilot study of the Reasoning and Rehabilitation programme with mentally disordered offenders. Journal of Forensic Psychiatry and Psychology 21, 490500.Google Scholar
Cohen, J (1992). A power primer. Psychological Bulletin 112, 155159.Google Scholar
Colledge, M, Collier, P, Brand, S (1999). Crime Reduction Programme and Constructive Regimes in Prisons. Programmes for Offenders: Guidance for Evaluators. Home Office Research, Development and Statistics Directorate: London.Google Scholar
Cullen, AE, Soria, C, Clarke, AY, Dean, K, Fahy, T (2011). Factors predicting dropout from the Reasoning and Rehabilitation program with mentally disordered offenders. Criminal Justice and Behavior 38, 217230.Google Scholar
D'Zurilla, TJ, Nezu, AM, Maydeu-Olivares, A (2002). Social Problem-Solving Inventory-Revised (SPSI-R): Technical Manual. Multi-Health Systems: North Tonawanda, NY.Google Scholar
Davidson, KM, Tyrer, P, Tata, P, Cooke, D, Gumley, A, Ford, I, Walker, A, Bezlyak, V, Seivewright, H, Robertson, H, Crawford, MJ (2009). Cognitive behaviour therapy for violent men with antisocial personality disorder in the community: an exploratory randomized controlled trial. Psychological Medicine 39, 569577.Google Scholar
Davis, MA (1980). A multidimensional approach to individual differences in empathy. JSAS Catalog of Selected Documents in Psychology 10, 85.Google Scholar
Dolan, M, Blackburn, R (2005). Interpersonal factors as predictors of disciplinary infractions in incarcerated personality disordered offenders. Personality and Individual Differences 40, 897907.Google Scholar
Donnelly, JP, Scott, M (1999). Evaluation of an offending behaviour program with a mentally disordered offender population. British Journal of Forensic Practice 1, 2532.Google Scholar
First, MB, Gibbon, M, Spitzer, RL, Williams, JBW, Benjamin, LS (1997). Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). American Psychiatric Press, Inc.: Washington, DC.Google Scholar
Fox, S, De Koning, E, Leicht, S (2003). The relationship between attribution of blame for a violent act and EPQ-R sub-scales in male offenders with mental disorder. Personality and Individual Differences 34, 14671475.Google Scholar
Frude, N, Honess, T, Maguire, M (1994). Crime-Pics II Manual. Michael and Associates: Cardiff.Google Scholar
Gendreau, P, Little, T, Goggin, C (1996). A meta-analysis of the predictors of adult offender recidivism: what works! Criminology 34, 575607.Google Scholar
Gudjonsson, GH, Singh, KK (1989). The revised Gudjonsson Blame Attribution Inventory. Personality and Individual Differences 10, 6770.Google Scholar
Haddock, G, Barrowclough, C, Shaw, JJ, Dunn, G, Novaco, RW, Tarrier, N (2009). Cognitive–behavioural therapy v. social activity therapy for people with psychosis and a history of violence: randomised controlled trial. British Journal of Psychiatry 194, 152157.Google Scholar
Hart, SD, Cox, D, Hare, R (1995). The Hare PCL: SV: Psychopathy Checklist: Screening Version. Multi-Health Systems: New York.Google Scholar
Hodgins, S (2008). Violent behaviour among people with schizophrenia: a framework for investigations of causes, and effective treatment, and prevention. Philosophical Transactions of The Royal Society B 363, 25052518.Google Scholar
Hodgins, S, Cote, G (1993). Major mental disorder and antisocial personality disorder: a criminal combination. Bulletin of the American Academy of Psychiatry and the Law 21, 155160.Google Scholar
Hodgins, S, Müller-Isberner, R (eds) (2000). Mentally Disordered Offenders: Concepts and Methods for Effective Treatment and Prevention. John Wiley & Sons: Chichester, UK.Google Scholar
Hodgins, S, Müller-Isberner, R (2005). Cognitive–behavioural interventions in schizophrenia. British Journal of Psychiatry 186, 445.Google Scholar
Hollin, CR (1999). Treatment programs for offenders. Meta-analysis, ‘what works,’ and beyond. International Journal of Law and Psychiatry 22, 361372.Google Scholar
Hollin, CR, Palmer, EJ (2009). Cognitive skills programmes for offenders. Psychology, Crime and Law 15, 147164.Google Scholar
Jones, JP, Thomas-Peter, BA, Trout, A (1999). Normative data for the Novaco Anger Scale from a non-clinical sample and implications for clinical use. British Journal of Clinical Psychology 38, 417424.Google Scholar
Kay, SR, Opler, LA, Fiszbein, A (2000). Positive and Negative Syndrome Scale. Multi-Health Systems Inc.: Toronto.Google Scholar
Linehan, MM (1993). Cognitive–Behavioural Treatment of Borderline Personality Disorder. Guilford Press: New York.Google Scholar
McGuire, J (2005). Social problem solving: basic concepts, research and applications. In Social Problem-Solving and Offenders: Evidence, Evaluation and Evolution (ed. McMurran, M. and McGuire, J.). John Wiley & Sons: Chichester, UK.Google Scholar
McGuire, J (2009). Reducing personal violence: risk factors and effective interventions. In The Neurobiological Basis of Violence: Science and Rehabilitation (ed. Hodgins, S., Viding, E. and Plodowski, A.), pp. 287327. Oxford University Press: Oxford, UK.Google Scholar
McMurran, M, Egan, V, Richardson, C, Ahmadi, S (1999). Social problem solving in mentally disordered offenders: a brief report. Criminal Behaviour and Mental Health 9, 315322.Google Scholar
Mesholam-Gately, RI, Giuliano, AJ, Goff, KP, Faraone, SV, Seidman, LJ (2009). Neurocognition in first-episode schizophrenia: a meta-analytic review. Neuropsychology 23, 315336.Google Scholar
Monahan, J, Steadman, HJ, Silver, E, Appelbaum, PS, Robbins, PC, Mulvey, EP, Roth, L, Grisso, T, Banks, S (2001). Rethinking Risk Assessment: the MacArthur Study of Mental Disorder and Violence. Oxford University Press: New York.Google Scholar
Morgan, RD, Fisher, WH, Duan, N, Mandracchia, JT, Murray, D (2010). Prevalence of criminal thinking among state prison inmates with serious mental illness. Law and Human Behavior 34, 324336.Google Scholar
Novaco, RW (1994). Anger as a risk factor for violence. In Violence and Mental Disorder: Developments in Risk Assessment (ed. Monahan, J. and Steadman, H. J.), pp. 2159. University of Chicago Press: Chicago.Google Scholar
Porporino, FJ, Fabiano, EA (2000). Program Overview of Cognitive Skills Reasoning and Rehabilitation Revised: Theory and Application. T3 Associates: Ottawa, Canada.Google Scholar
Porporino, FJ, Fabiano, EA, Robinson, D (1991). Focusing on Successful Reintegration: Cognitive Skills Training for Offenders. R-19 Research Branch, The Correctional Services: Ottawa, Canada.Google Scholar
Pullen, S (1996). Evaluation of the Reasoning and Rehabilitation Cognitive Skills Development Program as Implemented in Juvenile ISP in Colorado. National Institute of Justice: Washington, DC.Google Scholar
Robinson, D, Grossman, M, Porporino, FJ (1991). Effectiveness of the Cognitive Skills Training Programme: From Pilot to National Implementation. Correctional Service of Canada: Ottawa, Canada.Google Scholar
Ross, RR, Fabiano, EA (1985). Time to Think: A Cognitive Model of Delinquency Prevention and Offender Rehabilitation. Institute of Social Science and Arts: Johnson City, TN.Google Scholar
Ross, RR, Fabiano, EA, Ewles, CD (1988). Reasoning and rehabilitation. International Journal of Offender Therapy and Comparative Criminology 32, 2935.Google Scholar
Tapp, J, Fellowes, E, Wallis, N, Blud, L, Moore, E (2009). An evaluation of the Enhanced Thinking Skills (ETS) programme with mentally disordered offenders in a high security hospital. Legal and Criminological Psychology 14, 201212.Google Scholar
Tong, LSJ, Farrington, DP (2006). How effective is the “Reasoning and Rehabilitation” programme in reducing reoffending? A meta-analysis of evaluations in four countries. Psychology, Crime and Law 12, 22.Google Scholar
Verheul, R, Van Den Bosch, LM, Koeter, MW, De Ridder, MA, Stijnen, T, Van Den Brink, W (2003). Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands. British Journal of Psychiatry 182, 135140.Google Scholar
Webster, CD, Douglas, K, Eaves, D (1997). HCR–20: Assessing Risk for Violence–Version 2. Simon Fraser University, Mental Health, Law, and Policy Institute: Barnaby, British Columbia.Google Scholar
Wilson, DB, Bouffard, LA, Mackenzie, DL (2005). A quantitative review of structured, group-oriented, cognitive–behavioral programs for offenders. Criminal Justice and Behavior 32, 172204.Google Scholar
Young, S (2010). Programmed interventions for offenders. In The Cambridge Handbook of Forensic Psychology (ed. Brown, J. M. and Campbell, E. A.), pp. 384392. Cambridge University Press: Cambridge.Google Scholar
Young, S, Chick, K, Gudjonsson, GH (2010). A preliminary evaluation of Reasoning and Rehabilitation 2 in mentally disordered offenders (R&R2M) across two secure forensic settings in the United Kingdom. Journal of Forensic Psychiatry and Psychology 21, 336349.Google Scholar