Cognitive-Behavioral Therapy Efficacy for Reducing Recidivism Rates of Moderate- and High-Risk Sexual Offenders: A Scoping Systematic Literature Review

Moderators of Sexual Recidivism as Indicator of Treatment Effectiveness in Persons With Sexual Offense Histories: An Updated Meta-analysis

The present meta-analysis is an update of the meta-analysis by Schmucker and Lösel [Campbell Syst. Rev. 2017; 13: 1-75], which synthesized evidence on sexual recidivism as an indicator of treatment effectiveness in persons with sexual offense histories. The updated meta-analysis includes 37 samples comprising a total of 30,394 individuals with sexual offense histories, which is nearly three times the sample size reported by Schmucker and Lösel (2017: 28 samples, N = 9781). In line with Schmucker and Lösel (2017), the mean treatment effect was small with an odds ratio of 1.54 [95% CI 1.22, 1.95] (p < .001). A moderator analysis suggested three predictors of importance, i.e., risk level, treatment specialization, and author confounding. Greater treatment effectiveness was suggested in high- and medium-compared to low-risk individuals and in specialized compared to non-specialized treatments. Authors affiliated with treatment programs reported larger effectiveness than independent authors. These findings were overall in line with Schmucker and Lösel (2017), though the effects of risk level and treatment specialization were stronger in the current meta-analysis. The findings of the updated meta-analysis reinforce the evidence for the first and second principle of the Risk-Need-Responsivity model. The results may support researchers and decision-makers in interpreting the current evidence on sexual recidivism as an indicator of treatment effectiveness, and, based on that, implement and carry out informative, methodologically sound evaluations of ongoing treatment programs in persons with sexual offense histories.

Traumatic brain injury and mental health outcomes among recently incarcerated men

This study examined the association between experiencing a traumatic brain injury (TBI) before or during incarceration and several postrelease negative mental health consequences in a cohort of men recently released from prison. The goal of the study was to explicate the variety of mental health-related issues incurring a TBI has on one's ability to successfully reintegrate back into society following incarceration. Using data from the LoneStar Project, we used ordinary least squares regression and logistic regression to assess the prevalence of depressive symptoms, stress, trauma flashbacks, and psychosis in a representative sample of men released from Texas prisons (N = 498) approximately 9 months post-prison release. Recently released men with a history of head injury exhibited higher levels of depression, B = 0.204, 95% CI [.071, .337]; stress, B = 0.266, 95% CI [.116, .416]; experiencing trauma-related flashbacks, odds ratio (OR) = 2.950, 95% CI [1.740, 5.001]; and psychosis, OR = 3.093, 95% CI [1.601, 5.975], compared to their non-head-injured counterparts. TBIs-whether sustained before or during incarceration-pose significant risks for adverse mental health outcomes, particularly for recently released individuals during the already challenging and strained period of reintegration.

The Effectiveness of Psychological Treatment in Adult Male Convicted for Sexual Offenses Against Children: A Systematic Review

Child sexual abuse is a public health problem of global magnitude with profound and negative consequences for the victims and society. Thus, psychological intervention with individuals who sexually offended against children is crucial for reducing recidivism. Numerous reviews and meta-analyses have shown the effectiveness of psychological interventions in individuals who sexually offended, but few reviews have been done on this subtype of offenders. This article reviews evaluation studies of intervention programs designed to treat individuals who sexually offended against children, providing a more detailed account of treatment procedures. Articles were identified from peer-reviewed databases, bibliographies, and experts. Following full-text review, 12 studies were selected for inclusion by meeting the following criteria: quantitative or qualitative research studies published in English from 2000 to 2020 with titles or abstracts that indicated a focus on treatment effectiveness, detailing the psychological treatment procedures on adult, male individuals convicted for child sexual abuse. Cognitive-behavioral therapy with a relapse prevention approach was the most frequent modality found in child sexual offending treatment. Besides, different criminogenic and non-criminogenic factors emerge as targets for intervention. Study design, study quality, and intervention procedures shortened the accumulation of evidence in treatment effectiveness.

Where do they stand? A post-structuralist examination of offense-supportive narratives constructed by men convicted of child sexual abuse

Decisions to engage in child sexual abuse (CSA) are not motivated solely by sexual/romantic interest in children. Given the complex interplay of personal, relational, and societal factors involved, we explored the narratives men constructed around their subjective motivations for offending, situated within the post-structuralist constructs of desire, power, and ethical subjectivity. Qualitative interviews were conducted with 25 men charged/convicted of CSA. Offenses were often contextualized as attempts to satisfy sexual and/or emotional desires. While some participants reported a persistent interest in children, others attempted to satisfy these desires through CSA in response to negative experiences with adults, including sexual overregulation, sexual objectification, and demoralization. Participants' subversion of social and ethical norms was aided by offense-supportive narratives that stemmed from their interactions with/interpretations of the world. Interventions to prevent CSA may benefit from a post-structuralist perspective of the social and cultural mechanisms by which men's decisions to engage in CSA are shaped.

The efficacy of CBT based interventions to sexual offenders: A systematic review of the last decade literature

Sexual violence is a significant public health problem and a devastating issue for mental health throughout the world. Clinicians and researchers have worked, over the last decades, to develop effective strategies aimed at reducing sexual abuse rates. Multiple treatment approaches for sex offenders have been developed, with Cognitive Behavioral Therapy (CBT) been the most widely used therapy model with recognized effectiveness. In this sense, the present study aimed to analyze and evaluate the effectiveness of CBT based interventions in the treatment of individuals convicted of sexual crimes. For this purpose, a systematic review of articles published between 2012 and 2022 was carried out in the databases Pubmed, Science Direct, APA PsycNet and Scielo, with the keywords "cognitive behavioral therapy", "CBT", "sexual offender", "sexual crimes" and others. As a result, eight studies were selected that met the defined inclusion criteria. Cognitive-behavioral interventions have shown great promise in reducing sexual crime recidivism and improving self-control, emotional regulation, intra and interpersonal social skills, supporting the hypothesis that CBT may be a promising model of intervention in forensic settings with sex offenders.

Effectiveness of a program for the development of socio-emotional competences in people admitted to a penitentiary center

The purpose of this paper was to evaluate the effectiveness of a program for the development of social and emotional competences and self-esteem among a group of inmates at a penitentiary center, as well as to determine the possible correlation between the variables of the program (social skills, emotional competences, and self-esteem). The objective was to equip inmates with social competences in emotional regulation strategies that would be useful to them in the penitentiary center and, at the same time, facilitate their future social inclusion. In order to measure the pre- and post- treatment variables, the Social Skills Scale, the Perceived Emotional Intelligence Scale (TMMS-24), and the Rosenberg Self-Esteem Scale (RSES) were administered to a group of 51 inmates in a penitentiary center. The experimental group consisted of 29 inmates, with 21 forming the control group. The pretest-posttest ANOVAs showed that the program led to a significant (p < 0.01) increase in: (1) positive social behaviors; (2) emotional competences; (3) self-esteem. Positive correlations were also observed between the three variables. The results suggest the importance of implementing programs for the promotion of the socio-emotional development of people incarcerated in penitentiary centers.

Does Gender Affect Judges' Perceptions of Sexual Assault Cases?

There is growing recognition that females engage in harmful sexual behaviour that is similar in severity and type to males. Existing research, however, suggests that there is a bias towards leniency in judicial systems for female sexual offenders (FSOs) in comparison to male sexual offenders (MSOs). Specifically, FSOs receive shorter sentences than do MSOs and are less likely to be sentenced to prison. The majority of research examining disparity in sentence outcomes for FSOs have been analysed through a quantitative lens. Qualitative methodology is also needed to understand any subjective differences in the way that judges perceive case-relevant factors and whether these perceptions differ as a function of the offender's gender. The present study is a qualitative study that examined judges' perceptions and descriptions of FSO compared to MSO in 10 matched cases of sexual offending. The study found that although there were many similarities in how judges perceived FSO compared to MSO, there were also unique differences that could explain more lenient sentences for FSOs (i.e. the vulnerability, poor mental health and adverse backgrounds of FSOs). Other unique differences found were that judges' perception of FSOs behaviour was described as depraved and cruel, whereas MSOs similar behaviour was not described in such an emotive way. The present study provides additional insight into the reasons for a bias towards leniency for FSOs. In particular, it points towards judicial focus on particular personal circumstances that are seen as relevant in sentencing FSOs but not for MSOs.

Hormonal response to perceived emotional distress in incarcerated men with sexual sadism

Sexual sadists derive pleasure from humiliation, domination and infliction of pain on victims. They display increased penile arousal and activation of brain regions involved in sexual arousal and emotional states when viewing stimuli depicting individuals in physical distress. Neuroactive hormones modulate these regions, but it is unknown if sexual sadists also have endocrine responses to depictions of individuals in distress. The present study examined endocrine responses, elicited by viewing a video depicting an individual in extreme emotional distress, in incarcerated adult male sexual offenders (n = 23) with varying levels of sadistic traits. Sadism, was measured by the Severe Sexual Sadism Scale (SeSaS). Testosterone (T), adrenocorticotropic hormone (ACTH), and oxytocin (OT) were assayed before and after participants watched a video depicting an individual in emotional distress. T responses to the video were significantly and positively associated with SeSaS scores. There were no significant associations between sexual sadism and OT or ACTH. Our findings provide physiological evidence of atypical processing of distress cues in sadism consistent with the role of testosterone in sexual arousal and aggressive behaviors. These findings have implications for the evaluation and treatment of sexual sadists.

[Therapeutic Factors in Offender Treatment: A Systematic Review]

This paper presents a systematic literature review of international research on therapeutic factors in offender treatment. The review was based on the PRISMA criteria; PsycINFO and PSYNDEX as well as references given in included studies were browsed. Only quantitative empirical studies published between 1990 and 2018 were included. In this paper, evidence for common factors (therapeutic alliance, social climate, feedback) and therapist factors (interpersonal skills/characteristics, personality, therapy expectations) from 19 journal articles are reported. Some tendencies emerged, but there was no conclusive evidence on the effect of common factors and therapist factors on the therapy outcome. This non-conclusive evidence is mostly due to the methodological shortcomings of primary studies, heterogeneity of outcome variables and the low number of studies that looked at each of these variables. In sum, there is not enough evidence to date to show a strong relationship between common factors and therapist factors and a (positive) outcome in the treatment of offenders.

The Integration of People Convicted of a Sexual Offence Into the Community and Their (Risk) Management

PURPOSE OF REVIEW

We are reviewing recent research into the community integration of men convicted of a sexual offence and their (risk) management. This is a high-profile political issue that binds together research in psychology, criminology, politics, health, public health, and policy studies. The review will demonstrate that a multi-disciplinary, life course, EpiCrim-oriented approach is the most effective way of reducing re-offending and promoting desistance in this population.

RECENT FINDINGS

Research demonstrates that life course development, especially from psychology and criminology, has an impact on whether people sexually offend or not. Therefore, to understand sexual offending behaviour, we need to look at the aetiology of said behaviour from a nature and a nurture perspective. Therefore, we need to use an Epidemiological Criminology (a marriage of Public Health and criminology) approach that works at all four stages of the Socio-Ecological Model (SEM) (individual, interrelationship, community, and societal). The research encourages a person first approach, that we look at Adverse Childhood Experiences and past trauma in the lives of men who sexually offend and use this, in conjunction with strength-based approaches, to inclusively integrate them into society. The prevention of sexual offending, both first time offending, and relapse prevention require a multi-level, multi-disciplinary approach. Successful desistance from sexual offending is as much about the community and society as it is about the individual.

Does Treatment for Sexual Offending Work?

PURPOSE OF REVIEW

We review and synthesize the literature on the effectiveness of offense-focused treatment for sexual offending. Specifically, we consider whether the extant literature suggests treatment is effective in reducing sexual reoffending and features of effective interventions. We also consider how the design of program evaluations may influence treatment outcomes.

RECENT FINDINGS

Recent research suggests that offense-focused psychological treatment for sexual offending shows some level of effectiveness in reducing both sexual and general reoffending. Further, there appear to be key program, individual, and study design features associated with treatment effectiveness. Although recent findings paint an optimistic outlook for offense-focused psychological treatment for sexual offending, further high-quality differential studies are needed to fully understand the range of content, delivery, and individual factors associated with successful treatment outcomes so as to establish what works best for whom.

Reducing recidivism using the Reasoning and Rehabilitation program: a pilot multi-site-controlled trial among prisoners in Switzerland

OBJECTIVES

This study evaluated whether the Reasoning and Rehabilitation (R&R2) program was effective in reducing recidivism, minimizing dropout rates, and improving outcomes related to attitudes, behaviors, and personality among people living in detention.

METHODS

Data were collected in eight Swiss German-speaking prisons among males detained for violent offenses using a quasi-experimental controlled design (R&R2: n = 129, treatment as usual [TAU]: n = 84). Measures included recidivism, dropout rate, and self-report questionnaires (hostile attribution bias, aggressiveness, interpersonal problems, and willingness to accept responsibility). Data were analyzed using mixed-effect models.

RESULTS

Participants in the R&R2 group were less likely to reoffend in comparison with the TAU group in the intention-to-treat (n = 51, odds ratio = 0.75, p = .060) and the per-protocol (excluding dropouts; n = 38, odds ratio = 0.65, p = .068) analyses. They also had lower self-reported scores of spontaneous and reactive aggressiveness (p = .047 and p = .070) and excitability (p = .086).

CONCLUSIONS

The findings of this pilot project were promising, with the R&R2 program leading to reduced recidivism and dropout rate. Even though these results should be considered preliminary, the R&R2 program appeared to be a relevant approach in reducing recidivism after prison.

A narrative review of research on clinical responses to the problem of sexual offenses in the last decade

Research on the treatment and programs for people who have committed sexual offenses has greatly increased in the past decade. The aim of this review is to discuss research that has been published over that period (2010-2019) that is relevant for treatment providers. The articles included in this review were found through PsycINFO and PubMed (Medline) using the keywords "treatment or therapy" and "sex offen*". The inclusion criteria were publications that discuss treatment of persons who have committed sexual offenses (written in the English language only). Any articles that examined only special populations were excluded, such as those that examined persons who committed sexual offenses who were female, had intellectual disabilities, deafness, juveniles, etc., because these groups will likely have needs and responsivity factors that differ from the "average" natal-born male sex offender. Results showed that several meta-analyses indicate that treatment is effective in reducing sexual recidivism. The most frequently used treatment for sex offenders is cognitive behavioral therapy, which is often provided in conjunction with pharmacological treatment to reduce sexual impulsivity and/or sex drive. This review is limited to the specific key search terms. The findings of this review support the use of treatment and a community reintegration approach when treating persons who have committed sexual crimes to prevent sexual recidivism.

The Intensity and Timing of Sex Offender Treatment

Current evidence about the impact of specialized sex offender treatment on reoffending remains inconsistent, drawing attention to the need to focus more on those program characteristics that potentially moderate outcome. This review considers current professional perspectives and evidence on two defining aspects of treatment: its intensity and timing. It is concluded that insufficient evidence currently exists to articulate best practice in this area and there is a pressing need to collect empirical evidence about the effectiveness of different intensity treatments offered at different stages of sentence.

An Etiological Approach to Sexual Offender Assessment: CAse Formulation Incorporating Risk Assessment (CAFIRA)

PURPOSE OF REVIEW

Case formulations (CF) have been the cornerstone of effective practice in clinical psychology since the 1950s and now form one of the core competencies in clinical and forensic assessment. The use of CFs within forensic settings is becoming more relevant when working with offenders who have experienced significant trauma, suffered from personality disorder, and have displayed sexually abusive behavior. Furthermore, most North American and European jurisdictions insist that expert witnesses adopt an idiosyncratic approach to risk assessment and consider the characteristics of the individual as part of a wider formulation of the problem behavior. This article focuses specifically on CF incorporating risk assessment procedures of sexual offenders.

RECENT FINDINGS

While empirical support for the use of risk analysis and formulation in managing offending behavior generally, and sexual offending behavior in particular, is limited, there is mounting evidence to suggest that CF can improve understanding of an individual's problem sexual behaviors. We argue that by integrating risk formulations into the CF provides a conceptually robust link between the etiologically development of the problem sexual behavior and effective assessment and risk management of sexual offenders. As forensic treatment programs increasingly moved toward strength-based approaches, in keeping with the Risk-Need-Responsivity principles Andrews and Bonta (2004), and the Good Lives Model Ward and Stewart (Prof Psychol Res Pract 34:353-60, 2003) of offender rehabilitation, the use of CFs in the assessment, treatment, and management of sexual offenders is indispensable. We present an etiological framework for understanding risk in an individual sexual offender by integrating a case formulation model to include the use of (static, stable, and acute) actuarial and clinical risk assessment measures as well as protective risk factors, referred to as the CAse Formulation Incorporating Risk Assessment (CAFIRA) model.

Study on the Therapeutic Effects of Drug and Cognitive-Behavioral Therapy on Non-Erosive Reflux Disease Patients With Emotional Disorders

OBJECTIVE

To assess the correlation between the incidence of non-erosive reflux disease (NERD) and mental and psychological factors, deepen the understanding of the pathogenesis of NERD and explore effective treatments.

METHODS

NERD patients with mood disorders who met the inclusion criteria were randomly divided into a drug treatment group, a psychotherapy group, and a psychotherapy combined with drug treatment group. Before and after treatment, the patients were retrospectively analyzed using the gastroesophageal reflux disease Questionnaire, Hamilton Depression Scale, Hamilton Anxiety Scale, and SF-36 Quality of Life Scale.

RESULTS

All three treatments were found to relieve patients' symptoms and improve their quality of life to some extent. The psychotherapy combined with drug treatment group showed the best overall curative effect. The Hamilton Depression and Anxiety Scale scores were significantly lower in the psychotherapy-alone group and psychotherapy combined with drug treatment group than in the drug treatment alone group at 4, 8, and 12 weeks (P < 0.05).

CONCLUSION

Medication, psychotherapy, and psychotherapy combined with medication can relieve clinical symptoms and improve quality of life to varying degrees in patients with NERD.