RESUMO
Background: Psychological recidivism-reducing interventions with serious, young violent offenders in residential care have unsatisfactory effects. We tested if a complementary individual cognitive behavioral therapy (iCBT) intervention focusing problem-solving, cognitive self-control, and relapse prevention reduces criminal recidivism beyond usual institutional care encompassing interventions such as social skills training and prosocial modeling (treatment-as-usual; TAU). Method: We consecutively approached 115 eligible serious, male violent crime offenders in five residential treatment homes run by the Swedish National Board of Institutional Care. Eighty-one (70%) 16 to 21-year-old youth at medium-high violent recidivism risk were included and randomized to an individualized 15 to 20-session CBT intervention plus TAU (n = 38) or to TAU-only (n = 43), 4-6 months before release to the community. Participants were assessed pre- and post-treatment, at 12 months (self-reported aggressive behavior, reconvictions) and 24 months (reconvictions) after release. Intent-to-treat analyses were applied. Results: The violent reconviction rate was slightly higher for iCBT+TAU vs. TAU-only youth at 12 months (34 vs. 23%, d = 0.30, 95% CI: -0.24 to 0.84) and 24 months following release (50 vs. 40%, d = 0.23, 95% CI: -0.25 to 0.72), but neither of these differences were significant. Cox regression modeling also suggested non-significantly, negligibly to slightly more violent, and any criminal recidivism in iCBT+TAU vs. TAU-only youth during the entire follow-up. Further, we found no significant between-group differences in conduct problems, aggression, and antisocial cognitions, although both iCBT+TAU and TAU-only participants reported small to large within-group reductions across outcome measures at post-treatment. Finally, the 12-month follow-up suggested marginally more DSM-5 Conduct Disorder (CD) symptoms of "aggression to people and animals" in iCBT+TAU vs. TAU-only youth (d = 0.10, 95% CI: -0.40 to 0.60) although this difference was not significant. Conclusion: We found no additive effect of individual CBT beyond group-based TAU in residential psychological treatment for serious, young male violent offenders. Limited sample size and substantial treatment dropout reduced the robustness of intent-to-treat effect estimates. We discuss the possible impact of treatment dose and integrity, participant retention, and TAU quality.
RESUMO
BACKGROUND: Aggression replacement training (ART) is a widely used cognitive behavioural intervention for reducing aggression-related recidivism among criminal offenders. Its effectiveness in reducing offending, however, remains uncertain. AIM: To examine the effect of ART on adult offenders' criminal recidivism rates. METHOD: We compared 1,124 convicted adult offenders who began ART in the Swedish Prison and Probation Services 2003-2009 with 3,372 offenders in the system at the same time who did not participate in ART. Linkage with nationwide, longitudinal registries allowed extensive propensity score-matched controlling for baseline differences (e.g. sociodemographics, criminal history, psychiatric morbidity, and substance misuse) between groups. RESULTS: Intent-to-treat analyses suggested similar 1-year general reconviction rates (according to the National Crime Register) between the two groups (ART participants 50% [n = 465]: comparison participants 51% [n = 1,492]; hazard ratio [HR] = 0.97, 95% CI [0.88, 1.07]) and similar one-year violent recidivism (ART participants 19% [n = 174]: comparison participants 18% [n = 547]; HR = 1.02, 95% CI [0.89, 1.17]). For ART completers, findings suggested a marginal decrease in reconvictions for any recidivism, but not for violent recidivism specifically. Sensitivity analyses yielded similar results. CONCLUSIONS AND IMPLICATIONS: Our findings add to the emerging literature suggesting no effect of ART on reoffending among adult offenders. Originally designed for adolescents, it may be that the programme should include components for more adult-specific needs. Further, although group differences in reoffending did not emerge, research with a wider range of outcomes may be worthwhile before abandoning this approach with offenders.