Promoting a Safe Environment in Our Cities: Towards a Theoretical Model of "Moral Deficit" for Appropriate Psychopathic Therapy.

The increasing reported incidents of knife crime in cities and the release on parole of "rehabilitated" violent criminals are creating an unsafe urban environment. Such occurrences suggest that measures taken to address psychopathic-oriented behaviour may have been ineffective because the individual's degree of "moral deficit" is not fully accounted for in the application of specific therapies. This study developed a theoretical model of "moral deficit" that is aligned with the appropriateness of therapy, ranging from the extreme "classical approach" of total confinement justified by a belief in the incurability of psychopaths to the modern therapy that aims to reintegrate the psychopath with society using "moralizing therapy". Analysis of secondary data from extant literature was used to develop the theoretical model of "moral deficit". Secondary data analysis suggests that the extent of psychopathic "moral deficit" may be an important factor in the selection of appropriate therapeutic measures for psychopathy treatment and the rehabilitation of psychopaths as law-abiding members of society. We conclude that a specific type of psychopathic moral deficit may have an important bearing on the appropriateness of treatment. It is recommended that the treatment of psychopathy makes greater provision for the extent and type of psychopathic "moral deficit" in assessing the most appropriate applications for the treatment of psychopathy and promoting the safety of urban environments.

Psychopathy and treatment outcome: Results from a sexual violence reduction program.

The present study examined the association of psychopathy, measured by the Hare Psychopathy Checklist-Revised (PCL-R; Hare, 1991, 2003), to sexual offender treatment completion, change, and recidivism in a Canadian sample of 302 treated sexual offenders followed up in the community 17.6 years post release. Sexual violence risk and treatment change was evaluated via the Violence Risk Scale-Sexual Offense version (Wong, Olver, Nicholaichuk, & Gordon, 2003-2017), and general violence risk via the Sex Offender Risk Appraisal Guide (Quinsey, Harris, Rice, & Cormier, 1998). High-psychopathy men had significantly higher rates of sexual offender treatment noncompletion (30%) than low-psychopathy men (6%), although they did not evidence significantly less therapeutic change. The Affective facet of the PCL-R uniquely, significantly predicted decreased therapeutic progress, and along with the Lifestyle facet, it predicted treatment noncompletion. Examination of recidivism outcomes revealed that treatment completion in and of itself was not significantly associated with decreased sexual or violent recidivism among psychopathic offenders; however, therapeutic change, reflecting risk reduction, was significantly associated with decreased sexual and violent recidivism after controlling for baseline risk and PCL-R score. Results of survival analysis indicated that a subgroup of high-risk psychopathic men who made substantial treatment gains had lower trajectories of sexual and violent recidivism over the follow-up period relative to other high-risk men who demonstrated fewer treatment benefits. The issue of therapeutic pessimism with implications for the treatment and retention of high-psychopathy sexual offenders, per the two-component model, is discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Risks, strengths, gender, and recidivism among justice-involved youth: A meta-analysis.

OBJECTIVE: Debate ensues regarding female-specific risk and strength factors among adolescent offenders. Using meta-analysis, we examined whether risk and strength factors predicted recidivism differentially between male and female youth. METHOD: Database searches identified 22 studies, representing 50,601 justice-involved youth (11,952 females and 38,649 males) and a total of 584 effect sizes. RESULTS: For the global risk domains, there is some evidence for gender neutrality (i.e., risk factors predict to the same degree for both males and females) among most domains (e.g., antisocial peer relations, problematic family circumstances and parenting, substance abuse, antisocial personality/behavior, and antisocial attitudes/orientation). Although the global domains of mental health and child abuse were not significantly predictive for either gender, the global child abuse results trended in favor of predicting recidivism for females. When global risk domains were broken into indicators, some evidence for gender differences emerged (e.g., chronic alcohol use and family substance abuse predicted more strongly for females than for males). Last, gender comparisons among the global strength domains revealed that prosocial peers and the absence of substance abuse predicted success (i.e., no recidivism) for both genders, though a stronger effect emerged for males. In addition, education/employment strengths predicted success for males, whereas prosocial values predicted success for females. Limitations such as the lack of studies that defined constructs from the female experience, and the small number of primary studies are discussed. CONCLUSIONS: Advancing the future of gender informed practice with justice-involved youth will require careful consideration of both gender similarities and differences. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Efficacy of the Unified Protocol for transdiagnostic treatment of comorbid psychopathology accompanying emotional disorders compared to treatments targeting single disorders.

OBJECTIVE: This study aimed to examine whether the Unified Protocol (UP), a transdiagnostic cognitive-behavioral therapy for emotional disorders (i.e., anxiety, mood, and related disorders), is efficacious in the treatment of co-occurring emotional disorders compared to established single disorder protocols (SDPs) that target specific disorders (e.g., panic disorder). METHOD: Participants included 179 adults seeking outpatient psychotherapy. Participant age ranged from 18 to 66 years, with an average of 30.66 years (SD = 10.77). The sample was 55% female and mostly Caucasian (83%). Diagnostic assessments were completed with the Anxiety Disorder Interview Schedule (ADIS), and disorder-specific, clinician-rated measures for the comorbid diagnoses of interest. RESULTS: In both treatment conditions, participants' mean number of diagnoses dropped significantly from baseline to posttreatment, and baseline to 12-month follow-up. Additionally, large effects were observed for changes in comorbid generalized anxiety (ESSG: UP = -1.72; SDP = -1.98), social anxiety (ESSG: UP = -1.33, -0.86; SDP = -1.60, -1.54), and depression (ESSG: UP = -0.83; SDP = -0.84). Significant differences were not observed in between-group comparisons. CONCLUSIONS: Results suggest that both the UP and SDPs are efficacious in reducing symptoms of comorbid emotional disorders. The clinical, practical, and cost-effective advantages of transdiagnostic CBT are discussed.

Racial/Ethnic Disproportionality in Psychiatric Diagnoses and Treatment in a Sample of Serious Juvenile Offenders.

Psychiatric disorder prevalence has been shown demonstrably higher among justice-involved adolescents than youth in the general population. Yet, among arrested juveniles, little is known regarding racial/ethnic differences in disorder prevalence, the role of trauma exposure in the diagnosis of behavioral disorders, or subsequent psychiatric treatment provided to adolescents with such diagnoses. The current study examines racial/ethnic disparity in psychiatric diagnoses and treatment of behavioral disorders associated with delinquency, controlling for traumatic experiences, behavioral indicators, and prior offending among serious juvenile offenders. Logistic regression is employed to explore the racial/ethnic disproportionality in behavioral disorder diagnoses and psychiatric treatment provision among 8763 males (57.7 % Black, 11.8 % Hispanic) and 1,347 females (53.7 % Black, 7.6 % Hispanic) admitted to long-term juvenile justice residential placements in Florida. The results indicate Black males are 40 % more likely, and Black females 54 % more likely to be diagnosed with conduct disorder than Whites, even upon considerations of trauma, behavioral indicators, and criminal offending. Black and Hispanic males are approximately 40 % less likely to be diagnosed with ADHD than White males, with no racial/ethnic differences for females. Importantly, Black males are 32 % less likely to receive psychiatric treatment than White males, with no differences between White and Hispanic males, or any female subgroups. Traumatic exposures increased the odds of oppositional defiant disorder and ADHD, but not conduct disorder for males, though adverse childhood experiences were unrelated to behavioral disorder diagnoses among females.

The Importance of the Mentor-Mentee Relationship in Women's Desistance From Destructive Behaviors.

According to the literature on desistance, the process of reentering society after imprisonment is distinct from the process of desistance as the former is a broader, institutional process that may influence the latter. Scholars have also acknowledged gendered differences in both reentry and desistance processes. Among the array of players in the lives of formerly incarcerated individuals, mentors have become an increasingly popular form of social support in postincarceration programs--particularly for women in reentry. Given the increasing interest in mentoring programs, this study uses semistructured interviews with mentors (n= 10) and clients (n= 11) in a women's postincarceration mentoring program to assess the role of mentors in the reentry process and the desistance process. It was found that mentors aid in these processes by serving as facilitators of change for women who are open to such change and by facilitating in constructive behavioral adjustments.

Testing the Predictive Validity of the LSI-R Using a Sample of Young Male Offenders on Probation in Guangzhou, China.

This study explored the predictive validity of the Level of Service Inventory-Revised (LSI-R) with 112 young male probationers on recidivism for new offense and rearrest in Guangzhou, China, from 2010 to 2013. Using bivariate correlations, logistic regression, and receiver operating characteristics (ROC) analysis, the LSI-R total score was found to be a stable and significant predictor of recidivism. The LSI-R total score and subscales of Criminal History and Leisure/Recreation were significantly correlated to recidivism. There was significant association between time at risk and recidivism. Increase in the LSI-R total score was associated with greater likelihood that recidivism would occur. There was no recidivism in low-risk group, and higher recidivism rates were found in moderate-and high-risk groups. The LSI-R was effective in specifying recidivists and non-recidivists with area under the curve (AUC) coefficient of .733. The current study supports the utility of the LSI-R, which is applicable to different cultural and social contexts, as a risk/need assessment instrument for young male probationer recidivism in Guangzhou. Sufficient training and accumulated experience of administering the LSI-R would be necessary to reduce regional variation. Future studies with larger samples across different offender groups are needed. Limitations and implications for offender assessment in China are discussed.

Taking the Good Life to the Institution: Forensic Service Users' Perceptions of the Good Lives Model.

Previous literature has highlighted a number of concerns about forensic care and rehabilitation by those who use the services. The Good Lives Model (GLM) is a strength-based, humanistic approach to offender rehabilitation that has been largely overlooked by forensic mental health practitioners. This study explored the impact of a brief GLM program on forensic service users' perceptions of rehabilitation, both within and beyond therapeutic programs, using a thematically linked, multiple-case study research design. Pre-post comparisons of participants' perceptions of rehabilitation suggested three different outcomes: definite change, subtle change, and no change. Possible factors associated with participants' divergent experiences included level of exposure to the GLM, readiness to change, and practitioners' adherence to the GLM and experience with the model. The importance of attending to the wider system for successful implementation of this innovative approach is highlighted.

Therapist perception of treatment outcome: Evaluating treatment outcomes among youth with antisocial behavior problems.

Effective evaluation of treatment requires the use of measurement tools producing reliable scores that can be used to make valid decisions about the outcomes of interest. Therapist-rated treatment outcome scores that are obtained within the context of empirically supported treatments (ESTs) could provide clinicians and researchers with data that are easily accessible and complimentary to existing instrumentation. We examined the psychometric properties of scores from the Therapist Perception of Treatment Outcome: Youth Antisocial Behavior (TPTO:YAB), an instrument developed to assess therapist judgments of treatment success among families participating in an EST, Multisystemic Therapy (MST), for youth with antisocial behavior problems. Data were drawn from a longitudinal study of MST. The initial 20-item TPTO:YAB was completed by therapists of 111 families at midtreatment and 163 families at treatment termination. Rasch model dimensionality analyses provided evidence for 2 dimensions reflecting youth- and caregiver-related aspects of treatment outcome, although a bifactor analyses suggested that these dimensions reflected a single more general construct. Rasch analyses were also used to assess item and rating scale characteristics and refine the number of items. These analyses suggested items performed similarly across time and that scores reflect treatment outcome in similar ways at mid and posttreatment. Multilevel and zero-order analyses provided evidence for the validity of TPTO:YAB scores. TPTO:YAB scores were moderately correlated with scores of youth and caregiver behaviors targeted in treatment, adding support to its use as a treatment outcome measurement instrument.

A multiaspect program integrity assessment of the cognitive-behavioral program EQUIP for incarcerated offenders.

Studies on the effectiveness of correctional treatment have widely failed to assess program integrity. This study examined the program integrity of EQUIP in 34 treatment groups of incarcerated offenders, using a new multiaspect program integrity instrument (MIPIE). The first aim of our study was to assess the reliability and validity of the MIPIE. The second aim was to describe the practical application of the instrument as an integrity feedback tool. Results showed that a two-factor solution for the MIPIE appeared to be the most adequate and that the composite program integrity scale of the first factor had a good internal consistency. The interobserver agreement was high. Furthermore, moderate to high relationships were found between observers and trainers, but trainers reported significantly higher program integrity levels. EQUIP was implemented with diverse integrity levels, with higher levels for the United States and program developer sites. By using the MIPIE, detailed feedback can be provided to improve program implementation.

"So, what is a psychopath?" Venireperson perceptions, beliefs, and attitudes about psychopathic personality.

This study surveyed over 400 individuals attending jury duty regarding various perceptions, attitudes, and beliefs they had concerning psychopathic personality (psychopathy). The protocol included (a) prototype ratings of what participants considered to be core features, using the Comprehensive Assessment of Psychopathic Personality (CAPP) prototype rating scale; (b) questions concerning knowledge and beliefs about psychopathy (e.g., prevalence in society); and (c) attitudinal scales concerning potential associated features (e.g., criminality, rehabilitation potential), etiological underpinnings, and moral judgments and legal sanctions. Consistent with results of earlier studies using expert raters, jury panel members rated most of the 33 individual CAPP items and all 6 CAPP scales as at least moderately prototypical, with Self and Dominance domains obtaining the highest mean ratings. Many participants also strongly endorsed symptoms of psychosis (e.g., delusions) as prototypical of psychopathy. Despite this, they viewed psychopaths as responsible for their own actions, as capable of determining right from wrong, and as generally not "insane." Our findings indicate that jury panel members view the prototypical psychopath as highly dominant, self-focused, and lacking in remorse and empathy and reinforce the need for expert witnesses to clearly differentiate between psychopathy and psychotic-spectrum disorders.

Effects of aerobic exercise on cognitive performance and individual psychopathology in depressive and schizophrenia patients.

Cognitive deficits are core symptoms in patients with schizophrenia (SZ) and major depressive disorder (MDD), but specific and approved treatments for cognitive deterioration are scarce. Experimental and clinical evidence suggests that aerobic exercise may help to reduce psychopathological symptoms and support cognitive performance, but this has not yet been systematically investigated. In the current study, we examined the effects of aerobic training on cognitive performance and symptom severity in psychiatric inpatients. To our knowledge, to date, no studies have been published that directly compare the effects of exercise across disease groups in order to acquire a better understanding of disease-specific versus general or overlapping effects of physical training intervention. Two disease groups (n=22 MDD patients, n=29 SZ patients) that were matched for age, gender, duration of disease and years of education received cognitive training combined either with aerobic physical exercise or with mental relaxation training. The interventions included 12 sessions (3 times a week) over a time period of 4 weeks, lasting each for 75 min (30 min of cognitive training+45 min of cardio training/mental relaxation training). Cognitive parameters and psychopathology scores of all participants were tested in pre- and post-testing sessions and were then compared with a waiting control group. In the total group of patients, the results indicate an increase in cognitive performance in the domains visual learning, working memory and speed of processing, a decrease in state anxiety and an increase in subjective quality of life between pre- and post-testing. The effects in SZ patients compared with MDD patients were stronger for cognitive performance, whereas there were stronger effects in MDD patients compared with SZ patients in individual psychopathology values. MDD patients showed a significant reduction in depressive symptoms and state anxiety values after the intervention period. SZ patients reduced their negative symptoms severity from pre- to post-testing. In sum, the effects for the combined training were superior to the other forms of treatment. Physical exercise may help to reduce psychopathological symptoms and improve cognitive skills. The intervention routines employed in this study promise to add the current psychopathological and medical treatment options and could aid the transition to a multidisciplinary approach. However, a limitation of the current study is the short time interval for interventions (6 weeks including pre- and post-testing).

Self-reported physical and emotional abuse among youth offenders and their association with internalizing and externalizing psychopathology: a preliminary study.

The aim of this exploratory study was twofold. First, the severity of physical and emotional abuse perpetrated by parents and its association with internalizing and externalizing problems were explored in a sample of 104 male and female youth offenders. Second, we tested the moderate effect of callous-unemotional traits on the relation between physical and emotional victimization and internalizing and externalizing problems in boys. The analyses revealed that a high percentage of youth offenders reported having been physically abused. More severe physical abuse was not related to higher levels of internalizing or externalizing problems. Young offenders' emotional abuse levels were low; however, this type of abuse was positively associated with externalizing problems among boys, regardless of the level of callous-unemotional traits. Thus, we suggest that youth offenders must be assessed using measures of physical and emotional abuse, and their case management should integrate specific programs to focus on the family environment to which the adolescents will most likely return after their sentence.

Positive criminology in practice.

The discourse regarding offender rehabilitation has been criticized by various scholars who have claimed that reducing negative causes and managing risk will not automatically prompt positive human development and elements that are associated with desistance. Positive criminology is an innovative concept that challenges the common preoccupation with negative elements, by placing emphasis on human encounters and forces of inclusion that are experienced positively by target individuals and that can promote crime desistance. However, as the concept is relatively new, there are still no guiding principles for the practice of positive criminology that could direct research and the criminal justice system. This article attempts to fill that gap by providing principles that could be practiced by criminal justice personnel and examples of different interventions that reflect positive criminology. The article also provides ideological explanations for adopting the concept of positive criminology in practice.

Moderators of correctional treatment success: an exploratory study of racial differences.

An important area in correctional rehabilitation research is to better understand how offenders differentially respond to correctional treatments. Potential treatment moderators forwarded in the literature are gender, race/ethnicity, and personality types. This exploratory study asked whether a group of parolees had demographic and personality moderators of treatment and, if so, were the moderating influences different by race? An experimental design was used to randomly assign a sample of 937 male parolees (n = 658 African American, n = 279 White) to the experimental group that received the cognitive-behavioral treatment program and the control group that did not. Discrete-time event history analysis independently tested the program-moderating effects of demographic and personality characteristics (age, prior employment status, educational attainment, marital status, social class, risk of recidivism, prior violence, IQ, reading level, cognitive maturity, personality type, residential urbanization) on recidivism for African American and White parolees. This study found that the age group and personality type of the parolees interacted with the cognitive-behavioral program in ways that created racially disparate recidivism outcomes.

Crime and substance misuse in adjudicated delinquent youth: the worst of both worlds.

The purpose of this study was to determine whether comorbid offending and substance misuse in previously adjudicated delinquents correlated better with measures of concurrent antisocial cognition and personality and subsequent criminality and substance misuse than offending or substance misuse alone. A sample of 1,177 youths was divided into four groups based on self-reported crime and substance misuse data from Wave 4 (ages 16-21) of the Pathways to Desistance study (Mulvey, 2012): a no-crime and substance-misuse (NCS) group, a crime-only (CO) group, a substance-misuse-only (SO) group, and a crime and substance-misuse (C&S) group. As predicted, youths in the C&S group earned significantly higher scores on concurrent measures of neuroticism, grandiosity/manipulation, callousness/unemotionality, impulsivity/irresponsibility, and moral disengagement, and significantly lower scores on measures of agreeableness, conscientiousness, impulse control, suppression of aggression, and consideration of others than did youths in the other three groups. Prospective analyses revealed that C&S participants engaged in more subsequent crime and experienced more substance-related social problems than participants in the other three groups and reported significantly more substance-related dependency symptoms and episodes of alcohol/drug treatment than participants in the NCS and CO groups. Hence, previously adjudicated youths who experienced problems with crime and substances in late adolescence/early adulthood were at increased risk for concurrent antisocial cognition and personality problems and subsequent crime and substance-misuse problems compared with participants in the other three groups. The prospective effects were found to be partially mediated by antisocial cognition in the form of moral disengagement.

The potential use of genetics to increase the effectiveness of treatment programs for criminal offenders.

During the past couple of decades, the amount of research examining the genetic underpinnings to antisocial behaviors, including crime, has exploded. Findings from this body of work have generated a great deal of information linking genetics to criminal involvement. As a partial result, there is now a considerable amount of interest in how these findings should be integrated into the criminal justice system. In the current paper, we outline the potential ways that genetic information can be used to increase the effectiveness of treatment programs designed to reduce recidivism among offenders. We conclude by drawing attention to how genetic information can be used by rehabilitation programs to increase program effectiveness, reduce offender recidivism rates, and enhance public safety.

Rehabilitation group coparticipants' risk levels are associated with offenders' treatment performance, treatment change, and recidivism.

OBJECTIVE: Exposure to antisocial others within treatment group sessions may have negative impact. We extend prior research with adolescents by examining rehabilitation group composition among adult male incarcerated offenders. METHOD: Data were gathered from institution files of rehabilitation completers (N = 1,832; M age = 33.5; 19% Aboriginal, 68% Caucasian), including general, substance, violent, and sex offenders. Capacities for treatment (including motivation, learning ability, and inhibitory control) were gathered from intake assessments. At the beginning and end of rehabilitation, providers rated program performance. Risk for recidivism and postrelease recidivism were gathered from official files, up to 3 years following release. RESULTS: Group effects accounted for up to 40% of variance in program outcomes. Group features (average group participant risk to reoffend and risk score diversity) significantly interacted with treatment capacities to explain program outcomes. Most models revealed a dampening effect whereby the positive association between capacities and outcome was reduced in groups of higher risk and more risk diverse coparticipants. Group composition typically accounted for 30-38% of variance between groups, but total variance in outcome explained was generally small. Higher average group risk predicted postrelease recidivism among family violence offenders. CONCLUSIONS: Coparticipants should be considered when researching and providing group programs to adult offenders, with specific attention toward how positive outcomes may be attenuated in the presence of criminogenic coparticipants.