Technical profiles of child sexual exploitation material offenders.

The idiographic technical profiles of child sexual exploitation material (CSEM) offenders provide insight into their behaviours and context for their interactions with technology, but minimal quantitative work has been done to evaluate their sociability, technical ability and technophilia compared to non-offenders. This work used an online survey to compare an offender group consisting of English-speaking adults previously convicted of CSEM offenses (N = 78) with a reference population of non-offenders (N = 254). The survey assessed sociability, technical ability and technophilia through self-rating and information on occupation, level of education and device ownership. The study found that CSEM offenders had slightly lower sociability than non-offenders, though not at a level of clinical interest. Additionally, CSEM offenders had no statistically significant difference in technical ability and lower overall technophilia when compared to non-offenders. This study fails to support popular perceptions of CSEM offenders being technically savvy loners who are early adopters of new technologies.

Accelerating the development of a psychological intervention to restore treatment decision-making capacity in patients with schizophrenia-spectrum disorder: a study protocol for a multi-site, assessor-blinded, pilot Umbrella trial (the DEC:IDES trial).

BACKGROUND: A high proportion of patients diagnosed with schizophrenia-spectrum disorders will at some point in their lives be assessed as not having the capacity to make their own decisions about pharmacological treatment or inpatient care ('capacity'). Few will be helped to regain it before these interventions proceed. This is partly because effective and safe methods to do so are lacking. Our aim is to accelerate their development by testing, for the first time in mental healthcare, the feasibility, acceptability and safety of running an 'Umbrella' trial. This involves running, concurrently and under one multi-site infrastructure, multiple assessor-blind randomised controlled trials, each of which is designed to examine the effect on capacity of improving a single psychological mechanism ('mechanism'). Our primary objectives are to demonstrate feasibility of (i) recruitment and (ii) data retention on the MacArthur Competence Assessment Tool-Treatment (MacCAT-T; planned primary outcome for a future trial) at end-of-treatment. We selected three mechanisms to test: 'self-stigma', low self-esteem and the 'jumping to conclusions' bias. Each is highly prevalent in psychosis, responsive to psychological intervention, and hypothesised to contribute to impaired capacity. METHODS: Sixty participants with schizophrenia-spectrum diagnoses, impaired capacity and one or more mechanism(s) will be recruited from outpatient and inpatient mental health services in three UK sites (Lothian, Scotland; Lancashire and Pennine; North West England). Those lacking capacity to consent to research could take part if the key criteria were met, including either proxy consent (Scotland) or favourable Consultee advice (England). They will be allocated to one of three randomised controlled trials, depending on which mechanism(s) they have. They will then be randomised to receive, over an 8-week period and in addition to treatment as usual (TAU), 6 sessions of either a psychological intervention which targets the mechanism, or 6 sessions of assessment of the causes of their incapacity (control condition). Participants are assessed at 0 (baseline), 8 (end-of-treatment) and 24 (follow-up) weeks post-randomisation using measures of capacity (MacCAT-T), mechanism, adverse events, psychotic symptoms, subjective recovery, quality of life, service use, anxiety, core schemata and depression. Two nested qualitative studies will be conducted; one to understand participant and clinician experiences and one to investigate the validity of MacCAT-T appreciation ratings. DISCUSSION: This will be the first Umbrella trial in mental healthcare. It will produce the first 3 single-blind randomised controlled trials of psychological interventions to support treatment decision-making in schizophrenia-spectrum disorder. Demonstrating feasibility will have significant implications not only for those seeking to support capacity in psychosis, but also for those who wish to accelerate the development of psychological interventions for other conditions. TRIAL REGISTRATION: ClinicalTrials.gov NCT04309435 . Pre-registered on 16 March 2020.

Self Perceptions and Cognitions of Child Sexual Exploitation Material Offenders.

Identifying the self-perceptions of child sexual exploitation material (CSEM) consumers compared to a reference population of non-consumers is critical in establishing distorted cognitions that may not be elucidated when comparison is made with groups who have committed other offenses. This exploratory work utilizes a quantitative approach toward identifying how individuals previously convicted of child pornography offenses view CSEM and CSEM offending, using a group of non-offenders as a baseline. The target group was selected based on their inclusion in two sex offender registries for child pornography offenses (n = 78). A reference group of non-offenders (n = 254) was gender-matched from a subset of a prior study evaluating the public perceptions of CSEM. Both groups were adults located within the United States and were asked questions using an online survey about their general perceptions of CSEM, their endorsement of CSEM beliefs, and their opinions related to the legality of various forms of CSEM and associated laws and sentencing guidelines. The study found that CSEM consumers more accurately assessed risks associated with CSEM offending, but that they exhibited potential minimization-based cognitive distortions related to severity and victimization and more strongly endorsed child erotica and virtual child pornography being legal. Additionally, they endorsed treatment over prison, and were strongly opposed to sex offender registration for child pornography offenses. The results provide potential treatment targets, including behavioral areas that may be pathways to CSEM offending.

Suicidal ideation in offenders convicted of child sexual exploitation material offences.

Understanding the prevalence of suicidal ideation in Child Sexual Exploitation Material (CSEM) offenders and their psychological concerns provides the basis for early treatment and intervention. This research solicited responses (n = 78) via an anonymous, web-based survey from adults in the United States previously convicted of CSEM offences. Significant suicidal ideation was present in 73% of respondents (n = 57), and 19% (n = 15) reported attempting suicide after they were made aware of an investigation, with 41% (n = 32) stating they would have been likely to seek counselling if provided a contact. Most of the respondents felt they were not treated with fairness, understanding, and compassion by investigators, and that their primary psychological strains were going to jail and their families finding out. This research highlights the need for more empathetic investigative approaches, as well as the need for more rapid assessment and treatment of proximal suicide risk in this population.

Public Perceptions of Child Pornography and Child Pornography Consumers.

Understanding the public's perceptions of child pornography helps identify gaps in awareness and knowledge, impacts legislative decision making, quantifies stigmatization, and provides a baseline for identifying differences between lay and offender populations for clinical purposes. This research provides a comprehensive public survey assessing these issues. An Internet-based sample of 524 adults (mean age = 47 years, 51% female) within the USA were asked about their understanding and beliefs related to child pornography and individuals who view child pornography. The questions covered three topic areas-general perceptions of child pornography, endorsement of child pornography beliefs, and opinions related to the legality of various forms of child pornography as well as the decision making related to sentencing and sex offender registration for child pornography consumers. The research found that the public viewed these offenses as more severe than most other crimes and that there was an overestimation by the public of risks related to recidivism and contact offending. Additionally, the research found that there was support for most of the current sentencing guidelines in the USA, including sex offender registration, and that there was limited support for treatment over incarceration.

Predicting Risk of Reoffending in Persons with Child Sexual Exploitation Material Offense Histories: The Use of Child Pornography Offender Risk Tool in a Scottish Population.

In the past decade, there has been an increase in child sexual exploitation material (CSEM) offenses and convictions. Although research shows that individuals with CSEM offence histories generally are at low risk of reoffending, certain factors do increase in CSEM convictions, in order to assist with case prioritization, management and supervision, risk assessment is helpful across agencies. The Child Pornography Offender Risk Tool (CPORT) was created specifically for this population and shows significant predictive validity for various outcomes. This study aimed to validate the use of the CPORT in a Scottish sample of 141 adult males who were convicted of CSEM offenses. Receiver Operating Characteristic (ROC) and logistic regression analyses indicated that the CPORT significantly predicted any recidivism (Area Under the Curve = .81), any sexual recidivism (AUC = .78) and CSEM recidivism (AUC = .74), suggesting that it is a valid risk assessment tool for Scottish populations. Recommendations for further research and clinical implications are discussed.

Collecting and viewing behaviors of child sexual exploitation material offenders.

BACKGROUND: The collecting behaviors of child sexual exploitation material (CSEM) offenders provide insight into their cognitions and motivations that have clinical applications. OBJECTIVE: This study analyzed the CSEM collecting and viewing behaviors of previously convicted offenders. PARTICIPANTS AND SETTINGS: A postal letter soliciting participation in an online survey was sent to adults previously convicted of CSEM offenses in the United States. Comparison information from a non-offending population of adults within the United States (N = 524) was collected and compared to the CSEM respondents (N = 78). METHOD: A mixed-methods approach was utilized. The CSEM group was compared to a gender-matched sample from the non-offending group for general adult sexual exploitation material (SEM) viewing. Exploratory analyses of CSEM offender behaviors related to collecting, collection diversity, and recidivism were conducted. RESULTS: The majority (78%) of the offenders did not organize their content and 74% deleted their entire collection on at least one occasion. Offenders viewed more diverse categories of adult SEM than non-offenders, including more bestiality, hentai, teen, and nudist/naturist material. None of the offenders viewed CSEM exclusively, and 74% viewed more adult SEM than CSEM. The age range of CSEM content viewed did not support highly preferential viewing but did support general novelty seeking. The self-reported recidivism rate was 10%, with infrequent post-conviction CSEM activity. CONCLUSION: Treatment professionals should not assume that pedophilic interests are the sole or even primary motivator for CSEM behavior. Problematic Internet usage, general pornography consumption, coping issues, or novelty seeking may be more appropriate targets for some offenders.

Post-stroke emotionalism: a qualitative investigation.

Introduction: Post-stroke emotionalism, outbursts of involuntary crying or laughing, is common after stroke. Little is known about the psychosocial factors associated with this neurological disorder.Aim: To investigate participant's experiences of emotionalism and explore how they managed their symptoms.Methods: A qualitative study that used framework analysis. Participants were recruited across inpatient and outpatient stroke settings. The average time since stroke was 4.3 months.Results: Eighteen semi-structured interviews were conducted. Four themes were identified: (1) Spontaneous and uncontrollable emotional reactions; (2) Incongruence; (3) Social reactions (sub-theme: The stigma of expressed emotions) and (4) Convalescence. Participants with negative experiences described greater disability, avoidance and mood problems. Positive experiences were shaped by a better understanding of the condition, an increased sense of control, social support and optimism. Few participants knew that their emotionalism was caused by stroke. Embarrassment and social withdrawal were commonly reported and had a detrimental effect on participant's mood and quality of life.Conclusions: Earlier recognition of emotionalism in clinical settings is needed as is promoting discussions about emotional reactions after-stroke. This will reduce the likelihood that patients will develop erroneous beliefs about emotionalism and unhelpful coping responses that may lead to adjustment difficulties in the months that follow their stroke.Implications for rehabilitationThe unpredictable and uncontrollable nature of emotionalism can be embarrassing and cause social withdrawal or avoidance.Waiting for emotionalism episodes to pass, distraction, humor or optimism and social support are successful means of managing the condition.Professionals play a key role in raising awareness that emotionalism is a neurological condition and not a clinical mood disorder as this will promote better understanding for patients, their families and those around them.Encouraging patients to talk about their emotional reactions early after stroke will normalize their experiences and may prevent them from developing unhelpful beliefs that could affect their approach to recovery.

Risk factors for inpatient violence and self-harm in forensic psychiatry: the role of head injury, schizophrenia and substance misuse.

OBJECTIVE: To investigate factors relevant to violence and self-harm in forensic psychiatric inpatients the cross-sectional association between four potential contributory factors; head injury, schizophrenia, drug and alcohol misuse, and self-harm or violence-related outcomes was examined. METHODOLOGY: Data were extracted from an existing dataset of routinely collected data on all patients under the care of Scotland's Forensic Mental Health Managed Care Network, of whom (n = 432) met inclusion criteria. A Factorial MANOVA and Pearson's chi-square tests were conducted to assess the relationship between potential contributory factors and self-harm and violence. RESULTS: Forty-seven individuals had a documented head injury (10.9%). The presence of head injury was significantly associated with inpatient violence and assessed violence risk. Number of historic violent offences was significantly associated with a history of drug misuse and co-morbid alcohol misuse and schizophrenia. Self-harm was significantly associated with drug misuse and a diagnosis of schizophrenia. CONCLUSION: These findings highlight a significant association between head injury and actual/assessed risk in forensic psychiatry, over and above that of substance misuse and a diagnosis of schizophrenia, emphasising the need for routine assessment of head injury in clinical practice. Further examination of the impact of head injury in forensic psychiatric populations is needed.

The paranoia as defence model of persecutory delusions: a systematic review and meta-analysis.

BACKGROUND: An influential psychological model of persecutory delusions proposed that they are caused by a bias towards holding others responsible for negative events (an externalising attributional bias), preventing the individual from becoming aware of underlying low self-esteem. An early version of the model predicted self-esteem would, therefore, be preserved in people with these delusions, but a later version suggested it would be unstable, and that there would be a discrepancy between explicit and implicit self-esteem, with the latter being lower. We did a comprehensive meta-analytical test of the key predictions of this model and assessed the quality of evidence. METHODS: We searched PubMed from Jan 1, 1994, to July 31, 2018, and collated systematic reviews of the defensive model's predictions in relation to persecutory delusions. We also searched PsycINFO, MEDLINE, Embase, and Web of Science for articles published from Jan 1, 2012, to Sept 10, 2016. Cross-sectional data from case-control, longitudinal, or experimental studies that examined self-esteem or the externalising attributional bias in individuals diagnosed as having schizophrenia-spectrum disorder were eligible for meta-analyses of group differences if at least 50% of participants with psychosis also had current persecutory delusions. Uncontrolled and longitudinal studies were included in meta-analyses of correlations and self-esteem instability, respectively. Study and outcome quality were assessed with the Agency for Healthcare Research and Quality assessment tool, and a modified version of Grading of Recommendations Assessment, Development and Evaluation, respectively. The study protocol is registered with PROSPERO, number CRD42016032782. FINDINGS: We screened 3053 records, examined 104 full-text reports, and included 64 eligible studies. Consistent with the predictions of both versions of the model, paranoia severity in psychosis was positively correlated with the degree of externalising attributional bias (21 studies involving 1128 individuals; r=0·18, 95% CI 0·08 to 0·27, with moderate quality evidence). People with persecutory delusions also had a greater externalising attributional bias than non-clinical individuals (27 studies involving 1442 individuals; g=0·48, 95% CI 0·23 to 0·73) and depressed individuals (ten studies involving 421 individuals; g=1·06, 0·48 to 1·63), and people with psychosis without persecutory delusions (11 studies involving 480 individuals; g=0·40, 0·12 to 0·68), all based on moderate quality evidence. Contrary to the predictions in the early version of the model, paranoia severity in psychosis was negatively correlated with explicit self-esteem (23 studies involving 1866 individuals; r=-0·26, 95% CI -0·34 to -0·17, with high quality evidence). People with persecutory delusions also had lower explicit self-esteem than non-clinical individuals (22 studies involving 1256 individuals; g=-0·88, 95% CI -1·10 to -0·66, with high quality evidence) and explicit self-esteem similarly low to that in people with psychosis without persecutory delusions (11 studies involving 644 individuals; g=-0·26, -0·54 to 0·02, with moderate quality evidence). Consistent with the predictions in the later version of the model, self-esteem instability was positively correlated with paranoia severity in psychosis (four studies involving 508 individuals; r=0·23, 95% CI 0·11-0·34, with high quality evidence), and people with persecutory delusions had a greater discrepancy between their implicit and explicit self-esteem than depressed individuals (seven studies involving 398 individuals; g=0·61, 95% CI 0·37 to 0·85, with moderate quality evidence). They had higher explicit self-esteem than depressed individuals (13 studies involving 647 individuals; g=0·89, 95% CI 0·51 to 1·28, with moderate quality evidence), but similarly low implicit self-esteem (seven studies involving 398 individuals; g=-0·19, -0·45 to 0·07, with low quality evidence). In contrast to the later predictions, people with persecutory delusions did not have a greater self-esteem discrepancy than non-clinical individuals (ten studies involving 592 individuals; g=-0·17, 95% CI -0·45 to 0·12), although the evidence was very low quality. People with psychosis with or without persecutory delusions did not differ for implicit self-esteem (four studies involving 167 individuals; g=-0·24, 95% CI -0·77 to 0·30, with low quality evidence) or self-esteem discrepancies (four studies involving 165 individuals; g=0·17, -0·19 to 0·53, with moderate quality evidence). INTERPRETATION: The predictions that self-esteem would be preserved in people with persecutory delusions in the early version of the paranoia as defence model and that implicit-explicit self-esteem discrepancy would be greater in people with persecutory delusions than in non-clinical individuals and people with psychosis without persecutory delusions in the later version of the model were not supported. By contrast, the later version correctly predicted that people with persecutory delusions have a greater self-esteem discrepancy than people with depression and a greater externalising attributional bias than all control groups, and that both this bias and self-esteem instability are associated with increased paranoia severity. Nevertheless, the reviewed data had limitations. Experimental studies, which might include interventionist-causal trials, are needed. FUNDING: None.

On the Road to Recovery psychological therapy versus treatment as usual for forensic mental health patients: study protocol for a randomized controlled feasibility trial.

BACKGROUND: On the Road to Recovery (OTRTR) is a brief low intensity group psychological therapy that aims to improve patients' insight into their mental disorder and develop adaptive coping skills to help manage distress. OTRTR is currently delivered in forensic mental health services in Scotland. However, to date, this therapy has not been evaluated as to its effectiveness or safety for forensic patients. METHODS: This is a parallel-group feasibility randomized controlled trial with single-blind assessments comparing OTRTR therapy to treatment as usual (TAU) for forensic mental health patients. Fifty participants will be recruited from high, medium, and low secure forensic mental health services in Scotland. Participants will receive OTRTR for approximately 12 weeks or continue treatment as usual for 12 weeks. The trial's primary aims relate to testing the acceptability and feasibility of key trial procedures that would be necessary for a definitive RCT of OTRTR. The secondary aims include estimating therapeutic effect sizes on clinical outcomes including insight and coping skills. The study design also features an adverse event monitoring plan to estimate the safety of OTRTR for participants, as well as use of intensive longitudinal methods to identify "key ingredients" to the OTRTR therapy protocol. DISCUSSION: This study will inform the design and sample size for a future full-scale randomized controlled trial (RCT), which will be conducted to determine the effectiveness of the On the Road to Recovery intervention in improving forensic mental health patients' clinical insight and coping skills. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN75126867 registered 27 July 2017.

Social Behavior and Impairments in Social Cognition Following Traumatic Brain Injury.

OBJECTIVES: The negative effect of changes in social behavior following traumatic brain injury (TBI) are known, but much less is known about the neuropsychological impairments that may underlie and predict these changes. The current study investigated possible associations between post-injury behavior and neuropsychological competencies of emotion recognition, understanding intentions, and response selection, that have been proposed as important for social functioning. METHODS: Forty participants with TBI and 32 matched healthy participants completed a battery of tests assessing the three functions of interest. In addition, self- and proxy reports of pre- and post-injury behavior, mood, and community integration were collected. RESULTS: The TBI group performed significantly poorer than the comparison group on all tasks of emotion recognition, understanding intention, and on one task of response selection. Ratings of current behavior suggested significant changes in the TBI group relative to before the injury and showed significantly poorer community integration and interpersonal behavior than the comparison group. Of the three functions considered, emotion recognition was associated with both post-injury behavior and community integration and this association could not be fully explained by injury severity, time since injury, or education. CONCLUSIONS: The current study confirmed earlier findings of associations between emotion recognition and post-TBI behavior, providing partial evidence for models proposing emotion recognition as one of the pre-requisites for adequate social functioning. (JINS, 2017, 23, 400-411).

The feasibility and clinical benefits of improving facial affect recognition impairments in schizophrenia: Systematic review and meta-analysis.

BACKGROUND: People diagnosed with schizophrenia have significant difficulty accurately recognising emotions expressed by others. This may generate anomalous experiences which, if misinterpreted, could contribute to experiences of social defeat, psychotic symptoms and reduced social functioning. It remains unclear whether this impairment is responsive to non-pharmacological intervention, or what the effect of modifying it is. METHODS: We did a systematic review and meta-analysis to examine whether and to what extent facial affect recognition impairments can be improved by psychological intervention and, if so, whether this leads to improvements in psychotic symptoms and social functioning. RESULTS: A total of 8 randomised controlled trials (RCTs) consisting of 300 participants were included. Focused yet brief psychological interventions led to very large improvements in facial affect recognition ability in psychosis [k=8, N=300, g=1.26, 95% Confidence Interval (CI) 0.92, 1.60, I2 41%]. Early evidence suggests this may cause large improvements in social functioning (k=3, N=109, g=0.98, 95% CI 0.37, 1.36, I2 38%), but not psychotic symptoms. CONCLUSIONS: Facial affect recognition difficulties in schizophrenia are highly responsive to psychological interventions designed to improve them, and there is early evidence that this may lead to large gains in social functioning for this group - but not symptoms. A large-scale high-quality RCT with longer-term follow-up period is now required to overcome the limitations of the existing evidence.

Social cognition and paranoia in forensic inpatients with schizophrenia: A cross-sectional study.

BACKGROUND: People diagnosed with schizophrenia have difficulties in emotion recognition and theory of mind, and these may contribute to paranoia. The aim of this study was to determine whether this relationship is evident in patients residing in a secure forensic setting. METHOD: Twenty-seven male participants with a diagnosis of schizophrenia and a history of offending behaviour were assessed using The Awareness of Social Inference Test (TASIT), The Ambiguous Intentions Hostility Questionnaire (AIHQ) and The Green et al. Paranoid Thought Scales (G-PTS). Individuals were recruited from two medium secure and one high secure forensic hospital in Scotland. RESULTS: Correlation, logistic and multiple regression analyses did not find that emotion recognition and theory of mind were associated with indices of paranoid thinking. CONCLUSION: Social cognition did not appear to be related to indices of paranoia in this forensic sample. Although participants reported low levels of paranoia overall, the results are consistent with recent conclusions that theory of mind impairments are not specifically linked to paranoia in people diagnosed with schizophrenia.

Attitudes of paediatric medical ward staff to a dog visitation programme.

No previous studies regarding either structured, strictly controlled pet visitation programmes in paediatric hospital wards or hospital staff attitudes towards them have been conducted in Australia. Information regarding these is essential in order to minimize problems during implementation of such programmes. The aim of the study was to analyse hospital staff perceptions regarding the introduction of a pet visitation programme in an acute paediatric medical ward prior to and following implementation of the programme and to compare attitudes between the various professional groups. The study consisted of two cross-sectional surveys. A total of 224 anonymous questionnaires were distributed to administrators, doctors, nursing staff and therapists 6 weeks before and 195 were distributed 12 weeks after the introduction of a pet visitation programme. Responses were received from 115 respondents (before the programme introduction) and 45 respondents (after the programme introduction). Prior to the introduction of the dog visitation programme, there were high staff expectations that the programme would distract children from their illness, relax children and that it was a worthwhile project for the hospital to undertake. Following implementation of the programme these expectations were strongly endorsed, in addition to the perception that the ward was a happier place, the work environment was more interesting and that nurses accepted the dogs. After implementation staff were less concerned about the possibility of dog bites and dogs doing damage to equipment. Allied health staff and non-clinical staff were more positive about the programme with respect to ward climate and acceptance than were doctors and nurses. We conclude that well-planned dog visitation programmes result in positive anticipation among staff and high levels of satisfaction following programme impact.