A randomised controlled trial of a cognitive behaviourally informed intervention for changing violent sexual attitudes among adult sexual offenders in prison.

BACKGROUND: Predatory sexual acts by adults cause concern worldwide. Patterns of distorted thinking and weakened self-control are among the leading explanations. Amidst growing concerns about sexual offences in Nigeria, it might be that more psychologically informed interventions in prison could reduce the risks of further harm compared with the standard prison regime. AIMS: To test the effectiveness of a cognitive behaviourally informed intervention (CBII) in reducing violent sexual attitudes among men in prison in Nigeria for a sexual offence. METHODS: In a randomised controlled trial, men in two prisons who responded to in-prison advertising about the trial were screened for nature of offence and willingness to participate. Those nearing their sentence end or in other psychological therapy were excluded. Sample size was confirmed by power calculation. The Compulsive Sexual Behaviour Inventory (CSBI-22) and the Hypersexual Behaviour Inventory (HBI) were administered before, immediately after and 3 months after completion of a 12-session (18 h) Cognitive Behavioural Informed Intervention or equivalent periods of 'treatment as usual' (TAU) alone. The CBII was designed to change sexual attitudes, and delivered by trained cognitive therapists to the men, as a group, in one of the prisons while the controls received only TAU in the other. RESULTS: Before the intervention, the 39 men in each group had similar psychosocial histories and sexual attitude scores. Following CBII, the intervention group showed a significant reduction in scale scores that was sustained, whereas the TAU group showed no significant change in scores. An ANCOVA analysis confirmed between-group differences immediately after the intervention and 3 months later. CONCLUSIONS: This randomised controlled trial adds to existing knowledge in the field because prior studies have been from high income countries, where interventions are generally delivered in more privacy and at greater length. Given that our study had to be limited to change in sexual attitudes as the main outcome, future research must focus on the extent to which such change maps on to changes in interpersonal behaviour among such men. If these findings can be extended in this way and replicated, this could pave the way for more cost-efficient interventions in higher income countries too.