A Long-Term Outcome Assessment of the Effects on Subsequent Reoffense Rates of a Prison-Based CBT/RNR Sex Offender Treatment Program With Strength-Based Elements.

This article describes an evaluation of the effects of an early version (1991-2001) of Rockwood's prison-based Cognitive Behavioral Therapy/Risk-Needs-Responsivity (CBT/RNR) sex offender program that had emerging elements of a strength-based approach. This program was implemented under contract to Correctional Service of Canada (CSC) and continued to evolve in response to emerging evidence until it closed in 2013. Thus, the program as evaluated here did not involve a fixed approach as did the comparison CSC program (hereafter referred to as SOTP). Long-term reoffense data, from Rockwood's program (n = 579), were compared with SOTP (n = 625) and with a group of untreated men (n = 107) sentenced for sex offenses. A modified brief actuarial risk scale (BARS-M) was used to control for baseline risk among the three groups, along with additional controls for age at release, victim type, and individual differences in the length of long-term follow-up period. Both treatment groups displayed lower rates of both sexual and violent reoffending when compared with the no-treatment offenders. Overall, the Rockwood program generated the lowest recidivism rates. The results demonstrate that prison-based sex offense-specific treatment can be effective. We discuss the strengths and limitations of the current design through the Collaborative Outcome Data Committee's guidelines.

Long-term epidemiological survey of Kudoa thyrsites (Myxozoa) in Atlantic salmon (Salmo salar L.) from commercial aquaculture farms.

Kudoa thyrsites (Myxozoa) encysts within myocytes of a variety of fishes. While infected fish appear unharmed, parasite-derived enzymes degrade the flesh post-mortem. In regions of British Columbia (BC), Canada, up to 4-7% of fillets can be affected, thus having economic consequences and impacting the competitiveness of BC's farms. K. thyrsites was monitored in two farms having high (HP) or low (LP) historical infection prevalence. At each farm, 30 fish were sampled monthly for blood and muscle during the first year followed by nine samplings during year two. Prevalence and intensity were measured by PCR and histology of muscle samples. In parallel, fillet tests were used to quantify myoliquefaction. Infections were detected by PCR after 355 and 509 degree days at LP and HP farms, respectively. Prevalence reached 100% at the HP farm by 2265 degree days and declined during the second year, whereas it plateaued near 50% at the LP farm. Infection intensities decreased after 1 year at both farms. Blood was PCR-positive at both farms between 778 and 1113 degree days and again after 2000 degree days. This is the first monitoring project in a production environment and compares data between farms with different prevalence.

Phallometric assessments of sexual interests: an update.

This paper reviews recent evidence on the value of phallometric (i.e., erectile) measures of sex offenders plus earlier crucial papers. Distinctions are made between types of measuring devices with the volumetric instrument appearing to be the most sensitive. Considering the meaning of responses it is concluded that arousal below 10 % of full erection is not reliably interpretable and that only deviant profiles (those displaying equal or greater arousal to deviant sex) can be confidently interpreted. The specificity and sensitivity of phallometry is satisfactory with child molesters but not with other types of sex offenders, although there remains a need to satisfactorily distinguish among subtypes of child molesters. There are enduring disagreements concerning the meaning of rapists' responses and no test has yet reliably identified deviance among exhibitionists. It is concluded that despite its long history, problems remain with phallometric assessments and clinicians should be cautious in interpreting the meaning of these responses.

Changes in coping following treatment for child molesters.

Relapse prevention theory assumes that specific coping skills deficits contribute to sexual reoffending. Recent research suggests that the general coping style of sexual offenders is also ineffective. In this study changes were examined in specific and general coping deficits following a treatment program that incorporated specific skills training as well as modifying general styles. Treated incarcerated child molesters were compared to a group of incarcerated child molesters on a waiting list for treatment. Groups completed various measures aimed at identifying coping strategies used in specific high-risk situations and general coping styles. Compared to the waiting list group, treated child molesters identified more effective coping strategies in specific high-risk situations. Changes are noted in their general coping styles with an increase in the endorsement of task-focused strategies and social diversion strategies. No changes in their endorsement of ineffective strategies such as emotion-focused or distraction strategies occurred. Implications for treatment are discussed.

Phallometric testing with sexual offenders: limits to its value.

In many settings phallometric evaluations of sexual arousal are routinely conducted with sexual offenders and these evaluation procedures also serve as research instruments. There are, however, problems with the psychometric bases of these assessments, and studies reporting their use have so many idiosyncratic features that comparisons are of dubious value. Evidence concerning the reliability and criterion validity of phallometric testing leaves a lot to be desired, although the research has suggested an important but limited value in predicting subsequent recidivism. Suggestions are made for further research and for the clinical use of phallometric assessments within more comprehensive evaluations of sexual offenders.

Cognitive distortions in sex offenders: an integrative review.

Clinicians and researchers have noted that maladaptive beliefs and distorted thinking play an important role in facilitating or justifying sexual offenses. There have been a number of attempts to describe the nature of these beliefs and to develop ways of measuring them, but in the absence of any integrating theory. We suggest that an understanding of the cognitive processes underlying the initiation, maintenance, and justification of sexual offending is a vital prerequisite to the development of successful treatment programs. In this paper, we use a social cognition framework to review the literature on the role of cognition in sexual offending. Pertinent research in the sexual offending domain, specifically cognitive products, information processing, cognitive change, and the impact of affective and motivational factors on cognitive processes, is described and related to the social cognitive approach. Implications for future research and clinical practice are discussed in light of the major issues and problems highlighted in our review.

The role of male sexual arousal in rape: six models.

This article examines men's sexual arousal to rape cues and its possible role in sexual assault. The article presents six different models that have been described in the literature to account for men's sexual arousal to descriptions of rape. The models are divided into two broad categories, response control models and stimulus control models, and are further divided into models postulating a "trait" that might distinguish rapists from other men and those postulating a "state" that might be present in men while they commit a sexual assault. A number of the models are supported by empirical data, and some of these data are reviewed. The article suggests that different models may be operating in different men when they commit sexual assault. These models are discussed in relation to the current literature on the classification and diagnosis of sexual offenders.

Intimacy, loneliness and sexual offenders.

As part of a general theory of sexual offending, it is suggested that the failure to achieve intimacy in relations with adults produces emotional loneliness, which leads to an aggressive disposition, and a tendency to pursue sex with diverse partners in the hope of finding intimacy through sexuality or through less threatening partners. The development of intimacy and its benefits are described, as are the consequences that befall those who fail to achieve it. The history of sexual offenders illustrates why they fail to develop the attitudes and skills necessary to attain intimacy, and why this failure leads to sexual abuse. Finally, suggestions are made for the modification of programs for the assessment and treatment of sexual offenders, in order to include problems of intimacy and loneliness.

The abstinence violation effect in sex offenders: a reformulation.

It is argued that the central issue in the treatment of sexually aggressive behavior is the tendency to relapse shown by offenders. A model of the relapse process is presented along with what is described as its central feature, the abstinence violation effect (AVE). This construct is critically examined and its shortcomings identified. A brief description of Weiner's attributional theory is provided and this is used to reformulate the AVE. The advantages of the reformulated AVE are described, as are the clinical implications. Suggestions are then made for future research.

Cognitions and courage in the avoidance behavior of acrophobics.

Fifty subjects (29 fearless and 21 fearful) were tested in a potentially acrophobia-inducing situation, and their avoidance behavior and self-reported fear were noted. Subjects also completed various scales intended to measure their fearfulness and thoughts in hypothetical height-phobic, social-phobic and nonphobic situations. Interviews conducted immediately after the behavioral test, evaluated their thinking, fearfulness and tactics designed to deal with any fear they experienced. Analyses indicated that catastrophic thinking is more evident than irrational thinking in height situations and that such thinking was the best predictor of behavior among the measures used. The results are discussed in terms of their relevance for cognitive views of acrophobia and in terms of their relevance for treatment.

The effects of masturbatory reconditioning with nonfamilial child molesters.

Abel and Annon's (Reducing deviant sexual arousal through satisfaction, Denver, Colo., 1982) suggested combination of 'directed masturbation' and 'satiation' to alter deviant sexual preferences, was applied to 10 nonfamilial child molesters. Post-treatment assessments revealed significant reductions in deviant arousal as was expected, but unfortunately there were also reductions in appropriate arousal although these changes did not achieve statistical significance. The results are discussed in terms of their meaning but it is concluded that empirical support for these clinically popular procedures remains weak.

The abstinence violation effect in child molesters.

The reformulation of the abstinence violation effect (AVE) is briefly described together with the empirical support for the construct. Twenty-six incarcerated male child molesters were assessed, using the Differential Emotions Scale and the Attributional Dimension Scale, at three points (high-risk, lapse, and relapse) while they listened to an audiotaped recording of a description of their most typical offense chain. Eighteen Ss experienced an AVE at the point of relapse and 7 as a result of lapse. There were significant increases in most negative emotions and decreases in interest over the relapse chain. There were significantly higher disgust, contempt, hostility, fear, shame, shyness and anger scores reported by those showing an AVE. Conversely, the AVE group showed significantly lower scores for joy and surprise. There were no significant differences on any of the 4 attributional dimensions across the relapse process but those showing an AVE reported significantly more uncontrollability and higher stability scores. The significance of these results for clinical practice are discussed.

The treatment of exhibitionists: a focus on sexual deviance versus cognitive and relationship features.

Two studies compared treatment of exhibitionists aimed at either: (1) modifying deviant sexual preferences; or (2) changing cognitions, enhancing relationship and interpersonal skills, and improving awareness of relapse prevention issues. Recidivism rates of these two programs were compared with each other and with the rates observed in untreated offenders. Results supported the focus on broader cognitive and social issues. Clearly exhibitionists can be treated effectively.

Differentiating rapists and non-offenders using the rape index.

Some studies have suggested that phallometrically derived rape indices can differentiate groups of rapists and non-offenders. There are other studies however which cast doubt on this assertion, at least in so far as it applies to all but those few rapists who are sadistic. These studies have used rape indices which are derived from rapists' sexual responses to audiotaped descriptions of mutually consenting sex and brutal sexual assaults. It was hypothesized however, that stimuli which put more emphasis on the degrading and humiliating elements of rape would improve discriminability. Stimuli were compiled to test this hypothesis. The results indicate that neither rape indices derived from the physically brutal elements nor the degrading elements of rape were able to discriminate between rapists and non-offenders. Furthermore, these indices were not related to offence histories. The results are discussed in terms of their implications for the assessment of rapists and theoretical considerations of their behaviour.

Exhibitionists: sexual preferences for exposing.

An assessment of the sexual preferences of exhibitionists and matched non-offenders, revealed greater arousal to scenes of exposing among the offenders but the actual degree of deviant preferences was not marked. Closer analyses of the individual response profiles, using various criteria for deviance, indicated that only a small proportion of exhibitionists displayed deviant arousal. We take these results, along with the findings from previous research, to deny the primacy of sexual motivation in exhibiting behavior. We also consider these results to indicate that there is little value in determining the sexual preferences of exhibitionists when planning treatment or estimating their risk to re-offend.

Self-report and behavioral assertion in two groups of sexual offenders.

Role play and self-report measures of assertion were administered to a sample of rapists and child molesters as well as to groups of institutional and socioeconomic status controls. Clear differences emerged on the self-report measures, with high socioeconomic status men appearing to be the most assertive, less socially anxious, and endorsing the most liberal attitudes towards women. No differences were observed on the behavioral role plays, which required assertion in a number of heterosexual situations. There were also no differences between the groups on two related questionnaires measuring knowledge of appropriate behavior and actual predicted behavior in the same scenarios as were role played. Desynchrony between self-report and behavioral measures of assertion is not an uncommon finding with a prison population. Implications for the identification of relevant treatment targets, attempts at isolating causal variables and the relationship between attitudes toward women and assertion are discussed.

In vivo desensitization in the treatment of recurrent nightmares.

The literature, although sparse, suggests that behavioral interventions targeting the overt waking manifestations of the fear content of nightmares, can effectively reduce the frequency and intensity of these dreams. A 20-year-old female with recurrent nightmares centering on a fear of snakes, was treated by in vivo desensitization in which she approached a live, harmless snake. During treatment the client displayed habituation of fear of the snake and this corresponded to reductions in her nightmares. By the end of treatment and at 3-month and 1-year follow-up evaluations, she was free of fear and her nightmares had been eliminated. It is suggested that in vivo behavioral treatment of the content of nightmares may be a very effective way to eliminate these distressing dreams.

The relationship between self-esteem and deviant sexual arousal in nonfamilial child molesters.

Changes in self-esteem as a result of direct treatment were evaluated in 12 nonfamilial child molesters, and the relationship between these changes and reductions in deviant arousal was assessed. Treatment enhanced self-esteem, and these improvements were significantly correlated with reductions in deviant arousal even though deviant fantasies were not targeted in treatment. Implications of these findings for theoretical analyses of sexual offending and for treatment are discussed.

Brief research report: the reliability of the rape index in a sample of rapists and nonrapists.

Erectile responses of a sample of incarcerated rapists (N = 60) and male university students (N = 41) were monitored during verbal descriptions of adult heterosexual interactions. The verbal descriptions varied in terms of the consent given by the female and the degree of force or coercion used by the male. Each subject was tested in two laboratory sessions, and rape indices were calculated as the ratio of rape arousal to consenting arousal. The discrimination between consenting and nonconsenting cues was stronger in nonrapists than rapists. This difference was observed mainly because of an increase in the nonrapists' discrimination in the second session, in which nonrapists' arousal to consenting cues was enhanced. Based on the whole sample, test-retest reliability coefficients were unacceptably low. Eliminating subjects exhibiting only minimal arousal according to various criteria yielded higher coefficients in both groups. However, in the nonrapist group, acceptable levels of reliability were only reached after eliminating all subjects who did not reach at least 75% of full erection (over half the sample). We concluded that the reliability of the rape index is questionable, particularly when there is doubt as to whether the subject being tested is a rapist or a nonrapist, or when testing only nonrapists.

Victim blame and the disinhibition of sexual arousal to rape vignettes.

The present study examined the effects of differing levels of victim blame on the sexual arousal of males to rape vignettes. In the first experiment, a between-subjects experimental design was used to compare four groups of eight university males for their erectile responses to vignettes rated as low, medium, and high along a victim blame continuum. All groups found a consenting vignette more arousing than a nonconsenting vignette, however, this difference was significantly smaller for subjects in the high blame condition compared to the low and medium blame conditions. A second experiment supported the disinhibiting effect of the high victim blame manipulation using 12 university males in a within-subjects experimental design. The disinhibiting influence of victim blame on male sexual arousal to rape cues was discussed in relation to our broader understanding of sexual assault.