Abstract
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.
Highlights
Interpersonal violence is a profound global social and public health problem
No between-group or interaction effects were found using mixed-design ANOVAs except for proactive aggression where individual cognitive behavioral therapy (iCBT)+TAU participants reported a tendency toward more self-reported improvement [F(1,70) = 2.99, p < 0.10]
We found no significant difference in conduct disorder (CD) symptom scores between iCBT+TAU and TAU-only participants (t = 0.39, df = 62, p = 0.70, d = 0.09) as reported by the youth themselves or their social service case managers
Summary
Interpersonal violence is a profound global social and public health problem. In a recent annual victim survey in Sweden, 3.5% of the population over 15 years reported physical assault victimization during 2018 [2] whereas 1.1% of US residents over 12 years described having been a victim of violent crime in 2019 [3]. Considering the huge costs in human suffering and economic terms alike, even small reductions in violent crime is important [e.g., [4]]. 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)
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