Abstract
BackgroundWhen treating addicted offenders in a forensic psychiatric setting, a primary concern is to decrease antisocial cognitions and behaviors. The cognitive style of offenders is often characterized by impulsiveness, egocentricity, irrational thinking, and rigidity. We examined the relative efficacy of Reasoning and Rehabilitation Program (R&R) and Dialectical Behavioral Therapy– Forensic (DBT-F) on the domains of underlying psychological constructs (e.g., mental flexibility, planning, and problem-solving).Materials and MethodsThe R&R and DBT-F were introduced in a forensic-psychiatric hospital for offenders with substance addictions in Germany. We compared pre- and post-tests to measure the cognitive skills of addicted offenders having undergone R&R (N = 47), DBT-F (N = 34), or Treatment as Usual (TAU; N = 28). Participants’ skills (cognitive flexibility, ability to inhibit cognitive interference, cognitive performance/mental speed, divergent and convergent reasoning/problem solving) were assessed using neuropsychological instruments. Analyses of variance were conducted to investigate whether there were significant improvements within groups and whether these differences were significant between groups. To examine the predictive power of treatment-program on outcomes, and diagnosis of personality disorder, a hierarchical regression model was used.ResultsBoth programs were associated with improvements in nearly all of the measured constructs. The only construct on which the R&R and DBT-F groups differed significantly was word fluency, with those receiving R&R improving more than those receiving DBT-F. A regression model showed no predictive power for age, IQ, or diagnosis of personality disorder. Treatment group explained 13.8% of variance in cognitive flexibility but did not predict variance in other outcomes.ConclusionSurprisingly, we did not find superiority for one intervention over TAU or differential effects between the two programs. Future research should use larger samples and additional outcomes, including recidivism, to identify possible effects of treatment programs. Additionally, qualitative methods might inform us about these programs are implemented as well as which outcomes may be relevant.
Highlights
Preliminary results focusing on the effects of Rehabilitation Program (R&R) in comparison with TAU were published reporting on changes in cognitive style, impulsiveness, and social cognitions [106,107,108]. These findings indicated that mental flexibility, planning and problem-solving could be improved in the R&R-group compared to controls
We examined the outcome of two evidence-based programs (R&R and Dialectical Behavioral Therapy– Forensic (DBT-F)) in an addicted offender population in direct comparison with controls (TAU)
Our evidence suggests that that there is clinical utility associated with implementing R&R and DBT in forensic treatment settings
Summary
The maximum length of stay is related to the prison sentence given at the same time, it cannot be longer than two years plus two thirds of this prison sentence but is usually much shorter than that. Disordered offenders (mostly diagnosed with psychotic disorders, severe intellectual disabilities, or disorders of sexual preference) are treated in forensic-psychiatric hospitals according § 63 StGB on the condition that they have committed an offense in a state of criminal irresponsibility or of diminished responsibility. When treating addicted offenders in a forensic psychiatric setting, a primary concern is to decrease antisocial cognitions and behaviors. We examined the relative efficacy of Reasoning and Rehabilitation Program (R&R) and Dialectical Behavioral Therapy– Forensic (DBT-F) on the domains of underlying psychological constructs (e.g., mental flexibility, planning, and problem-solving)
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