Cognitive Skills Programmes Research Articles

The modification of criminogenic factors on addicted offenders The effectiveness of the Reasoning and Rehabilitation Program

At the Clinic of Forensic Psychiatry in Rostock, Germany, we treat addicted offenders in a closed psychiatric setting. In 2009 we implemented the “Reasoning and Rehabilitation Program” (R & R, Ross & Fabiano, 1986), a cognitive skills program, in our clinic. There are several international studies confirming the efficacy of this training in diminishing recidivism.We examined a sample of 31 inpatients randomly distributed among the experimental (R & R) and the control group. Most of the study participants had committed homicide or other serious violent offenses. Prisoners with schizophrenia, organic mental disorders and mental retardation were excluded from the study. The target skills were assessed by treating psychotherapists, primary nurses and by the patients themselves.Our findings indicated that problem-solving, awareness of consequences, social perspective-taking, cognitive style, the ability to learn by experience, and persistence in the experimental group were significantly improved. The awareness of consequences has changed significantly in the assessment of the treating psychotherapists, the primary nurses, and the offenders themselves.Our current data are similar to our recent work, where we found significant changes in mental flexibility, planning, and problem-solving and positively assessed tendencies in some skills (Wettermann et al., 2012, 2011).Verification of these findings in a larger sample would strengthen the research foundation for this important training to diminish prisoner recidivism.

A Controlled Trial of a Cognitive Skills Program for Personality-Disordered Offenders

Objective: There is a need to find effective treatments for individuals with antisocial and borderline personality disorder who are known to be difficult to engage and treat. Many of these individuals share considerable overlap with symptoms of ADHD, hence this study aimed to evaluate the Reasoning and Rehabilitation ADHD program (R&R2 ADHD) among patients with severe personality disorder. Method: A total of 31 males detained in a “dangerous and severe personality disorder” unit completed questionnaires at baseline and post treatment to assess social problem solving, violent attitudes, anger, ADHD symptoms, emotional control, and social functioning. A total of 16 patients participated in the group condition, and their scores were compared with 15 waiting-list controls who received treatment as usual. Results: In all, 76% of group participants completed the program. In contrast to controls, they showed significant improvements in scores with mainly medium effect sizes. Conclusion: R&R2 ADHD was effective in a small sample of severely personality-disordered offenders.

Gender-responsive programming: a qualitative exploration of women's experiences of a gender-neutral cognitive skills programme

This study examined the experiences of seven women attending the pilot of a new cognitive skills programme in custody. The women were interviewed individually, and four took part in a focus group, one week after finishing a gender-neutral programme. Responses were subject to content analysis. Results indicated that the women felt the programme was relevant to their needs, that they experienced change as a result of the programme, and felt the collaborative facilitation style was responsive to their needs. However, all of the women described disengaging from the programme at points, and the majority felt that they would have been able to engage in the material more meaningfully had the programme been longer. Practical ways of improving the responsivity of programmes for women offenders are discussed.

A multisite randomized trial of a cognitive skills program for male mentally disordered offenders: Violence and antisocial behavior outcomes.

Despite a large evidence base indicating that cognitive skills programs can reduce reoffending in individuals without mental illness, there have been no randomized controlled trials (RCTs) to determine their effectiveness in mentally disordered offenders (MDOs). In the first RCT of a cognitive skills program for MDOs, we aimed to investigate whether participation in the Reasoning and Rehabilitation (R&R) program reduced violence and antisocial behavior in this population. Eighty-four male inpatients with a psychotic disorder and a history of violence were recruited from medium secure forensic hospitals. Participants were randomized to receive the R&R program, consisting of 36 two-hour sessions, or treatment as usual (TAU). Incidents of violence and antisocial behavior (verbal aggression, substance use, and leave violations) were assessed during treatment and at 12-months posttreatment. Relative to the TAU group, incident rates of verbal aggression and leave violations during the treatment period were significantly lower in the R&R group; the effect on verbal aggression was maintained at 12-months posttreatment. Half of those randomized to receive R&R did not complete treatment; post hoc analyses were therefore conducted to compare treatment responses in program completers and noncompleters. After controlling for psychopathic traits, incidents of violence, verbal aggression, and leave violations during treatment were significantly lower in program completers, and there were significant effects of program completion on verbal aggression and substance use at 12-months posttreatment. R&R leads to a reduction in incidents of antisocial behavior in MDO populations, with potentially greater impact on those who complete treatment.

Reconviction following a cognitive skills intervention: An alternative quasi‐experimental methodology

Purpose. Enhanced Thinking Skills (ETS) has been the most widely delivered cognitive skills programme in the prisons of England and Wales. Four quasi‐experimental outcome studies have produced mixed results, a qualitative survey of offenders’ and facilitators’ experience on the programme proved useful in programme refinement, and a study using random allocation provided evidence that ETS impacts significantly and positively on short‐term attitudinal change. This study aims to make a further contribution, using another methodology, to the accumulation of evidence.Methods. This was a real‐world evaluation, comparing the reconviction outcomes of the population of 17,047 ETS participants in custody from 2000 to 2005 with a national cohort of 19,792 prisoners released over the same period.Results. Overall, prisoners who had attended ETS were found to reoffend at a rate 6.4 percentage points less than the cohort (rising to 7.5 percentage points for programme completers) and 9.5 percentage points less than the predicted rate. In all but the very highest risk group and in every sentence length band, the reoffending outcomes for ETS participants were significantly better than for prisoners in the cohort.Conclusions. It is argued that this non‐experimental methodology makes a contribution to the ‘What Works’ evidence.

A multi-site randomized controlled trial of a cognitive skills programme for male mentally disordered offenders: social–cognitive outcomes

Cognitive skills programmes have been associated with improvements on psychometric measures and reductions in antisocial behaviour in mentally disordered offenders (MDOs). However, to date there have been no randomized controlled trials (RCTs) of such programmes with this population. In the first RCT of a cognitive skills programme with MDOs we aimed to determine if participation in the Reasoning and Rehabilitation (R&R) programme was associated with improvements in social-cognitive skills and thinking styles. A total of 84 men with a primary diagnosis of psychotic disorder and a history of violence were recruited from medium-secure forensic units and allocated to receive R&R (n=44) or treatment as usual (TAU; n=40). At baseline and post-treatment interviews, participants completed questionnaires to assess social problem-solving, criminal attitudes, anger experience, blame externalizing and perspective-taking. Researchers were not blind to group status. The R&R group demonstrated significant improvements on measures of social problem-solving relative to the TAU group, some of which were maintained at 12 months post-treatment. Only half of those allocated to receive R&R completed the full programme. In post-hoc analyses programme completers showed improvements in social problem-solving at the end of treatment and changes in criminal attitudes at 12 months post-treatment. Among male MDOs, R&R participation was associated with improvements in social-cognitive skills, some of which were maintained for up to 12 months post-treatment. Our finding that programme completers do better may reflect pre-treatment patient characteristics. This study establishes that multi-site RCTs can be conducted in medium-secure forensic units.

Methodological Considerations in the Evaluation of Offender Interventions

Attrition from offender interventions presents methodological problems when the effectiveness of the intervention is under evaluation. This article proposes a treatment-received (TR) design, which incorporates one-to-one matching on criminogenic variables. This design permits the comparison of completer, noncompleter, and nonstarter groups with their paired comparisons and, hence, allows a more accurate evaluation of program completion and noncompletion effects. A sample of 173 offenders, referred to one of two general offending behavior cognitive skills programs within community settings, was matched one-to-one by criminogenic variables to offenders from an appropriate comparison group. Reconviction analyses were undertaken using intention to treat (ITT) analysis, TR analysis using the full comparison group, and TR analysis using matched comparison groups. The ITT design found no impact of group membership on reconviction. The TR designs, however, provided evidence of moderate effects of completion: For every three completers, five of the matched comparison group members were reconvicted. The analysis also suggested a noncompletion effect: Noncompleters were twice as likely as their matched comparison group to be reconvicted.

Factors Predicting Dropout From the Reasoning and Rehabilitation Program With Mentally Disordered Offenders

Studies evaluating the implementation of cognitive skills programs with mentally disordered offenders (MDOs) have reported high dropout rates, but little is known about the factors associated with treatment noncompletion. The authors analyzed data from the first randomized controlled trial of the Reasoning and Rehabilitation (R&R) program with MDOs to determine predictors of treatment dropout. Patients with psychotic disorders were recruited from medium-secure hospitals in the United Kingdom. Fifty percent of the 44 participants allocated to receive R&R prematurely terminated treatment. Program dropout was significantly predicted by scores on the Clinical and Risk Management scales of the Historical, Clinical, Risk Management—20, Factor 2 scores of the Psychopathy Checklist—Screening Version, antisocial personality disorder (ASPD), psychopathy, and recent violence. Psychopathy, ASPD, and recent violence emerged as the strongest predictors of dropout in multivariate analyses. Strategies to improve treatment retention should be targeted at MDOs who display high levels of impulsivity, poor behavioral controls, and antisocial or psychopathic traits.

Toward a biosocial theory of offender rehabiltiation: Why does cognitive-behavioral therapy work?

Objective The growing insights from neuropsychological research, including within biosocial criminology, have not yet been systematically incorporated into the study of correctional rehabilitation. Given developments in related fields, we argue that moving toward a biosocial theory of offender rehabilitation or neurocriminology will enrich our understanding and effectiveness of these interventions. A particularly promising area to investigate is cognitive-behavioral therapy (CBT). In this regard, we examine research on the neural correlates of skills that are addressed in correctional cognitive skills programs. Results A review of the literature reveals that social skills, coping skills, and problem-solving skills are consistently associated with activation in the medial prefrontal cortex, dorsolateral prefrontal cortex, dorsomedial prefrontal cortex, ventromedial prefrontal cortex, orbitofrontal cortex, cingulate cortex, insula, and temporo-parietal junction. Conclusions CBT programs that effectively target social skills, coping skills, and problem-solving skills should correspond to increased activity in these regions. The implications of this research are discussed.

An investigation into the design and effectiveness of a mandatory cognitive skills programme for at-risk medical students

Background: Many medical schools provide academic support programmes to aid increasing numbers of students from diverse backgrounds. There have been calls for research into successful intervention programmes, and for detailed descriptions of how they work.Aims: To explore the efficacy of a mandatory intervention programme for at-risk medical students.Method: Students who failed and then repeated first semester were required to participate in a cognitive skills programme, following a syllabus based on principles drawn from both educational experience and multi-disciplinary theory and practice. Performance of programme participants was compared to the performance of students who repeated prior to the mandatory programme.Results: Of the participants (n = 216), 91% passed their repeat semester, compared to 58% (n = 715) for controls (p < 0.0001). This significant effect persisted for progression through the school for the subsequent three semesters (p < 0.0005).Conclusion: A mandatory programme that draws on a blend of theories and research-proven techniques can make a positive difference to the outcomes for at-risk medical students.

An evaluation of the Enhanced Thinking Skills (ETS) programme with mentally disordered offenders in a high security hospital

Purpose. Further to evidence of the successful application of cognitive skills programmes with offenders in HM prison service, the Enhanced Thinking Skills (ETS) training course is now delivered in various secure forensic hospitals, and its usefulness with an offender patient population merits examination. Our aim was to evaluate the impact of ETS using measures designed to capture change in key areas targeted by the course, and a more global measure of mental well‐being.Methods. Offender patients (N = 83) referred for ETS between 2001 and 2006 via a wider groupwork service within a high security hospital were administered questionnaires before and after the training course, which was minimally adjusted to meet the needs of the patient population. Attendance rates, including ‘drop‐out’ (completion of 10 or less sessions) were recorded. Demographics by subgroup (completers vs. non‐completers), and the clinical significance of any changes endorsed by participants post‐group were examined.Results. ETS completers were significantly more likely than non‐completers to endorse changes in thinking style (e.g. a reduction in post‐course scores). Significant differences were observed at both the group and individual level in the direction of less externalization of blame, a slight increase in tolerance of frustration, an increase in social conformity, and improvement in critical reasoning skills. Furthermore there was a reduction in the endorsement of aggressive solutions to social problems.Conclusions. These findings demonstrate a significant short‐term impact of the course for mentally disordered offenders with regards change in aspects of their thinking style and enhancement of their social problem solving skills. This profile lends some support to the provision of ETS within secure hospital settings.

Cognitive skills programmes for offenders

Following the impact of the meta-analyses and ‘What Works’ in offender treatment, cognitive skills programmes for offenders have become widely used in both the community and in custody. This overview is primarily concerned with the issue of effectiveness: do cognitive skills programmes have an effect on reoffending? The extant evidence suggests that there are lower rates of reoffending among offenders who complete cognitive skills programmes. However, there is a debate in the literature as to whether this ‘completion effect’ is a real treatment effect or an artificial side-effect of the use of non-randomised research designs. The ‘research design’ view is considered in detail, leading to the conclusion that it is based on a less than convincing argument and that a pragmatic explanation (which does not exclude a treatment effect) for the completion effect is required.

Surfaces and depths: evaluating the theoretical assumptions of cognitive skills programmes

Cognitive skills programmes for offenders such as Reasoning and Rehabilitation (R & R) have been around now for over 20 years and were developed in part to address their poor reasoning and decision-making skills. In this paper we critically examine the theoretical underpinnings of the R & R programme in light of current theoretical developments and research from cognitive neuroscience, philosophy, biology, and psychology. After considering recent theoretical and empirical research on rationality, emotions, distributed cognition, and embodiment we conclude with some thoughts about how to fine-tune cognitive skills programmes such as R & R in light of this research.

Generic Correctional Programming for Mentally Ill Offenders

This pilot study examined differences in criminal attitudes and hostile attribution biases among three groups of offenders diagnosed with serious mental disorders. It also compared the criminal outcomes for a sample of mentally ill offenders (MIO's) who completed a modified version of the Options cognitive skills program with a treatment-as-usual sample of MIO's. Results showed that pre- and posttest change scores for the Overgeneralization subscale of the Hostile Interpretations Questionnaire (HIQ), the Identification with Criminal Others subscale of the Criminal Sentiments Scale—Modified (CSS-M), and the HIQ Authority subscale differed between the groups of offenders with serious mental disorders. Participants identified for treatment by the pilot program (intended treatment group) and participants who completed the entire intervention had fewer arrests, including fewer arrests for violent offenses, but had higher technical probation violations than a treatment-as-usual comparison group.

Assessing Suitability for Offender Rehabilitation

Although the need to assess appropriate candidates for offender rehabilitation programs is widely acknowledged, few assessment tools are available that have been validated for use with offender populations. This article reports on the development and validation of a brief self-report measure designed to assess treatment readiness in offenders who have been referred to a cognitive skills program. The measure, the Corrections Victoria Treatment Readiness Questionnaire, displayed acceptable levels of convergent and discriminant validity, and was able to predict treatment engagement and treatment performance at the midpoint of the program. Suggested cutoff points are reported for use in assessing offenders for this type of program. It is concluded that the measure can play a valuable role in the assessment of offenders who are being considered for rehabilitative treatment.

Why don't offenders complete treatment? Prisoners’ reasons for non-completion of a cognitive skills programme

In an evaluation of the Enhanced Thinking Skills (ETS; Cann et al., 2003) programme, reconviction at 1 year was higher for treatment non-completers (i.e. those allocated to treatment who started but did not complete) than for untreated prisoners (i.e. those not allocated to treatment). It may be that non-completion increases risk of reconviction for some offenders, hence efforts should be made to reduce non-completion rates. In designing retention strategies, the views of offenders are important. This study, conducted with adult male prisoners, elicited information from ETS non-completers (n=18) about what interfered with programme completion. For comparison, views on ETS of completers (n=6) were taken. The main themes were: (1) non-completers were motivated to stop offending and motivated for treatment; (2) compared with completers, non-completers saw ETS as less relevant and less well-timed in relation to their current concerns; (3) some non-completers found ETS too demanding, while others found ETS too slow and patronizing; and (4) working in a group was an area of dissatisfaction for non-completers. Limitations are the small sample size, varying reasons for non-completion, and gathering of offenders’ views retrospectively. In future, treatment engagement should be studied prospectively, examining different categories of non-completers, and using larger samples.

Understanding ‘What Works’: Accredited Cognitive Skills Programmes for Young Offenders

This research assessed effectiveness of prison-based cognitive skills programmes for young offenders in England and Wales, using reconviction as the outcome measure. Reconviction rates were compared between offenders who started a programme (N= 1,534) and a matched comparison group who did not (N= 1,534). Programme participation did not lead to a statistically significant reduction in reconviction, at one- or two-years following discharge. However, when offenders who dropped out of a programme and their matched comparisons were excluded from analysis, the one-year reconviction rate for programme completers was statistically significantly lower (p &lt;0.05).

A Meta-Analysis of Adolescent Psychosocial Smoking Prevention Programs Published Between 1978 and 1997 in the United States

Psychosocial smoking prevention studies have shown inconsistent results and theory-driven programs have been related to program success. This meta-analysis was used as a judgment tool for resolving these issues by estimating average program effects and investigating the relative efficacy of program types. The present study examined 65 adolescent psychosocial smoking prevention programs (1978 to 1997) among students in Grades 6 to 12 in the United States. Three program modalities (social influence, cognitive behavior, life skill) and two program settings (exclusively school based, school-community-incorporated) were identified as major a priori classifications. Knowledge had the highest effect sizes (.53) at short-term (< or = 1 year) but rapidly decreased (.19) at long-term (> 1 year). Behavioral effect was the most meaningful, being persistent over a 3-year period (.19 at < or = 1 year; .18 at 1 to 3 years). Adolescent smoking reduction rates were increased by using either cognitive behavior or life skills program modalities, and/or a school-community-incorporated program setting.

Course of patients with histories of aggression and crime after discharge from a cognitive-behavioral program.

Patients exhibiting aggressive or criminal behavior present a challenge to treaters and caregivers. After discharge from an inpatient facility, such patients are at high risk of rehospitalization and rearrest. A long-term behaviorally based cognitive skills program was developed and administered to a group of such high-risk inpatients. The authors report the results of a postdischarge follow-up of this group. After patients entered the inpatient treatment program, their psychiatric and criminal histories were recorded, and a battery of psychological measures were administered, including IQ tests and the Hare Psychopathy Checklist. After discharge, multiple sources were used to obtain information about patients' outcomes. Eighty-five patients were followed for between six months and two years after discharge. Thirty-three of these patients (39 percent) remained stable in the community, 35 (42 percent) were rehospitalized, and 17 (20 percent) were arrested. Several variables that were ascertained before discharge predicted rehospitalization or arrest rates: comorbid antisocial personality disorder, higher score on the Psychopathy Checklist, history of arrests for violent crimes, and history of a learning disability. In addition, patients who developed substance use problems or did not adhere to medication treatment after discharge were more likely to be rehospitalized or arrested. Arrest rates were low compared with those observed in studies with similar populations. Although this outcome may be attributable to the treatment program, this naturalistic study could not prove that. The predictors of poor outcome may be used to develop a follow-up treatment program that focuses more resources on patients who are at the highest risk.

The Georgia Cognitive Skills Experiment

Effects of the Georgia Cognitive Skills Program, a replication of Ross and Fabiano’s Reasoning and Rehabilitation, were examined for 468 parolees randomly assigned to treatment and comparison groups between May 1997 and July 1998. The evaluation tested the effects on arrests/revocations, technical violations, and employment at 9 months and returns to prison at 18 to 30 months. Survival analysis found slightly lower (statistically insignificant) recidivism rates for experimental participants than comparisons. No significant differences were found between experimental and comparison participants on technical violations and employment. Statistically controlling for offender risk factors, program completers had significantly fewer rearrests/revocations and returns to prison and more favorable employment outcomes than comparisons and dropouts. Results were similar for low-risk and medium/high-risk parolees.