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

Abstract

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.

A Multi-Site Controlled Trial of the R&R2MHP Cognitive Skills Program for Mentally Disordered Female Offenders

“…The present study applied a very stringent completion rate of 80% attendance. The completion rate obtained in the present study of 78% is considerably higher than the rate of 50% reported by Cullen et al [18] using the original 36-session version of the R&R program and applying the same completion criteria as the current study. Their sample was drawn solely from medium security whereas the current study included participants from low security, just over one-third of whom were in the treatment condition.…”

“…By contrast, other studies have reported post-treatment improvement in the Impulsivity/Carelessness, Avoidance and Total scales in MDO"s following treatment with the longer 36-session R&R intervention [17,18] and in offenders with severe personality disorder following treatment with the 15-session R&R2 ADHD [28]. At 12-month follow-up, Cullen et al [18] found the effect for Impulsivity/ Carelessness was sustained but results indicated less improvement in negative problem orientation compared with controls. As noted by Cullen et al, the R&R program may have differential impact on the varied functional modalities on the SPSI-RS with problem-solving orientation (positive/ negative) being more resistant to change than problem-solving style.…”

“…Whilst ETS and R&R were not designed to meet the complex needs of MDOs, uncontrolled pilot studies indicated they were effective in improving thinking styles and social problem-solving in this population [14][15][16]. Subsequent controlled studies of the R&R program have supported these findings [15,17,18] and a multi-site randomized controlled trial conducted by Cullen et al [18] in medium secure services has reported specific improvements in social-problem solving post-treatment and at 12 month follow-up. However only half of those allocated to receive R&R completed the program; dropout was predicted by "high risk" patients presenting with psychopathy, antisocial personality traits and violent behaviour [17].…”

“…Measures of violent attitudes and locus of control were re-administered at three month follow up. It was hypothesized that group completion would be favorable compared with the 50% rate previously reported [17,18] and that group participants would show greater improvement at outcome than waiting-list controls.…”

Forensic psychologists should use the behavioral experiment to facilitate cognitive change in clients who have offended

“…However, numerous studies show that specialized CBT leads to reductions in attitudes supporting child sexual offending behavior (Beech et al, 1998;Bumby, 1996;Watson & Stermac, 1994) and antisocial attitudes supporting a range of offending behaviors (e.g., Cullen, Clarke, Kuipers, Hodgins, Dean, & Fahy, 2012;Gannon et al, 2014;Valliant & Antonowicz, 1991;Yessine & Kroner, 2004). Nevertheless, while reductions in offensesupportive attitudes reported across these studies are positive, associated effect sizes are generally modest suggesting that reductions in offense-supportive cognition could be further improved (see Beech et al, 1998 for one exception).…”