Lardén Martin, Högström Jens, Långström Niklas
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Swedish Prison and Probation Service, Norrköping, Sweden.
Front Psychiatry. 2021 Aug 2;12:670957. doi: 10.3389/fpsyt.2021.670957. eCollection 2021.
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). 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 ( = 38) or to TAU-only ( = 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. The violent reconviction rate was slightly higher for iCBT+TAU vs. TAU-only youth at 12 months (34 vs. 23%, = 0.30, 95% CI: -0.24 to 0.84) and 24 months following release (50 vs. 40%, = 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 ( = 0.10, 95% CI: -0.40 to 0.60) although this difference was not significant. 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.
针对居住在护理机构中的严重暴力青少年罪犯的心理减少累犯干预措施效果并不理想。我们测试了一种以解决问题、认知自我控制和预防复发为重点的补充性个体认知行为疗法（iCBT）干预措施，是否能在包括社交技能培训和亲社会示范等干预措施（常规机构护理；TAU）之外，进一步降低犯罪累犯率。我们连续接触了瑞典国家机构护理委员会管理的五家居住治疗机构中的115名符合条件的严重男性暴力犯罪罪犯。其中81名（70%）年龄在16至21岁、暴力累犯风险中等偏高的青少年被纳入研究，并在释放到社区前4至6个月，随机分为接受15至20节个体化CBT干预加TAU（n = 38）或仅接受TAU（n = 43）的组。在治疗前和治疗后、释放后12个月（自我报告的攻击行为、再次定罪）和24个月（再次定罪）对参与者进行评估。采用意向性分析。在释放后12个月（34%对23%，p = 0.30，95%CI：-0.24至0.84）和24个月（50%对40%，p = 0.23，95%CI：-0.25至0.72）时，iCBT + TAU组的暴力再次定罪率略高于仅接受TAU组的青少年，但这些差异均无统计学意义。Cox回归模型也显示，在整个随访期间，iCBT + TAU组与仅接受TAU组的青少年相比，暴力累犯和任何犯罪累犯的差异不显著，只是有轻微增加。此外，我们发现两组在行为问题、攻击行为和反社会认知方面没有显著差异，尽管iCBT + TAU组和仅接受TAU组的参与者在治疗后各项结果指标上均报告了组内从小到大幅度的降低。最后，12个月的随访显示，iCBT + TAU组的青少年在DSM - 5品行障碍（CD）中“对人和动物的攻击”症状略多于仅接受TAU组的青少年（p = 0.10，95%CI：-0.40至0.60），尽管这种差异不显著。我们发现在针对严重年轻男性暴力罪犯的居住心理治疗中，个体CBT在基于组的TAU基础上没有附加效果。样本量有限和大量治疗脱落降低了意向性治疗效果估计的稳健性。我们讨论了治疗剂量和完整性、参与者保留率以及TAU质量的可能影响。
