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"Smart people (like smart lawyers) can come up with very good explanations for mistaken points of view."

- Richard P. Feynman, Physicist

"There is a danger in clarity, the danger of over looking the subtleties of truth."

-Alfred North Whitehead

October 25, 2010

How to Increase the Effectiveness of Treatment

In an earlier blog entry, I discussed research that showed cognitive behavioral therapy (CBT) to be effective in reducing criminal recidivism. Cognitive Behavioral Treatment Reduces Recidivism I will discuss factors impacting the effectiveness of CBT in this entry. If you follow the literature on the effectiveness of various treatment modalities for criminality, you will see that some studies show that a treatment modality is effective and some studies show that the same treatment modality is ineffective in reducing further criminal acts. (Occasionally, one sees that a treatment actually causes additional criminality.)

One of the reasons for these differences is that treatment modalities for criminality are not homogeneous like for example, a specific medication. If researchers study the effect of 81 mg of aspirin, we can be relatively assured that the treatment group received 81 mg of acetylsalicylic acid in each and every study. However, researchers testing, for example, CBT may be testing a different technique of CBT, a different topic for the CBT such as domestic violence, sex offending, or general criminality, and these programs will be delivered by different service providers at differing skill levels. Each CBT program is in many ways sui generis.

A recent study took a closer look at this issue as it relates to CBT.[i] First, these researchers performed a meta-analysis on 58 different studies of CBT. This research showed that CBT resulted in a reduction of the mean recidivism rate by about 25%.[ii] The researchers also determined that the most effect CBT programs were twice as effective as the average program resulting in a decrease in recidivism of about 50% over those individuals who were not treated.[iii]

The researchers then attempted to ascertain what factors made a CBT program more or less effective. The researchers made these conclusions:

1. The most important factor in making CBT effective was high quality implementation, which was associated with low treatment dropout, close monitoring of program quality and implementation, and adequately trained CBT providers.

2. There were no significant benefits of using “brand-name” CBT programs and that it was the general technique of CBT that was effective.

3. An anger control component and an interpersonal problem solving and peer pressure component within a CBT program enhance its effectiveness.

4. A victim impact component (getting offenders to consider the impact of their behavior on victims) and a behavioral modification component (behavioral contracts and rewards/punishment schemes) appear to reduce CBT’s effectiveness.

5. That treatment effects were greater for higher risk offenders than for low risk offenders. (Refuting the hypothesis that higher risk offenders are not amenable to treatment, and confirming the hypothesis that offenders need to first be assessed for risk, with the high risk offenders receiving the treatment)[iv]

6. CBT was as effective for juveniles as for adults.

7. The treatment setting had no effect on effectiveness. Treatment in prison was as effect as treatment in the community.[v]

[i] Lipsey, Mark W., Nana A. Landenberger, Sandra J. Wilson (2007), “Effects of Cognitive Behavioral Programs for Criminal Offenders”, Campbell Systematic Reviews, The Campbell Collection, pp. 1-27.

[ii] Ibid. p 12.

[iii] Ibid p. 21

[iv] The treatment of high risk offenders, because of their otherwise higher recidivism rates, has a greater potential for reducing recidivism compared to low risk offenders who may never recidivate even without treatment.

[v] Ibid. p. 22-23.

The views expressed in this blog are solely the views of the author(s) and do not represent the views of any other public official or organization.

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