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

Published online by Cambridge University Press:  16 August 2011

A. E. Cullen ,
A. Y. Clarke ,
E. Kuipers ,
S. Hodgins ,
K. Dean  and
T. Fahy
A. E. Cullen*
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK
A. Y. Clarke
Affiliation:
South London and Maudsley NHS Trust, London, UK
E. Kuipers
Affiliation:
Department of Psychology, Institute of Psychiatry, King's College London, London, UK Biomedical Research Centre for Mental Health at the Institute of Psychiatry, King's College London and the South London and Maudsley NHS Foundation Trust, London, UK
S. Hodgins
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK Département de Psychiatrie, Université de Montréal, Montréal, Canada Department of Psychiatry, Heidelberg University, Heidelberg, Germany
K. Dean
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK South London and Maudsley NHS Trust, London, UK
T. Fahy*
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK South London and Maudsley NHS Trust, London, UK
*
*Address for correspondence: A. E. Cullen and T. Fahy, Department of Forensic and Neurodevelopmental Sciences (Box P023), Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. (Email: [email protected]or [email protected])
*Address for correspondence: A. E. Cullen and T. Fahy, Department of Forensic and Neurodevelopmental Sciences (Box P023), Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. (Email: [email protected]or [email protected])
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Abstract

Background

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.

Method

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.

Results

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.

Conclusions

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.

Keywords

Cognitive skillscriminal attitudesmentally disordered offendersproblem-solvingpsychosisReasoning and Rehabilitation (R&R) programme
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 3 , March 2012 , pp. 557 - 569
Copyright
Copyright © Cambridge University Press 2011

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