Cognitive Behavioural Therapy (CBT)

Impact on crime
Evidence quality 3
Effect
How it works
cog full Evidence quality 2
Mechanism
Where it works
where full Evidence quality 2
Moderator
How to do it
what full Evidence quality 3
Implementation
What it costs
cost empty Evidence quality 0
Economic cost
* This is based on the strongest scores from a number of systematic reviews

What is the focus of the intervention?

Cognitive Behavioural Therapy (CBT) for offenders targets ‘criminal thinking’ as a factor which contributes towards criminal behaviour. By assuming that this ‘criminal thinking’ is a cognitive deficit which has been learned, CBT focuses on teaching offenders to understand the thinking processes and choices that precede criminal behaviour.

CBT programmes aim to build cognitive skills and restructure biased or distorted thinking. Elements of CBT for offenders may include cognitive skills training, anger management, moral development and relapse prevention.

CBT can be delivered in correctional and community settings and is used for both adults and juveniles.

This narrative is primarily based on one review of 58 studies. A second review based on 12 studies provides additional evidence in the mechanism and implementation sections below, and a third review based on 8 studies provides additional evidence in the moderator section. The crime outcome measured in all three reviews was reoffending.

EFFECT

How effective is it?

Overall, the evidence suggests that CBT has reduced crime.

The overall evidence comes from Review 1, based on 58 studies. A meta-analysis of outcomes from all 58 studies showed a statistically significant reduction in reoffending of 25% amongst participants who received CBT compared to those who did not. 

Review 1 also tested to see if there was a correlation between the effect size and study methodology, finding no statistically significant effect. Studies of arguably weaker methodology found similar levels of reoffending to those of stronger methodologies.

There was also no significant difference between the level of attrition of participants and the overall levels of reoffending of participants.

Finally, there was no significant difference between levels of reoffending depending on the type of reoffending measure – whether this was re-arrest or reconviction.

How strong is the evidence?

The review was sufficiently systematic that many forms of bias that could influence the study conclusions can be ruled out. 

Review 1 considered many elements of validity, conducted relevant statistical analyses and used quality assurance to ensure the accuracy of the information collected from primary studies. It also took into account the potential effects of publication bias, and only combined studies of similar methodological quality.

 However, the review did not take into account the possible effect of statistical outliers.

MECHANISM

How does it work?

Review 1 noted that CBT is based on the assumption that cognitive deficits and distortions characteristic of offenders are learned rather than inherent. Programs for offenders, therefore, emphasise individual accountability and attempt to teach offenders to understand the thinking processes and choices that immediately preceded their criminal behaviour.

Learning to self-monitor thinking is typically the first step, after which the therapeutic techniques seek to help offenders identify and correct biased, risky, or deficient thinking patterns.

All cognitive behavioural interventions, therefore, employ a set of structured techniques aimed at building cognitive skills in areas where offenders show deficits and restructuring offenders’ thinking in areas where it is biased or distorted.

These techniques typically involve cognitive skills training, anger management, and various supplementary components related to social skills, moral development, and relapse prevention. Relapse prevention is increasingly popular and is aimed at developing cognitive risk-management strategies along with a set of behavioural contracts for avoiding or deescalating the precursors to offending behaviour (e.g., high-risk situations, places, associates, or maladaptive coping responses).

CBT has a well-developed theoretical basis that explicitly targets “criminal thinking” as a contributing factor to deviant behaviour. Review 1 also noted that elements of CBT programmes may focus on assuming personal responsibility for crimes (e.g., challenging offenders’ tendency to justify their behaviour by blaming the victim), and on developing victim empathy (e.g., by correcting their minimization of the harm they caused). These specifically work to remove offenders’ excuses for committing crimes.

Review 2 noted that the basic premise underlying CBT is that thoughts, images, beliefs and attitudes are intimately related to how we behave. Therefore, it is necessary to direct interventions to both cognitive and behavioural aspects of the criminal behaviour. To be as effective as possible, CBT may also need to focus on predictors of criminal behaviour such as criminological thinking and antisocial attitudes.

MODERATORS

In which contexts does it work best?

Review 1 found no significant difference in the rates of reoffending for adults or juveniles who were given CBT. They did find that CBT worked significantly better for high risk participants. The review also found that CBT programmes with more sessions per week and more hours of treatment showed significantly lower rates of reoffending, while programmes with higher quality implementation also had significantly lower rates of reoffending. The review tested the relationship between different elements of treatment within CBT programmes and levels of participant reoffending, finding that the treatment elements which were associated with significantly lower levels of reoffending were cognitive restructuring, anger management, and individual attention for participants outside of group sessions.

Review 3 focussed upon the effect of CBT upon different ethnic groups in Canada. The review found that there were significant reductions in reoffending for all ethnic groups they assessed (Caucasian, Black, Aboriginal and Other), and that there were no significant differences between the levels of reoffending for these groups.

In Canada, aboriginal-specific correctional programs were developed in collaboration with Aboriginal Elders and experts and are primarily delivered by Aboriginal facilitators. These programmes supplement the usual approach with culturally specific teachings, scenarios, and ceremonies and include involvement with Aboriginal Elders. However, when the review tested the effect of aboriginal-specific programmes, they found that levels of reoffending were similar whether aboriginals participated in culturally specific or generic CBT programmes.

IMPLEMENTATION

What can be said about implementing this initiative?

Review 1 noted a number of programme components that CBT tends to include. These are techniques such as cognitive skills training, anger management, and supplementary components related to social skills, moral development and relapse prevention.

CBT programmes may differ in their emphasis depending upon the needs of the participants and the types of participants involved. Some are geared mainly toward anger control and building conflict resolution skills. Others centre on assuming personal responsibility for crimes, and on developing victim empathy.

The review does not state whether CBT varies by offence type.

Review 1 conducted a statistical analysis of the effects of what they believed to be the optimal implementation of a CBT programme. This included no design problems, no participant attrition and using arrest as the reoffending outcome. It also presumed that the participants were moderately high risk offenders who received 2 sessions per week of high quality implemented CBT for 16 weeks. The programme included anger management techniques and interpersonal problem solving components. The review authors calculated that such an optimal programme would lead to a 52% decrease in reoffending compared to a control group who received no treatment. The review authors concluded that the most effective CBT programmes include high quality implementation as represented by low proportions of treatment dropouts, close monitoring of the quality and fidelity of the treatment implementation, and adequate CBT training for the providers.

Review 2 focussed on youths in residential treatment who exhibited antisocial behaviour. 

The review noted that residential programmes may have difficulty in maintaining and generalising changes in behaviour, if peers, family and school cannot be directly included in the treatment programmes. For cognitive behavioural therapy it is important that the treatment includes the opportunity to rehearse new skills and behaviours in the environments where they naturally occur, i.e. in society back home. Therefore, it is uncertain whether any sustainable treatment effects can be obtained in a context in which the person has been placed against his or her will and where there are very limited contacts with his or her usual environment.

ECONOMIC CONSIDERATIONS

How much might it cost?

None of the reviews reported any information about the costs of CBT programmes, or any cost/benefit analyses.

General considerations

• All of the reviews showed significant reductions in reoffending for participants who were given CBT. These reductions were for adults and juveniles, and participants of all ethnicities.

Summary

Overall, the evidence suggests that CBT has reduced crime. A reduction of 25% in reoffending was seen amongst participants of CBT programmes compared to those who did not receive any treatment. Significant reductions were seen amongst adults and juveniles, and amongst participants of all different ethnicities.

Programmes which saw the greatest reductions in reoffending were characterised by high quality implementation and programme elements including anger management skills and interpersonal problem solving carried out in a non-institutional environment.

Ratings for Individual Reviews

Review 1

How it works
cog full Evidence quality 2
Mechanism
Where it works
where full Evidence quality 2
Moderator
How to do it
what full Evidence quality 3
Implementation
What it costs
cost empty Evidence quality 0
Economic cost

Review 2

How it works
cog full Evidence quality 1
Mechanism
Where it works
where full Evidence quality 1
Moderator
How to do it
what full Evidence quality 1
Implementation
What it costs
cost empty Evidence quality 0
Economic cost

Review 3

How it works
cog full Evidence quality 1
Mechanism
Where it works
where full Evidence quality 2
Moderator
How to do it
what full Evidence quality 1
Implementation
What it costs
cost empty Evidence quality 0
Economic cost

Resources


Review 1: Lipsey, M.W., Landenberger, N.A. and Wilson, S.J. (2007) 'Effects of cognitive-behavioral programs for criminal offenders', Campbell Systematic Reviews 2007:6, DOI: 10.4073/csr.2007.6

Review 2: Armelius, B.Å. and Andreassen, T.H. (2007) 'Cognitive-behavioral treatment for antisocial behavior in youth in residential treatment', Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005650. DOI: 10.1002/14651858.CD005650.pub2.

Review 3: Usher, A. M. and Stewart, L. A. (2014) 'Effectiveness of Correctional Programs With Ethnically Diverse Offenders: A Meta- Analytic Study', International Journal of Offender Therapy and Comparative Criminology, Vol 58(2) 209–230

 
This narrative was prepared by UCL Jill Dando Institute and was co-funded by the College of Policing and the Economic and Social Research Council (ESRC).  ESRC Grant title: 'University Consortium for Evidence-Based Crime Reduction'.  Grant Ref: ES/L007223/1.

Uploaded on 08/12/2015

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