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Practice Profile

Cognitive Behavioral Therapy (CBT) for Moderate- and High-Risk Adult Offenders

Evidence Ratings for Outcomes:

Promising - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types

Practice Description

Practice Goals
Cognitive behavioral therapy (CBT) is a problem-focused, therapeutic approach that attempts to help people identify and change dysfunctional beliefs, thoughts, and patterns of behavior that contribute to their problem behaviors. For adult offenders, CBT explains how cognitive deficits, distortion, and flawed thinking processes can lead to criminal behavior. CBT programs emphasize individual accountability and attempt to help adult offenders to understand their thinking processes and the choices they make before they commit a crime (Lipsey, Landenberger, and Wilson 2007).
 
Practice Theory
CBT is based on a theoretical foundation that focuses on how “criminal thinking” contributes to criminal behavior and offending. For instance, distorted cognition is a characteristic very often found in criminal offenders. This can include self-justificatory thinking, misinterpretation of social cues, feelings of dominance and entitlement, and a lack of moral reasoning (Development Services Group, Inc. 2010; Lipsey, Landenberger, and Wilson 2007). CBT is based on the idea that an offender’s cognitive deficits and criminal-thinking patterns are learned, and not inherited, behavior. Therefore, CBT interventions typically use a set of structured techniques that attempt to build cognitive skills in areas in which offenders show deficits. CBT can also restructure cognition in areas where offenders show biased or distorted thinking.
 
Target Population
Moderate- and high-risk adult offenders are often the target of CBT interventions. “Risk” refers to the probability that an individual will reoffend. For instance, a low-risk offender has a low probability of reoffending, whereas moderate- and high-risk offenders have higher probabilities of reoffending (Lowenkamp and Latessa 2004). CBT programs may target specific risk factors (such as antisocial attitudes or substance abuse problems) that place offenders at higher risks of recidivating.
 
Practice Components
CBT can be delivered in various criminal justice settings, including institutions (such as prison) and community-based settings. CBT can also be delivered as part of a multifaceted program or a standalone intervention.
 
CBT for adult offenders addresses a number of problems associated with criminal behavior such as social skills, means–end problem solving, moral reasoning, self-control, impulse management, and self-efficacy. Techniques to address these problems include cognitive skills training, role playing, anger management, and other strategies that focus on improving social skills, moral development, or relapse prevention (Clark 2010; Lipsey, Landenberger, and Wilson 2007).
 
Key Personnel
CBT programs are usually delivered by training professionals or paraprofessionals. Non-therapist group facilitators generally receive 40 hours or more of specialized training to deliver the program. Certain characteristics of CBT counselors are important to the therapy process. For example, an essential aspect of CBT is that counselors and clients establish a positive rapport; therefore, counselors need to show support, honesty, sensitivity, and acceptance (Clark 2010).

Meta-Analysis Outcomes

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Promising - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types
Aos and Drake (2013) aggregated the results from 32 studies to examine the impact of cognitive behavioral therapy (CBT) on crimes committed by moderate- and high-risk adult offenders. They found a significant effect size (-0.14) favoring the treatment group, meaning that moderate- and high-risk adult offenders who received CBT were significantly less likely to commit crime, compared with adult offenders who did not receive CBT.
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Meta-Analysis Methodology

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Meta-Analysis Snapshot
 Literature Coverage DatesNumber of StudiesNumber of Study Participants
Meta-Analysis 11987 - 2010320

Meta-Analysis 1
Aos and Drake (2013) examined the effectiveness of evidence-based, public policy options that can affect the number of crimes committed. The options were sorted into three general categories: prisons, police, and programs. Programs included prevention programs designed to prevent the occurrence of crime, or intervention programs intended to reduce the likelihood that new crimes would be committed. For this review, the focus was on adult intervention programs, specifically cognitive behavioral therapy (CBT).
 
To identify studies, bibliographies of systematic and narrative reviews of the research literature were consulted; citations in individual studies were located; independent literature searches of research databases (such as ProQuest, EBSCO, ERIC, and SAGE) were conducted; and authors of primary research were contacted. Studies that used random assignment and quasi-experiments were included. Studies were excluded if the treatment group was made up solely of program completers. Studies were also excluded if there was not enough information available to calculate an effect size (WSIPP 2015).  
 
Part of the report examined the effectiveness of CBT to reduce crimes committed by moderate- and high-risk adult offenders. A broad group of studies was gathered to assess the impact of CBT. Studies were included if CBT had been delivered to adults in either an institutional or community setting. However, studies on CBT delivered specifically for sex offender treatment were excluded from the analysis.
 
A total of 32 studies were included in the analysis of CBT programs. The 32 studies included 38 effect sizes (meaning a few studies had multiple comparison groups). The studies included female and male offenders, and the average age of program participants was 28. An assortment of offender types were involved in the studies, including federal drug offenders, male Swedish prisoners, female prisoners, adult probationers, Canadian federal offenders, and DWI offenders. Less than half (44 percent) of the studies looked at “brand name” CBT programs, including Moral Reconation Therapy, Reasoning and Rehabilitation, Thinking for a Change, and Aggression Replacement Training.
 
The calculated effect size was the standardized mean difference. A random effects model was used to calculate the weighted average effect size across all of the included studies.
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Cost

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Aos and Drake (2013) conducted a cost–benefit analysis of cognitive behavioral therapy (CBT) for moderate- and high-risk adult offenders. They estimated that the cost of delivering CBT is approximately $419 per participant (specifically in the state of Washington). In addition, they found that overall, due to reductions in crimes committed by adult offenders, CBT has a benefit-to-cost ratio of $24.72; that is, for every one dollar spent on CBT programming, there is a benefit of $24.72.
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Other Information

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Aos and Drake (2013) found there was no significant difference in effectiveness for cognitive behavioral therapy (CBT) programs delivered in prison versus in the community. There was also no significant difference between “brand name” and “homegrown” CBT programs. However, effect sizes were significantly higher for CBT programs when the program developer was involved in the research study.
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Evidence-Base (Meta-Analyses Reviewed)

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These sources were used in the development of the practice profile:

Meta-Analysis 1
Aos, Steve, and Elizabeth Drake. 2013. Prison, Police, and Programs: Evidence-Based Options that Reduce Crime and Save Money. Olympia, Wash.: Washington State Institute for Public Policy.
http://www.wsipp.wa.gov/ReportFile/1396/Wsipp_Prison-Police-and-Programs-Evidence-Based-Options-that-Reduce-Crime-and-Save-Money_Full-Report.pdf
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Additional References

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These sources were used in the development of the practice profile:

Clark, Patrick. 2010. “Preventing Future Crime with Cognitive Behavioral Therapy.” NIJ Journal 265:22–25.

Development Services Group, Inc. 2010. “Cognitive Behavioral Treatment.” Literature review. Washington, D.C.: Office of Juvenile justice and Delinquency Prevention.
http://www.ojjdp.gov/mpg/litreviews/Cognitive_Behavioral_Treatment.pdf

Lipsey, Mark W., Nana A. Landenberger, and Sandra J. Wilson. 2007. “Effects of Cognitive-Behavioral Programs for Criminal Offenders.” Campbell Systematic Reviews 6.

Lowenkamp, Christopher T., and Edward J. Latessa. 2004. “Understanding the Risk Principle: How and Why Correctional Interventions Can Harm Low-Risk Offenders.” Topics in Community Corrections:3–8.
https://www.uc.edu/content/dam/uc/ccjr/docs/articles/ticc04_final_complete.pdf

(WSIPP) Washington State Institute for Public Policy. 2015. Benefit-Cost Technical Documentation: Washington State Institute for Public Policy Benefit-Cost Model. Olympia, Wash.: Washington State Institute for Public Policy.
http://www.wsipp.wa.gov/TechnicalDocumentation/WsippBenefitCostTechnicalDocumentation.pdf
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Related Programs

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Following are CrimeSolutions.gov-rated programs that are related to this practice:

Thinking for a Change Promising - One study
A cognitive–behavioral curriculum developed by the National Institute of Corrections that concentrates on changing the criminogenic thinking of offenders. The program is rated Promising. There was a statistically significant difference in the proportion of offenders who recidivated between the treatment group and the control group. The control group was 57 percent more likely to be arrested during the follow-up period.

Enhanced Thinking Skills (England) Effective - More than one study
This is a prison-based, cognitive–behavioral skills enhancement program in England. The program is rated Effective. The evaluations of the program showed significantly reduced reconviction rates of program participants, compared with non-participants.

Cognitive Skills Training (Georgia) No Effects - More than one study
Implemented by the Georgia Board of Pardons and Paroles, this is a cognitive–behavioral program for male parolees that aims to build psychosocial skills in areas such as self-control, interpersonal problem-solving, and critical reasoning. The program is rated No Effects. The authors found no statistically significant effect of program participation on recidivism and employment measures.

Choosing to Think, Thinking to Choose No Effects - One study
This is a cognitive–behavioral therapy program, consisting of 14 sequential classroom lessons, for high-risk probationers and delivered by probation officers in a community correctional environment. This program was rated No Effects. Results indicate that participants had a statistically significant lower recidivism rate, measured as committing any new offense compared with nonparticipants, however, no statistically significant differences were found across individual offense types.
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Practice Snapshot

Age: 28 - 40

Gender: Both

Targeted Population: High Risk Offenders, Prisoners

Settings: Correctional, Other Community Setting

Practice Type: Cognitive Behavioral Treatment, Individual Therapy

Unit of Analysis: Persons