PROTOCOL: Cognitive‐Behavioral Programs for Juvenile and Adult Offenders: A Meta‐Analysis of Controlled Intervention Studies

This review will examine the effect of cognitive-behavioral treatment (CBT) on the criminal behavior of juvenile and adult offenders. It represents an update and extension of a prior meta-analysis on this topic (Lipsey, Chapman, & Landenberger, 2001) and reflects the insights gained from our more recent meta-analytic work on this topic (Landenberger & Lipsey, 2005; Lipsey & Landenberger, 2006). This main questions on which this review will focus are: (1) whether cognitive-behavioral treatments reduce the reoffense rates of juvenile and adult offenders; and (2) whether treatment effects differ for offenders with different characteristics (e.g., juvenile vs. adult) and for programs with different characteristics (e.g., type of “brandname” CBT program, amount of service, quality of implementation). One of the notable characteristics of chronic offenders is distorted cognition—self-justificatory thinking, misinterpretation of social cues, deficient moral reasoning, schemas of dominance and entitlement, and the like (Beck 1999; Dodge 1993; Walters 1990; Walters & White 1989; Yochelson & Samenow 1976). Offenders with such distorted thinking may react to essentially benign situations as threatening, e.g., be predisposed to perceive comments others make about them as disrespectful or attacking. They may hold conceptualizations of themselves, others, and the world that justify antisocial behavior, e.g., “nobody can be trusted,” “everyone is against me,” or “society doesn't give me a chance.” Their behavior may be guided by dysfunctional assumptions and rules about how one should behave, e.g., “you have to punish people for messing with you or they won't respect you,” “you have to rebel against authority or they will break you.” And, they may have deficient cognitive skills for long-term planning, problem solving, and decision-making that contribute to maladaptive and rigid behavior. Cognitive-behavioral treatments (CBT) for offenders are designed to correct these dysfunctional and criminogenic thinking patterns. They employ systematic training regimens aimed at “cognitive restructuring” such that offenders develop more adaptive patterns of reasoning and reacting in situations that trigger their criminal behavior. For instance, CBT may train offenders to monitor their patterns of automatic thoughts to situations in which they tend to react with violence. Various techniques are rehearsed for assessing the validity of those thoughts and substituting accurate interpretations for biased ones. Often role-play or practice in real situations is used to help consolidate new ways of coping with situations that tend to prompt criminal behavior. CBT may focus on anger management, assuming personal responsibility for behavior (e.g., challenging offenders’ tendency to excuse their behavior by blaming the victim, society, or other circumstances beyond their control), taking a moral and empathetic perspective on interpersonal behavior (e.g., victim impact awareness), problem solving, life skill development, setting goals, or any combination of these themes. A relapse prevention component is also often included, which teaches offenders strategies for avoiding or deescalating the precursors to offending behavior (e.g., high-risk situations, places, associates, or maladaptive coping responses). Several reviews and meta-analyses have found that structured, directive, skill-oriented programs are generally more effective in reducing the subsequent reoffense rates of offenders than less structured programs (e.g., Andrews et al. 1990; Lipsey & Wilson 1998; Lösel & Koferl 1989; Palmer 1994; Redondo, Sanchez-Meca, & Garrido 1999). Cognitive-behavioral interventions appear to be especially effective among such programs. A recent meta-analysis of group-oriented cognitive behavioral programs for offenders examined 20 studies of varying levels of methodological quality and concluded that CBT was effective for reducing criminal behavior among offenders (Wilson, Allen, & MacKenzie, in press). Nearly all of the studies showed positive effects (thought not necessarily statistically significant) and representative CBT programs were found to reduce recidivism by 20-30% compared to untreated control groups. The Wilson et al. meta-analysis was restricted to programs delivered in groups, but this is a minor limitation since virtually all such programs for offenders are conducted in a group format. A more interesting aspect of this meta-analysis is the range of offenders represented in the studies it included– some used general samples of offenders, others treated only specialized types of offenders, e.g., sex offenders, drug offenders, DUI cases, or batterers. Much of the variability in effects found across studies may have been due to differences in the response of these different types of offenders, though there were too few studies in any one category for Wilson et al. to closely examine this factor. The only other meta-analysis of the effectiveness of CBT programs on the reoffense rates of offenders of which we are aware is Pearson, Lipton, Cleland, & Lee (2002). This meta-analysis included 69 research studies but covered both behavioral (e.g., contingency contracting, token economy) and cognitive-behavioral programs. Pearson et al. found that cognitive-behavioral programs were more effective in reducing recidivism than the behavioral ones, with a mean recidivism reduction for treated groups of about 30%. Moreover, studies of higher methodological quality showed the largest effect sizes. The criteria for identifying cognitive-behavioral programs in this meta-analysis were rather broad, however. They included not only interventions directed specifically toward altering cognitions, but also social skills training and problem-solving programs for which cognitive change was not the main focus. The overall results of this meta-analysis showed that the odds of recidivating for offenders receiving CBT were only about 55% of those for offenders in the control groups. Examination of selected moderator variables further revealed that demonstration programs set up by researchers for research and demonstration purposes produced larger effects than “real world” practice programs. In addition, the effects for offenders treated while on probation were larger than those for offenders treated while incarcerated. Practice programs implemented on a more or les routine basis in correctional facilities, therefore, showed the smallest effects on recidivism but those effects were, nonetheless, positive and statistically significant. Studies will be assessed and selected for inclusion in the meta-analysis based on the following criteria (detailed criteria are presented in Appendix A): Publication. Eligible studies may be either published or unpublished. Country of origin. Studies may be conducted in any country and be published in any language. Intervention. The treatment under investigation must be directed toward changing participants’ distorted or dysfunctional cognitions or toward teaching new cognitive skills in areas where participants have deficits. The therapeutic techniques should involve specific, relatively structured learning experiences designed to affect such cognitive processes as interpreting social cues, reasoning about right and wrong behavior, and making decisions about appropriate behavior. When the program also includes other elements, the cognitive-behavioral component should be centrally featured rather than only a secondary component. (A detailed definition of CBT is provided in Appendix A.) Participants. The recipients of the intervention must be criminal offenders, either juveniles or adult, who are treated while on probation, incarcerated/institutionalized, or during aftercare/parole. They should be drawn from a general offender population and not be selected for, or restricted to, those committing specific types of offenses (e.g., sex offenses, DUI) or problem behaviors (e.g., drug use). Outcome measures. The study must report subsequent delinquent or criminal offending as an outcome variable. It should also present quantitative data or statistical information that permits computation or reasonable estimation of an effect size statistic representing the contrast between the subsequent criminal behavior of treated versus untreated offenders. Research methods. The study must use a design in which participants are assigned to intervention and control conditions either randomly or with a nonrandom procedure that does not involve manifest differential selection. That is, if nonrandom assignment is used, the selection procedure must not involve treatment-related differentiation (e.g., volunteers vs. nonvolunteers, treatment completers vs. dropouts) and the groups must be matched explicitly or implicitly on key demographic variables and/or prior offense histories or evidence must be provided that indicates the degree of initial equivalence between the groups on such variables. Control groups can represent placebo, wait-list, no treatment, or “treatment as usual” conditions, with the latter restricted to cases of clearly routine probation, institutional, or aftercare/parole practices. Initial library. An initial set of 14 studies eligible under the above criteria was assembled and analyzed for the Lipsey, Chapman, and Landenberger (2001) paper. This set of studies will be expanded through a comprehensive search using the procedures described below. Database searches. Computerized bibliography searches will be conducted, mainly through the DIALOG SYSTEM. The search will cover studies reported during the period from 1965 to the present date. To the best of our knowledge, the first report of the application of CBT to offenders was by Yochelson and Samenow (1976), who described work conducted over the 5-6 years prior to publication of their volume. We thus don't expect to find eligible studies prior to 1970, but will search back to 1965 to ensure none are missed. The keywords that will be used for searching the computer bibliographies will involve concatenations of words that describe the population of interest (e.g., inmates, offenders, parolees), CBT treatment (e.g., cognitive, CBT, criminal thinking), and effectiveness research (e.g., outcomes, evaluation, effectiveness). The keywords for the initial search are identified in Appendix B, but others will be added as they are identified during the search process itself. Campbell Collaboration. Campbell Collaboration members will serve as a network to help locate eligible studies. The Campbell Collaboration Social, Psychological, Educational and Criminological Trials Register (C2-SPECTR) will serve as an additional resource. International contacts. Our efforts to find studies from outside the U.S. will include corresponding with researchers and criminal justice personnel in countries known for their efforts in offender rehabilitation and research (e.g., Australia, Canada, German speaking countries, New Zealand, Scandinavian countries, South Africa, Spain, UK, and others) and ask for their suggestions and help in locating eligible studies, particularly unpublished and fugitive literature. Recent reviews on offender rehabilitation approaches in countries outside the U.S. will provide additional leads and addresses of contact personnel (e.g., 2001 series of international reviews available via Sciencedirect.com). Cross-referencing of bibliographies. The references in relevant review articles, meta-analyses, and primary studies will be scanned for new leads. Conference programs. Recent conference programs will be searched for eligible research presentations and posters at professional meetings of such organizations as the American Evaluation Association, the American Psychological Association, the American Psychological Society, the American Society of Criminology, the Academy of Criminal Justice Sciences, the International Society of Criminology, the American Sociological Association, the Society for Prevention Research, and others. Candidate papers will be requested directly from the authors. Internet searches. Relevant government websites (e.g., NIJ, NIC, OJJDP, Home Office), foundation, professional associations and policy research firm websites will be searched. In addition, keyword searches will be conducted using search engines such as yahoo.com or google.com. Electronic journals. Vanderbilt University subscribes to a large number of electronic journals (e.g., via OVID and Sciencedirect.com). The keywords listed in Appendix B will be used to search the article database. Keyword searching the entire document may lead to eligible studies that were missed in abstract searches. Preliminary screening. Once a candidate study is identified, a preliminary screening will be made on the basis of title, abstract, and other available information (e.g., authors known to be conducting intervention research). For those reports that appear promising, an attempt will then be made to examine a full copy for closer scrutiny. Study retrieval. Available sources for reports are the Vanderbilt University libraries, interlibrary loan, authors and sponsoring agencies, purchases from University Microfilms, book and journal publishers, and on-line journals. Appendix C provides a preliminary bibliography of potentially eligible studies. It includes studies identified in Lipsey, Chapman, and Landenberger (2001) plus other candidate studies located since. Primary studies in the field of offender treatment vary widely with regard to implementation and methodological quality of their research design. The highest quality outcome studies employ individual-level random assignment designs, monitor implementation throughout the delivery of the program, and measure reoffending at multiple time points over a period of two years or longer. Nearly all studies report outcomes as the percentage of reoffending participants in the treatment and control group. Based on the previous meta-analysis of CBT programs (Lipsey, Chapman, & Landenberger, 2001), it is expected that about half of eligible studies employ a random assignment design, about two thirds provide sample sizes up to 100 (treatment plus control), half use rearrest and the other half reconviction as the outcome measure, and about two thirds of studies report recidivism over the first year post-treatment with the remaining third following participants longer. Ninety percent of studies are conducted with primarily male offender samples, including either Anglo or mixed samples (half of studies do not report the ethnic mix). Adult offender studies are about as frequent as juvenile offender studies. Demonstration programs are about as frequent as ongoing practical programs. In about two thirds of studies, treatment is delivered in correctional settings with one third providing CBT to participants in the community (probationers or parolees). More than three quarters of studies examine CBT programs that are delivered in a group format for a duration of 5-20 weeks and a total of 5-80 treatment contact hours. This synthesis will examine only outcomes related to subsequent delinquent/criminal behavior (recidivism). Some studies will report multiple measures of recidivism (e.g., arrest, conviction, probation violations, disciplinary infractions, or breakdowns of different types of offenses). When more than one such outcome is reported, only one will be selected for the analysis. To keep as much comparability as possible across the studies, coders will select the outcome measure that is most frequently represented in other studies in the collection. Based on the pool of previously reviewed studies, it is expected that rearrest and reconviction are the two most common measures and will be the coders’ first choice if available; if not, coders will select the next most frequently represented measure of criminal behavior available. In some studies, recidivism will be reported for different time intervals, e.g., 6-months and one year post treatment. In those cases also the measure with the timing closest to that most commonly used across all the studies will be chosen to maximize comparability between studies. Moderator analysis with method variables will be conducted to determine if there are systematic differences in the outcomes as a of the recidivism is or the timing of those measures. variables. Appendix provides a of variables that will be as of this This may be expanded if in the of will be on those moderator variables that relevant in our previous review (Lipsey, Chapman, & Landenberger, will be used to break study to contrast and This at outcomes representing Studies may report additional outcomes, but these are not the of the review and will not be we will the of these measures and they may be for inclusion in meta-analytic studies will be by two coders of the authors and a research will be based on the of in the entire sample of studies. specific are found to be particularly they will be reviewed and by one of the authors. will be by all of the eligible studies we have reported outcomes as or of offenders in research who This information can be in odds representing the odds of recidivating among the treatment group to the odds among the control group. The odds provides an effect size statistic for meta-analysis that statistical and results & Wilson For study reports that do not report recidivism outcomes as we will the odds if possible using statistical information is reported for the intervention vs. control e.g., for of variables we will the mean and it to an odds using the described in et al. The statistical analysis will be conducted using and a set of by Wilson & effects analysis will be used with the random effects component using method of or size will be to less highest not an large sample sizes will also be to the used in effect size that the corresponding effect sizes will not a on any analysis. of data on variables other than effect sizes will be based on the mean for the most studies. When larger are the will not be used in the analysis. In all cases, will first be made to contact the researchers to determine if they can the odds will which are statistically significant. The random effects mean odds across the studies, and will be To examine the in effects across studies, a of the of the odds will be & & a sample of studies is expected to be the will not have for the as under these further investigation of effect size variability will be One potentially moderator of effect sizes that will be analyzed is type of research design. only and will be eligible for inclusion in this they may different design type will be used as a control in the analysis if the differences are too or and studies will be analyzed and reported will be conducted to determine whether the of of or other such analysis decisions have on the will be conducted by the relevant multiple under different assumptions and procedures on these and the The review will not include studies. Some information presented in reports of eligible and studies (e.g., of treatment will be included in the of made by the This review will be three years to include new treatment studies published in any language. The primary will the lead in this This of this was by the of data and from meta-analysis that have been by the of the of Justice and Prevention and the of The study must the effects of a cognitive-behavioral intervention or treatment. of a Cognitive-behavioral treatment is directed toward changing offenders’ distorted or dysfunctional cognitions or in of cognitive thinking, automatic teaching new cognitive skills in areas where offenders with the that such cognitive will in more adaptive and/or less antisocial behavioral or training approaches to social skills are only eligible if they clearly cognitive variables as the of social skills e.g., use of and to social behavior directly not be Studies must use or that groups receiving a treatment or control must be across treatment conditions that one or more treatments with one or more control Control conditions may be “treatment as treatment, or any other set up as a contrast to the treatment that does represent a to such are eligible the secondary treatment is clearly as a control (e.g., a treatment not expected to be To be a study must of the following in the treatment and control conditions were matched on key demographic variables and/or prior offense or evidence is provided that indicates the degree of initial equivalence between the groups on such variables. the selection procedure must not involve treatment-related differentiation (e.g., volunteers vs. nonvolunteers, treatment completers vs. only studies are eligible (e.g., studies in which the effects of treatment are examined by measures treatment with measures treatment on a treatment In the of the recipients of the cognitive-behavioral intervention must be identified as to behavior under whether or not or are that offenses for juveniles include violations, and of the juvenile sample offenses, the study is not In the of adult offenders, the recipients of the intervention must be specifically as criminal offenders, though is not That is, offenders may be from criminal on probation, in a program For both juveniles and the study sample should represent a general offender population and not be selected for, or restricted to, those committing specific types of offenses (e.g., sex offenses, DUI) or problem behaviors (e.g., drug use). The keywords to be used in the bibliography searches will be three treatment and type of The searches will cover the period from 1965 through search will be using the DIALOG Database that they will include in and of the relevant from the three will be with category but will be by between studies included in the Lipsey, & Landenberger (2001) published of of Country of Canada, Research nonrandom nonrandom Control treatment as other size Offenders in all all Demonstration program vs. ongoing practical program correctional probation or weeks treatment of no Primary of CBT skills training other CBT skills training prevention behavioral skill component component moral reasoning component program following but not size treatment Primary program based about CBT of change of but not and but not and other of from from

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