Practice Profile: Cognitive Behavioral Therapy (CBT) for Adults at Moderate- and High-Risk of Offending

Evidence Rating for Outcomes

Crime & Delinquency | Multiple crime/offense types

Date: This profile was posted on February 09, 2016

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 those who commit crimes. 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 individual'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 the subjects show deficits. CBT can also restructure cognition in areas where individuals show biased or distorted thinking.

Target Population

Moderate- and high-risk adults are often the target of CBT interventions. “Risk” refers to the probability that an individual will reoffend. For instance, a low-risk person has a low probability of reoffending, whereas moderate- and high-risk individuals 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 individuals 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 adults 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 prev

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 Snapshot
	Literature Coverage Dates	Number of Studies	Number of Study Participants
Meta Analysis 1	1987-2010	32	0

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 adults. 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 those who have been convicted of a sex offense 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 females and males, and the average age of program participants was 28. An assortment of offender types were involved in the studies, including those who have been convicted of a federal drug offense, male Swedish incarcerated persons, female who were incarcerate, adults on probation, those in Canadian federal prison, and those convicted of a DWI. 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.