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Cognitive behaviour therapy for violent men with antisocial personality disorder in the community: an exploratory randomized controlled trial

Published online by Cambridge University Press:  30 July 2008

K. M. Davidson*
Affiliation:
Faculty of Medicine, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
P. Tyrer
Affiliation:
Department of Psychological Medicine, Imperial College London, London, UK
P. Tata
Affiliation:
Adult Psychology Services, Central North West London NHS Foundation Trust, Psychology Department, London, UK
D. Cooke
Affiliation:
Department of Psychology, Glasgow Caledonian University, Glasgow, UK
A. Gumley
Affiliation:
Faculty of Medicine, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
I. Ford
Affiliation:
Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, UK
A. Walker
Affiliation:
Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, UK
V. Bezlyak
Affiliation:
Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, UK
H. Seivewright
Affiliation:
Department of Psychological Medicine, Imperial College London, London, UK
H. Robertson
Affiliation:
Faculty of Medicine, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
M. J. Crawford
Affiliation:
Department of Psychological Medicine, Imperial College London, London, UK
*
*Address for correspondence: Professor K. M. Davidson, Faculty of Medicine, University of Glasgow, Gartnavel Royal Hospital, Great Western Road, Glasgow G12 0XH, UK. (Email: k.davidson@clinmed.gla.ac.uk)

Abstract

Background

Little information exists on treatment effectiveness in antisocial personality disorder (ASPD). We investigated the feasibility and effectiveness of carrying out a randomized controlled trial of cognitive behaviour therapy (CBT) in men with ASPD who were aggressive.

Method

This was an exploratory two-centre, randomized controlled trial in a community setting. Fifty-two adult men with a diagnosis of ASPD, with acts of aggression in the 6 months prior to the study, were randomized to either treatment as usual (TAU) plus CBT, or usual treatment alone. Change over 12 months of follow-up was assessed in the occurrence of any act of aggression and also in terms of alcohol misuse, mental state, beliefs and social functioning.

Results

The follow-up rate was 79%. At 12 months, both groups reported a decrease in the occurrence of any acts of verbal or physical aggression. Trends in the data, in favour of CBT, were noted for problematic drinking, social functioning and beliefs about others.

Conclusions

CBT did not improve outcomes more than usual treatment for men with ASPD who are aggressive and living in the community in this exploratory study. However, the data suggest that a larger study is required to fully assess the effectiveness of CBT in reducing aggression, alcohol misuse and improving social functioning and view of others. It is feasible to carry out a rigorous randomized controlled trial in this group.

Type
Original Articles
Copyright
Copyright © 2008 Cambridge University Press

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References

Brooner, RK, Kidorf, M, King, VL, Stoller, K (1998). Preliminary evidence of good treatment response in antisocial drug abusers. Drug and Alcohol Dependence 49, 249260.CrossRefGoogle ScholarPubMed
Coid, J, Yang, M, Roberts, A, Ullrich, S (2006 b). Violence and psychiatric morbidity in the national household population of Britain: public health implications. British Journal of Psychiatry 189, 1219.CrossRefGoogle ScholarPubMed
Coid, J, Yang, M, Tyrer, P, Roberts, A, Ullrich, S (2006 a). Prevalence and correlates of personality disorder in Great Britain. British Journal of Psychiatry 188, 423431.CrossRefGoogle ScholarPubMed
Compton, WM, Conway, KP, Stinson, FS, Colliver, JD, Grant, BF (2005). Prevalence, correlates, and comorbidity of DSM-IV antisocial personality syndromes and alcohol and specific drug use disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry 66, 677685.CrossRefGoogle ScholarPubMed
Davidson, K, Norrie, J, Tyrer, P, Gumley, A, Tata, P, Murray, H, Palmer, S (2006). The effectiveness of cognitive behaviour therapy for borderline personality disorder: results from the BOSCOT trial. Journal of Personality Disorders 20, 450465.CrossRefGoogle ScholarPubMed
Davidson, KM (2007). Cognitive Therapy for Personality Disorders: A Guide for Clinicians, 2nd edn. Routledge: Hove.CrossRefGoogle Scholar
Duggan, C, Huband, N, Smailagic, N, Ferriter, M, Adams, C (2007). The use of psychological treatments for people with personality disorder: a systematic review of randomized controlled trials. Personality and Mental Health 1, 95125.CrossRefGoogle Scholar
Eastman, N (1999). Who should take responsibility for antisocial personality disorder? British Medical Journal 318, 206207.CrossRefGoogle ScholarPubMed
Emmelkamp, PMG, Benner, A, Kuipers, A, Feiertag, GA, Koster, HC, van Apeldoorn, FJ (2006). Comparison of brief dynamic and cognitive-behavioural therapies in avoidant personality disorder. British Journal of Psychiatry 189, 6064.CrossRefGoogle ScholarPubMed
Farrington, DP, Coid, JW, Harnett, L, Jolliffe, D, Soteriou, N, Turner, R, West, DJ (2006). Criminal careers up to age 50 and life success up to age 48: new findings from the Cambridge Study in Delinquent Development. London, Home Office (Research Study No. 299).Google Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1996). Structured Clinical Interview for Axis I DSM-IV disorders – Patient Edition (With Psychotic Screening) (SCID-I/P (W/Psychotic Screen)) Version 2. Biometrics Research Department, New York State Psychiatric Institute: New York.Google Scholar
Fowler, D, Freeman, D, Smith, B, Kuipers, E, Bebbington, P, Bashforth, H, Coker, S, Gracie, A, Dunn, G, Garety, P (2006). The Brief Core Schema Scales (BCSS): psychometric properties and associations with paranoia and grandiosity in non-clinical and psychosis samples. Psychological Medicine 36, 749759.CrossRefGoogle ScholarPubMed
Gavin, DR, Ross, HE, Skinner, HA (1989). Diagnostic validity of the Drug Abuse Screening Test in the assessment of DSM-III drug disorders. British Journal of Addiction 84, 301307.CrossRefGoogle ScholarPubMed
Knapp, M, Beecham, J (1990). Costing mental health services: the client service receipt inventory. Psychological Medicine 20, 893908.CrossRefGoogle Scholar
Messina, N, Farabee, D, Rawson, R (2003). Treatment responsivity of cocaine-dependent patients with antisocial personality disorder to cognitive-behavioral and contingency management interventions. Journal of Consulting and Clinical Psychology 71, 320329.CrossRefGoogle ScholarPubMed
Moran, P (1999). The epidemiology of antisocial personality disorder. Social Psychiatry and Psychiatric Epidemiology 34, 231242.CrossRefGoogle ScholarPubMed
Novaco, RW (2003). The Novaco Anger Scale and Provocation Inventory (NAS-PI). Western Psychological Services: Los Angeles, CA.Google Scholar
Personal Social Services Research Unit (2007). Unit Costs of Health and Social Care. University of Kent at Canterbury: UK.Google Scholar
Saunders, JB, Aasland, OG, Babor, TF, de la Fuente, JR, Grant, M (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption. II. Addiction 88, 791804.CrossRefGoogle ScholarPubMed
Scott, S, Knapp, M, Henderson, J, Maughan, B (2001). Financial cost of social exclusion: follow-up study of antisocial children into adulthood. British Medical Journal 323, 15.CrossRefGoogle ScholarPubMed
Shaw, BF, Elkin, I, Yamaguchi, J, Olmsted, M, Vallis, MT, Dobson, KS, Lowery, A, Sotsky, SM, Watkins, JT, Imber, SD (1999 a). Therapist competence ratings in relation to clinical outcome in cognitive therapy of depression. Journal of Consulting and Clinical Psychology 67, 837846.CrossRefGoogle ScholarPubMed
Shaw, J, Appleby, L, Amos, T, McDonnell, R, Harris, C, McCann, K, Kiernan, K, Davies, S, Bickley, H, Parsons, R (1999 b). Mental disorder and clinical care in people convicted of homicide: national clinical survey. British Medical Journal 318, 12401244.CrossRefGoogle ScholarPubMed
Skinner, H (1982). The Drug Abuse Screening Test. Addictive Behaviours 7, 363371.CrossRefGoogle ScholarPubMed
Steadman, H, Mulvey, EP, Monahan, J, Robbins, PC, Appelbaum, P, Grisso, T, Roth, LH, Silver, E (1998). Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Archives of General Psychiatry 55, 393401.CrossRefGoogle ScholarPubMed
Steadman, H, Silver, E, Monahan, J, Appelbaum, P, Robbins, PC, Mulvey, EP, Grisso, T, Roth, LH, Banks, S (2000). A classification tree approach to the development of actuarial violence risk assessment tools. Law and Human Behavior 24, 83100.CrossRefGoogle Scholar
Torgesen, JK, Wagner, RK, Rashotte, CA (1999). TOWRE Test of Word Reading Efficiency. Pro-Ed: Austin, TX.Google Scholar
Tyrer, P, Nur, U, Crawford, M, Karlsen, S, McLean, C, Rao, B, Johnson, T (2005). Social Functioning Questionnaire: a rapid and robust measure of perceived functioning. International Journal of Social Psychiatry 51, 265275.CrossRefGoogle ScholarPubMed
Young, JE, Beck, AT (1980). Cognitive Therapy Rating Scale: Manual. Center for Cognitive Therapy: Philadelphia, PA.Google Scholar
Zigmond, AS, Snaith, RP (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 67, 361370.CrossRefGoogle ScholarPubMed