Psychological Medicine

Original Articles

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

K. M. Davidsona1 c1, P. Tyrera2, P. Tataa3, D. Cookea4, A. Gumleya1, I. Forda5, A. Walkera5, V. Bezlyaka5, H. Seivewrighta2, H. Robertsona1 and M. J. Crawforda2

a1 Faculty of Medicine, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK

a2 Department of Psychological Medicine, Imperial College London, London, UK

a3 Adult Psychology Services, Central North West London NHS Foundation Trust, Psychology Department, London, UK

a4 Department of Psychology, Glasgow Caledonian University, Glasgow, UK

a5 Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, UK


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.

(Received February 22 2008)

(Revised June 12 2008)

(Accepted June 20 2008)

(Online publication July 30 2008)


c1 Address for correspondence: Professor K. M. Davidson, Faculty of Medicine, University of Glasgow, Gartnavel Royal Hospital, Great Western Road, Glasgow G12 0XH, UK. (Email: