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Cited by 112Psychopathy, Forensic Psychiatry, Sexual OffendingCrime Patterns and InterventionsPsychotherapy Techniques and Applications

Psychological interventions for adults who have sexually offended or are at risk of offending

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Dennis, Jane A, Khan, Omer, Ferriter, Michael, Huband, Nick, Powney, Melanie J, Duggan, Conor·2012·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd007507.pub2PMC PMC11972834
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Abstract

BACKGROUND: Sexual offending is a legal construct that overlaps, but is not entirely congruent with, clinical constructs of disorders of sexual preference. Sexual offending is both a social and a public health issue. Victim surveys illustrate high incidence and prevalence levels, and it is commonly accepted that there is considerable hidden sexual victimisation. There are significant levels of psychiatric morbidity in survivors of sexual offences.Psychological interventions are generally based on behavioural or psychodynamic theories.Behavioural interventions fall into two main groups: those based on traditional classical conditioning and/or operant learning theory and those based on cognitive behavioural approaches. Approaches may overlap. Interventions associated with traditional classical and operant learning theory are referred to as behaviour modification or behaviour therapy, and focus explicitly on changing behaviour by administering a stimulus and measuring its effect on overt behaviour. Within sex offender treatment, examples include aversion therapy, covert sensitisation or olfactory conditioning. Cognitive behavioural therapies are intended to change internal processes - thoughts, beliefs, emotions, physiological arousal - alongside changing overt behaviour, such as social skills or coping behaviours. They may involve establishing links between offenders' thoughts, feelings and actions about offending behaviour; correction of offenders' misperceptions, irrational beliefs and reasoning biases associated with their offending; teaching offenders to monitor their own thoughts, feelings and behaviours associated with offending; and promoting alternative ways of coping with deviant sexual thoughts and desires.Psychodynamic interventions share a common root in psychoanalytic theory. This posits that sexual offending arises through an imbalance of the three components of mind: the id, the ego and the superego, with sexual offenders having temperamental imbalance of a powerful id (increased sexual impulses and libido) and a weak superego (a low level of moral probation), which are also impacted by early environment.This updates a previous Cochrane review but is based on a new protocol. OBJECTIVES: To assess the effects of psychological interventions on those who have sexually offended or are at risk of offending. SEARCH METHODS: In September 2010 we searched: CENTRAL, MEDLINE, Allied and Complementary Medicine (AMED), Applied Social Sciences Index and Abstracts (ASSIA), Biosis Previews, CINAHL, COPAC, Dissertation Abstracts, EMBASE, International Bibliography of the Social Sciences (IBSS), ISI Proceedings, Science Citation Index Expanded (SCI), Social Sciences Citation Index (SSCI), National Criminal Justice Reference Service Abstracts Database, PsycINFO, OpenSIGLE, Social Care Online, Sociological Abstracts, UK Clinical Research Network Portfolio Database and ZETOC. We contacted numerous experts in the field. SELECTION CRITERIA: Randomised trials comparing psychological intervention with standard care or another psychological therapy given to adults treated in institutional or community settings for sexual behaviours that have resulted in conviction or caution for sexual offences, or who are seeking treatment voluntarily for behaviours classified as illegal. DATA COLLECTION AND ANALYSIS: At least two authors, working independently, selected studies, extracted data and assessed the studies' risk of bias. We contacted study authors for additional information including details of methods and outcome data. MAIN RESULTS: We included ten studies involving data from 944 adults, all male.Five trials involved primarily cognitive behavioural interventions (CBT) (n = 664). Of these, four compared CBT with no treatment or wait list control, and one compared CBT with standard care. Only one study collected data on the primary outcome. The largest study (n = 484) involved the most complex intervention versus no treatment. Long-term outcome data are reported for groups in which the mean years 'at risk' in the community are similar (8.3 years for treatment (n = 259) compared to 8.4 in the control group (n = 225)). There was no difference between these groups in terms of the risk of reoffending as measured by reconviction for sexual offences (risk ratio (RR) 1.10; 95% CI 0.78 to 1.56).Four trials (n = 70) compared one behavioural programme with an alternative behavioural programme or with wait list control. No meta-analysis was possible for this comparison. For two studies (both cross-over, n = 29) no disaggregated data were available. The remaining two behavioural studies compared imaginal desensitisation with either covert sensitisation or as part of adjunctive drug therapy (n = 20 and 21, respectively). In these two studies, results for the primary outcome (being 'charged with anomalous behaviour') were encouraging, with only one new charge for the treated groups over one year in the former study, and in the latter st

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  • The evidence from this review and its companion review into psychological treatments suggests that whatever advances in treatment occur will be at the margins, i.e., equipoise remains.

    “The evidence from this review (and from its companion review into psychological treatments for sexual offenders, Dennis 2012) suggests that, whatever advances in treatment are likely to occur, they will be at the margins - i.e., equipoise remains.”

    From Pharmacological interventions for those who have sexually offended or are at risk of offending (2015) · cites this paper as Dennis 2012

    The Authors’ conclusions say that current evidence does not establish a benefit from psychological interventions and call for further randomised trials, supporting the point that equipoise remains. The review does not predict that future advances in treatment will be only marginal. (LLM, conf=0.85)

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2 of the 164 references couldn’t be matched to a known paper.

Research works printed but not linked: 7

  1. Anderson‐Varney TJ. An Evaluation of a Treatment Program for Imprisoned Child Sex Offenders [PhD thesis]. Michigan: Michigan State University, 1991. [Google Scholar]
  2. Hopkins RE. An evaluation of communication and social skills groups for sex offenders at HMP Frankland. Prison Service Psychology Conference: Conference Proceedings; 1991 Oct 16‐18; Scarborough (UK). London: Home Office, 1991:77‐91.
  3. Marques JK, Nelson C, Alarcon J‐M, Day DM. Preventing relapse in sex offenders. In: Louis DR, Hudson SM, Ward T editor(s). Remaking Relapse Prevention With Sex Offenders: A Sourcebook. Thousand Oaks, California: Sage, 2000:321‐40. [Google Scholar]
  4. McAnaney MW. Heterosocial skills training with sex offenders [PhD thesis]. Gainesville: University of Florida, 1981. [Google Scholar]
  5. McAnaney MW. Correspondence with investigator concerning study protocol, allocation concealment and knowledge of any other studies not identified in this review. Email to: J Dennis 24 August 2011.
  6. Romero JJ, Williams LM. Group psychotherapy and intensive probation supervision with sex offenders. Federal Probation 1983;47:36‐42. [Google Scholar]
  7. Ryan PE. A Study of the Effect of the Transtheoretical Approach upon Sex Offenders [PhD thesis]. Fort Worth, TX: School of Religious Education, Southwestern Baptist Theological Seminary, 1997. [Google Scholar]

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Authors
Dennis, J. A., Khan, O., Ferriter, M., Huband, N., Powney, M. J., & Duggan, C.
Affiliations
  • Queen's University Belfast (GB)
  • Rampton Hospital (GB)
  • University of Nottingham (GB)
  • University of Manchester (GB)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2012-12-12
Volume
2012
Issue
12
Pages
CD007507-CD007507
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd007507.pub2
PMC
PMC11972834
OpenAlex
W4211076775
Cited by
112
References
164
Citations by year
2026: 3 · 2025: 4 · 2024: 4 · 2023: 6 · 2022: 6 · 2021: 14 · 2020: 11 · 2019: 11 · 2018: 9 · 2017: 10 · 2016: 10 · 2015: 17 · 2014: 4 · 2013: 3
FWCI
1.11
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Explore Bristol Research (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
  • Social Sciences › Sociology and Political Science › Crime Patterns and Interventions
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
sexual offending, sex offender treatment, psychological intervention, cognitive behavioral therapy, behavior therapy, psychodynamic psychotherapy, recidivism, sexual victimization, aversion therapy, olfactory conditioning, offender rehabilitation
MeSH terms
Adolescent, Adult, Aged, Behavior Therapy, Humans, Male, Middle Aged, Psychoanalytic Therapy, Psychotherapy, Risk, Sex Offenses, Randomized Controlled Trials as Topic, Young Adult, Criminals, Watchful Waiting

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