Psychological interventions for those who have sexually offended or are at risk of offending
Abstract
Background
Sexual offending is both a social problem and a public health issue. To date, no positive treatment effects have been found in quasi‐experimental institutional treatment programmes.
Objectives
To evaluate effects of psychological interventions on target sexual acts, urges or thoughts for people who have been convicted, or cautioned, for sexual offences.
Search methods
33 electronic databases including the Cochrane Controlled Trials Register (Issue 4, 2002) were searched. Relevant authors and organisations were contacted for additional data.
Selection criteria
Randomised controlled trials (RCTs) involving adults treated in institutional or community settings for sexual behaviours that have resulted in conviction or caution for sexual offences, or offences or violent behaviours with a sexual element. Behavioural, cognitive‐behavioural, psychodynamic, and psychoanalytic therapies were compared with each other, drug treatment, or standard care.
Data collection and analysis
Independent assessors selected and assessed studies and extracted data. Data were excluded where more than 50% of participants were lost to follow‐up. For binary outcomes, standard estimations of risk ratio (RR) and their 95% confidence intervals (CI) were calculated. Where possible, number‐needed‐to‐treat or harm statistics (NNT, NNH) and their 95% CIs were calculated.
Main results
We included nine RCTs with over 500 male offenders, 231 of whom have been followed up for a decade. Cognitive behavioural therapy (CBT) in groups may reduce re‐offence at one year for child molesters when compared with standard care (n=155, 1 RCT, RR any sexual/violent crime ‐ 0.41 CI 0.2 to 0.82, NNT 6 CI 3 to 20). However, when CBT was compared with a trans‐theoretical counselling group therapy the former may have increased poor attitudes to treatment (corrected n=38, 1 RCT, RR 2.8 CI 1.26 to 6.22, NNH 2 CI 1 to 5). The largest trial compared broadly psychodynamic group therapy with no treatment for 231 men guilty of paedophilia, exhibitionism or sexual assault. Re‐arrest over ten years was greater for those allocated to group therapy (result not statistically significant [n=231, 1 RCT, RR 1.87 CI 0.78 to 4.47]).
Authors' conclusions
Limited data make recommendations difficult. One study suggests that a cognitive approach results in a decline in re‐offending after one year. Another large study shows no benefit for group therapy and suggests the potential for harm at ten years. The ethics of providing this still‐experimental treatment to a vulnerable and potentially dangerous group of people outside of a well‐designed evaluative study are debatable. This review proves such studies are possible.
PICOs
Plain language summary
Behavioural and/or 'talking' therapy is often recommended (and provided) to people who have committed sex offences. However, the effects of such treatments are unclear. This updated review suggests that, based on a small number of reported trials, cognitive behavioural treatments (CBT) and general psychotherapeutic groups have been investigated more often than other treatments. Some evidence suggests that CBT may decrease re‐offending at a year, however the general approach may contribute to re‐arrest levels up to ten years later. This review shows that evaluative studies are possible in this difficult area, and further ones are urgently needed to resolve persisting uncertainties.
