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

Tracy Kenworthy; Clive E Adams; Charlotte Bilby; Belinda Brooks‐Gordon; Mark Fenton

doi:10.1002/14651858.CD004858

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Analysis 1.1

Comparison 1 BEHAVIOURAL: ELECTRICAL AVERSION vs SELF REGULATION, Outcome 1 Leaving the study early ‐ by 1 week.

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Analysis 2.1

Comparison 2 BEHAVIOURAL: RELAXATION TREATMENT vs SELF REGULATION, Outcome 1 Leaving the study early ‐ by 1 week.

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Analysis 3.1

Comparison 3 BEHAVIOURAL: ELECTRICAL AVERSION vs RELAXATION TREATMENT, Outcome 1 Leaving the study early ‐ by 1 week.

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Analysis 4.1

Comparison 4 BEHAVIOURAL: IMAGINAL DESENSITISATION vs COVERT SENSITISATION, Outcome 1 Behaviour: No change or increase of target behaviour.

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Analysis 4.2

Comparison 4 BEHAVIOURAL: IMAGINAL DESENSITISATION vs COVERT SENSITISATION, Outcome 2 Desire: No change or increased desire for target behaviour.

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Analysis 4.3

Comparison 4 BEHAVIOURAL: IMAGINAL DESENSITISATION vs COVERT SENSITISATION, Outcome 3 Attitude to treatment: Requesting further treatment within 1 year.

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Analysis 5.1

Comparison 5 BEHAVIOURAL: IMAGINAL DESENSITISATION vs MEDROXYPROGESTERONE, Outcome 1 Behaviour: No change in target behaviour.

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Analysis 5.2

Comparison 5 BEHAVIOURAL: IMAGINAL DESENSITISATION vs MEDROXYPROGESTERONE, Outcome 2 Desire: No change in desire for target behaviour.

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Analysis 5.3

Comparison 5 BEHAVIOURAL: IMAGINAL DESENSITISATION vs MEDROXYPROGESTERONE, Outcome 3 Leaving the study early ‐ by 1 year.

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Analysis 6.1

Comparison 6 COGNITIVE: COGNITIVE BEHAVIOURAL GROUP THERAPY vs NO TREATMENT, Outcome 1 Recidivism by over 1 year.

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Analysis 7.1

Comparison 7 COGNITIVE: COGNITIVE, SOCIAL, EDUCATIONAL TREATMENT vs STANDARD CARE, Outcome 1 Behaviour: Heterosocial skills: Average endpoint score at 6 weeks (HSB, high = good).

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Study	Intervention	Mean	SD	N	Notes
Anderson‐Varney 1991	Cognitive, social educational programme	10.63	8.47	30	Group effect not significant [F(1,58) = 0.389]
Anderson‐Varney 1991	Standard care	13.63	14.98	30
Hopkins 1991	Cognitive, social educational programme	10.5	8.9	8
Hopkins 1991	Standard care	10.9	9.2	7

Analysis 7.2

Comparison 7 COGNITIVE: COGNITIVE, SOCIAL, EDUCATIONAL TREATMENT vs STANDARD CARE, Outcome 2 Behaviour: Social avoidance and distress: Average endpoint score at 2 months (SADS, high = poor, data skewed).

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Analysis 7.3

Comparison 7 COGNITIVE: COGNITIVE, SOCIAL, EDUCATIONAL TREATMENT vs STANDARD CARE, Outcome 3 Self esteem: Average endpoint scores (various scales).

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Analysis 7.4

Comparison 7 COGNITIVE: COGNITIVE, SOCIAL, EDUCATIONAL TREATMENT vs STANDARD CARE, Outcome 4 Cognitive distortions: 1. Average endpoint score at 2 months (ABCS, high = good).

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Study	Intervention	Mean	SD	N	Notes
Anderson‐Varney 1991	Cognitive, social educational programme	12.73	10.25	30	[F (1,58)=0.637]
Anderson‐Varney 1991	Standard care	13.53	10.82	30

Analysis 7.5

Comparison 7 COGNITIVE: COGNITIVE, SOCIAL, EDUCATIONAL TREATMENT vs STANDARD CARE, Outcome 5 Cognitive distortions: 2. Average endpoint score at 2 months (MSI, high = good, data skewed).

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Analysis 7.6

Comparison 7 COGNITIVE: COGNITIVE, SOCIAL, EDUCATIONAL TREATMENT vs STANDARD CARE, Outcome 6 Sexual knowledge: Average endpoint score at 2 months (MSI, high = good).

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Analysis 7.7

Comparison 7 COGNITIVE: COGNITIVE, SOCIAL, EDUCATIONAL TREATMENT vs STANDARD CARE, Outcome 7 Anxiousness / inadequacy: 1. Average endpoint scores (various scales, non‐skewed data).

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Study	Intervention	Mean	SD	N	Notes
Hopkins 1991	Cognitive, social, educational group	13.9	8.0	8
Hopkins 1991	Standard care	17.7	9.2	7

Analysis 7.8

Comparison 7 COGNITIVE: COGNITIVE, SOCIAL, EDUCATIONAL TREATMENT vs STANDARD CARE, Outcome 8 Anxiousness / inadequacy: 2. Average fear of negative evaluation by 6 months (FNE, high = poor, skewed data).

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Analysis 7.9

Comparison 7 COGNITIVE: COGNITIVE, SOCIAL, EDUCATIONAL TREATMENT vs STANDARD CARE, Outcome 9 Leaving the study early.

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Analysis 8.1

Comparison 8 COGNITIVE: COGNITIVE GROUP THERAPY vs TRANSTHEORETICAL COUNSELLING GROUP THERAPY (CLUSTER DERIVED DATA), Outcome 1 Attitudes to treatment: Poor attitude ‐ at 24 weeks.

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Analysis 8.2

Comparison 8 COGNITIVE: COGNITIVE GROUP THERAPY vs TRANSTHEORETICAL COUNSELLING GROUP THERAPY (CLUSTER DERIVED DATA), Outcome 2 Cognitive distortions: Cognitive distortions & immaturity ‐ at 24 weeks.

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Analysis 8.3

Comparison 8 COGNITIVE: COGNITIVE GROUP THERAPY vs TRANSTHEORETICAL COUNSELLING GROUP THERAPY (CLUSTER DERIVED DATA), Outcome 3 Sexual knowledge: Poor knowledge of sex ‐ at 24 weeks.

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Analysis 8.4

Comparison 8 COGNITIVE: COGNITIVE GROUP THERAPY vs TRANSTHEORETICAL COUNSELLING GROUP THERAPY (CLUSTER DERIVED DATA), Outcome 4 Sexual obsessions: High levels of obsession ‐ at 24 weeks.

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Analysis 8.5

Comparison 8 COGNITIVE: COGNITIVE GROUP THERAPY vs TRANSTHEORETICAL COUNSELLING GROUP THERAPY (CLUSTER DERIVED DATA), Outcome 5 Social sexual desirability: Denies interest to the point of promoting asexual image ‐ at 24 weeks.

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Analysis 9.1

Comparison 9 PSYCHOTHERAPY ‐ UNSPECIFIED: GROUP PSYCHOTHERAPY vs NO GROUP THERAPY, Outcome 1 Rearrest within 10 years.

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Comparison 1. BEHAVIOURAL: ELECTRICAL AVERSION vs SELF REGULATION

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Leaving the study early ‐ by 1 week Show forest plot	1	8	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 1. BEHAVIOURAL: ELECTRICAL AVERSION vs SELF REGULATION

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Comparison 2. BEHAVIOURAL: RELAXATION TREATMENT vs SELF REGULATION

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Leaving the study early ‐ by 1 week Show forest plot	1	8	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 2. BEHAVIOURAL: RELAXATION TREATMENT vs SELF REGULATION

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Comparison 3. BEHAVIOURAL: ELECTRICAL AVERSION vs RELAXATION TREATMENT

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Leaving the study early ‐ by 1 week Show forest plot	1	8	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 3. BEHAVIOURAL: ELECTRICAL AVERSION vs RELAXATION TREATMENT

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Comparison 4. BEHAVIOURAL: IMAGINAL DESENSITISATION vs COVERT SENSITISATION

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Behaviour: No change or increase of target behaviour Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 by 1 month	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 by 1 year	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.14, 3.17]
2 Desire: No change or increased desire for target behaviour Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2.1 by 1 month	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.07, 13.87]
2.2 by 1 year	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.02, 7.32]
3 Attitude to treatment: Requesting further treatment within 1 year Show forest plot	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.05, 4.67]

Comparison 4. BEHAVIOURAL: IMAGINAL DESENSITISATION vs COVERT SENSITISATION

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Comparison 5. BEHAVIOURAL: IMAGINAL DESENSITISATION vs MEDROXYPROGESTERONE

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Behaviour: No change in target behaviour Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 by 1 month	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.02, 7.32]
1.2 by 1 year	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Desire: No change in desire for target behaviour Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2.1 by 1 month	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.02, 7.32]
2.2 by 1 year	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Leaving the study early ‐ by 1 year Show forest plot	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 5. BEHAVIOURAL: IMAGINAL DESENSITISATION vs MEDROXYPROGESTERONE

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Comparison 6. COGNITIVE: COGNITIVE BEHAVIOURAL GROUP THERAPY vs NO TREATMENT

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Recidivism by over 1 year Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 involving any combination of sex and violence	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.41 [0.20, 0.82]
1.2 involving both sex and violence	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.12 [0.01, 2.11]
1.3 involving only sex	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.78 [0.28, 2.14]
1.4 involving only violence	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.28 [0.08, 0.98]

Comparison 6. COGNITIVE: COGNITIVE BEHAVIOURAL GROUP THERAPY vs NO TREATMENT

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Comparison 7. COGNITIVE: COGNITIVE, SOCIAL, EDUCATIONAL TREATMENT vs STANDARD CARE

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Behaviour: Heterosocial skills: Average endpoint score at 6 weeks (HSB, high = good) Show forest plot	1	37	Mean Difference (IV, Fixed, 95% CI)	7.70 [1.45, 13.95]

2 Behaviour: Social avoidance and distress: Average endpoint score at 2 months (SADS, high = poor, data skewed) Show forest plot			Other data	No numeric data

3 Self esteem: Average endpoint scores (various scales) Show forest plot	3		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

3.1 average endpoint score at 6 weeks (SSI)	1	37	Mean Difference (IV, Fixed, 95% CI)	13.20 [‐5.04, 31.44]
3.2 average endpoint scores at 2 months (IRI, high = good)	1	60	Mean Difference (IV, Fixed, 95% CI)	‐0.80 [‐5.62, 4.02]
3.3 average endpoint scores at 6 months (Rosenburg's Scale, high = good)	1	15	Mean Difference (IV, Fixed, 95% CI)	1.60 [‐1.89, 5.09]
4 Cognitive distortions: 1. Average endpoint score at 2 months (ABCS, high = good) Show forest plot	1	60	Mean Difference (IV, Fixed, 95% CI)	13.43 [6.81, 20.05]

5 Cognitive distortions: 2. Average endpoint score at 2 months (MSI, high = good, data skewed) Show forest plot			Other data	No numeric data

6 Sexual knowledge: Average endpoint score at 2 months (MSI, high = good) Show forest plot	1	60	Mean Difference (IV, Fixed, 95% CI)	3.26 [0.31, 6.21]

7 Anxiousness / inadequacy: 1. Average endpoint scores (various scales, non‐skewed data) Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

7.1 average heterosocial anxiety endpoint score at 6 weeks (SRIA, high = poor)	1	37	Mean Difference (IV, Fixed, 95% CI)	‐14.0 [‐43.57, 15.57]
7.2 average sexual inadequacy endpoint score at 2 months (MSI, high = poor)	1	60	Mean Difference (IV, Fixed, 95% CI)	‐6.20 [‐13.46, 1.06]
8 Anxiousness / inadequacy: 2. Average fear of negative evaluation by 6 months (FNE, high = poor, skewed data) Show forest plot			Other data	No numeric data

9 Leaving the study early Show forest plot	1	40	Risk Ratio (M‐H, Fixed, 95% CI)	2.0 [0.20, 20.33]

Comparison 7. COGNITIVE: COGNITIVE, SOCIAL, EDUCATIONAL TREATMENT vs STANDARD CARE

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Comparison 8. COGNITIVE: COGNITIVE GROUP THERAPY vs TRANSTHEORETICAL COUNSELLING GROUP THERAPY (CLUSTER DERIVED DATA)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Attitudes to treatment: Poor attitude ‐ at 24 weeks Show forest plot	1	38	Risk Ratio (M‐H, Fixed, 95% CI)	2.8 [1.26, 6.22]

2 Cognitive distortions: Cognitive distortions & immaturity ‐ at 24 weeks Show forest plot	1	38	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.76, 1.32]

3 Sexual knowledge: Poor knowledge of sex ‐ at 24 weeks Show forest plot	1	38	Risk Ratio (M‐H, Fixed, 95% CI)	1.1 [0.62, 1.95]

4 Sexual obsessions: High levels of obsession ‐ at 24 weeks Show forest plot	1	38	Risk Ratio (M‐H, Fixed, 95% CI)	1.5 [0.80, 2.81]

5 Social sexual desirability: Denies interest to the point of promoting asexual image ‐ at 24 weeks Show forest plot	1	38	Risk Ratio (M‐H, Fixed, 95% CI)	1.83 [0.85, 3.94]

Comparison 8. COGNITIVE: COGNITIVE GROUP THERAPY vs TRANSTHEORETICAL COUNSELLING GROUP THERAPY (CLUSTER DERIVED DATA)

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Comparison 9. PSYCHOTHERAPY ‐ UNSPECIFIED: GROUP PSYCHOTHERAPY vs NO GROUP THERAPY

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Rearrest within 10 years Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 for sex offense	1	231	Risk Ratio (M‐H, Fixed, 95% CI)	1.87 [0.78, 4.47]
1.2 for any offense	1	231	Risk Ratio (M‐H, Fixed, 95% CI)	9.20 [3.88, 21.78]

Comparison 9. PSYCHOTHERAPY ‐ UNSPECIFIED: GROUP PSYCHOTHERAPY vs NO GROUP THERAPY

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