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

Jane A Dennis; Omer Khan; Michael Ferriter; Nick Huband; Melanie J Powney; Conor Duggan

doi:10.1002/14651858.CD007507.pub2

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Figure 1

From Gelb 2007 (used with permission of the Sentencing Advisory Council, Melbourne, Victoria, Australia)

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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

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Analysis 1.1

Comparison 1 Behavioural: imaginal desensitisation versus covert sensitisation, Outcome 1 Anomalous desire (target behaviour) assessed by interview.

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Analysis 1.2

Comparison 1 Behavioural: imaginal desensitisation versus covert sensitisation, Outcome 2 Lost to follow‐up.

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Analysis 2.1

Comparison 2 Behavioural: medication plus imaginal desensitisation vs medication alone, Outcome 1 Anomalous desire (target behaviour) assessed by interview.

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Analysis 2.2

Comparison 2 Behavioural: medication plus imaginal desensitisation vs medication alone, Outcome 2 Adverse events.

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Analysis 3.1

Comparison 3 CBT group therapy versus no treatment, Outcome 1 Recidivism at 1 year + at risk.

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Analysis 3.2

Comparison 3 CBT group therapy versus no treatment, Outcome 2 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 3.3

Comparison 3 CBT group therapy versus no treatment, Outcome 3 Cognitive distortions: 2. Average endpoint score at 2 months (MSI, high = good, data skewed).

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Analysis 3.4

Comparison 3 CBT group therapy versus no treatment, Outcome 4 Sexual obsessions.

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Analysis 3.5

Comparison 3 CBT group therapy versus no treatment, Outcome 5 Anxiety (generic social avoidance or distress).

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Study	Outcome	Treatment (SOTEP) (n = 259)	Control (no treatment) (n = 225)
Marques 1994	Dropped out before starting treatment	55/259	0/225
Marques 1994	Left treatment early (voluntarily)	27/259	0/225
Marques 1994	Left treatment early (compulsory return to prison due to management problems)	10/259	0/255

Analysis 3.6

Comparison 3 CBT group therapy versus no treatment, Outcome 6 Leaving treatment early.

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Analysis 4.1

Comparison 4 CBT group therapy versus transtheoretical counselling (cluster), Outcome 1 Cognitive distortions/immaturity ‐ at 24 weeks.

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Analysis 4.2

Comparison 4 CBT group therapy versus transtheoretical counselling (cluster), Outcome 2 Sexual obsessions: high levels of obsession ‐ at 24 weeks.

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Analysis 4.3

Comparison 4 CBT group therapy versus transtheoretical counselling (cluster), Outcome 3 Leaving treatment early.

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Analysis 5.1

Comparison 5 Group psychotherapy versus probation, Outcome 1 Rearrest within 10 years.

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Comparison 1. Behavioural: imaginal desensitisation versus covert sensitisation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Anomalous desire (target behaviour) assessed by interview Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 Reduced at one month	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.57 [0.24, 1.35]
1.2 Reduced at one year	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.6 [0.19, 1.86]
2 Lost to follow‐up Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

Comparison 1. Behavioural: imaginal desensitisation versus covert sensitisation

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Comparison 2. Behavioural: medication plus imaginal desensitisation vs medication alone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Anomalous desire (target behaviour) assessed by interview Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 Reduced by 1 month	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	1.67 [0.54, 5.17]
1.2 Reduced by 1 year	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.6 [0.19, 1.86]
2 Adverse events Show forest plot	1	20	Risk Ratio (M‐H, Random, 95% CI)	0.57 [0.24, 1.35]

Comparison 2. Behavioural: medication plus imaginal desensitisation vs medication alone

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Comparison 3. CBT group therapy versus no treatment

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

1.1 Involving only sex offences	1	484	Risk Ratio (M‐H, Fixed, 95% CI)	1.10 [0.78, 1.56]
2 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]

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

4 Sexual obsessions Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Subtotals only

4.1 Sexual inadequacies scale of the MSI	1	60	Mean Difference (IV, Random, 95% CI)	‐6.20 [‐13.46, 1.06]
5 Anxiety (generic social avoidance or distress) Show forest plot	3	112	Std. Mean Difference (IV, Random, 95% CI)	‐0.23 [‐0.61, 0.14]

6 Leaving treatment early Show forest plot			Other data	No numeric data

Comparison 3. CBT group therapy versus no treatment

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Comparison 4. CBT group therapy versus transtheoretical counselling (cluster)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cognitive distortions/immaturity ‐ at 24 weeks Show forest plot	1	38	Risk Ratio (M‐H, Random, 95% CI)	1.0 [0.76, 1.32]

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

3 Leaving treatment early Show forest plot	1	65	Risk Ratio (M‐H, Random, 95% CI)	1.68 [0.80, 3.49]

Comparison 4. CBT group therapy versus transtheoretical counselling (cluster)

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Comparison 5. Group psychotherapy versus probation

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 offence	1	231	Risk Ratio (M‐H, Fixed, 95% CI)	1.87 [0.78, 4.47]

Comparison 5. Group psychotherapy versus probation

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