62 — February/March 2011 Corrections Today

Author’s Note: Findings and conclu-sions reported in the article are those ofthe authors and do not necessarily rep-resent the official position or policies ofthe U.S. Department of Justice. This arti-cle was adapted from the NIJ Journal265 article “Preventing Future CrimeWith Cognitive Behavioral Therapy.”

Cognitive-behavioral therapy (CBT)reduces recidivism among bothjuvenile and adult offenders. TheCBT approach represents the

view that most people can become awareof their own thoughts and behaviors, andcan change them for the better. A person’sthoughts, which may stem from his or herexperiences, often influence and trigger aperson’s behavior. Unfortunately, as a per-son develops, his or her thoughts maysometimes become distorted and fail toreflect reality accurately. Most experiencedcorrections professionals recognize thecharacteristics of such distorted thinkingamong criminal offenders — distortedthinking that an offender can changethrough CBT.

In a recent review and analysis ofresearch on offender programs, MarkLipsey of the Peabody Research Insti-tute at Vanderbilt University exam-ined the effectiveness of variousapproaches to intervention withyoung offenders. The systematic meta-analysis review examined results from548 studies conducted from 1958 to2002 including evaluations of interven-tion policies, practices and programs.Lipsey grouped evaluation studiesinto seven categories:

• Surveillance;• Deterrence;• Discipline;• Restorative programs;• Counseling;

• Skill building; and• Multiple coordinated services.

When the effects of these interven-tions were combined into categoriesand compared in meta-analysis, thosebased on punishment and deterrenceappeared to increase criminal recidi-vism (most often equated with re-arrestwithin 12 months after intervention);whereas therapeutic approaches basedon counseling, skill building and multi-ple services had the greatest impact inreducing further criminal behavior (seeFigure 1).

Lipsey also examined the effective-ness of various therapeutic interven-tions by comparing different counselingand skill-building approaches. Resultsshowed that cognitive-behavioral skill-building approaches are more effectivein reducing further criminal behaviorthan other therapeutic interventions. Ina separate systematic review, NanaLandenberger and Lipsey showed that programs based on cognitive-

behavioral therapy are effective withjuvenile and adult criminal offendersin various criminal justice settingsincluding prison, community residen-tial, probation and parole. Studiespublished from 1965 through 2005were examined according to particu-lar research criteria. A total of 58 stud-ies were included in their review andanalysis. Results showed CBT to beconsistently associated with reducedrecidivism even among offenders athighest risk of recidivism.

Criminal Offenders andthe Cognitive Perspective

From the cognitive perspective,experiences, beliefs, attitudes and val-ues affect the way people think andhow they view problems. These viewsmay be a result of emotional andbehavioral systems that distort theway a person views reality, interactswith other people, and experienceeveryday life. This in turn can con-

NIJ Update

Cognitive-Behavioral Therapy:

An Evidence-Based Intervention For OffendersBy Patrick M. Clark

Figure 1. Effectiveness of Interventions With Criminal Offenders

tribute to unrealistic, arbitrary orcrooked inferences and distortions inthinking and behavior.

Offenders often exhibit one ormore of the following characteristics:

• Thought patterns that areimmature or developmentallyarrested;

• Shortfalls in problem-solvingand decision-making;

• Inability to consider the effectsof their behavior;

• Thoughts involving egocentricviews of self, and a negativebelief or lack of trust in otherpeople;

• Distorted thoughts that ham-per their ability to reason andaccept blame for wrongdoing;

• Mistaken belief of entitlement,which makes them unable todelay gratification, confusewants and needs, and disre-spect others;

• Tendency to act on impulse;• Lack of self-control and empa-

thy;• Inability to manage feelings of

anger; and • Use of force and violence as a

means to achieve their goals.

CBT has been found to be effectivewith juvenile and adult offenders, withsubstance abusing and violent offend-ers, and with probationers, prisonersand parolees. It has also been foundto be effective in various criminaljustice settings, both in institutionsand in the community. CBT pro-grams designed for offenders direct-ly address problems associated withcriminal behavior. For instance,most cognitive skill-building pro-grams for offenders include lessonsand exercises to increase positivesocial skills, means-ends problem-solving, critical reasoning, moral rea-soning, cognitive style, self-control,impulse management and self-efficacy.

The Landenberger and Lipseystudy found no correlation betweenoffender risk and positive programresults. In fact, some of the largesteffects were apparent among moreserious offenders. It may be that theenabling, self-help approach repre-sented by CBT is more effective inengaging typically resistant clients,increasing participation and the ben-efits of participation.

Recent Emergence of CBTCBT has only recently come into

prominence as one of the fewapproaches to psychotherapy that hasbeen broadly validated with research,although it has been used in psycho-logical therapy for more than 40 years.CBT focuses on patterns of thinking,and the beliefs, attitudes and valuesthat underlie thinking. It has shown tobe reliably effective with a wide varietyof personal problems and behaviorsincluding those important to criminaljustice such as aggression, substanceabuse, being anti-social, and persistentdelinquent and criminal behavior.

Unlike other approaches, CBTplaces responsibility for thinking in thehands of the client and supplies him orher with the means of solving prob-lems in everyday living, focusing onthe present rather than the person’spast. People taking part in CBT learnspecific skills that they can use toeffectively solve daily problems, aswell as skills they can use to achievelegitimate goals and objectives. CBTfirst concentrates on developing skillsto recognize distorted or unrealisticthinking when it happens, and then onchanging that thinking or belief toeliminate problematic behavior.

How Does It Work?The typical CBT program is pro-

vided by trained professionals orparaprofessionals. Training for non-therapist group facilitators ofteninvolves 40 hours or more of special-ized lessons and skill building.Licensed and certified therapists oftendeliver CBT programs, especially asthey often involve individual counsel-ing as well as group sessions.

The programs, often offered insmall group settings, incorporatelessons and exercises involving roleplay, modeling or demonstrations.Individual counseling sessions are alsooften part of CBT. Clients are givenhomework and actually conductexperiments on their own in betweensessions. The willingness to change isnecessary for CBT to be effective inreducing further criminal behavior.These components are important togauge an individual’s readiness forchange and to foster engagement inthe change process.

Brand name or prepackaged pro-grams such as “Aggression Replace-ment Therapy,” “Reasoning forChange,” “Thinking for Change,” andothers often limit time and scope ofCBT. They involve 20-30 sessionssometimes lasting up to 20 weeks.The more treatment provided or themore sessions participants attend,the greater the apparent impact on,and decrease in recidivism.

Characteristics of the providerappear to be important to increasingprogram effects. Counselor honesty,empathy and sensitivity are helpfultraits for those delivering therapeuticprograms. Support and encourage-ment, partnership or alliance, andacceptance appear necessary in estab-lishing effective rapport. This may beespecially important in CBT as coun-selors often take on the role of coach.It seems important that during CBT,counselors are consistent in modelingand expressing the pro-social attitudesand behaviors, and moral values andreasoning that are often part of CBTwith criminal offenders.

Overall FindingsResearch on CBT has reported pos-

itive findings regarding a multitude ofmood, personality and behavioralproblems. Unlike other traditional andpopular therapies, CBT has been thesubject of more than 400 clinical trialsinvolving a broad range of conditionsand populations. It has successfullyaddressed many issues experiencedby children, including disruptive ornoncompliant behavior, aggression,oppositional defiant disorder andattention deficit hyperactivity disor-der. For adults, CBT has been shownto help with marital problems, sexualdysfunction, depression, mood disor-ders and substance abuse. It has alsobeen shown to be as useful as antide-pressant medication for individualswith depression, and appears to besuperior to medication in preventingrelapses.

It also appears that CBT is moreeffective in reducing further criminalbehavior when delivered with otherprogram items such as supervision,employment, education and training,and other mental health counseling.The CBT approach has recently beenused in many prepackaged or brandname programs. The National Institute

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of Corrections recently published athorough and comprehensive reviewof CBT, which provides detaileddescriptions of these, and other pro-grams. Interestingly, although the Landenberger and Lipsey reviewshowed these programs were effec-tive, in comparison, no single programwas superior in reducing recidivism.

Overall, the CBT approach canproduce significant decreases inrecidivism even among high-riskoffenders. More research is neededto determine when this interventionmay be most effective or why CBT is effective across offender groups.Perhaps the therapy could be moreeffective in preventing criminalbehavior if delivered in early inter-vention and parenting training pro-grams. If so, there are far-reachingbenefits of this approach for reduc-ing crime and needless victimization.

ENDNOTES1 Lipsey, M.W. 2009. The primary factorsthat characterize effective interventionswith juvenile offenders: A meta-analyticoverview. Victims and Offenders, 4(2):124-147. New York: Routledge.

2 Landenberger, N.A., and M. Lipsey. 2005. The positive effects of cognitive-behavioral programs for offenders: Ameta-analysis of factors associated witheffective treatment. Journal of ExperimentalCriminology, 1(4):451-476. New York:Springer.

3 Yochelson, S., and S.E. Samenow. 1976.The criminal personality: Volume I. a pro-file for change. New York: Jason Aronson.

Walters, G. 1990. The criminal lifestyle: Pat-terns of serious criminal conduct. NewburyPark, Calif.: Sage Publications.

Walters, G.D. and T.W. White. 1989. Thethinking criminal: A cognitive model oflifestyle criminality. Criminal Justice

Research Bulletin, 4(4):1-10. Huntsville,Texas: Criminal Justice Center, Sam Hous-ton State University.

4 Milkman, H., and K. Wanberg. 2007. Cognitive-behavioral treatment: A reviewand discussion for correction professionals.Washington, D.C.: U.S. Department of Jus-tice, National Institute of Corrections.Retrieved from http://nicic.gov/Library/021657.

Patrick M. Clark is a social science analyst with NIJ’s Crime Control andPrevention Division.

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Reprinted with permission of the American Correctional Association, Alexandria, Va. All rights reserved.