Cognitive-behavioral therapy (CBT) for individuals involved in the justice system

There is strong evidence that cognitive-behavioral therapy (CBT) reduces recidivism among youth (Campbell-Lipsey 2007, Wilson 2005, Jeong 2017, Jewell 2015) and adults convicted of crimes (Campbell-Lipsey 2007, Han 2023a, Wilson 2005, Ferguson 2013, Barnes 2017, Usher 2014, Feucht 2016); effects are strongest for those with a high risk of recidivism (Campbell-Lipsey 2007). CBT also reduces recidivism among those with sexual offenses (Rocha 2023, Harrison 2020,Campbell-Schmucker 2017, Grady 2017).

CBT can reduce recidivism among those with substance-related offenses (Han 2023a, Easton 2018 McMurran 2007, Quinn 2015, Needham 2015). CBT may also reduce recidivism among youth who have sexually offended (Carpentier 2021). For male youth with violent and chronic offenses, CBT can be particularly effective in reducing the recurrence of serious crimes (Campbell-Garrido 2007). An evaluation of a CBT program designed for women who have offended suggests CBT can reduce rearrests and reconviction when implemented with high fidelity (Duwe 2015).

A systematic review that evaluated studies of prison-based CBT found it has no effects on recidivism; experts suggest that prison-based treatment may not be effective to reduce recidivism unless it is linked with continuing support for individuals once they have been released. Individuals who were formerly incarcerated face employment, accommodation, and financial difficulties that are not addressed by mental health treatment alone (Beaudry 2021).

CBT can improve coping skills for youth in detention institutions (Ratnam 2021). CBT can also reduce suicidal ideation among those in prison (Pedrola-Pons 2024). A study of justice-involved youth in the community setting suggests that trauma-informed CBT is associated with improved emotional regulation and decreased distress (Dumornay 2022a). Compared to treatment as usual, CBT can also decrease self-reported impaired driving among those who have received a first DUI (Osilla 2019). CBT may be less effective for those who have elevated anti-social personality traits (Lester 2024).

The most effective CBT programs usually include anger management and interpersonal skills training. Training staff in CBT, closely monitoring programs, and ensuring program fidelity also result in better outcomes (Gannon 2019, Campbell-Lipsey 2007). CBT may be more effective in reducing recidivism when it is combined with other interventions such as basic skills or vocational training (Hsieh 2022). CBT for youth who have offended appears to reduce recidivism more when it includes group parenting education, particularly when parents complete the education (Jeong 2017). A study of community-based CBT for men who are violent towards their partners indicates that both individual and group therapy are effective at reducing self-reported partner assault, and group therapy is more effective (Murphy 2020a).

A cost-benefit analysis estimates a $6.31 return for every dollar invested in CBT programs (WSIPP-CBT 2023).

It is unclear what impact CBT for individuals involved in the justice system could have on disparities in reincarceration. Black men are most likely to be reincarcerated, even though they may have lower recidivism risk scores than others (Ropes Berry 2020, Mears 2008). Overall, people who are Black or Hispanic are disproportionately arrested and subsequently convicted and incarcerated, leading to higher rates of incarceration (NASEM 2014).

Analysis of Canada-based CBT programs indicates that CBT is effective for offenders with various ethnic backgrounds (Usher 2014). However, a Georgia-based study of the Reasoning and Rehabilitation (R&R) program indicates that R&R is less effective in reducing recidivism for non-white participants than for white participants (Van Voorhis 2013). The follow-up study suggests that facilitator gender, number of facilitators, and class size have differential impacts for Black men when compared to white men. Black men may have lower recidivism rates when they participate in programs with female facilitators and follow recommended guidelines of two facilitators for every four to eight participants (Spiropoulos 2018). Higher rates of recidivism are linked with living in resource-poor neighborhoods (Mears 2008, Kubrin 2006).

Stories about crime or dangerous activity have repeated throughout U.S. history and have been used to justify the incarceration of certain groups of people. After the Civil War, the 13^th Amendment outlawed slavery except as punishment for a crime (US Const. XIII). This led to the passage of Black codes, or laws designed to limit the freedom of Black Americans and create a supply of prison labor (History-Black codes). In 1918, Congress passed the Chamberlain-Kahn Act, which allowed the government to arrest any woman suspected of prostitution and incarcerate women who tested positive for sexually transmitted infections (History-Stern 2019). During World War II the U.S. government imprisoned about 120,000 Japanese Americans in internment camps, most of whom were U.S. citizens (History-Japanese internment).

In 1965, Congress’s Law Enforcement Assistance Act marked the beginning of federal government involvement in criminal justice and law enforcement and the Johnson Administration declared a “war on crime” a year later (NASEM 2014). Between 1970 and 2000, U.S. incarceration increased by 400 percent and 1,553,574 individuals were imprisoned in 2009 (Vera-Mass incarceration causes). This was driven by increasingly harsh and punitive sentencing laws alongside aggressive policing such as during the Nixon Administration’s “war on drugs” (NASEM 2014). Politicians used racially coded language to link crime with minority communities and Black Americans in particular (NASEM 2014). Today the prison industry, including private prisons and other companies that benefit from large prison populations, spends substantial resources lobbying for punitive laws and fewer regulations of prison labor (NASEM 2014). Mass incarceration today disproportionately harms Black people, other people of color, and those living in poverty (Vera-Mass incarceration statistics).

• Who in your community has been involved in the justice system?
• What resources and partnerships are needed to provide CBT for individuals who are or were formerly involved in the justice system?
• What barriers do individuals involved in the justice system face to living a healthy life? What supports besides CBT do they need?

There are some cognitive-behavioral therapy (CBT) programs widely used in the U.S. criminal justice system, such as Aggression Replacement Training (EPISCenter-ART), Criminal Conduct and Substance Abuse Treatment-Strategies for Self-Improvement and Change (SSC), Moral Reconation Therapy (MRT), Reasoning and Rehabilitation (R&R), and Thinking for a Change (NIC-T4C) (US DOJ-CBT).

Addictions-CBT - Addictions.com. Cognitive-behavioral therapy (CBT).

NIC-CBT - National Institute of Corrections (NIC). Cognitive behavioral therapy (CBT). U.S. Department of Justice.

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Barnes 2017* - Barnes GC, Hyatt JM, Sherman LW. Even a little bit helps: An implementation and experimental evaluation of cognitive-behavioral therapy for high-risk probationers. Criminal Justice and Behavior. 2017;44(4):611-630.

Beaudry 2021 - Beaudry, G., Yu, R., Perry, A. E., & Fazel, S. (2021). Effectiveness of psychological interventions in prison to reduce recidivism: A systematic review and meta-analysis of randomized controlled trials. The Lancet Psychiatry, 8(9), 759–773.

Campbell-Garrido 2007 - Garrido V, Morales LA. Serious (violent or chronic) juvenile offenders: A systematic review of treatment effectiveness in secure corrections. Campbell Systematic Reviews. 2007:7.

Campbell-Lipsey 2007 - Lipsey MW, Landenberger NA, Wilson SJ. Effects of cognitive-behavioral programs for criminal offenders. Campbell Systematic Reviews. 2007:6.

Campbell-Schmucker 2017 - Schmucker M, Lösel F. Sexual offender treatment for reducing recidivism among convicted sex offenders: A systematic review and meta-analysis. Campbell Systematic Reviews. 2017:8.

Carpentier 2021 - Carpentier, J., & Proulx, J. (2021). Recidivism rates of treated non-treated and dropout adolescent who have sexually offended: A non-randomized study. Frontiers in Psychology, 12, 757242.

Dumornay 2022a - Dumornay, N. M., Finegold, K. E., Chablani, A., Elkins, L., Krouch, S., Baldwin, M., Youn, S. J., Marques, L., Ressler, K. J., & Moreland-Capuia, A. (2022). Improved emotion regulation following a trauma-informed CBT-based intervention associates with reduced risk for recidivism in justice-involved emerging adults. Frontiers in Psychiatry, 13, 951429.

Duwe 2015* - Duwe G, Clark V. Importance of program integrity: Outcome evaluation of a gender-responsive, cognitive-behavioral program for female offenders. Criminology & Public Policy. 2015;14(2):301-328.

Easton 2018* - Easton, C. J., Crane, C. A., & Mandel, D. (2018). A randomized controlled trial assessing the efficacy of cognitive behavioral therapy for substance‐dependent domestic violence offenders: An integrated substance abuse‐domestic violence treatment approach (SADV). Journal of Marital and Family Therapy, 44(3), 483–498.

EPISCenter-ART - Evidence-based Prevention & Intervention Support Center (EPISCenter). Aggression Replacement Training (ART). Pennsylvania Commission on Crime and Delinquency, Penn State University Prevention Research Center.

Ferguson 2013 - Ferguson LM, Wormith JS. A meta-analysis of moral reconation therapy. International Journal of Offender Therapy and Comparative Criminology. 2013;57(9):1076-1106.

Feucht 2016 - Feucht T, Holt T. Does cognitive behavioral therapy work in criminal justice? A new analysis from CrimeSolutions.gov. NIJ Journal. 2016;(277):10-17.

Gannon 2019 - Gannon, T. A., Olver, M. E., Mallion, J. S., & James, M. (2019). Does specialized psychological treatment for offending reduce recidivism? A meta-analysis examining staff and program variables as predictors of treatment effectiveness. Clinical Psychology Review, 73, 101752.

Grady 2017* - Grady MD, Edwards D, Pettus-Davis C. A longitudinal outcome evaluation of a prison-based sex offender treatment program. Sexual Abuse: A Journal of Research and Treatment. 2017;29(3):239-266.

Han 2023a - Han, S., Hyatt, J. M., Barnes, G. C., & Sherman, L. W. (2023). A Bayesian analysis of a cognitive-behavioral therapy intervention for high-risk people on probation. Evaluation Review, 48(6), 991–1023.

Harrison 2020* - Harrison, J. L., O’Toole, S. K., Ammen, S., Ahlmeyer, S., Harrell, S. N., & Hernandez, J. L. (2020). Sexual offender treatment effectiveness within cognitive-behavioral programs: A meta-analytic investigation of general, sexual, and violent recidivism. Psychiatry, Psychology and Law, 27(1), 1–25.

History-Black codes - History.com. (2023, March 29). Black codes.

History-Japanese internment - History.com. (2024, April 17). Japanese internment camps.

History-Stern 2019 - Stern, S.W. (2019, July 21). America’s forgotten mass imprisonment of women believed to be sexually immoral. History.com.

Hsieh 2022 - Hsieh, M.-L., Chen, K.-J., Choi, P.-S., & Hamilton, Z. K. (2022). Treatment combinations: The joint effects of multiple evidence-based interventions on recidivism reduction. Criminal Justice and Behavior, 49(6), 911–929.

Jeong 2017* - Jeong S, Fenoff R, Martin JH. Evaluating the effectiveness of an evidence-based cognitive restructuring approach: 1-year results from Project ASPECT. International Journal of Cognitive Therapy. 2017;10(1):1-16.

Jewell 2015* - Jewell JD, Malone MD, Rose P, Sturgeon D, Owens S. A multiyear follow-up study examining the effectiveness of a cognitive behavioral group therapy program on the recidivism of juveniles on probation. International Journal of Offender Therapy and Comparative Criminology. 2015;59(3):259-272.

Kubrin 2006 - Kubrin, C. E., & Stewart, E. A. (2006). Predicting who reoffends: The neglected role of neighborhood context in recidivism studies. Criminology, 44(1), 165–197.

Lester 2024* - Lester, M., Scanlon, F., & Batastini, A. (2024). Doubling down on dosage: Exploring the interplay between dosage effects, antisocial traits, treatment attitudes, and recidivism-related therapy outcomes. Journal of Criminal Psychology.

McMurran 2007* - McMurran M. What works in substance misuse treatments for offenders? Criminal Behaviour and Mental Health. 2007;17(4):225-233.

Mears 2008 - Mears, D. P., Wang, X., Hay, C., & Bales, W. D. (2008). Social ecology and recidivism: Implications for prisoner reentry. Criminology, 46(2), 301–340.

MRT - Moral Reconation Therapy (MRT). MRT changes minds.

Murphy 2020a - Murphy, C. M., Eckhardt, C. I., Clifford, J. M., LaMotte, A. D., & Meis, L. A. (2020). Individual versus group cognitive-behavioral therapy for partner-violent men: A preliminary randomized trial. Journal of Interpersonal Violence, 35(15–16), 2846–2868.

NASEM 2014 - National Academies of Sciences, Engineering, and Medicine (NASEM), National Research Council. (2014). The growth of incarceration in the United States: Exploring causes and consequences. The National Academies Press.

Needham 2015* - Needham M, Gummerum M, Mandeville-Norden R, et al. Association between three different cognitive behavioral alcohol treatment programs and recidivism rates among male offenders: Findings from the United Kingdom. Alcoholism: Clinical and Experimental Research. 2015;39(6):1100-1107.

NIC-T4C - National Institute of Corrections (NIC). Thinking for a Change (T4C). U.S. Department of Justice.

Osilla 2019 - Osilla, K. C., Paddock, S. M., McCullough, C. M., Jonsson, L., & Watkins, K. E. (2019). Randomized clinical trial examining cognitive behavioral therapy for individuals with a first‐time DUI offense. Alcoholism: Clinical and Experimental Research, 43(10), 2222–2231.

Pedrola-Pons 2024 - Pedrola-Pons, A., Sanchez-Carro, Y., Pemau, A., Garcia-Ramos, A., & De La Torre-Luque, A. (2024). Efficiency of psychological interventions in the prevention of suicidal behavior and self-injury in penitentiary population: A systematic review. International Journal of Law and Psychiatry, 92, 101948.

Quinn 2015* - Quinn TP, Quinn EL. The effect of cognitive-behavioral therapy on driving while intoxicated recidivism. Journal of Drug Issues. 2015;45(4):431-446.

R&R - Ross RR, Fabiano E, Ross RD. The reasoning & rehabilitation (R&R) program. Ottawa, CAN: Cognitive Centre of Canada.

Ratnam 2021* - Ratnam, K. K. Y., Nordin, A., Tok, P. S. K., Farid, N. D. N., & Dahlui, M. (2021). Mental health interventions in Juvenile detention institutions: A systematic review of what works. Adolescent Psychiatry, 11(4), 203–224

Rocha 2023* - Rocha, I. C. O., & Valença, A. M. (2023). The efficacy of CBT based interventions to sexual offenders: A systematic review of the last decade literature. International Journal of Law and Psychiatry, 87, 101856.

Ropes Berry 2020 - Ropes Berry, K., Kennedy, S. C., Lloyd, M., Veeh, C. A., & Tripodi, S. J. (2020). The intersectional effects of race and gender on time to reincarceration. Justice Quarterly, 37(1), 132–160.

Spiropoulos 2018 - Spiropoulos, G. V., Van Voorhis, P., & Salisbury, E. J. (2018). Programmatic moderators of CBT correctional treatment for whites and African Americans. International Journal of Offender Therapy and Comparative Criminology, 62(8), 2236–2258.

US Const. XIII - U.S. Const. amend. XIII.

US DOJ-CBT - Thigpen ML, Keiser GM. Cognitive-behavioral treatment (CBT): A review and discussion for corrections professionals. Washington, D.C.: U.S. Department of Justice (U.S. DOJ), National Institute of Corrections (NIC); 2007.

Usher 2014* - Usher AM, Stewart LA. Effectiveness of correctional programs with ethnically diverse offenders: A meta-analytic study. International Journal of Offender Therapy and Comparative Criminology. 2014;58(2):209-230.

Van Voorhis 2013 - Van Voorhis, P., Spiropoulos, G., Ritchie, P. N., Seabrook, R., & Spruance, L. (2013). Identifying areas of specific responsivity in cognitive–behavioral treatment outcomes. Criminal Justice and Behavior, 40(11), 1250–1279.

Vera-Mass incarceration causes - Vera Institute of Justice. Causes of mass incarceration. Retrieved October 22, 2024.

Vera-Mass incarceration statistics - Vera Institute of Justice. Incarceration statistics. Retrieved October 22, 2024.

WI DOC-Becky Young 2023 - Wisconsin Department of Corrections (WI DOC). (2023). Becky Young recidivism reduction annual report: Fiscal year 2023.

Wilson 2005* - Wilson DB, Bouffard LA, Mackenzie DL. A quantitative review of structured, group-oriented, cognitive-behavioral programs for offenders. Criminal Justice and Behavior. 2005;32(2):172-204.

WSIPP-CBT 2023 - Washington State Institute for Public Policy (WSIPP). (2023). Cognitive behavioral therapy (CBT) (for individuals classified as high- or moderate risk).