Intervention Review

Cognitive-behavioral treatment for antisocial behavior in youth in residential treatment

  1. Bengt-Åke Armelius1,*,
  2. Tore Henning Andreassen2

Editorial Group: Cochrane Developmental, Psychosocial and Learning Problems Group

Published Online: 17 OCT 2007

Assessed as up-to-date: 14 JUN 2005

DOI: 10.1002/14651858.CD005650.pub2


How to Cite

Armelius BÅ, Andreassen TH. Cognitive-behavioral treatment for antisocial behavior in youth in residential treatment. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005650. DOI: 10.1002/14651858.CD005650.pub2.

Author Information

  1. 1

    University of Umeå, Department of Psychology, Umeå, Sweden

  2. 2

    Regional University of Bodø, Faculty of Social Sciences, Bodø, Norway

*Bengt-Åke Armelius, Department of Psychology, University of Umeå, Umeå, 901 87, Sweden. bengt-ake.armelius@psy.umu.se.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 17 OCT 2007

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Cognitive-behavioral therapy (CBT) appears to be effective in the treatment of antisocial behavior both in adolescents and adults. Treatment of antisocial behavior in youth in residential settings is a challenge since it usually involves more serious behavioral problems and takes place in a closed setting. The motivation for change is usually low and there is little possibility to address the maintenance of any behavioral changes following release.

Objectives

To investigate the effectiveness of CBT in reducing recidivism of adolescents placed in secure or non-secure residential settings. A secondary objective was to see if interventions that focus particularly on criminogenic needs are more effective than those with a more general focus on cognitions and behavior.

Search methods

We searched a number of databases including: CENTRAL 2005 (Issue 2), MEDLINE 1966 to May 2005, Sociological Abstracts 1963 to May 2005, ERIC 1966 to November 2004, Dissertation Abstracts International 1960s to 2005. We contacted experts in the field concerning current research.

Selection criteria

Both randomised controlled trials and studies with non-randomized comparison groups were included. Participants had to be young people aged 12-22 and placed in a residential setting for reasons of antisocial behavior.

Data collection and analysis

Two reviewers independently reviewed 93 titles and abstracts; 35 full-text reports were retrieved and data from 12 trials eligible for inclusion were extracted and entered into RevMan. Results were synthesized using a random effects model, due to the significant heterogeneity across included studies. Results are reported at 6, 12 and 24 months post-treatment, and presented in graphical (forest plots) form. Odds ratios are used throughout and intention-to-treat analyses were made with drop-outs imputed proportionally. Pooled estimates were weighted with inverse variance methods and 95% confidence intervals were used.

Main results

The results for 12 months follow-up show that although single studies generally show no significant effects, the results for pooled data are clearly significant in favor of CBT compared to standard treatment with an odds ratio of 0,69. The reduction in recidivism is about 10% on the average. There is no evidence of effects after 6 or 24 months or when CBT is compared to alternative treatments.

Authors' conclusions

CBT seems to be a little more effective than standard treatment for youth in residential settings. The effects appear about one year after release, but there is no evidence of more long-term effects or that CBT is any better than alternative treatments.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Cognitive-behavioral treatment for antisocial youth in residential care

Results of twelve studies, five RCTs and seven non-RCTs including a control group, conducted in the USA, Canada and Great Britain suggest that Cognitive Behavioral Treatment (CBT) in residential settings is more effective than standard treatment in reducing criminal behavior in adolescents twelve months after release from the institution. The results are consistent across studies although the studies vary in quality. There is no evidence that the results of CBT are better than those of alternative treatments, i.e. treatments other than CBT.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

針對接受機構治療 (residential treatemnt) 的青年的反社會行為之認知行為治療 (Cognitivebehavioral therapy, CBT) Armelius BA, Andreassen TH

認知行為治療對青少年以及成人的反社會行為有效果。治療在機構環境中青年之反社會行為是一項挑戰,因其通常牽涉到較嚴重的行為問題,且發生在較封閉的環境。改變的動機通常很低,且行為若有改變,也不太可能在離開機構之後繼續追蹤維持。

目標

欲研究對於居住在有保全或無保全系統之機構環境中的青少年,認知行為治療降低重複犯罪行為的效果。次要目的是想看看以致使犯罪需求 (criminogenic needs) 為焦點的介入,是否比更廣泛地以認知和行為為重點的介入還有效。

搜尋策略

我們搜尋了以下的資料庫,包括: CENTRAL 2005年第2期, MEDLINE (1966年至2005年5月), Sociological Abstracts (1963年至2005年5月), ERIC (1966年至2004年10月), Dissertation Abstracts International (1960年至2005年) 。我們也和這方面的專家連絡,以了解目前的研究狀況。

選擇標準

我們收納了隨機對照試驗以及非隨機採樣比較的研究。受試者必須是12到22歲之間的年輕人,且因為反社會行為而被安置在機構環境中。

資料收集與分析

2位文獻回顧者分別回顧了93篇文章的題目和摘要。其中挑選出35篇全文報告,並將其中符合收納條件的12篇研究的數據輸入RevMan分析。因為收納的研究的高異質性,結果以隨機效果模式進行統整。在停止治療後的第6,12,和24個月之後報告結果並以森林圖 (forest plots) 呈現。整個過程皆以勝算比 (Odds ratio) 來計算,另外也計算治療意願分析 (intentiontotreat analyses) ,以中途退出狀況來作比例歸因。綜合的估計數據以變異數倒數的方法來計算加權比重,並計算95% 信賴區間。

主要結論

經過12個月的追蹤,雖然這些單一研究並沒有顯示出明顯的治療效果,但是綜合的資料明確地顯示認知行為治療比標準治療的效果好,勝算比為0.69。犯罪行為的減少比率平均約為10% 。在第6個月和24個月時認知行為治療並無較佳的效果;若和其他治療方式比較,亦無較有效的證據。

作者結論

對於在機構環境中的青年,認知行為治療似乎稍微較標準治療有效果。治療效果約在離開機構一年後出現,但是沒有證據顯示更長期的效果或是認知行為治療比其他治療方式有效。

翻譯人

本摘要由成功大學附設醫院黃惠群翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

本回顧收納的12篇研究,包括5篇隨機對照試驗和7篇有對照組的非隨機對照試驗,研究地點在美國、加拿大、和英國。統整的結果推論認知行為治療對於機構環境中青少年,可較標準治療有效地減少他們在離開機構後的12個月時的犯罪行為。雖然各研究的品質不一,這個結果在各個研究中是一致的。此外,沒有證據顯示認知行為治療的結果比其他認知行為以外的治療方式有效。