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      Effectiveness of an Individual Cognitive-Behavioral Intervention for Serious, Young Male Violent Offenders: Randomized Controlled Study With Twenty-Four-Month Follow-Up

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          Abstract

          Background: Psychological recidivism-reducing interventions with serious, young violent offenders in residential care have unsatisfactory effects. We tested if a complementary individual cognitive behavioral therapy (iCBT) intervention focusing problem-solving, cognitive self-control, and relapse prevention reduces criminal recidivism beyond usual institutional care encompassing interventions such as social skills training and prosocial modeling (treatment-as-usual; TAU).

          Method: We consecutively approached 115 eligible serious, male violent crime offenders in five residential treatment homes run by the Swedish National Board of Institutional Care. Eighty-one (70%) 16 to 21-year-old youth at medium-high violent recidivism risk were included and randomized to an individualized 15 to 20-session CBT intervention plus TAU ( n = 38) or to TAU-only ( n = 43), 4–6 months before release to the community. Participants were assessed pre- and post-treatment, at 12 months (self-reported aggressive behavior, reconvictions) and 24 months (reconvictions) after release. Intent-to-treat analyses were applied.

          Results: The violent reconviction rate was slightly higher for iCBT+TAU vs. TAU-only youth at 12 months (34 vs. 23%, d = 0.30, 95% CI: −0.24 to 0.84) and 24 months following release (50 vs. 40%, d = 0.23, 95% CI: −0.25 to 0.72), but neither of these differences were significant. Cox regression modeling also suggested non-significantly, negligibly to slightly more violent, and any criminal recidivism in iCBT+TAU vs. TAU-only youth during the entire follow-up. Further, we found no significant between-group differences in conduct problems, aggression, and antisocial cognitions, although both iCBT+TAU and TAU-only participants reported small to large within-group reductions across outcome measures at post-treatment. Finally, the 12-month follow-up suggested marginally more DSM-5 Conduct Disorder (CD) symptoms of “aggression to people and animals” in iCBT+TAU vs. TAU-only youth ( d = 0.10, 95% CI: −0.40 to 0.60) although this difference was not significant.

          Conclusion: We found no additive effect of individual CBT beyond group-based TAU in residential psychological treatment for serious, young male violent offenders. Limited sample size and substantial treatment dropout reduced the robustness of intent-to-treat effect estimates. We discuss the possible impact of treatment dose and integrity, participant retention, and TAU quality.

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          Diagnostic and Statistical Manual of Mental Disorders

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            Intraclass correlations: uses in assessing rater reliability.

            Reliability coefficients often take the form of intraclass correlation coefficients. In this article, guidelines are given for choosing among six different forms of the intraclass correlation for reliability studies in which n target are rated by k judges. Relevant to the choice of the coefficient are the appropriate statistical model for the reliability and the application to be made of the reliability results. Confidence intervals for each of the forms are reviewed.
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              Peer contagion in child and adolescent social and emotional development.

              In this article, we examine the construct of peer contagion in childhood and adolescence and review studies of child and adolescent development that have identified peer contagion influences. Evidence suggests that children's interactions with peers are tied to increases in aggression in early and middle childhood and amplification of problem behaviors such as drug use, delinquency, and violence in early to late adolescence. Deviancy training is one mechanism that accounts for peer contagion effects on problem behaviors from age 5 through adolescence. In addition, we discuss peer contagion relevant to depression in adolescence, and corumination as an interactive process that may account for these effects. Social network analyses suggest that peer contagion underlies the influence of friendship on obesity, unhealthy body images, and expectations. Literature is reviewed that suggests how peer contagion effects can undermine the goals of public education from elementary school through college and impair the goals of juvenile corrections systems. In particular, programs that "select" adolescents at risk for aggregated preventive interventions are particularly vulnerable to peer contagion effects. It appears that a history of peer rejection is a vulnerability factor for influence by peers, and adult monitoring, supervision, positive parenting, structure, and self-regulation serve as protective factors.
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                02 August 2021
                2021
                : 12
                : 670957
                Affiliations
                [1] 1Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden
                [2] 2Swedish Prison and Probation Service , Norrköping, Sweden
                [3] 3Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden
                [4] 4Stockholm Health Care Services , Stockholm, Sweden
                [5] 5Department of Medical Epidemiology and Biostatistics, Karolinska Institutet , Stockholm, Sweden
                [6] 6National Board of Health and Welfare , Stockholm, Sweden
                Author notes

                Edited by: Pietro Pietrini, IMT School for Advanced Studies Lucca, Italy

                Reviewed by: Ricardo Barroso, University of Trás-os-Montes and Alto Douro, Portugal; Malin Hildebrand Karlén, University of Gothenburg, Sweden

                *Correspondence: Martin Lardén martin.larden@ 123456kriminalvarden.se

                This article was submitted to Forensic Psychiatry, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2021.670957
                8365084
                34408675
                b4276ac3-763d-48d4-9c9b-8383a1c1fa68
                Copyright © 2021 Lardén, Högström and Långström.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 22 February 2021
                : 30 June 2021
                Page count
                Figures: 1, Tables: 3, Equations: 0, References: 76, Pages: 14, Words: 10506
                Categories
                Psychiatry
                Original Research

                Clinical Psychology & Psychiatry
                violent crime,randomized controlled (clinical) trial,treatment outcome,reoffending,young offenders,cognitive behavioral therapy,residential treatment,aggression

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