New treatments have reduced aggression in male offenders with antisocial personality disorder

New treatments have reduced aggression in male offenders with antisocial personality disorder

A new psychological therapy designed by a team of UCL-led researchers has been found to reduce levels of violence and aggression in male offenders with antisocial personality disorder (ASPD).

The study, published inThe Lancet Psychiatryand funded by the National Institute for Health and Care Research (NIHR), examined whether aggression and antisocial behavior could be improved by a modified form of mentalizing treatment (MBT).

Mentalization-based treatment is a type of therapy that helps people understand their own thoughts and feelings, as well as those of others.

The new treatment, known as MBT-ASPD, aims to improve the ability of male offenders with ASPD to recognize both their own and others' thoughts and feelings and to improve their interactions and decision-making.

Antisocial personality disorder is a mental health condition characterized by a persistent pattern of disregarding or violating the rights of others. Symptoms include deceit, impulsivity, aggression, recklessness, and lack of remorse. It often involves crime.

In the largest study of its kind, 157 male probationers with ASPD in England and Wales received a 12-month course of MBT-Aspd alongside standard probation services. A control group of 156 participants received probationary services without MBT-Aspd.

Treatment included weekly 75-minute group therapy sessions from two trained MBT clinicians, often supported by an expert through experience. The group allowed participants to examine social interactions including their personal values ​​and observe how others thought about issues that affected them, how their actions were viewed by others, and how their perceptions of themselves corresponded to others' perceptions of them.

Participants also received monthly 50-minute individual therapy sessions. These sessions focused on developing mental skills (such as self-awareness, empathy for others, perspective, and reflective thinking), particularly in situations of interpersonal conflict.

Results showed that men who received MBT-ASPD had aggression scores that were approximately 50% lower than those in standard probationary services.

While both groups showed a decrease in ASPD symptoms, the MBT-ASPD group showed a significantly greater decrease of 63% in the number of symptoms at the 12-month follow-up.

Additionally, men in the MBT-Aspd group committed 46% fewer crimes than those in the standard probation group over a three-year follow-up period.

Given the huge personal and societal costs of antisocial personality disorder - including increased risk-taking, poorer health outcomes, reduced employment and an estimated annual economic burden of £16.7 billion in the UK - this study is a major breakthrough.

Antisocial personality disorder has historically been difficult to treat, but our results demonstrate that psychological intervention, requiring relatively limited therapist training, can meaningfully improve outcomes for individuals with this disorder while reducing its impact on society. “

Professor Peter Fonagy, Chief Investigator, UCL Psychology & Language Sciences

Despite previous mixed results from other psychological treatments such as cognitive behavioral therapy (CBT), MBT-ASPD offers a promising new approach for male offenders. The study provides some of the strongest evidence that structured therapy can be effective in reducing aggression and criminal behavior in individuals with ASPD.

Co-author and senior clinician professor Anthony Bateman (UCL Psychology & Linguistics) said: "This study suggests that clinicians can now be more optimistic when treating individuals with antisocial traits, who are often viewed as untreatable and consequently face barriers to both access and physical health care."

Encouraged by these results, the research team now calls for further studies to determine whether MBT-ASPD is applicable to a broader range of individuals, including those involved in severe violent behavior, such as: B. Intimate partner violence could be beneficial.

Co-author Dr. Elizabeth Allison (UCL-Psychology & Linguistics) said: “Traditional justice methods such as imprisonment have not been effective in re-abusing

“In addition, we need to assess how variations in treatment intensity and duration affect outcomes and whether the benefits of therapy are maintained over time.”

The study was conducted in collaboration with researchers from Anna Freud, Newcastle University, King's College London, Royal Holloway, National Probation Service London Division, University of Prince Edward Island, Bangor University, University of Nottingham and Imperial College London.

Study limitations

While the results are promising, the study had some limitations. The design made it difficult to isolate the specific effects of MBT-Aspd from the additional attention participants.

Data collection issues and missing data—exacerbated by CoVID-19-related delays—may also have impacted the results.

Because the study focused on male offenders ages 21 and older under probation supervision, the results may not be directly generalizable to other populations such as younger offenders or those outside the probation system.

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