Loading ...

TOPLINE:

Mentalisation-based treatment (MBT) reduced aggression scores by more than half in male offenders with antisocial personality disorder (ASPD) after 12 months of therapy, a trial found.

METHODOLOGY:

• Researchers conducted MOAM, a multicentre, assessor-masked, randomised controlled superiority trial across 13 sites in England and Wales (2016-2018), including 313 male offenders aged 21 years or older who were convicted and under National Probation Service (NPS) supervision.
• The participants (mean age, 34.2 years; 79% White) had ASPD, scored ≥ 15 on the Overt Aggression Scale-Modified (OAS-M), and were randomly assigned (1:1) to receive either MBT-ASPD plus probation or probation alone.
• The treatment group received 12 months of weekly 75-minute group therapy sessions and monthly 50-minute individual sessions, whereas the control group continued with probation as usual.
• The primary outcome measure was aggression, assessed by the OAS-M at 12 months post-randomisation, with follow-ups every 3 months up to 24 months.

TAKEAWAY:

• The MBT-ASPD group had significantly lower aggression scores at 12 months than the control group (adjusted mean difference, −73.5; P < .0001).
• Treatment effects persisted at 18 months (adjusted mean difference, −62.4; P = .0037) but were not significant at 24 months.
• Compared with the control group, the MBT-ASPD group showed significant reductions in violent behaviours at 12 months (P = .0021) and improved mentalising abilities overall (P = .044).
• Additionally, compared with the control group, the MBT-ASPD group showed significant reductions in total offenses by the third year post-randomisation (incidence rate ratio, 0.54; P = .0024).

IN PRACTICE:

"The available evidence supports the provision of rehabilitative social cognition-focused treatment for people with convictions for violent offences with ASPD. The study gives evidence for a readily accessible approach that does not require extensive training," the authors wrote.

SOURCE:

The study was led by Peter Fonagy, PhD, Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom. It was published online in The Lancet Psychiatry.

LIMITATIONS:

Distinguishing MBT-ASPD's specific effects from the effects of increased attention in therapy was challenging due to the probation-as-usual comparator. Incomplete data on probation treatment and missing data posed additional constraints despite high retention rates. Difficulties obtaining data from the Ministry of Justice, exacerbated by COVID-19–related delays, hindered timely reporting. Generalisability was limited by the study's focus on male offenders under NPS supervision and the absence of lived experience among the authors. Variability in how aggression was measured across studies further complicated comparisons.

DISCLOSURES:

This study was funded by the National Institute for Health Research Health Technology Assessment programme. All authors reported receiving grants from the National Institute for Health Care Research, and two additionally reported receiving honoraria for MBT training.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.