Revisiting the effectiveness of Cognitive Behavioural Therapy in the Criminal Justice System

Cognitive behavioural therapy (CBT) is used widely in the criminal justice system (CJS) in England and Wales. However, concerns are being raised about its effectivness.

Reviews question the effectiveness of CBT

A review of one-to-one CBT to treat depression found its impact had fallen substantially over time, from early trials in the late 70s to contemporary trials. A subsequent study of group CBT for depression was less clear cut. However, both these studies also suggested that standardised programmes using less qualified staff are less effective than non-standardised programmes using more highly qualified staff. A recent review of specialized psychological offence treatments to reduce recidivism also highlights that programmes with consistent input from a qualified psychologist had the best resuts and hints at a reduced effect over time. However, standardised programmes using less qualified staff is the delivery model used routinely in the CJS and a substantial body of evaluation research supports the idea of a “scale-up penalty” in the delivery of criminal justice interventions whereby measures of effectiveness drop considerably when an intervention moves from a demonstration project to large-scale delivery across a service (see, for example Yohros and Welsh)

Has modern CBT strayed too far from its origins?

There has also been criticism of how closely the practice of CBT adheres to the theoretical underpinnings of CBT. Critics have argued that fidelity to the original principles of CBT has eroded overtime. The early developers of CBT drew heavily on philosophies such as stoicism. More recently, ‘third wave’ CBT theorists draw on Eastern philosophies such as Buddhism. For an overview of these debates see Robertson). Both philosophical approaches offer a full account of how to live the ‘good’ life (eudemonia) that is lacking in the mainstream practice of CBT in the CJS, which focuses on understanding and correcting thoughts, without the foundation of a broader philosophy of life.

Study aims

The aim of this study is to revisit the effectiveness of CBT in the CJS. We will undertake a systematic review of the evidence worldwide to ask whether there is evidence of its effect diminishing over time and whether standardised programmes using less qualified staff are less effective. We will also ask whether CBT in the CJS is engaged sufficiently with its underlying theory and whether this theory is coherent. Our findings will help us identify implications for policy and practice.

Project team

The project is led by Professor Chris Fox and Dr. Kirstine Szifris at the Policy Evaluation and Research Unit and is being undertaken in collaboration with Professor Shadd Maruna at Queen's University Belfast. The project is supported by an Advisory Group including senior researchers, policy-makers and people with lived experience from across the CJS.

Funder

This project is funded by The Nuffield Foundation.

What are we doing?

There are three main phases to the project.

Phase 1: We will develop a ‘provocation’ to encourage critical reflection on CBT. “Provocation” is an innovative research tool for encouraging critical reflection in the social sciences. The purpose is to develop a dialogue that can “…bring to light that which has been overlooked or obscured so that a more critical examination can take place.” (Pangrazio 2016: 226). In drawing up the provocation we will engage with a range of experts in the philosophy of CBT as well as people who are ‘experts by experience’. The provocation will help us identify and understand logical and moral inconsistencies, gaps, exclusions and methodological limitations within CBT as practiced in the CJS.

Phase 2: Building on the theoretical and philosophical assessment in Phase 1, we will undertake a Systematic Review, incorporating a meta-analysis of the use of CBT in criminal justice settings. We will examine the effect of moderator variables (e.g. staff training, professional qualifications and implementation factors) on the effects of CBT on recidivism, and we will undertake a regression analysis exploring the effect of CBT on recidivism over time.

Phase 3: We will draw the findings from the first two phases of work together in order to consider implications for the use of CBT in the England and Wales CJS. This phase will include an invited workshop with a range of actors involved in CBT in the CJS including those designing, managing and delivering CBT programmes and those who have lived experience of CBT. We will set out policy and practice recommendations.

What will be the outcomes?

Key outputs from the project will include:

- A Provocation exploring theoretical challenges to the use of CBT in criminal justice settings (publication likely in mid to late 2021)
- A Systematic Review, incorporating a meta-analysis of the use of CBT in criminal justice settings and a regression analysis exploring its effect over time (publication likely in 2022)
- Two policy and practice briefings (publication in 2022)

What are the timescales?

The project started in January 2021. It will run until 2022.

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