Focus Area: Cognitive Behavioral Treatment

Cognitive-behavioral treatment (CBT) aims to change individuals’ behavior by addressing their basic thinking patterns. Recognizing that flawed thought patterns and cognitive deficits or distortions can result in criminal behavior, CBT teaches new strategies to manage thoughts and emotions. The goal of treatment is to help individuals understand how to apply these new thought management strategies in multiple contexts in order to facilitate more successful reintegration into society upon release.

To help practitioners, program administrators, and policymakers identify research-supported programs and interventions, an overview and discussion is provided on the key findings from a review of high quality evaluations on cognitive-behavioral treatment programs.

What the Research Says about Cognitive-Behavioral Treatment Programs

Findings: Overall, research evaluated offers limited evidence of the effectiveness of cognitive behavioral programs in improving reentry outcomes. Eight of the nine studies reviewed evaluated the Reasoning and Rehabilitation (R&R) Program or a variant including Enhanced Thinking Skills, Cognitive Skills Training, and the Georgia Cognitive Skills Program. R&R was originally developed in Canada and targets the cognitive foundations of offenders’ behavior building skills in areas such as self-control, interpersonal problem solving and critical reasoning. Only two of the eight R&R evaluations found an overall beneficial effect of program participation on recidivism. Further, an evaluation of the psychoeducational component of the EQUIP program found reduced recidivism for female, but not male, participants compared to those in a control group.

Notably, however, the review yielded mixed findings looking across topic areas at programs that paired CBT with additional treatment or services. For example, each of the seven sex offender treatment studies summarized included a CBT component and three found evidence of a beneficial impact of treatment on recidivism outcomes. Further, four of the five programs reviewed and categorized in other topic areas found beneficial effects of program participation on relevant outcomes:

  • California’s Preventing Parolee Crime Program was developed to offer a wide array of reentry services to parolees including CBT-based substance abuse treatment and participation in the program was associated with a significant reduction in reincarceration relative to a matched comparison group.
  • The Offender Substance-Abuse Pre-Release Program was designed and implemented by the Correctional Service of Canada to address the substance abuse needs of federal inmates and participants experienced lower rates of reincarceration and reconviction than those in a comparison group.
  • Participants in the Iowa Department of Corrections’ Moving On, a program for female inmates based on relational theory, motivational interviewing, and cognitive-behavioral approaches, had significantly lower rearrest and reconviction rates than individuals in a matched control group at 18 and 24 months post-release.
  • An evaluation of Forever Free, a prison-based substance abuse treatment program for women that incorporated elements of therapeutic communities and CBT, found that participants were significantly less likely to report having used illicit drugs during the follow-up period and were more likely to be employed than individuals in a comparison group.

These findings suggest that CBT may be more effective with reentry populations when delivered as one piece of a more comprehensive intervention.

Highlights: The review yielded mixed results. Two of the studies found overall beneficial effects of CBT program participation alone on recidivism outcomes, three demonstrated mixed results and four documented no evidence of an impact. Only one study measured the effect of CBT on an outcome other than recidivism, employment, and found no significant differences in employment outcomes between the treatment and control groups.

  • Evidence of Significant Improvement in Recidivism Outcomes:
    • One evaluation of the Enhanced Thinking Skills Program (ETS), an adaptation of the Reasoning and Rehabilitation (R&R) Program for the UK population, found that the one-year reconviction rate was 6.2 percentage points lower for participants than a matched control group.
    • One of three studies reviewed evaluated the ETS and R&R programs found statistically significant, beneficial effects of program participation on reconviction rates at two and five years after release from prison, particularly for medium-low and medium-high risk individuals. Note, however, that the other two studies discussed below did not detect an effect.
  • Mixed Results on Recidivism Outcomes:
    • The EQUIP program is a multi-component cognitive-behavioral program that aims to foster strong interpersonal skills and address cognitive issues and social skill deficiencies. A randomized controlled trial design showed that though female participants in the program were significantly less likely to recidivate than those in a control group, no significant differences were identified for male participants.
    • Two evaluations of the Cognitive Skills Training Program, another variant of R&R that was pilot-test and then implemented nationwide in Canada, found no overall effect of program participation on multiple recidivism outcomes. Notably, however, both programs found statistically significant, beneficial effects of participation for low risk offenders.
  • No Evidence of Impact on Recidivism Outcomes
    • Two of the three studies reviewed evaluated the ETS and R&R programs found no significant differences in reconviction between participants and matched controls.
    • Two randomized control evaluations of the Georgia Cognitive Skills Program, the R&R curriculum implemented throughout the state, found no significant differences in recidivism between treatment and control groups.
  • No Evidence of Impact on Employment Outcomes
    • The two studies of the Georgia Cognitive Skills Program also found no significant differences in employment outcomes between treatment and control groups.

Future Areas of Research

Although there is a large body of research examining the effectiveness of CBT programs for individuals returning from incarceration, many of these studies suffer from serious methodological problems.

Given the small number of studies meeting criteria for rigor, as well as the fact that most of these studies only evaluated one core program, substantial further research is needed to determine the effectiveness of cognitive-behavioral treatment in helping offenders successfully transition back to the community. Future research should:

  • Minimize the potential for selection bias by using random assignment, if possible;
  • Minimize the differences across study groups through the use of relevant comparison groups, rigorous matching procedures, and controls that account for relevant background variables; and
  • Evaluate the effects of these programs on post-release outcomes other than recidivism, such as employment or substance use.

Summary of Evaluations and Outcomes

Rigor Evaluation Recidivism Employment Substance Abuse
Basic Rigor Cann et al., 2003 (not evaluated) (not evaluated)
Basic Rigor Duwe & Clark, 2015 (not evaluated) (not evaluated)
Basic Rigor Falshaw et al., 2003; Falshaw et al., 2004 (not evaluated) (not evaluated)
Basic Rigor Friendship et al., 2002; Friendship et al., 2003 (not evaluated) (not evaluated)
Basic Rigor Porporino & Robinson, 1995 (not evaluated) (not evaluated)
Basic Rigor Robinson, 1995; Robinson, 1996 (not evaluated) (not evaluated)
Basic Rigor Sadlier, 2010 (not evaluated) (not evaluated)
High Rigor Spruance et al., 2001; Van Voorhis et al., 2002 (not evaluated)
High Rigor Van Voorhis et al., 2001; Van Voorhis et al., 2004 (not evaluated)