Neuropsychological and Emotional Deficits Predict Correctional Treatment Response

摘要

The research found that inmates with deficits in the cognitive functions examined in this study were less likely to progress in cognitive-behavioral therapy (CBT), which involves analyzing and making decisions about one's behavior and then engaging in constructive behavioral change. Particular cognitive functions that impeded progress under CBT were lack of behavioral inhibition and inability to change responses, impulsivity when selecting high-risk choices, and cognitive inflexibility. None of the background variables distinguished between treatment groups, including education, duration of total prison time, family history of criminality, mental illness, drug abuse, aggressive behavior, stressful events during the first treatment group, and attitude about treatment. A history of physical abuse significantly predicted treatment outcomes, and younger inmates did better in treatment. The extent to which psychological problems were experienced in the past 30 days distinguished between low and high treatment response. The authors suggest that inmates who do not respond well to CBT may be more effectively influenced by targeted, neurocognitive-based treatment regimens suitable for reducing violence among prison inmates. The study recruited 224 male inmates of 3 medium/maximum security facilities in Maryland. CBT programming was similar in the three institutions. The inmates received baseline testing of several complementary dimensions of executive cognitive function (ECF) and conditions that influence its development. These involved three ECF tasks and one emotional perception task, saliva cortisol responses to a stressful task, a general neuropsychological test, several psychological and behavioral surveys, and a historical inventory that assessed prior drug use and child and family background. In addition, interactive virtual reality vignettes were used to assess actual pretreatment and posttreatment change in decisionmaking.