Mental health articles

Treatment of antisocial personality

Psychological interventions

Interventions to reduce antisocial behaviour have focused almost exclusively on young people within the criminal system – fortuitously perhaps, as attempts at change in older people may prove more diffi cult (Davidson et al. 2008). As such, they may be better considered as programmes designed to change criminal behaviour than antisocial personality per se. The consensus of these studies is that the classic ‘boot camp’ or incarceration does not work. More effective interventions appear to be those targeting the family. Borduin, for example, described a multi-systemic, family-based approach, the goal of which was to provide participants with the skills to help them cope with family and other problems. Family interventions aimed to improve parenting skills, encourage parents to support their child, and reduce levels of parental stress within the household. Parents were encouraged to develop strategies to monitor and reward progress at school, and to establish homework routines. Peer-oriented interventions were designed to increase affi liation with pro-social peers through participation in youth group meetings, organized athletics and after-school activities. Sanctions were applied following associations with deviant peers. Cognitive behavioural interventions focused on teaching social and problem-solving skills. Interventions generally lasted up to fi ve months, with initial sessions occurring as frequently as once a day, tailing off to weekly as therapy progressed. This approach has achieved signifi cant success rates. Henggeler et al., for example, compared it with monitoring and general counselling in a group of ‘serious juvenile offenders’, most of whom had committed some form of violent crime. Immediately following the intervention, participants in the multi-systemic intervention had improved their family and peer relationships more than those in the comparison condition. By one-year follow-up, they had also been arrested less frequently and had spent less time in prison: an effect that held up to the two-year follow-up. In a four-year follow-up of a similar trial by the same group, Borduin et al. reported a halving of the known recidivism rate among those who received the intervention compared with a control group (21 versus 47 per cent) four years after the intervention.

One problem faced by this type of intervention is that many parents do not engage with any therapy. With this in mind, Nock and Kazdin  examined how a brief intervention could enhance parent participation in this type of intervention. They used a technique they called participation enhancement intervention, which involved giving parents information about the importance of attendance and adherence, eliciting motivational statements about attending and adhering to treatment, and helping parents to identify and develop plans for overcoming problems that may occur over the period of treatment. The total time of the intervention was between 4 and 45 minutes and formed part of the fi rst three therapy sessions. It also proved effective. Parents who received the intervention reported higher levels of treatment motivation, attended more treatment sessions, and engaged more in the treatment than those in a control group. A different approach to the treatment of antisocial behaviour does not involve the identifi cation of particular individuals with particular problems. Instead, preventive programmes may target all ‘at risk’ individuals. The best place to run such programmes may be within the normal day-to-day running of schools. An example of this approach is the ‘good behaviour game’, a widely used classroom management approach in the USA that rewards children for engaging in appropriate on-task behaviour during teaching. In it, the class is divided into two teams and a point is awarded to each team for any inappropriate behaviour involving one of its members. The team with the fewest points at the end of each day wins a group reward. If both teams keep their points below a preset level, they share the reward. The intervention therefore both reinforces and establishes group pressure and norms supporting appropriate behaviour. In one study of the effectiveness of this approach, Petras et al. compared rates of antisocial, violent and criminal behaviour in young men aged between 19 and 21 years who had attended schools in poor to lower middle-class areas of the US which had either implemented the programme or were in control areas. Those who had shown signs of early problems at baseline – the key target group of the programme – were signifi cantly less likely to engage in any of these outcomes if they attended the schools in which the programme had been implemented.