Why are Psychopaths Difficult to Treat? Testing the Two-Component Model for the Treatment of PCL Psychopaths

<p>Psychopathic personality disorder as conceptualised by the family of scales referred to as the Psychopathy Checklist (PCL), is often cited as a specific responsivity characteristic that will interfere with an otherwise effective treatment programme. However, most research on the treatment of prisoners high on PCL psychopathy asks whether or not they are treatable as opposed to why they are difficult to treat. The Two-Component model (2-C; Wong & Olver, 2015) for the treatment of PCL psychopaths proposes that treatment difficulties observed for those high on PCL psychopathy are primarily caused by the interpersonal and affective personality features of psychopathy represented by PCL Factor 1 (F1). Thus the 2-C model suggests that therapists work around the emotional deficits and disruptive behaviours associated with PCL F1 to focus on changing risk-relevant behaviours that are associated with PCL Factor 2 (F2). In this thesis, we test the assumptions of the 2-C model with a group of high-risk violent men who attended an intensive violence treatment programme and were assessed with a PCL instrument. Specifically, we examined whether the personality features of PCL psychopathy led to more treatment difficulties than the behavioural features by exploring relationships between the factors/facets of the PCL and treatment completion, reconviction, change on dynamic risk, the therapeutic alliance and behaviour during treatment. In support of the 2-C model we found that PCL:SV Part 1 and its underlying facets were significantly associated with higher rates of removal from treatment, a poorer therapeutic alliance, and lower levels of emotional and performance based behaviours during treatment. Mediation analyses also revealed that the relationships between PCL:SV Part 1 variables and removal were partly explained by lower levels of emotional and performance based behaviours. Also in support of the 2-C model, we found that PCL:SV Part 2 and its underlying facets demonstrated stronger, significant associations with pre-treatment dynamic risk and post-treatment reconvictions when compared with PCL:SV Part 1 variables. Furthermore, poorer performance based behaviours during treatment mediated relationships between PCL:SV Part 2 variables and reconviction outcomes. Several of our findings however, also failed to support or contradicted assumptions of the 2-C model. All these findings are discussed in relation to their implications for the 2-C model, psychopathy treatment research, specific responsivity, the structure of PCL psychopathy, and the utility of the PCL in forensic and legal settings.</p>

Why are Psychopaths Difficult to Treat? Testing the Two-Component Model for the Treatment of PCL Psychopaths

<p>Psychopathic personality disorder as conceptualised by the family of scales referred to as the Psychopathy Checklist (PCL), is often cited as a specific responsivity characteristic that will interfere with an otherwise effective treatment programme. However, most research on the treatment of prisoners high on PCL psychopathy asks whether or not they are treatable as opposed to why they are difficult to treat. The Two-Component model (2-C; Wong & Olver, 2015) for the treatment of PCL psychopaths proposes that treatment difficulties observed for those high on PCL psychopathy are primarily caused by the interpersonal and affective personality features of psychopathy represented by PCL Factor 1 (F1). Thus the 2-C model suggests that therapists work around the emotional deficits and disruptive behaviours associated with PCL F1 to focus on changing risk-relevant behaviours that are associated with PCL Factor 2 (F2). In this thesis, we test the assumptions of the 2-C model with a group of high-risk violent men who attended an intensive violence treatment programme and were assessed with a PCL instrument. Specifically, we examined whether the personality features of PCL psychopathy led to more treatment difficulties than the behavioural features by exploring relationships between the factors/facets of the PCL and treatment completion, reconviction, change on dynamic risk, the therapeutic alliance and behaviour during treatment. In support of the 2-C model we found that PCL:SV Part 1 and its underlying facets were significantly associated with higher rates of removal from treatment, a poorer therapeutic alliance, and lower levels of emotional and performance based behaviours during treatment. Mediation analyses also revealed that the relationships between PCL:SV Part 1 variables and removal were partly explained by lower levels of emotional and performance based behaviours. Also in support of the 2-C model, we found that PCL:SV Part 2 and its underlying facets demonstrated stronger, significant associations with pre-treatment dynamic risk and post-treatment reconvictions when compared with PCL:SV Part 1 variables. Furthermore, poorer performance based behaviours during treatment mediated relationships between PCL:SV Part 2 variables and reconviction outcomes. Several of our findings however, also failed to support or contradicted assumptions of the 2-C model. All these findings are discussed in relation to their implications for the 2-C model, psychopathy treatment research, specific responsivity, the structure of PCL psychopathy, and the utility of the PCL in forensic and legal settings.</p>

The Contribution of Cognitive Impulsivity to Criminal Risk

<p>Impulsivity increases risk for general, violent and sexual offending. Accordingly, helping offenders to become better regulators of their impulses is one goal of offender rehabilitation. In a correctional setting, the assessment of impulsivity focuses on personality and behaviour, but not cognition; cognitive impulse control impairments are inferred from personality styles and behavioural patterns suggestive of acting before thinking. However, empirical findings challenge the validity of inferring cognition from personality and behavioural measures. Additionally, without assessing cognition, practitioners are limited in their ability to isolate which cognitive processes are most impaired and therefore worthy of intervention for individual offenders. To establish the contribution of cognitive impulse control to criminal risk, a theoretically derived, empirically supported neurocognitive assessment framework was adopted. The framework is based on the notion that impulsive behaviour arises from three, potentially dissociable skill domains that support impulse control: decisionmaking, perceptual and motor impulse control. A cohort of 77 men attending intensive cognitive-behavioural rehabilitation was recruited from four of New Zealand’s prison-based Special Treatment Unit Rehabilitation Programmes (STURPs). A neurocognitive battery of five tasks collectively representing each cognitive impulse control domain was administered before and after the 8-month treatment programme. Study One explored pre-treatment clinically impaired performance within and across each cognitive impulse control domain. Compared to normative data, performance was typically in the average to below average range, but it was not clinically impaired overall. When performance was clinically impaired, it was most pronounced on tasks requiring cognitive flexibility. Study Two explored treatment change in cognitive impulse control. The study also compared pre-treatment cognitive impulse control between offenders who went on to complete the treatment programme and those who were prematurely removed for responsivity or conduct-related issues. No pre-treatment cognitive impulse control differences were found between treatment completers and non-completers. Treatment completers displayed small pre-post treatment improvements in some areas of cognitive impulse control, but not others. Study Three explored cross-sectional and predictive relationships between cognitive impulse control, dynamic criminal risk, trait anger and anger control. Although there was little association between these variables before treatment, some cognitive impulse control outcomes predicted post-treatment dynamic criminal risk, trait anger and anger control. Thus, the evidence suggested that certain aspects of cognitive impulse control might function as facilitators of treatment change. Together, the findings highlighted the importance of evaluating cognitive impulse control as part of the risk assessment, and clinical formulation process. The findings also suggested that interventions designed to develop cognitive impulse control abilities either before, or as a complement to traditional cognitive-behavioural interventions, have the potential to maximise treatment response.</p>

The Contribution of Cognitive Impulsivity to Criminal Risk

<p>Impulsivity increases risk for general, violent and sexual offending. Accordingly, helping offenders to become better regulators of their impulses is one goal of offender rehabilitation. In a correctional setting, the assessment of impulsivity focuses on personality and behaviour, but not cognition; cognitive impulse control impairments are inferred from personality styles and behavioural patterns suggestive of acting before thinking. However, empirical findings challenge the validity of inferring cognition from personality and behavioural measures. Additionally, without assessing cognition, practitioners are limited in their ability to isolate which cognitive processes are most impaired and therefore worthy of intervention for individual offenders. To establish the contribution of cognitive impulse control to criminal risk, a theoretically derived, empirically supported neurocognitive assessment framework was adopted. The framework is based on the notion that impulsive behaviour arises from three, potentially dissociable skill domains that support impulse control: decisionmaking, perceptual and motor impulse control. A cohort of 77 men attending intensive cognitive-behavioural rehabilitation was recruited from four of New Zealand’s prison-based Special Treatment Unit Rehabilitation Programmes (STURPs). A neurocognitive battery of five tasks collectively representing each cognitive impulse control domain was administered before and after the 8-month treatment programme. Study One explored pre-treatment clinically impaired performance within and across each cognitive impulse control domain. Compared to normative data, performance was typically in the average to below average range, but it was not clinically impaired overall. When performance was clinically impaired, it was most pronounced on tasks requiring cognitive flexibility. Study Two explored treatment change in cognitive impulse control. The study also compared pre-treatment cognitive impulse control between offenders who went on to complete the treatment programme and those who were prematurely removed for responsivity or conduct-related issues. No pre-treatment cognitive impulse control differences were found between treatment completers and non-completers. Treatment completers displayed small pre-post treatment improvements in some areas of cognitive impulse control, but not others. Study Three explored cross-sectional and predictive relationships between cognitive impulse control, dynamic criminal risk, trait anger and anger control. Although there was little association between these variables before treatment, some cognitive impulse control outcomes predicted post-treatment dynamic criminal risk, trait anger and anger control. Thus, the evidence suggested that certain aspects of cognitive impulse control might function as facilitators of treatment change. Together, the findings highlighted the importance of evaluating cognitive impulse control as part of the risk assessment, and clinical formulation process. The findings also suggested that interventions designed to develop cognitive impulse control abilities either before, or as a complement to traditional cognitive-behavioural interventions, have the potential to maximise treatment response.</p>

Comparison of Effectiveness of Phonological and Whole-Word Treatment Programmes within Two Dyslexia Subtypes

<p>This thesis compares the effectiveness of two reading treatment programmes, each developed to address the key difficulties of two subtypes of developmental dyslexia - phonological and surface dyslexia, respectively. Previous cognitive neuropsychological research has commonly administered a single tailored treatment programme to each individual. However, this research administers both programmes to individuals from each subtype, and compares their effectiveness. In Experiment 1, a large group of reading-delayed children was screened, and, using Coltheart and Leahy's (1996) criteria, three children were identified as surface dyslexic and seven as phonological dyslexic. All were aged between 9 and 13 years. Following completion of a range of background tests to assess cognitive abilities potentially correlated with dyslexia, each child received two treatment programmes: 1) a phonologically-based programme training grapheme-to-phoneme correspondences (based on Broom and Doctor, 1995b) and 2) a whole-word programme (specifically designed for the current research), with pre- and post-tests throughout. Results indicated that all children significantly improved their reading of the trained words following both training programmes, regardless of subtype. For both subtypes, generalisation to untrained words was observed following the Phonological Programme, but not the Whole-word Programme. In Experiment 2, a second, more case-based investigation was conducted, focussing on one phonological dyslexic and one surface dyslexic, who were selected following extensive screening. Both were aged 10 years 11 months. Experiment 2 also examined the effectiveness of specific whole-word techniques. Results indicated a clear distinction between the responsiveness of the two participants, with each favouring their target treatment programme: the Phonological Programme was more effective for the phonological dyslexic than the Whole-word Programme, and vice versa for the surface dyslexic. The implications are discussed, with particular reference to suggestions for remediating reading disorders.</p>

Comparison of Effectiveness of Phonological and Whole-Word Treatment Programmes within Two Dyslexia Subtypes

<p>This thesis compares the effectiveness of two reading treatment programmes, each developed to address the key difficulties of two subtypes of developmental dyslexia - phonological and surface dyslexia, respectively. Previous cognitive neuropsychological research has commonly administered a single tailored treatment programme to each individual. However, this research administers both programmes to individuals from each subtype, and compares their effectiveness. In Experiment 1, a large group of reading-delayed children was screened, and, using Coltheart and Leahy's (1996) criteria, three children were identified as surface dyslexic and seven as phonological dyslexic. All were aged between 9 and 13 years. Following completion of a range of background tests to assess cognitive abilities potentially correlated with dyslexia, each child received two treatment programmes: 1) a phonologically-based programme training grapheme-to-phoneme correspondences (based on Broom and Doctor, 1995b) and 2) a whole-word programme (specifically designed for the current research), with pre- and post-tests throughout. Results indicated that all children significantly improved their reading of the trained words following both training programmes, regardless of subtype. For both subtypes, generalisation to untrained words was observed following the Phonological Programme, but not the Whole-word Programme. In Experiment 2, a second, more case-based investigation was conducted, focussing on one phonological dyslexic and one surface dyslexic, who were selected following extensive screening. Both were aged 10 years 11 months. Experiment 2 also examined the effectiveness of specific whole-word techniques. Results indicated a clear distinction between the responsiveness of the two participants, with each favouring their target treatment programme: the Phonological Programme was more effective for the phonological dyslexic than the Whole-word Programme, and vice versa for the surface dyslexic. The implications are discussed, with particular reference to suggestions for remediating reading disorders.</p>

A feasibility study of a novel work-focused relational group CBT treatment programme for moderate to severe recurrent depression

Purpose No current psychotherapeutic intervention is designed to enhance job retention in employees with moderate–severe recurrent depression. The aim of this study is to test the feasibility of a new, interdisciplinary work-focused relational group cognitive behavioural therapy (CBT) treatment programme for moderate–severe depression. Design/methodology/approach The programme was based on a theoretical integration of occupational stress, psychological, social/interpersonal and bio-medical theories. It consisted of up to four 1:1 psychotherapy sessions; 12 work-focused, full-day, weekly CBT sessions facilitated by a cognitive behavioural therapist and occupational therapist; and up to four optional 1:1 sessions with an occupational therapist. Depression severity (primary outcome) and a range of secondary outcomes were assessed before (first CBT session) and after (twelfth CBT session) therapy using validated instruments. Findings Eight women (26–49 years) with moderate–severe depression participated. Five were on antidepressant medication. While there was no statistically significant change in Hamilton Depression Rating Scale depression scores after therapy (n = 5; p = 0.313), Beck Depression Inventory-II depression scores significantly decreased after therapy (n = 8; –20.0 median change, p = 0.016; 6/8 responses, 7/8 minimal clinically important differences, two remissions). There were significant improvements in the secondary outcomes of overall psychological distress, coping self-efficacy, health-related quality of life and interpersonal difficulties after therapy. All clients in work at the start of therapy remained in work at the end of therapy. The intervention was safe and had 100% retention. Research limitations/implications A major limitation was recruitment shortfall, resulting in a small sample of middle-aged women, which reduces representativeness and increases the possibility of methodological weaknesses in terms of the statistical analysis. A definitive trial would need much larger samples to improve statistical power and increase confidence in the findings. Another major limitation was that two of the authors were involved in delivering the intervention such that its generalisability is uncertain. Practical implications This novel programme was evaluated and implemented in the real world of clinical practice. It showed promising immediate positive outcomes in terms of depressive symptoms, interpersonal difficulties and job retention that warrant further exploration in a longer-term definitive study. Social implications Empirical studies focused on enhancing job retention in employees with moderate–severe recurrent depression are lacking, so this study was highly relevant to a potentially marginalised community. Originality/value While limited by a recruitment shortfall, missing data and client heterogeneity, this study showed promising immediate positive outcomes for the new programme in terms of depressive symptoms, interpersonal difficulties and job retention that warrant exploration in a definitive study.

EVALUATING IMPEDIMENTS LEADING TO NON-ADHERENCE OF PHYSICAL THERAPY TREATMENT AMONGST INHABITANTS OF ROHTAK DISTRICT

Background:The rate of success of a physiotherapy treatment programme is strongly inuenced by the adherence of the patient with prescribed treatment programme. Non-adherence with the therapy given to the patient is often overlooked and is one of the reasons for failure to achieve desired results aimed for a given disease/condition. Methods:Atotal of 40 geriatric subjects (20 urban and 20 rural) were surveyed for information using self-questionnaire from Rohtak district. Results: Out of 40 subjects (10 urban males and 10 urban females and 10 rural males and 10 rural females) 70% of urban (30% females and 40% males) and 30% of rural (10% females and 20% males) population was found to be adherent to physical therapy treatment. Impediments identied in the current study that were statistically signicantly associated with non-adherence to physical therapy treatment among the geriatric population included residential locality (p=0.02), accessibility to physiotherapy clinics (p=0.001), paying capacity (p=0.003), compliance to unsupervised home based exercise treatment (p=0.01) and cooperation by family members (p= 0.01). A non-signicant relationship was found with ability of doing ADLs (p=0.06). Conclusion: The study shows that geriatric population of Rohtak district residing in urban areas are more adherent to physical therapy treatment programme as compared to those residing in rural areas.