The effectiveness of blended versus regular Forensic Outpatient Systemic Therapy in the treatment of juvenile antisocial behavior: a study protocol of a randomized controlled trial

Background: Antisocial behavior during adolescence can have long-lasting negative effects and leads to high societal costs. Forensic Outpatient Systemic Therapy (Forensische Ambulante Systeem Therapie; FAST) is a promising treatment for juveniles aged 12–21 showing severe antisocial behavior. The intensity, content and duration of FAST can be adjusted to the needs of the juvenile and their caregiver(s), which is considered crucial for effective treatment. Next to the regular version of FAST (FASTr), a blended version (FASTb) in which face-to-face contacts are replaced by minimally 50% online contacts over the duration of intervention was developed during the Covid-19 pandemic. The current study will investigate whether FASTb is equally effective as FASTr, and through which mechanisms of change, for whom, and under which conditions FASTr and FASTb work. Methods: A randomized controlled trial (RCT) will be carried out. Participants (N = 200) will be randomly assigned to FASTb (n = 100) or FASTr (n = 100). Data collection will consist of self-report questionnaires and case file analysis, and include a pre-test at the start of the intervention, a post-test immediately after the intervention, and a six month follow-up. Mechanisms of change will be investigated using monthly questionnaires of key variables during treatment. Official recidivism data will be collected at two-year follow-up. Discussion: This study aims to improve the effectiveness and quality of forensic mental health care for juveniles with antisocial behavior by studying the effectiveness of blended care, which has not been studied before in treatment of externalizing behavior. If found to be at least as effective as face-to-face treatment, blended treatment can help meet the urgent need for more flexible and efficient interventions in this field. In addition, the proposed study aims to unravel what works for whom, knowledge urgently needed in mental health care for juveniles with severe antisocial behavior. Trial registration: This trial was registered at ClinicalTrials.gov on 07/11/2022, registration number NCT05606978

Responsive Aggression Regulation Therapy (Re-ART) Improves Executive Functioning in Adolescents and Young Adults with Severe Aggression Problems: A Pilot Study

This pilot study (N = 25) compared the effects of a short, four-month version of Responsive Aggression Regulation Therapy Outpatient (Re-ART Compact) and the entire, ten-month intervention (Re-ART Complete) on specific executive functioning (EF) and the risk of violent recidivism in adolescents and young adults (13–23 years). Re-ART is a cognitive behavioral-based intervention for adolescents and young adults with severe aggression problems. The Re-ART Compact and Re-ART Complete groups were comparable on the EF measures inhibition, flexibility, emotion regulation, self-evaluation, and self-control, but the Re-ART Complete group showed more improved risk of violent recidivism. We conclude that Re-ART Compact can be used as a compact, short intervention for EF, which is a valuable addition to the field of forensic mental health care where many problem behaviors relate to poor EF

Factor Analysis With Unusual Sexual Interests:A Replication Study in a Representative Population Sample

A previous study found a variety of unusual sexual interests to cluster in a five-factor structure, namely submission/masochism, forbidden sexual activities, dominance/sadism, mysophilia, and fetishism (Schippers et al., 2021). The current study was an empirical replication to examine whether these findings generalized to a representative population sample. An online, anonymous sample (N = 256) representative of the Dutch adult male population rated 32 unusual sexual interests on a scale from 1 (very unappealing) to 7 (very appealing). An exploratory factor analysis assessed whether similar factors would emerge as in the original study. A subsequent confirmatory factor analysis served to confirm the factor structure. Four slightly different factors of sexual interest were found: extreme, illegal and mysophilic sexual activities; light BDSM without real pain or suffering; heavy BDSM that may include pain or suffering; and illegal but lower-sentenced and fetishistic sexual activities. The model fit was acceptable. The representative replication sample was more sexually conservative and showed less sexual engagement than the original convenience sample. On a fundamental level, sexual interest in light BDSM activities and extreme, forbidden, and mysophilic activities seem to be relatively separate constructs

Responsive Aggression Regulation Therapy (Re-ART): An Evaluation Study in a Dutch Juvenile Justice Institution in Terms of Recidivism

This article describes a quasi-experimental study of the effectiveness of Responsive Aggression Regulation Therapy (Re-ART) in terms of recidivism for 16- to 21-year-old juveniles with aggression problems and high risk of recidivism. In a Dutch juvenile justice institution, an experimental group received Re-ART (n = 63, Re-ART group) and a waitlist control group received Treatment as Usual (n = 28, TAU group). Results indicated that Re-ART is significantly more effective than TAU in reducing the juveniles’ recidivism risk for violent offending. Compared with the TAU group, the Re-ART group showed significantly less violent crimes after 2 and 3 years, less property crimes after 2 years, and less general recidivism after 2 and 3 years. There was no significant difference between groups in recidivism of property crimes with violence. Ethnicity, mild intellectual disabilities, substance abuse, and age did not moderate the effects on recidivism outcome, which indicates that Re-ART was equally effective for various groups

A quasi-experimental pilot study to the effects of Responsive Aggression Regulation Therapy (Re-ART) Outpatient for young adults

It is important to provide treatment for juvenile and young adult violent offenders, since no or (too) late treatment increases the risk of recidivism and persistent aggressive behavior in adulthood. In this study, we investigated the efficacy of the intervention Responsive Aggression Regulation Therapy (Re-ART) Outpatient, which has been developed for adolescents and young adults between 16 and 24 years old with severe aggression problems. This quasi-experimental (pilot) study compared the effects of Re-ART Outpatient (n = 47) with a control group (n = 29) receiving treatment as usual on measures regarding risk of violent recidivism, impulsivity, emotional/personal functioning, family functioning, motivation, handling anger, self-reported problem behavior, coping skills, and cognitive distortions. Re-ART showed significantly better results than the control group on risk of violent recidivism, impulsivity, emotional/personal functioning, motivation, handling anger, certain coping skills, and certain cognitive distortions. Family functioning and self-reported rule-breaking behavior did not differ significantly between the groups. The results implicate that Re-ART is a promising outpatient intervention for young adults with severe aggressive behavior. The results can be explained by the fact that Re-ART treats both systemically and individually and pays specific attention to stress reduction and the improvement of executive functions

A Meta-Analysis of the Effectiveness of EMDR and TF-CBT in Reducing Trauma Symptoms and Externalizing Behavior Problems in Adolescents

This multi-level meta-analysis tested if evidence-based trauma treatment was effective in reducing trauma symptoms and externalizing behavior problems in adolescents. Based on eight independent samples and 75 effect sizes, results indicated that Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization Reprocessing (EMDR) had a large and significant overall effect (d = 0.909) on reducing trauma symptoms and externalizing behavior problems. Trauma treatment significantly decreased trauma symptoms (large effect) and externalizing behavior problems (medium effect). Age and type of control group moderated treatment effects. Treatment was more effective in older adolescents. Trauma treatment for adolescents with externalizing behavior problems had a larger effect compared to no treatment, but not compared to treatment as usual. It seems important to provide a broad treatment offer for adolescents with severe externalizing behavior problems, in which, besides trauma treatment, attention is paid to reducing relevant individual risk factors for behavior problems

Effectiveness of Moral Developmental Interventions for Youth Engaged in Delinquent Behavior:A Meta-Analysis

There is vast empirical evidence showing that juvenile delinquency is associated with delays in moral development, including moral judgment, empathy, and self-conscious emotions (guilt and shame). Consequently, interventions have been developed that target moral development of juvenile delinquents to reduce criminal offense recidivism. However, a comprehensive synthesis of studies examining the effectiveness of these interventions was not yet available. The present meta-analysis of (quasi-)experimental research therefore examined the effects of interventions that target moral development of youth engaged in delinquent behavior. Interventions that targeted moral judgment (11 studies and 17 effect sizes) showed a significant and small-to-medium effect on moral judgment (d = 0.39), with intervention type as a significant moderator, but no significant effect on recidivism (d = 0.03; 11 studies and 40 effect sizes). No (quasi-)experimental studies were found that targeted guilt and shame in juvenile offenders, and an insufficient number of studies (i.e., only two) were found to conduct a meta-analysis of interventions that target empathy. The discussion focuses on potential ways to improve moral development interventions for youth engaged in delinquent behavior, and provides suggestions for future research.</p

Pedophilia is associated with lower sexual interest in adults: Meta-analyses and a systematic review with men who had sexually offended against children

Sexual interest in children is an important factor contributing to sexual (re)offending against children. The current state of research makes it difficult to conclude if people with pedophilia are overly interested in children, or have lower interest in adults, or both. This is relevant knowledge in treatment for preventing sexual (re)offenses against children. This study aimed to systematically analyze sexual interest in both children and adults in samples of men with pedophilia and comparison groups. A total of 55 studies (N = 8465) were included in four meta-analyses and a systematic review. Most included studies considered people who had sexually offended against children (PSOC; nPSOC = 5213). Results indicated that PSOC with pedophilia did not have a clear sexual preference for either children or adults. Compared to comparison groups, they had more absolute sexual interest in children and lower sexual interest in adults. We conclude that the lack of sexual interest in adults may be a relevant factor in PSOC with pedophilia. More studies are needed to disentangle sexual interest in children from sexual interest in adults, while using carefully matched comparison groups and appropriate research designs

Supplemental Material - Factor Analysis With Unusual Sexual Interests: A Replication Study in a Representative Population Sample

Supplemental Material for Factor Analysis With Unusual Sexual Interests: A Replication Study in a Representative Population Sample by Eveline E. Schippers, Wineke J. Smid, Larissa M. Hoogsteder, and Vivienne de Vogel in Sexual Abuse.</p