What is the Evidence for Psychological Interventions for Antisocial Personality Disorder?

Research Paper Title

Psychological interventions for antisocial personality disorder.


Antisocial personality disorder (AsPD) is associated with poor mental health, criminality, substance use and relationship difficulties.

This review updates Gibbon 2010 (previous version of the review).

To evaluate the potential benefits and adverse effects of psychological interventions for adults with AsPD.


The researchers searched CENTRAL, MEDLINE, Embase, 13 other databases and two trials registers up to 5 September 2019. They also searched reference lists and contacted study authors to identify studies.

Randomised controlled trials of adults, where participants with an AsPD or dissocial personality disorder diagnosis comprised at least 75% of the sample randomly allocated to receive a psychological intervention, treatment-as-usual (TAU), waiting list or no treatment.

The primary outcomes were aggression, reconviction, global state/functioning, social functioning and adverse events.

The researchers used standard methodological procedures expected by Cochrane.


  • This review includes 19 studies (eight new to this update), comparing a psychological intervention against TAU (also called ‘standard Maintenance'(SM) in some studies).
  • Eight of the 18 psychological interventions reported data on the primary outcomes.
  • Four studies focussed exclusively on participants with AsPD, and 15 on subgroups of participants with AsPD.
  • Data were available from only 10 studies involving 605 participants.
  • Eight studies were conducted in the UK and North America, and one each in Iran, Denmark and the Netherlands.
  • Study duration ranged from 4 to 156 weeks (median = 26 weeks).
  • Most participants (75%) were male; the mean age was 35.5 years.
  • Eleven studies (58%) were funded by research councils.
  • Risk of bias was high for 13% of criteria, unclear for 54% and low for 33%.
  • Cognitive behaviour therapy (CBT) + TAU versus TAU One study (52 participants) found no evidence of a difference between CBT + TAU and TAU for physical aggression (odds ratio (OR) 0.92, 95% CI 0.28 to 3.07; low-certainty evidence) for outpatients at 12 months post-intervention.
  • One study (39 participants) found no evidence of a difference between CBT + TAU and TAU for social functioning (mean difference (MD) -1.60 points, 95% CI -5.21 to 2.01; very low-certainty evidence), measured by the Social Functioning Questionnaire (SFQ; range = 0-24), for outpatients at 12 months post-intervention.
  • Impulsive lifestyle counselling (ILC) + TAU versus TAU One study (118 participants) found no evidence of a difference between ILC + TAU and TAU for trait aggression (assessed with Buss-Perry Aggression Questionnaire-Short Form) for outpatients at nine months (MD 0.07, CI -0.35 to 0.49; very low-certainty evidence).
  • One study (142 participants) found no evidence of a difference between ILC + TAU and TAU alone for the adverse event of death (OR 0.40, 95% CI 0.04 to 4.54; very low-certainty evidence) or incarceration (OR 0.70, 95% CI 0.27 to 1.86; very low-certainty evidence) for outpatients between three and nine months follow-up.
  • Contingency management (CM) + SM versus SM One study (83 participants) found evidence that, compared to SM alone, CM + SM may improve social functioning measured by family/social scores on the Addiction Severity Index (ASI; range = 0 (no problems) to 1 (severe problems); MD -0.08, 95% CI -0.14 to -0.02; low-certainty evidence) for outpatients at six months. ‘Driving whilst intoxicated’ programme (DWI) + incarceration versus incarceration.
  • One study (52 participants) found no evidence of a difference between DWI + incarceration and incarceration alone on reconviction rates (hazard ratio 0.56, CI -0.19 to 1.31; very low-certainty evidence) for prisoner participants at 24 months.
  • Schema therapy (ST) versus TAU One study (30 participants in a secure psychiatric hospital, 87% had AsPD diagnosis) found no evidence of a difference between ST and TAU for the number of participants who were reconvicted (OR 2.81, 95% CI 0.11 to 74.56, P = 0.54) at three years.
  • The same study found that ST may be more likely to improve social functioning (assessed by the mean number of days until patients gain unsupervised leave (MD -137.33, 95% CI -271.31 to -3.35) compared to TAU, and no evidence of a difference between the groups for overall adverse events, classified as the number of people experiencing a global negative outcome over a three-year period (OR 0.42, 95% CI 0.08 to 2.19).
  • The certainty of the evidence for all outcomes was very low.
  • Social problem-solving (SPS) + psychoeducation (PE) versus TAU One study (17 participants) found no evidence of a difference between SPS + PE and TAU for participants’ level of social functioning (MD -1.60 points, 95% CI -5.43 to 2.23; very low-certainty evidence) assessed with the SFQ at six months post-intervention.
  • Dialectical behaviour therapy versus TAU One study (skewed data, 14 participants) provided very low-certainty, narrative evidence that DBT may reduce the number of self-harm days for outpatients at two months post-intervention compared to TAU.
  • Psychosocial risk management (PSRM; ‘Resettle’) versus TAU One study (skewed data, 35 participants) found no evidence of a difference between PSRM and TAU for a number of officially recorded offences at one year after release from prison.
  • It also found no evidence of difference between the PSRM and TAU for the adverse event of death during the study period (OR 0.89, 95% CI 0.05 to 14.83, P = 0.94, 72 participants (90% had AsPD), 1 study, very low-certainty evidence).


There is very limited evidence available on psychological interventions for adults with AsPD.

Few interventions addressed the primary outcomes of this review and, of the eight that did, only three (CM + SM, ST and DBT) showed evidence that the intervention may be more effective than the control condition.

No intervention reported compelling evidence of change in antisocial behaviour.

Overall, the certainty of the evidence was low or very low, meaning that the researchers have little confidence in the effect estimates reported.

The conclusions of this update have not changed from those of the original review, despite the addition of eight new studies.

This highlights the ongoing need for further methodologically rigorous studies to yield further data to guide the development and application of psychological interventions for AsPD and may suggest that a new approach is required.


Gibbon, S., Khalifa, N.R., Cheung, N.H-Y., Vollm, B.A. & McCarthy, L. (2020) Psychological interventions for antisocial personality disorder. The Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.CD007668.pub3.

What is the Current Situation School Mental Health in ASEAN Countries?

Research Paper Title

Current Situation and Comparison of School Mental Health in ASEAN Countries.


School-based mental health interventions are considered to have potential for the promotion of mental health in developing countries.

The researchers held a workshop to discuss the promotion of mental health in schools in southeast Asian countries.

This review report aimed to summarise the current situation of school mental health in Association of Southeast Asian Nations (ASEAN) countries as reported by their representatives in this workshop.


To summarise the current situation of ASEAN countries in relation to school mental health, the researchers qualitatively analysed the content of the discussions from four perspectives:

  1. Laws and regulations;
  2. Mental health services;
  3. Teacher training on mental health; and
  4. Mental health education for students.


With regard to school mental health laws and regulations, this report could not provide clear conclusions because the laws were reported through the personal understanding of the public officers.

The results show that mental health services in schools are centred on professionals such as guidance counsellors, although the coverage varied among the different ASEAN countries.


Only Singapore conducted mental health training for teachers in a comprehensive way, and the number of people who were actually trained in other countries was very limited.

Cambodia, Malaysia, Myanmar, Philippines, Singapore, and Thailand included mental health education for students in health education or life skills subjects.


Nishio, A., Kakimoto, M., Bermardo, T.M.S. & Kobayashi, J. (2020) Current Situation and Comparison of School Mental Health in ASEAN Countries. Pediatrics International: Official Journal of the Japan Pediatrics Society. 62(4), pp.438-443. doi: 10.1111/ped.14137.

Components & Principles of Effective Treatments in Mental Health

For interventions (to at least be perceived) to be effective in the treatment of mental health conditions, from the perspective of the service user, there are a range of components that one must understand and appreciate.

  • Facilitative service environment(s):
    • Understand how the environment can affect a service user’s experience of treatment.
    • Prioritise good relationships between staff/volunteers and those using the services.
    • Taking a genuine interest in the service user.
    • Being respectful.
    • Helps service users feel at ease and prevent relapse.
  • Access to appropriate treatment(s).
  • Compassionate and non-judgemental support.
    • This can include peer, practical, and emotional support.
  • Interventions that are long enough in duration:
    • Treatment needs to be long enough in duration for the service user to avoid relapse and/or move into recovery.
    • Need for ongoing support.
    • Aftercare programme as a way of ensuring a supportive network to prevent relapse.
  • Interventions that offer stability.
  • Choices (in terms of treatment).
    • Service users like to feel they have a choice in their treatment.
    • Want to be treated as individuals.
    • Individualised care means provider must have flexibility in service delivery.
  • Opportunities to learn (or relearn) how to live.
    • Treatment should be seen as providing opportunities for service users to learn (vocational/life) skills to support them to live their lives.
    • This can aid service users to steer away from problematic patterns of behaviour by providing structure and purpose, alleviating boredom, and distraction from their condition.

The above should be provided with the following three principles in mind:

  1. Within the context of good relationships.
    • You are not there to be the service user’s best friend, but good/positive relationships aid effectiveness of treatment and perceptions of service.
  2. Person-centred care.
    • Where appropriate and practicable, the service/treatment should fit around the service user, not the service user around the service/treatment.
  3. Understanding the complexity of the service user’s (both personal and professional) circumstances.
    • Understanding of the service user’s circumstances can aid adherence to treatment and their journey through their condition.

Finally, remember that the way in which services and treatment are delivered, is considered by many service users, to be more important than the type of treatment provided.

Book: Mental Health Atlas 2017

Book Title:

Mental Health Atlas 2017.

Author(s): World Health Organisation (WHO).

Year: 2017.

Edition: Denoted by year.

Publisher: WHO.

Type(s): Paperback and digital.


The Mental Health Atlas series is considered the most comprehensive resource on global information on mental health and an important tool for developing and planning mental health services within countries and regions.

The Mental Health Atlas 2017 acquires new importance as it includes information and data on the progress towards the achievement of objectives and targets of the Comprehensive Mental Health Action Plan 2013–2020.

You can a download a free copy of the Mental Health Atlas 2017 here.

Book: Mastering the World of Psychology

Book Title:

Mastering the World of Psychology.

Author(s): Samuel E. Wood, Ellen Green Wood, and Denise Boyd.

Year: 2019.

Edition: Sixth (6th).

Publisher: Pearson.

Type(s): Hardcover, Paperback, and Kindle.


Mastering the World of Psychology, 5ed, provides students with more support than ever before, thanks to the Survey, Question, Read, Recite, and Review Learning Method, or SQ3R, which is integrated throughout the text. SQ3R shows students the relationship between psychological theory and learning. It is the strongest and most comprehensive programme for measuring progress and attaining successful outcomes in Introductory Psychology.

MyPsychLab is an integral part of the Wood/Wood/Boyd program. Engaging activities and assessments provide a teaching and learning system that measures students’ success. With MyPsychLab, students can watch videos on psychological research and applications, participate in virtual classic experiments, and develop critical thinking skills through writing.

College Students & Substance Use: Do They Require different Strategies for Prevention & Intervention?

Research Paper Title

Cumulative Risk of Substance Use in Community College Students.


Substance use in community college students has been explored in only a handful of studies.

Differences in population characteristics and substance use between 2- and 4-year students suggest that different factors may promote and thwart this behaviour.

Cumulative risk is a parsimonious methodology that provides better model stability and more statistical power, yet it has only been recently used in substance use research.

The aim of this study is to investigate multiple aspects of substance use risk in a population in need of substance use prevention and intervention services.


The researchers conducted a cross-sectional study of community college students (N = 288; 75% female) examining the relative contributions of different domains of cumulative risk (eg, life stressors, academic stressors, and mental health diagnoses) to develop different profiles of risk across substance use classes (ie, alcohol, cigarette, marijuana, and hard drug use).


Cumulative risk analyses indicated that alcohol and tobacco use were associated with the domains of life stressors and peer/family substance use, marijuana use with peer/family substance use and stressful childhood experiences, and hard drug use with peer/family substance use, lack of social support, low access to care, and stressful childhood experiences.


Different strategies for prevention and intervention may be necessary to effectively address different forms of substance use in this population.

Scientific Significance

The risk domain profiles related to specific drugs may lead to targeted interventions to reduce substance use in community college students.


Salgado García, F., Bursac, Z. & Derefinko, K.J. (2020) Cumulative Risk of Substance Use in Community College Students. The American Journal on Addictions. 29(2), pp.97-104. doi: 10.1111/ajad.12983. Epub 2020 Jan 3.

Qualified Withdrawal Treatment (QWT) & Alcohol Use Disorders (AUD)

Research Paper Title

The potential effects of an extended alcohol withdrawal treatment programme on morbidity and mortality among inpatients in the German city of Bremen: a simulation study.


According to the German guidelines, people with severe alcohol use disorders (AUDs) should receive withdrawal treatment.

Compared to somatic withdrawal treatment (SWT), extended duration and psychosocial elements of so-called “qualified withdrawal treatment” (QWT) aim to reduce relapse rates.

Despite promising results of prospective studies on QWT, only few German inpatients seeking withdrawal treatment receive QWT.

The researchers estimated the potential effects on mortality and morbidity for higher proportions of treatment-seeking patients receiving QWT rather than SWT in the German city of Bremen.


In 2016 and 2017, 2051 inpatients were admitted to two specialised hospitals for withdrawal treatment.

The potential beneficial effects of QWT over SWT were estimated by simulating treatment outcomes taken from two prospective studies.

Outcomes comprised number and length of all-cause hospitalisations within 5 years, as well as abstinence and all-cause mortality rates within 28 months.

Outcomes were estimated for actual and increased rates of QWT (25, 50%) among inpatients seeking alcohol treatment.


In the selected hospitals, 170 patients (8%) received QWT. If 25% of AUD inpatients were to receive QWT, benefits in abstinence rates (+ 18%), the total number of hospitalisations (- 9%) and hospital days (- 10%) could be expected.

If 50% of AUD inpatients were to receive QWT, benefits in abstinence rates (+ 45%), the total number of hospitalisations (- 23%) and hospital days (- 26%) were more pronounced, in addition to reductions in mortality (- 20%).


Increasing the proportion of people with severe AUD enrolled in extended withdrawal treatment programmes (such as QWT) may contribute to reduce overall alcohol-attributable burden of disease.

Randomised controlled trials or other prospective studies controlling for confounding factors are needed to determine the potential at the population level.


Manthey, J., Lindemann, C., Kraus, L., Reimer, J., Verthein, U., Schulte, B. & Rehm, J. (2020) The potential effects of an extended alcohol withdrawal treatment programme on morbidity and mortality among inpatients in the German city of Bremen: a simulation study. Substance Abuse Treatment, Prevention, and Policy. 15(1):1. doi: 10.1186/s13011-019-0249-7.

Quality of Life: Psychosocial Intervention in Men with Advanced Prostate Cancer

Research Paper Title

Technology-Based Psychosocial Intervention to Improve Quality of Life and Reduce Symptom Burden in Men with Advanced Prostate Cancer: Results from a Randomized Controlled Trial.


Men with advanced prostate cancer (APC) face multiple challenges including poor prognosis, poor health-related quality of life (HRQOL), and elevated symptom burden.

This study sought to establish the efficacy of a tablet-delivered, group-based psychosocial intervention for improving HRQOL and reducing symptom burden in men with APC.

The researchers hypothesised that men randomised to cognitive-behavioural stress management (CBSM) would report improved HRQOL and reduced symptom burden relative to men randomised to an active control health promotion (HP) condition.

Condition effects on intervention targets and moderators of these effects were explored.


Men with APC (N = 192) were randomised (1:1) to 10-week tablet-delivered CBSM or HP, and followed for 1 year.

Multilevel modelling was used to evaluate condition effects over time.


Changes in HRQOL and symptom burden did not differ between groups.

Men in both groups improved across several intervention targets; men in the CBSM condition reported greater increases in self-reported ability to relax, and both conditions showed improvements in cancer-related anxiety, cancer-related distress, and feelings of cohesiveness with other patients over time.

Moderating factors included baseline interpersonal disruption, fatigue, and sexual functioning.


Tablet-delivered CBSM and HP were well received by men with APC.

The hypothesised effects of CBSM on HRQOL and symptom burden were not supported, though improvements in intervention targets were observed across conditions.

Participants reported high-baseline HRQOL relative to cancer and general population norms, possibly limiting intervention effects.

The identified moderating factors should be considered in the development and implementation of interventions targeting HRQOL and symptom burden.


Penedo, F.J., Fox, R.S., Oswald, L.B., Moreno, P.I., Boland, C.L., Estabrook, R., McGinty, H.L., Mohr, D.C., Begale, M.J., Dahn, J.R., Flury, S.C., Perry, K.T., Kundu, S.D. & Yanez, B. (2020) Technology-Based Psychosocial Intervention to Improve Quality of Life and Reduce Symptom Burden in Men with Advanced Prostate Cancer: Results from a Randomized Controlled Trial. International Journal of Behavioral Medicine. doi: 10.1007/s12529-019-09839-7. [Epub ahead of print].