Clinical change in anger, shame, and paranoia after a structured cognitive-behavioral group program: Early findings from a randomized trial with male prison inmates

Abstract

Objectives: This study's main goal was to assess the efficacy of a structured cognitive-behavioral group program, Growing Pro-Social (GPS), in reducing anger, paranoia and external shame in male prison inmates.Methods: In this randomized trial, a treatment group (n=24) was compared to a control group (n=24) and both groups were assessed at pre-and post-treatment. Participants answered the State-Trait Anger Expression Inventory, the Paranoia Scale, and the Other as Shamer Scale.Treatment effects were tested using ANCOVA with baseline as covariate and condition as fixed factor. Additionally, in order to assess significant clinical change after intervention, the Reliable Change Index (RCI) was computed.Results: At baseline, no significant differences between conditions were found. ANCOVA with baseline as covariate showed significant differences between groups at post-treatment. When compared to controls, treatment subjects showed lower scores in anger-trait (temperament and reaction subscales) and paranoia. Concerning clinical change, a high percentage of treatment subjects presented improvements in anger, paranoia and external shame; the majority of controls showed significant deterioration in the same variables. After treatment, differences between groups were observed in the distributions by clinical change categories for anger-trait and its subscales, and paranoia. No differences between groups were found in anger-state and external shame.Conclusions: These results point out the GPS's ability to promote significant change in cognitive and emotional relevant variables associated with antisocial behavior.Keywords: Anger; Antisocial Behavior; Clinical Change; External Shame; Growing ProSocial; Paranoia Running head: CLINICAL CHANGE IN ANGER, SHAME, AND PARANOIA 3 Clinical change in anger, shame and paranoia after a structured cognitive-behavioral group program: Early findings from a randomized trial with male prison inmates Meta-analytic research (Andrews et al., 1990; Garret, 1985; Lipsey, 1995; Lipsey & Wilson, 1998; Lösel, 1995; McGuire 2001;Redondo et al., 1997;Redondo et al., 1999) has shown that multimodal programs have a significant impact in the reduction of recidivism in offenders. These studies pointed out that cognitive-behavioral based programs are among the most effective, namely when cognitive variables are included as targets for change (Bogestad et al., 2009; Hollin et al., 2013;Pearson et al., 2002;Wilson et al., 2005). It has been suggested that these interventions can be improved in order to achieve even better outcomes in recidivism reduction obeying to the Risk-Need-Responsivity (RNR) model (Andrews & Bonta, 2010a, b;Andrews et al., 2006;Andrews & Dowden, 2005; Dowden & Andrews, 2000, 2004. The RNR model is based in "human service principles", which state that recidivism reduction should be achieved through some type of treatment instead of punishment. Research has shown that punitive strategies actually increase criminal recidivism (Andrews & Bonta 2010a, 2010b Caldwell & R...

Effects of mindfulness‐based cognitive therapy on shame, self‐compassion and psychological distress in anxious and depressed patients: A pilot study

“…Therefore, cognitive-behavioural intervention with an emphasis on beliefs about evaluation by others may be a plausible approach for addressing external shame. For example, Brazão et al (2015) found that a cognitive-behavioural intervention for prison inmates resulted in a medium effect size difference between treatment and control groups and reliable change in more than half of the treatment group at post-treatment for external shame. Finally, approaches that emphasize compassion for self and others may be helpful in addressing external shame.…”

The Efficacy of the Growing Pro-social Program in Reducing Anger, Shame, and Paranoia over Time in Male Prison Inmates

“…By learning about the feelings and the expression of emotions, participants were invited to discover the usefulness and the diversity of the emotional states that humans can experience. Finally, participants were challenged to assess the adequacy and usefulness of their own emotional experiences (Brazão et al 2013; Brazão et al 2015a; Rijo et al 2007). We hypothesized that awareness and understanding about the function and meaning of emotions would promote emotion regulation, thus decreasing the severity and frequency of anger feelings and, consequently, increasing anger control.…”

“…The deterioration observed in controls (in anger-expression, anger-out, and anger-control) over a two-year period raises the question of whether traditional prison practices work toward rehabilitation or may be bolstering psychological and emotional processes related to maladaptive behavior (Ashkar and Kenny 2008; Constantine et al 2012; Lambie and Randell 2013; Morgan et al 2012). The traditional penitentiary interventions usually delivered in Portuguese prisons may not be effective enough to promote change at this level (Brazão et al 2015a, 2015b). From this point of view, outcomes in inmates who completed GPS may indicate that such a program can be useful in buffering a tendency to get worse over time.…”

“…A former pilot study on the effects of the GPS program tried to address this issue, by testing the ability of the program in reducing anger, shame, and paranoia in male prison inmates. Data were analyzed with the Reliable Change Index (Jacobson and Truax 1991), which assesses individual clinical change (for a detailed description on how this statistical method was used in this study, see Brazão et al 2015a). Results showed that, while the 24 treatment participants presented clinical improvement in anger, shame, and paranoia, the majority of the 24 controls showed clinical deterioration in the same variables between baseline and posttreatment assessments.…”

Promoting emotion and behavior regulation in male prison inmates: A secondary data analysis from a randomized controlled trial testing the efficacy of the growing pro-social program.

“…This RCT analyzed the program's ability to reduce the offender's cognitive malfunctioning, namely the use of cognitive distortions and the prominence of early maladaptive schemas (Brazão et al, 2015a;Brazão et al, 2017a). The impact of the GPS in variables that, from an evolutionary perspective, have been proposed as relevant variables associated with antisocial behavior, specifically anger, shame and paranoia, was also addressed by recent studies (Brazão, da Motta, Rijo, Salvador, Pinto-Gouveia, & Ramos, 2015b;Brazão, Rijo, Salvador, & Pinto-Gouveia, 2017b).…”