A pioneering psychological therapy developed by a team of researchers led by University College London (UCL) has shown significant success in reducing violence and aggression among male offenders diagnosed with antisocial personality disorder (ASPD). The study, published in The Lancet Psychiatry, explores the potential of a modified mentalization-based treatment (MBT) to reduce aggressive behaviors and antisocial tendencies.
The modified therapy, known as MBT-ASPD, is designed to improve individuals’ capacity to understand their own emotions and thoughts, as well as those of others. By enhancing interpersonal skills and decision-making abilities, the therapy aims to foster better social interactions among individuals with ASPD, a condition characterized by persistent disregard for others’ rights, impulsivity, aggression, and a lack of remorse.
For this groundbreaking study, 157 male offenders on probation with ASPD in England and Wales underwent a 12-month course of MBT-ASPD, alongside standard probation services. A control group of 156 participants received only the standard probation services. The MBT-ASPD intervention included weekly 75-minute group therapy sessions led by trained clinicians, supported by expert guidance from individuals with lived experience. The therapy focused on developing skills such as empathy, perspective-taking, and reflective thinking, particularly in situations of interpersonal conflict.
The results were striking: men who received MBT-ASPD displayed 50% less aggression compared to those in the control group. Additionally, the treatment group showed a 63% reduction in ASPD symptoms after 12 months, compared to the standard probation group. Over a three-year follow-up period, participants in the MBT-ASPD group committed 46% fewer offenses than those who received only the standard probation services.
Professor Peter Fonagy, Chief Investigator from UCL’s Psychology & Language Sciences, called the study a major breakthrough, noting the significant societal and economic costs associated with ASPD. “Our findings demonstrate that a psychological intervention requiring relatively limited therapist training can meaningfully improve outcomes for individuals with this condition while also reducing their impact on society,” he said.
The study provides strong evidence for the effectiveness of MBT-ASPD in reducing aggression and criminal behaviors in offenders with ASPD, particularly given the mixed results from other psychological treatments, such as Cognitive Behavioral Therapy (CBT). This new approach could offer a more promising avenue for treatment, especially for those who have previously been deemed untreatable.
Professor Anthony Bateman, co-author and lead clinician, expressed optimism about the potential for wider application of the treatment. “This study suggests that clinicians can now be more hopeful about treating individuals with antisocial traits, who have long faced barriers to accessing both physical and mental health care,” he said.
The research team, including Dr. Elizabeth Allison, also from UCL, emphasized the need for further studies to explore how MBT-ASPD could be adapted for more severe cases of violent behavior, including intimate partner violence. “Traditional justice methods, such as imprisonment, have not been effective in reducing reoffending in cases of domestic abuse,” Dr. Allison stated. “We need to explore how MBT-ASPD can be tailored to these situations.”
The study was a collaborative effort between UCL and several institutions, including Anna Freud, Newcastle University, King’s College London, and others. Despite its promising results, the study acknowledges some limitations, including challenges in isolating the specific effects of MBT-ASPD from the additional attention participants received. Data collection issues, exacerbated by COVID-19-related delays, also posed challenges.
The research team now calls for further investigation into the long-term benefits of MBT-ASPD, its potential applications to other populations, and how variations in treatment intensity and duration affect outcomes.
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