Cognitive behavioural therapy (CBT) is used widely in the criminal justice system (CJS) in England and Wales. However, concerns are being raised about its effectiveness. A recent review of one-to-one CBT to treat depression found its impact had fallen substantially over time, from early trials in the late 70s to contemporary trials. A subsequent study of group CBT for depression was less clear cut. However, these and other studies have also suggested that standardised programmes using less qualified staff are less effective than non-standardised programmes using more highly qualified staff, and the former is the delivery model used routinely in the CJS. There has also been criticism of how closely the practice of CBT in the CJS adheres to the theoretical underpinnings of CBT. Critics have argued that fidelity to the original principles of CBT has eroded overtime. In the CJS there are further concerns that CBT does not engage with the ‘whole’ person, and does not recognise the complexity of personal change. The aim of this study is to revisit the effectiveness of CBT in the CJS. We will undertake a systematic review of the evidence worldwide to ask whether there is evidence of its effect diminishing over time and whether standardised programmes using less qualified staff are less effective. We will also ask whether CBT in the CJS is engaged sufficiently with its underlying theory and whether this theory is coherent. Our findings will help us identify implications for policy and practice.

What is the need?

Cognitive behavioural therapy (CBT) has assumed a central role in criminal justice interventions on the grounds that a strong foundation of international evidence, including previous systematic reviews and meta-analyses, demonstrates its effectiveness in reducing recidivism. Indeed, most accredited programmes delivered in the CJS are rooted in CBT methodologies and aim to change attitudes and thinking of people convicted of an offence. However, to gain accreditation, programmes primarily have to demonstrate that they follow principles associated with the Risk, Needs, Responsivity (RNR) model, so the evidence for the effectiveness of many accredited programmes in the UK is one step removed from the programmes themselves. This might be of little concern if the broader evidence on CBT was secure, but concerns about the efficacy of CBT outside of the CJS as well as concerns about the design and delivery of CBT within the CJS are growing.

Johnsen and Friborg (2015) published a meta-analysis of one-to-one, face-to-face CBT showing that its effect as a treatment for depression has fallen substantially over time, from early trials conducted in the late 1970s to contemporary trials. This follows previous meta-analyses questioning whether CBT is superior to other non-CBT therapeutic treatments. Results from a subsequent study using a similar design to review temporal changes in the effects of group CBT as a treatment for depression was less clear-cut. However, these studies also suggest that standardised programmes using less qualified staff are less effective than other CBT work delivered by trained specialists, which should be a concern for programmes in the CJS. These echo concerns about the use of CBT in the criminal justice system where there is a concern about ‘sausage factory’ interventions and unresponsive ‘one size fits all’ approaches to rehabilitation and learning. A substantial body of evaluation research supports the idea of a “scale-up penalty” in the delivery of criminal justice interventions whereby measures of effectiveness drop considerably when an intervention moves from a demonstration project to large-scale delivery across a service.

There are also concerns that CBT as it is delivered in the CJS today is significantly removed from the origins of CBT. Original developers of CBT drew heavily on philosophies such as stoicism. More recently, ‘third wave’ CBT theorists draw on Eastern philosophies such as Buddhism. Both philosophical approaches offer a full account of how to live the ‘good’ life that is lacking in the mainstream practice of CBT in the CJS, which focuses on understanding and correcting thoughts, without the foundation of a broader philosophy of life. Critics argue that CBT programmes in the CJS stipulate a schema within which people have to work that prevents participants from articulating their past in a way that is meaningful to them and focuses narrowly on criminogenic issues without engaging in broader narrative accounts of individual behaviours.

What are we doing?

We adopt a three-stage approach:

• A review of mid-level theories that underpin CBT involving workshops with experts in which a series of ‘provocations’ are considered
• A Systematic Review and meta-analysis of the effects of CBT over time in the criminal justice system (CJS). The Systematic Review, incorporating a meta-analysis of the use of CBT in criminal justice settings and will examine the effect of moderator variables (e.g. staff training and implementation factors) on the effects of CBT on recidivism. We will also undertake a regression analysis exploring its effect over time.
• Synthesising findings from the first two stages we will consider implications for policy and practice in the English and Welsh CJS.

What will be the outcomes?

Outcomes will include

• A Provocation exploring theoretical challenges to the use of CBT in criminal justice settings
• A Systematic Review, incorporating a meta-analysis of the use of CBT in criminal justice settings and a regression analysis exploring its effect over time
• Two policy and practice briefings

What are the timescales?

The started in January 2021 and will run for approximately 18 months

Funder

This project is funded by the Nuffield Foundation

Project downloads

Provocations: Over the past 20 years, CBT has come under significant scrutiny. This document sets out a ‘typology of criticisms’ that provided the framework for developing four ‘provocations’ which were discussed with experts in a series of workshops in Spring/Summer 2021.