Question: In people with a diagnosis of antisocial / dissocial personality disorder, what is the most effective psychological intervention (including possible community treatment methods) in reducing emotional instability, risk and offending?

Answer:

No definite clinical implications can be made from the available evidence. The authors of a systematic review (SR) stated that professionals will therefore have to rely on their clinical experience, but recognise that good quality evidence supporting whatever intervention is chosen is virtually non-existent. They also stated that because it may be difficult to retain people with anti-social personality disorder (ASPD) and substance misuse in a treatment programme, contingency management may be useful. The authors of a randomised controlled trial (RCT) stated that for clients with a serious mental illness and a substance use disorder, integrated treatment such as assertive community treatment or standard clinical case management, should be provided by whatever route can be implemented and sustained.

There was consensus among the included studies that further research is needed in to clarify which psychological treatments are effective for people with ASPD. The authors of the SR acknowledged the difficulty in retaining this population group in a trial. They recommended that treatments be assessed in individuals incarcerated, and evaluate reconviction after release from prison as a primary outcome.  The authors of a RCT stated that future studies should further examine the effectiveness of different types of case management interventions and explore how the effectiveness of these approaches may vary for clients with different characteristics-for example, type and extent of substance use, mental health diagnosis, and stage of readiness for treatment.

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To view the Cochrane review which is included in this summary, click Related Documents, below.