Psychological interventions for antisocial personality disorder.

Area of Science:

• Psychiatry
• Psychology
• Clinical Trials

Background:

• Antisocial Personality Disorder (AsPD) is linked to significant life disturbances, including rule-breaking, criminality, substance use, unemployment, homelessness, and relationship issues.
• Effective psychological interventions for AsPD are crucial for improving patient outcomes and reducing societal costs.

Purpose of the Study:

• To systematically evaluate the efficacy and safety of psychological interventions for individuals diagnosed with Antisocial Personality Disorder (AsPD).
• To identify which psychological interventions, if any, demonstrate beneficial effects and to assess potential adverse effects in the AsPD population.

Main Methods:

• A comprehensive literature search was conducted across multiple databases (CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, ASSIA, BIOSIS, COPAC).
• Inclusion criteria specified prospective, controlled trials with random allocation of participants with AsPD to psychological interventions versus control conditions (treatment as usual, waiting list, or no treatment).
• Data extraction and analysis involved independent review by multiple authors, calculating mean differences and odds ratios for relevant outcomes.

Main Results:

• Eleven studies with 471 participants met the criteria, but data were available from only five studies (276 participants).
• Cognitive Behaviour Therapy (CBT) and contingency management showed some benefits for substance misuse in specific patient groups, but not consistently across all studies or populations.
• A multi-component intervention ('Driving Whilst Intoxicated program') was effective for drink-driving offenders, but overall, few studies addressed primary outcomes like aggression or reconviction.

Conclusions:

• There is currently insufficient high-quality trial evidence to support the widespread use of psychological interventions for adults with Antisocial Personality Disorder (AsPD).
• While certain interventions like contingency management and CBT demonstrated effectiveness for substance misuse outcomes, no significant improvements in core antisocial behaviors were observed.
• Further rigorous research is urgently needed to develop and validate effective psychological treatments for AsPD, addressing its significant impact on individuals and society.