Psychological interventions for antisocial personality disorder.

Area of Science:

• Psychiatry
• Clinical Psychology
• Evidence-Based Practice

Background:

• Antisocial personality disorder (AsPD) is linked to significant mental health issues, criminality, substance use, and relationship problems.
• This review provides an updated evaluation of psychological interventions for adults diagnosed with AsPD.

Purpose of the Study:

• To assess the potential benefits and adverse effects of psychological interventions for adults with AsPD.
• To synthesize evidence from randomized controlled trials comparing psychological interventions to control conditions.

Main Methods:

• Searched multiple databases (CENTRAL, MEDLINE, Embase) and trials registers up to September 2019.
• Included randomized controlled trials (RCTs) of adults with AsPD (≥75% of sample).
• Primary outcomes included aggression, reconviction, global functioning, social functioning, and adverse events.

Main Results:

• Included 19 studies (8 new), with data from 10 studies (605 participants).
• Most interventions showed no significant difference compared to treatment-as-usual (TAU) for primary outcomes.
• Contingency management (CM) + standard maintenance (SM), schema therapy (ST), and dialectical behavior therapy (DBT) showed some evidence of potential benefit, but with very low certainty.

Conclusions:

• Evidence for psychological interventions in AsPD is very limited and of low to very low certainty.
• Few interventions demonstrated effectiveness in improving antisocial behavior or other primary outcomes.
• Further methodologically rigorous studies are needed, and novel approaches may be required for effective AsPD treatment.