This new review sought to evaluate the effects of cognitive behavioural therapy (CBT) for young people aged 10 to 18 years who have exhibited harmful sexual behaviour (HSB).
The review authors included four randomised controlled trials (RCTs) with a total of 115 participants. Two studies involved males aged 12 to 18 years old. The other two studies described them simply as “adolescents”. Three studies took place in the USA and one in South Africa. All studies were of short duration; one lasted two months, two lasted three months and one lasted six months. No information was available on funding sources.
Two studies compared group-based CBT to no treatment (18 participants) or treatment as usual (21 participants). One compared CBT with sexual education (16 participants) and one compared CBT (19 participants) with mode-deactivation therapy (21 participants) and social skills training (20 participants). Three interventions were delivered in a residential setting by someone working there; the other delivered in the community by a licensed therapist undertaking a PhD.
Only one study (59 participants) assessed if CBT reduced HSB. It found little to no difference between CBT and alternative treatment on post-treatment sexual aggression scores.
In terms of the secondary outcomes, the review authors found very low-certainty evidence that CBT:
- made little to no difference to cognitive distortions, generally (1 study, 18 participants) or about rape (1 study, 21 participants) when compared with treatment as usual, or about inappropriate sexual fantasies (1 study, 16 participants) when compared with sexual education;
- may result in lower cognitive distortions about justifications or taking responsibilities for actions, apprehension confidence and social-sexual desirability (1 study, 16 participants) when compared with sexual education; and
- may result in greater improvements in victim empathy (1 study, 18 participants) when compared with no treatment (also measured by another study but no useable data was provided).
No study reported data on adverse events such as self-harm or suicidal behaviour.
The review authors concluded that it is unclear from the available evidence whether or not CBT reduces HSB in male adolescents. There were only four studies, with very small sample sizes, and the studies were rated at unclear or high risk of bias on most domains. The evidence was rated as very low quality meaning that the results are likely to change when additional studies are included. Better quality RCTs of individual and group-based CBT are needed, especially outside North America.
The evidence is current to June 2019.
Read the full review here on the Cochrane Library.