Review on 'psychological interventions for antisocial personality disorder' updated!

This review updates a previous Cochrane Review published in 2010. The objectives were to assess the potential benefits and adverse effects of psychological interventions for adults with antisocial personality disorder (AsPD).

The review authors searched for randomised controlled trials comparing a psychological intervention with treatment as usual (TAU; also called standard maintenance or SM), waiting list or no treatment, up to September 2019.

They included 19 studies, eight of which were new to this update; however, data were available from only 10 studies with 605 participants.

Data from single studies showed no evidence of a difference between:

  • cognitive behavioural therapy + TAU and TAU for physical aggression (n = 52, low-certainty evidence) or social functioning (n = 39, very low-certainty evidence);
  • impulsive lifestyle counselling + TAU and TAU for trait aggression (n = 118, very low-certainty evidence), the adverse event of death (n = 142, very low-certainty evidence), and incarceration (n = 142, very low-certainty evidence);
  • ‘driving whilst intoxicated’ programme + incarceration and incarceration for reconviction rates (n = 52, very low-certainty evidence);
  • schema therapy (ST) and TAU for the number of participants reconvicted (n = 30, very low-certainty evidence), and for overall adverse events (n = 30, very low-certainty evidence);
  • social problem solving + psychoeducation and TAU for participants’ level of social functioning (n = 17, very low-certainty evidence); and
  • psychosocial risk management and TAU for total number of officially recorded offences (n = 35, very low-certainty evidence) and the adverse event of death (n = 72, very low-certainty evidence).

Data from single studies showed that:

  • contingency management + SM may improve social functioning compared to SM (n = 83, low-certainty evidence);
  • ST may be more likely to improve social functioning compared to TAU (n = 30, very low-certainty evidence); and
  • dialectical behaviour therapy may reduce the number of self-harm days compared to TAU (n = 14, very low-certainty evidence).

Overall, the certainty of the evidence was very low, meaning that there is little confidence in the effect estimates.

The review authors concluded that there is very limited evidence available on psychological interventions for adults with AsPD.

Read the full review on the Cochrane Library