Psychopathy – Can we treat it? The effects of Compassion-Focused Therapy on detained youth

Diana Ribeiro da Silva, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra
Daniel Rijo, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra
Randall T. Salekin, University of Alabama
Marlene Paulo, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra
Rita Miguel, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra
Paul Gilbert, University of Derby

Objective To assess the preliminary efficacy of the PSYCHOPATHY.COMP in reducing psychopathic traits among male detained youth.
Method In this controlled trial, a treatment group (n = 24) and a control group (n = 22) answered the Youth Psychopathic Traits Inventory-Short at baseline and post-treatment. Treatment participants attended the PSYCHOPATHY.COMP, in addition to the Treatment As Usual (TAU); controls only received TAU. The treatment effects were tested both at a group level (2 × 2 mixed ANOVA) and at an individual level (Reliable Change Index; RCI).
Results ANOVAs showed medium to large effect sizes (η2p), while RCIs revealed strong to moderate effect sizes (Cramer’s V).
Conclusions Despite the PSYCHOPATHY.COMP, suggesting that interventions targeting psychopathic traits should be considered in the rehabilitation of detained youth, as the absence of tailored interventions may increase the levels of psychopathic traits and its associated risks.

Compassion focused therapy, Conduct disorder, Detained youth, Individual psychotherapeutic interventions, Juvenile justice system, Psychopathic traits

“Although there is a long debate whether psychopathic traits are treatable or not, few studies tested the efficacy of intervention programs in reducing psychopathic traits and there is still a scarcity of psychotherapeutic interventions specifically tailored to target psychopathic traits. Considering the high risk for detained youth with psychopathic traits to reoffend and to face prison sentences in adulthood, there is a clear need to build on previous research, developing and testing the efficacy of psychotherapeutic interventions specifically tailored to reduce psychopathic traits in this at-risk population.”

“the findings from [two of these] studies suggested that criminal recidivism rates can be reduced after the delivery of a cognitive-behavioral–based intervention to detained youth with psychopathic traits”

“Ribeiro da Silva and colleagues developed a new individual intervention, the PSYCHOPATHY.COMP program, which was specifically designed to target psychopathic traits (for a detailed description of the program, see Interventions section). The PSYCHOPATHY.COMP is based on Compassion Focused Therapy (CFT), an evolution-based approach to mental functioning that showed promising results in the treatment of several mental health problems in adulthood, some of them previously considered difficult to treat.”

“The PSYCHOPATHY.COMP is a manualized program of 20 60-min sessions, which runs on a weekly basis. Sessions must be delivered by therapists skillful in CFT. The program’s structure follows a progressive strategy of change, which occurs in four successive modules (see Table 1): (1) the basics of our mind; (2) our mind according to CFT; (3) compassionate mind training; and (4) recovery, relapse prevention, and finalization. As a common feature of all therapeutic sessions, therapists are focused on developing a secure therapeutic relationship, evaluating the motivational stage of the youth, and stimulating the CMT.”

“The results demonstrated that the PSYCHOPATHY.COMP was effective in reducing psychopathic traits in a sample of male detained youth. Considering the total score of the YPI-S, differences between treatment and control groups were found, i.e., with a large effect size, psychopathic traits reduced in the treatment group but not in the control group. A strong effect size was also observed concerning clinical change, i.e., while the majority of participants from the treatment group improved on the total score of the YPI-S and none treatment participant deteriorated, the majority of participants from the control group deteriorated over time. These findings suggested that the PSYCHOPATHY.COMP program may be an accurate therapeutic intervention to reduce psychopathic traits among male detained youth. Moreover, these data also indicated that the TAU may contribute to maintain or increase psychopathic traits in detained youth. These findings support the idea that the absence of tailored interventions targeting psychopathic traits may account for an important deterioration in the levels of psychopathic traits in detained youth, which may increase the odds of these youth to display disruptive and antisocial behavior after release.”

“Regarding GM traits, differences between groups were also found; GM traits reduced in the treatment group but not in the control group (with a medium effect size). A moderate effect size was also observed concerning clinical change in GM traits, i.e., while the majority of participants from the treatment group improved on the GM factor, the majority of participants at the control group deteriorated or showed no change over time. These findings suggest that the PSYCHOPATHY.COMP program may be able to provide substantial improvements on GM [Grandiose/Machiavellian] traits, compared to TAU.”

“In specific, while the majority of participants from the treatment group improved on the CU factor and none participant from the treatment group deteriorated, a high percentage of participants from the control group deteriorated or showed no change over time.”

“Besides acknowledging the influence of genetic, epigenetic, neural, and environmental effects, CFT also recognizes the importance of evolutionary influences to the human functioning. In specific, CFT also recognizes that humans have an innate set of basic motivations, crucial to surviving and thriving, which include universal and automatic reactions to physical and social threats/opportunities as well as basic attachment and affiliative instincts. To integrate these motivations and to regulate emotional states, humans may recourse to the threat system (common to all species; its function is to protect individuals from threats through archaic and automatic responses—freeze, flight, fight), to the drive system (its function is to allow individuals to experience positive feelings that encourage, guide, and motivate them to seek out resources to survive and thrive), and to the soothing system (its function is to allow individuals to experience tranquility and safeness). According to a CFT framework, mental health problems emerge when there is an unbalance of these emotion regulation systems, particularly when the threat activation commands individuals’ functioning. Central to the activation of the threat system is shame (unbearable and persistent feelings of being inadequate, inferior, and valueless) and shame regulation problems, which seem to have a key role in several mental health problems.”

“CFT conceptualizes antisocial behavior patterns and psychopathic traits as evolutionary rooted responses to deal with harsh rearing scenarios (i.e., rearing environments marked by traumatic experiences—e.g., unpredictability, threat, child abuse; and/or by the absence of affiliative signals—e.g., lack of warmth and safeness experiences), which interplay with other etiological factors, like genetic, epigenetic, and neural influences.”

“Young offenders with psychopathic traits tend therefore to be focused on short-term goals, presenting an overdeveloped and hypervigilant threat system and an under responsive soothing system as well as central emotional dysfunctions. These emotional dysfunctions comprise, among others, high levels of shame and emotion regulation problems, i.e., these youth tend to bar the experience of shame and other unpleasant emotions and/or attack others in potential shameful/threatening situations.’

“CFT-based interventions include the Compassionate Mind Training (CMT), i.e., training on specific practices that are designed to cope with the triggering of the threat system; develop the soothing system; balance the emotion regulation systems; overcome fears, blocks, and resistances to compassion; and promote the development of the different flows of compassion—give compassion to others, receive compassion from others, and self-compassion.”

“These results go against literature pointing out that CU traits may be particularly resistant to treatment efforts, highlighting that this set of traits may be effectively reduced if a tailored intervention protocol (which takes into account callous and unemotional features) is delivered to these youth.”

“A clinical case study demonstrated that the PSYCHOPATHY.COMP program was effective in reducing psychopathic traits and disruptive behavior in a juvenile detainee with CD and high levels of psychopathic traits.”

“In the current study, the therapeutic engagement assessment and the integrity of PSYCHOPATHY.COMP’s delivery were ensured by several factors, namely through the training and supervision of the therapists who run the program, through assessing the perception of the youth and of the therapists about each sessions, and through the integrity assessment of a percentage of delivered sessions by independent raters. Results indicated that both youth and therapist perceptions were very positive, as well as the independent raters’ assessments. Moreover, the attrition rate was residual. These findings are somehow contrary to previous research suggesting that detained youth with psychopathic traits tend to present poor therapeutic engagement, indicating that the PSYCHOPATHY.COMP program may help to solve therapeutic engagement issues in detained youth with psychopathic traits.”

As always, please join the discussion below if you have thoughts or comments to add!