A mentalization-based psychotherapy approach can significantly reduce violence and aggression in men diagnosed with antisocial personality disorder, according to a study published yesterday in The Lancet Psychiatry. Mentalization-based treatment aims to help people understand their own thoughts and feelings, as well as those of others, which then improves individuals’ empathy, emotional regulation, and decision making.
“Antisocial personality disorder is a major health and social problem, but scepticism about its treatability has restricted development of the evidence base for psychological treatments,” wrote Peter Fonagy, Ph.D., of University College, London, and colleagues.
Fonagy and colleagues enrolled 313 adult males in England and Wales who had antisocial personality disorder and were on probation for a criminal offense related to their behavior. The participants were randomly divided to receive either a 12-month course of mentalization-based therapy alongside their standard probation services or probation services alone.
The mentalization-based treatment involved weekly 75-minute group therapy sessions alongside monthly 50-minute individual therapy sessions. The group session explored the mental states that underlie various behaviors, particularly in situations involving conflict, while the individual sessions trained individuals how to improve skills such as self-awareness, empathy for others, and reflective thinking.
After 12 months, the adults receiving mentalization-based treatment showed significantly greater reductions in their aggression, with an average score of 90 on the Overt Aggression Scale Modified (down from a baseline of 158), compared with an average of 186 in the control group (up from a baseline of 169). Participants receiving the mentalization-based treatment also had greater reductions in antisocial symptoms such as hostility or impulsiveness after 12 months.
After three years, available data suggested that individuals who received mentalization-based treatment committed 46% fewer “re-offences” that resulted in a guilty verdict than those receiving standard probation services.
“Future research should explore [mentalization-based treatment’s] applicability to broader populations, including those who engage in the most frequent and socially damaging forms of serious violent behaviour affecting public safety such as intimate partner violence,” Fonagy and colleagues wrote. “Criminal justice interventions, including carceral punishment, have failed to reduce reoffending from domestic abuse in general. A therapeutic intervention based on an understanding of the origin of aggression could offer the prospect of a step change.”
For additional information, see the Psychiatric News Special Report “Antisocial Personality Disorder—The Patient in Need Often Overlooked.”
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