Scientific background

Scientific and theoretical background

Treatment programs for sexual offenders

Face-to-face treatments of persons that committed a child sexual abuse could reduce the relevant fall-back risk (e.g., Lösel & Schmucker, 2005). But the treatment’s effectiveness is conditional on the form of treatment. Programs for cognitive behaviour therapy are most effective in the treatment of sexual offenders at risk of fall-back according to meta-analyses (e.g., Lösel & Schmucker, 2005). This is especially true when the treatment follows the RNR-principle (Hanson et al., 2009). The RNR-principle is geared to the three principles risk, need and responsivity (Risk-Need-Responsivity; Andrews & Bonta, 2007) and primarily targets at fall-back prevention (Laws, Hudson & Ward, 2000). Here, it is expected that therapeutical treatment measures are especially effective (1) if the treatment focus on patients with a medium to high fall-back risk (risk-principle), (2) if the risk-variables are treated that are most strongly linked with fall-back risk (need-principle) and (3) if treatment measures are adjusted to the patients’ respective cognitive competences and learning styles (responsivity-principle). The application of these principles within the scope of a cognitive behaviour therapy is up to now the most frequently used and most effective treatment measure for humans that have committed sexual offences (Yates, Prescott & Ward, 2010; Lösel & Schmucker, 2005).

The risk-assessment must be updated regularly during the treatment process according to the risk-principle (Andrews & Bonta, 2010). This risk-assessment is based on statistical and dynamic risk-assessment tools (e.g. Rettenberger & Franqué, 2013) because the offender’s actual personal living conditions must be considered beside the assessment of the general fall-back risk. The statistical and firm-dynamic risk-factors must be supplemented by a focusing on acute-dynamic risk-factors (Hanson, Harris, Scott & Helmus, 2007). Recent treatment concepts focus therefore on empirically documented risk-factors (Mann, Hanson & Thornton, 2010).

These empirically documented risk-factors are furthermore relevant for the second aspect of RNR: the need-principle. Many conventional treatment programs are espececially not oriented towards the need-principle. This means that risk-variables are frequently adressed that are not associated with fall-back risk as has been demonstrated. Risk-variables that are associated with the likelihood of a (further) sexual assault and should be considered during the development of future treatment programs were determined in a meta-analysis and represent the basics of the intervention program developed in »@myTabu« (Mann, Hanson, & Thornton, 2010).

More recent therapy concepts that are not yet sufficiently studied and are therefore not included in the meta-analyses mentioned above stress the importance of positive aspects of a life without offences. The “Good-Live”-Modell (GLM, Ward & Steward, 2003) for instance does not follow a mere fall-back preventive approach but brings approach-goals into focus. These more recent concepts will also be integrated in the intervention program of »@myTabu«. Further information about the scientific design can be found in the clinical study protocol.

Internet-based interventions

One possibility to address many persons therapeutically are online-interventions. In the last two decades there were more than 100 randomized controlled trials to evaluate interned-based interventions in the realm of general clinical psychology. Moderate to very strong effect sizes were detected. Hedman, Ljótsson and Lindefors (2012) studied internet-based cognitive bevaviour therapy for different syndroms in the context of a meta-analysis and reported effect sizes between 0.38 and 2.27 for depression, 0.62 and 2.92 for panic disorder, 0.6 and 1.53 for social phobia as well as 0.89 and 1.69 for posttraumatic stress disorder. Similar effect sizes were discovered amongst others for internet-based treatment of generalized anxiety disorder, obsessive-compulsive disorder and arachnophobia. These online-therapies demonstrated that especially cognitive behavioural focused therapies with therapeutical supervision exhibit great effect sizes than therapies without supervision (Andersson & Cuijpers, 2009; Spek et al., 2007).

Internet-based therapies demonstrate not only a good success regarding therapy outcome but also with regard to patients’ satisfaction. Most patients rate supervised internet-based interventions as pleasent (87-88%) and personal (75-78%) and state that the therapeutical relationship increases during therapy (57-78%)  and that the majority of patients does not miss face-to-face contact (68-89%). Furtheremore, several forms of contact (e.g., chat and e-mail contact) led to a better therapeutical relationship than only one form of contact and the therapeutical relationship’s quality rating correlates with therapy success as it is the case in face-to-face therapies.

Because of the fact that supervised internet-based therapies lead to a symptom reduction among many studied disorders (Hedman et al., 2012) it is possible that these can also be applied in other areas such as treatment of potential and actual child abuse offenders and users of child abuse images. The English prevention program “Stop it now! UK and Ireland“ (The Lucy Faithfull Foundation, 2017) is a first attempt. It is available online and focus on users of child abuse material. It is a self-help program in which persons concerned can participate independently. This means that patients are not supported by a therapist during the work on the exercises; furthermore, there are no effectiveness studies published so far. It seems to be questionable wether mere self-help programms without supervision by a therapist are equally effective regarding the reduction of essential risk-factors like face-to-face therapies or supervised online-interventions (Andersson & Cuijpers, 2009; Spek et al., 2007).

In Germany there are according to our current knowledge no internet- and therapist-based treatment programs for individuals who sexually abused children and individuals who consumed child sexual exploitation material under community supervision (Wild, Fromberger et al., 2018).

Literature

Andersson, G., & Cuijpers, P. (2009). Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cognitive Behaviour Therapy, 38(4), 196-205.

Andrews, D. A. & Bonta, J. (2007). The risk-need-responsivity model of assessment and human service in prevention and corrections: Crime-prevention jurisprudence. The Canadian Journal of Criminology and Criminal Justice, 49, 439-464.

Fromberger, P., Schröder, S., Bauer, L., Siegel, B., Tozdan, S., Briken, P. et al. (2021). @myTabu—A Placebo Controlled Randomized Trial of a Guided Web-Based Intervention for Individuals Who Sexually Abused Children and Individuals Who Consumed Child Sexual Exploitation Material: A Clinical Study Protocol. Frontiers in Psychiatry, 11, 1-18. https://doi.org/10.3389/fpsyt.2020.575464

Hanson, R. K., Bourgon, G., Helmus, L., & Hodgson, S. (2009). The principles of effective correctional treatment also apply to sexual offenders: A meta-analysis. Criminal Justice and Behavior, 36, 865-891.

Hanson, R. K., Harris, A. J., Scott, T. L., & Helmus, L. (2007). Assessing the risk of sexual offenders on community supervision: The Dynamic Supervision Project (Vol. 5, No. 6). Ottawa, Ontario: Public Safety Canada.

Hedman, E., Ljótsson, B., & Lindefors, N. (2012). Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost–effectiveness. Expert Review of Pharmacoeconomics & Outcomes Research, 12(6), 745-764.

Laws, D. R., Hudson, S. M., & Ward, T. (2000). Remaking relapse prevention with sex offenders: A sourcebook (pp. 79-101). London: Sage Publications, Inc.

Lösel, F. & Schmucker, M. (2005). The effectiveness of treatment for sexual offenders: A comprehensive meta-analysis. Journal of Experimental Criminology, 1, 1-29.

Mann, R. E., Hanson, R. K., & Thornton, D. (2010). Assessing risk for sexual recidivism: Some proposals on the nature of psychologically meaningful risk factors. Sexual Abuse, 22(2), 191-217.

Rettenberger, M., & von Franqué, F. (2013). Handbuch kriminalprognostischer Verfahren. Hogrefe Verlag.

Spek, V., Cuijpers, P. I. M., Nyklíček, I., Riper, H., Keyzer, J., & Pop, V. (2007). Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychological Medicine, 37(3), 319-328.

The Lucy Faithful Foundation (2017). Stop it Now! UK and Ireland. Letzter Zugriff am 25.10.2019 über https://get-help.stopitnow.org.uk/

Ward, T. & Stewart, C. A. (2003). The treatment of sex offenders: Risk management and good lives. Professional Psychology, Research and Practice, 34, 353-360.

Wild, T. S., Fromberger, P., Jordan, K., Müller, I., & Müller, J. L. (2018). Web-Based Health Services in Forensic Psychiatry: A Review of the Use of the Internet in the Treatment of Child Sexual Abusers and Child Sexual Exploitation Material Offenders. Frontiers in Psychiatry, 9.

Yates, P. M., Prescott, D., & Ward, T. (2010). Applying the good lives and self-regulation models to sex offender treatment: A practical guide for clinicians. Brandon, Vermont: Safer Society Press.