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@myTabu – Konzept einer Therapeuten-gestützten Online-Intervention für verurteilte Personen, die Kindesmissbrauch begangen oder Missbrauchsabbildungen konsumiert haben
Abstract
Sexueller Missbrauch hat für Kinder sowohl kurzfristig als auch langfristig starke negative Folgen. Eine Vielzahl von Behandlungsprogrammen in Deutschland hat daher die Prävention von Kindesmissbrauch zum Ziel. Ein Ansatzpunkt ist dabei die Tertiärprävention, d. h. Maßnahmen zur Verhinderung von Rückfälligkeit. Bisher wurde dies mit uneinheitlichen Techniken in face-to-face-Settings umgesetzt. Digitale tertiärpräventive Programme existieren bis jetzt noch nicht. Das Konzept einer neu entwickelten Online-Intervention (@myTabu) für verurteilte Personen in Bewährungs-/Führungsaufsicht, die Kindesmissbrauch begangen oder Missbrauchsabbildungen konsumiert haben, wird in diesem Artikel dargestellt. Es wird erläutert, an welchen Risikofaktoren die Online-Intervention ansetzt und mit welchen psychotherapeutischen Techniken die Arbeit an den Risikofaktoren umgesetzt wird. Die Wirksamkeitsprüfung des therapeutischen Konzeptes erfolgt ab Januar 2021 im Rahmen einer placebo-kontrollierten klinischen Add-On Studie, deren Grundzüge skizziert werden.
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Offenders’ readiness to engage in changes that will reduce their risk of reoffending is now recognized to be as important as the design and delivery of programmes that support such change. Interest is growing in both how to increase engagement in change processes, and how to measure any improvements in engagement. This study evaluated the effects of a brief offending-focused motivational interviewing (MI) intervention on reconviction in male prisoners serving sentences for diverse crimes. Men who undertook MI were significantly less likely to be reconvicted than those who did not. The results also served to validate a stage-based measure of readiness to change derived from Prochaska and DiClemente's Transtheoretical Model. Prisoners who were offered MI increased their readiness to change by an average of one stage, while the scores of men who were not remained unchanged. Furthermore – whether men undertook MI or not – change in stage of change predicted reconviction. This was a high-risk sample, making the results intriguing for at least two reasons. First, reductions in recidivism are usually achieved only with much more intensive programmes for high-risk men. Second, according to ‘traditional’ cognitive–behavioural rehabilitation theory, programmes need to target change in dynamic risk factors directly to reduce reconviction risk. That these results were obtained with men whose initial motivation was low, and in the absence of any ‘traditional’ criminogenic rehabilitation, raises questions about whether there is more than one mechanism involved in desistance.
The identification of offence-related cognition is a major target of most cognitive–behavioural treatment programmes for sexual offenders, and a number of measures are available for this purpose. This study assessed the psychometric properties of a brief measure of beliefs that support and justify child sexual abuse: the Sex With Children (SWCH) scale. Factor analysis revealed two distinct types of belief: that sex with children is harmless, and that children actively provoke adults into having sex with them. The SWCH was also found to have good internal consistency, test–retest reliability and concurrent validity. Child molesters scored significantly more highly on the SWCH than did rapists or non-offenders, and high-risk child molesters reported more entrenched offence-supportive beliefs than lower risk child molesters. A relationship was also observed between general offence-supportive beliefs as measured by SWCH and offence-specific cognitions ascribing responsibility or enjoyment to the offender's victim. The SWCH subscales appeared to closely match two of the implicit theories hypothesized by Ward and Keenan (199937.
Ward , T. and
Keenan , T. 1999. Child molesters’ implicit theories. Journal of Interpersonal Violence, 14: 821–838. [CrossRef], [Web of Science ®], [CSA]View all references) to be related to child molestation. Sex offender treatment providers need to be aware of the relationship between underlying implicit theories and offence-specific distorted cognitions about the victim's experience.
Risk assessment and treatment for sexual offenders should focus on individual characteristics associated with recidivism risk. Although it is possible to conduct risk assessments based purely on empirical correlates, the most useful evaluations also explain the source of the risk. In this review, the authors propose that the basic requirements for a psychologically meaningful risk factor are (a) a plausible rationale that the factor is a cause of sexual offending and (b) strong evidence that it predicts sexual recidivism. Based on the second of these criteria, the authors categorize potential risk factors according to the strength of the evidence for their relationship with offending. The most strongly supported variables should be emphasized in both assessment and treatment of sexual offenders. Further research is required, however, to establish causal connections between these variables and recidivism and to examine the extent to which changes in these factors leads to reductions in recidivism potential.
Evidence from 61 follow-up studies was examined to identify the factors most strongly related to recidivism among sexual offenders. On average, the sexual offense recidivism rate was low (13.4%; n = 23,393). There were, however, subgroups of offenders who recidivated at high rates. Sexual offense recidivism was best predicted by measures of sexual deviancy (e.g., deviant sexual preferences, prior sexual offenses) and, to a lesser extent, by general criminological factors (e.g., age, total prior offenses). Those offenders who failed to complete treatment were at higher risk for reoffending than those who completed treatment. The predictors of nonsexual violent recidivism and general (any) recidivism were similar to those predictors found among nonsexual criminals (e.g., prior violent offenses, age, juvenile deliquency). Our results suggest that applied risk assessments of sexual offenders should consider separately the offender's risk for sexual and nonsexual recidivism.
A meta-analysis of 82 recidivism studies (1,620 findings from 29,450 sexual offenders) identified deviant sexual preferences and antisocial orientation as the major predictors of sexual recidivism for both adult and adolescent sexual offenders. Antisocial orientation was the major predictor of violent recidivism and general (any) recidivism. The review also identified some dynamic risk factors that have the potential of being useful treatment targets (e.g., sexual preoccupations, general self-regulation problems). Many of the variables commonly addressed in sex offender treatment programs (e.g., psychological distress, denial of sex crime, victim empathy, stated motivation for treatment) had little or no relationship with sexual or violent recidivism.
Die Arbeit beschäftigt sich mit der Behandlung von verurteilten Sexualstraftätern. Im Rahmen einer Metaanalyse soll der Forschungsstand zu rückfallpräventiver Wirksamkeit der Straftäterbehandlung zusammengefaßt werden. Im Zentrum der Analyse steht einerseits, inwieweit vorliegende Behandlungsangebote für diese Tätergruppe zielführend sind, andererseits soll versucht werden, spezifische Aspekte erfolgreicher Behandlung zu isolieren.
Der Autor nimmt eine allgemeine Charakterisierung von Sexualstraftätern, der Prävelanz sexueller Delinquenz und der Rückfälligkeit sowie der Folgen für die Opfer sexueller Übergriffe vor, um einen Überblick über den Gegenstandsbereich zu gewinnen und die Notwendigkeit eines angemessenen Umgangs mit Stratätern zu dokumentieren. In der darauf folgenden Konzentration auf behandlungsrelevante Charakteristika von Sexualstraftätern und den verfügbaren allgemeinen Behandlungskonzepten sollen die Grundlagen der anschließenden Wirksamkeitsüberprüfung solcher Maßnahmen gelegt werden. Es erfolgt die Darstellung einer eigenen umfassenden metaanalytischen Integration deutscher und internationaler rückfallbezogener Wirksamkeitsuntersuchungen.
Das 384 Seiten starke Buch ist eine Denkanstoß-Schatzkiste, wie Marsha Linehans Vorgänger-Skillstraining-Manual. Dank moderner Sprache, für den Anwender nutzbringend umgesetzter Anwendung lerntheoretischer Erkenntnisse und liebevoller Verlagstätigkeit ist es aber weitaus besser verdaulich als dieses. (...) ... verbindet in erfrischender Weise Spaß und Struktur, Möglichkeit zur eigenen Geschwindigkeit zwischen Hürdensprints und langmütiger Beharrlichkeit. Die Cartoons von Renate Alf befriedigen nicht nur das Kind im Therapeuten und im Klienten, sie sind an manchen Stellen darüber hinaus geradezu Mentalisierungsvorschläge für Zustände und Abläufe, die für Betroffene dann besser wiedererkennbar und regulierbar werden.
Background:
In previous research, variables such as age, education, treatment credibility, and therapeutic alliance have shown to affect patients' treatment adherence and outcome in Internet-based psychotherapy. A more detailed understanding of how such variables are associated with different measures of adherence and clinical outcomes may help in designing more effective online therapy.
Objective:
The aims of this study were to investigate demographical, psychological, and treatment-specific variables that could predict dropout, treatment adherence, and treatment outcomes in a study of online relaxation for mild to moderate stress symptoms.
Methods:
Participant dropout and attrition as well as data from self-report instruments completed before, during, and after the online relaxation program were analyzed. Multiple linear and logistical regression analyses were conducted to predict early dropout, overall attrition, online treatment progress, number of registered relaxation exercises, posttreatment symptom levels, and reliable improvement.
Results:
Dropout was significantly predicted by treatment credibility, whereas overall attrition was associated with reporting a focus on immediate consequences and experiencing a low level of intrinsic motivation for the treatment. Treatment progress was predicted by education level and treatment credibility, whereas number of registered relaxation exercises was associated with experiencing intrinsic motivation for the treatment. Posttreatment stress symptoms were positively predicted by feeling external pressure to participate in the treatment and negatively predicted by treatment credibility. Reporting reliable symptom improvement after treatment was predicted by treatment credibility and therapeutic bond.
Conclusions:
This study confirmed that treatment credibility and a good working alliance are factors associated with successful Internet-based psychotherapy. Further, the study showed that measuring adherence in different ways provides somewhat different results, which underscore the importance of carefully defining treatment adherence in psychotherapy research. Lastly, the results suggest that finding the treatment interesting and engaging may help patients carry through with the intervention and complete prescribed assignments, a result that may help guide the design of future interventions.
Trial registration:
Clinicaltrials.gov NCT02535598; http://clinicaltrials.gov/ct2/show/NCT02535598 (Archived by WebCite at http://www.webcitation.org/6fl38ms7y).
Sexual offences are a heterogeneous group of offences that entail very different diagnostic categories relevant for key issues of expert assessment. Sexual offender trials usually deal with issues related to (diminished) responsibility and the necessity of a referral to a forensic psychiatric hospital (§ 63 StGB, German penal code). Furthermore, risk assessment is seen as a necessary precondition for relapse prevention and consequently, it forms part of any expert assessment in sex offender trials. In terms of treatment, manualized treatment programs prevail. Usually they lend themselves to psychoeducative, cognitive-behavioral and psychodynamic concepts. Notwithstanding the focus of any individual program, core elements of all programs pertain to offence related (e.g., victim empathy, attitudes and individual values, minimizations, etc.) and more general psychotherapy modules (anger management, substance abuse, social skills training, etc.). Advantages and disadvantages of these programs are named and discussed.
We studied to what extent internet-based cognitive behaviour therapy (CBT) programs for symptoms of depression and anxiety are effective.
A meta-analysis of 12 randomized controlled trials.
The effects of internet-based CBT were compared to control conditions in 13 contrast groups with a total number of 2334 participants. A meta-analysis on treatment contrasts resulted in a moderate to large mean effect size [fixed effects analysis (FEA) d=0.40, mixed effects analysis (MEA) d=0.60] and significant heterogeneity. Therefore, two sets of post hoc subgroup analyses were carried out. Analyses on the type of symptoms revealed that interventions for symptoms of depression had a small mean effect size (FEA d=0.27, MEA d=0.32) and significant heterogeneity. Further analyses showed that one study could be regarded as an outlier. Analyses without this study showed a small mean effect size and moderate, non-significant heterogeneity. Interventions for anxiety had a large mean effect size (FEA and MEA d=0.96) and very low heterogeneity. When examining the second set of subgroups, based on therapist assistance, no significant heterogeneity was found. Interventions with therapist support (n=5) had a large mean effect size, while interventions without therapist support (n=6) had a small mean effect size (FEA d=0.24, MEA d=0.26).
In general, effect sizes of internet-based interventions for symptoms of anxiety were larger than effect sizes for depressive symptoms; however, this might be explained by differences in the amount of therapist support.
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