The abstinence violation effect in sex offenders: a reformulation

Kia Marama: A Cognitive-Behavioural Program for Incarcerated Child Molesters

A comprehensive cognitive-behavioural treatment program for incarcerated child molesters is described. This program operates within Kia Marama, a medium-security unit for sex offenders in the New Zealand prison system. It lasts 32 weeks and includes a four-week assessment process both before and after the 24 weeks of intensive treatment. Treatment covers a variety of issues including distorted cognitions, sexual issues, victim empathy, social skills, problem solving, life skills, stress management, and relapse-prevention training. In addition, when offenders are released they are supervised by professionals trained in relapse-prevention procedures. As this program began in late 1989, it is too early to properly estimate its success, but similar programs in North America have produced promising outcome data, and what tentative evidence we have to date suggests that the program is valuable.

Evaluation of Attributional Change in a Relapse Prevention Program for Child Molesters

Relapse prevention is a multimodal, cognitive-behavioural approach to treating, among other types of clients, child molesters. Rather than positing a cure as the outcome of treatment, it emphasises self-management and personal responsibility for avoiding or coping with situations that threaten self-control. The motivation to use these self-control strategies is likely to vary according to beliefs about the causes of their offending behaviour, particularly as a function of the degree to which they are seen as controllable. Fifteen child molesters, classified as preferential or situational type, and familial or nonfamilial, from the Kia Marama unit at Rolleston Prison reported on their causal beliefs concerning their offence-related behaviour at four points in their description of their most typical or recent relapse. This assessment was carried out at four points in the 35-week relapse-prevention based treatment program.

All participants made clinically positive changes in their causal ascriptions over treatment. Preferential participants judged the cause of their offending to be less controllable, and more stable at the time of offence, and more global than situational offenders. Compared with non-familial participants, incestuous participants evaluated the cause of their offending to be less stable at the time of their offence and less global across all the assessment points. The results are discussed in terms of the utility of attributional assessment as an interim measure of progress, particularly with respect to motivation to avoid reoffending.

Mental illness and sexual offending

Transinstitutionalization (ie, the criminalization of those with mental illness) is relevant to individuals committing sexual offenses. Mental illness can affect the treatment and risk management of individuals committing sexual offenses. In this article the current literature on mentally disordered sexual offenders is described, including how psychosis, mood disorders, anxiety disorders, attention-deficit/hyperactivity disorder, and dementing disorders may affect treatment and management.

Relapse prevention for sexual offenders: considerations for the "abstinence violation effect"

Relapse Prevention (RP) is a cognitive-behavioral approach originally developed for treatment of addictions and has since become an effective and popular method for treating sexual offenders. The Abstinence Violation Effect (AVE) is a pivotal RP construct describing one's cognitive and affective response to re-engaging in a prohibited behavior. We review the literature on the AVE in both addiction and sexual offender applications. We summarize the original and subsequent formulations of the AVE for addictions and modifications adopted for its application to sexual offenders. We argue that these modifications have generally failed to characterize sexual offense relapse cycles accurately or comprehensively. In particular, these modifications fail to specify accurately the AVE's occurrence and influence in the offense cycle. In response to these limitations, we suggest future directions for AVE research in sexual offenders.

Facing rejection: new relationships, broken relationships, shame, and stalking

This study provides a preliminary examination of the relationship among shame-proneness, emotions, and persistent, unwanted courting or pursuit behaviour. A total of 222 undergraduates completed a questionnaire measuring responses to the termination of a relationship or the declining of a date. The Test of Self-Conscious Affect was used to measure shame. Although shame was unrelated to types of intrusive behaviour, individuals who engaged more repetitively in covert pursuit tended to ruminate more over their love interest than did those who rarely engaged in such behaviour. Rumination was positively correlated with shame. Self-harm behaviours and harm toward others were associated with feelings of sadness and depression, and those who engaged more often in harm toward others also reported feelings of anger and jealousy. Conclusions are made regarding the function of shame and other emotions in intrusive behaviour and their potential relevance to treatment of stalkers.

A brief history of behavioral and cognitive behavioral approaches to sexual offender treatment: Part 2. The modern era

This paper is the second in our attempt to highlight the major influences, trends, and emerging issues in cognitive behavioral approaches to treating sexual offenders. In this paper the developments from 1970 until the present are covered.

Shame and guilt in child sexual offenders

In this article, the authors build on previous discussions of the possible role of shame and guilt in sexual offending. They review the general psychological literature on shame and guilt and conclude that the distinction between internal and external shame is an important one in considering sexual offenders. The effects of shame and guilt on victim empathy and relapse are discussed, and it is proposed that the phenomena of shame and guilt have implications for treatment beyond those identified in previous studies. Shame is a salient feature in the initial presentation of many sexual offenders against children. Furthermore, aspects of the treatment of sexual offenders can be characterized as a shift from shame toward guilt. Implications of shame and guilt for treatment of sexual offenders are described.

Motivation for behavior change among sex offenders. A review of the literature

Motivation for behavior change is considered a crucial issue in the treatment of sex offenders. However, there has been no systematic investigation of this issue. The first aim of this review is to draw together the literature related to motivation for behavior change among sex offenders. The second aim is to highlight issues that need to be addressed to facilitate an empirical investigation of motivation for change among sex offenders. It is argued that a better understanding of motivation for change among sex offenders will contribute to enhancing the efficacy of treatment programs for these offenders.

Sexual aggressors' perceptions of effectiveness of strategies to cope with negative emotions and deviant sexual fantasies

The aim of this study was to investigate sexual aggressors' perceptions of effectiveness of strategies to cope with high-risk situations and their reasons for not using the adaptive coping strategies they learned in treatment. A total of 32 sexual aggressors, incarcerated in a maximum security psychiatric institution, filled out the Coping Strategy Report daily for 2 months. A lack of will, ignorance, and an emotional disturbance were the most frequently reported reasons for not using adaptive coping strategies to deal with a negative mood, whereas anticipation of failure and emotional disturbance were most frequently reported with interpersonal conflicts. For deviant sexual fantasies, child molesters most frequently reported a lack of will and an anticipation of failure as justification for not using adaptive coping strategies, whereas sexual aggressors of women most frequently reported a lack of will and emotional disturbance. For negative moods and interpersonal conflicts, behavioral strategies, such as social skills, were reported to be the most effective. Cognitive strategies, such as covert sensitization, were reported to be most effective for coping with deviant sexual fantasies. Theoretical and clinical implications of these results are discussed.

The treatment of child sex abusers in England

A Council of Europe Fellowship was used to visit several centres in England managing and treating child sex abusers in a community setting. Aspects of the services reviewed included organisation, training of staff, assessment of abusers, methods of treatment and resources and facilities available. The application of the English experience to the establishment of treatment programmes in Ireland is discussed.

Relationships between conflict, affect and deviant sexual behaviors in rapists and pedophiles

The aim of the current study was to determine the relationship in sexual offenders between conflict, affective states and particular sexual behaviors (fantasies and masturbatory activities while having such fantasies). To this end we developed the "Fantasy Report", a self-assessment method for recording affective components and sexual behaviors. Thirteen rapists and 9 pedophiles filled out the Fantasy Report every 2 days for a period of 60 days. In rapists, negative mood and the presence of conflicts coincided with both overwhelming deviant sexual fantasies and increased masturbatory activities while having such fantasies. Furthermore, the emotions most frequently reported by rapists following conflicts were loneliness, humiliation, anger and feelings of inadequacy and rejection. Affective components, however, were not associated with nondeviant sexual behaviors. For the pedophiles, the data revealed a significant relationship only between negative moods and deviant sexual fantasies. These data are interpreted to mean that, in sexual offenders, negative affect is a crucial component in the chain that leads to deviant sexual behaviors.

The abstinence violation effect in child molesters

The reformulation of the abstinence violation effect (AVE) is briefly described together with the empirical support for the construct. Twenty-six incarcerated male child molesters were assessed, using the Differential Emotions Scale and the Attributional Dimension Scale, at three points (high-risk, lapse, and relapse) while they listened to an audiotaped recording of a description of their most typical offense chain. Eighteen Ss experienced an AVE at the point of relapse and 7 as a result of lapse. There were significant increases in most negative emotions and decreases in interest over the relapse chain. There were significantly higher disgust, contempt, hostility, fear, shame, shyness and anger scores reported by those showing an AVE. Conversely, the AVE group showed significantly lower scores for joy and surprise. There were no significant differences on any of the 4 attributional dimensions across the relapse process but those showing an AVE reported significantly more uncontrollability and higher stability scores. The significance of these results for clinical practice are discussed.

Cognitive and affective responses to successful coping during smoking cessation

Based on Marlatt's relapse model, this study examined the previously unexplored role of cognitive and affective responses that follow successful coping experiences during smoking cessation. Twenty-six smokers completed self-report measures of attribution, efficacy, and affect in response to smoking cessation behaviors during treatment and at 2-, 4-, and 8-week follow-ups. Subjects abstinent at 3-month follow-up were more likely to attribute their successful quitting behaviors to more internal, stable, and controllable factors, and they reported enhanced self-efficacy, compared with smokers. Differences in affective responses to successful coping by quitters and smokers were not significant. Implications of the findings with respect to relapse theory and relapse prevention treatment are discussed.