Long-term effects of multisystemic therapy for problem sexual behaviors: A 24.9-year follow-up to a randomized clinical trial.

Objective: Although there is evidence that the positive impact of multisystemic therapy for problem sexual behaviors (MST-PSB) reaches as far as young adulthood, the longer-term effects of MST-PSB into midlife are unknown. The present study examined criminal and civil court outcomes for sexually offending youths who participated on average 24.9 years earlier in a clinical trial of MST-PSB (Borduin et al., Journal of Consulting and Clinical Psychology, 2009, 77, p. 26). Method: Participants were 48 individuals who were originally randomized to MST-PSB or usual community services (UCS) and were at high risk of continued criminality. Arrest, incarceration, and civil suit data were obtained in middle adulthood when participants averaged 39.4 years of age. Results: Intent-to-treat analyses showed that MST-PSB participants had 85% fewer sexual offenses and 70% fewer nonsexual offenses than did UCS participants. In addition, MST-PSB participants were sentenced to 46% fewer days of incarceration and had 62% fewer family-related civil suits. Moreover, the favorable effects of MST-PSB on participants' crimes and civil suits were mediated by improved peer and family relations during treatment. Conclusion: The current study represents the longest and most comprehensive follow-up to date of an MST-PSB clinical trial and demonstrates that the positive effects of an evidence-based youth treatment for sexual crimes can last well into adulthood. Implications of the findings for policymakers, service providers, and researchers are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Effects of multisystemic therapy on caregivers of serious juvenile offenders: A 20-year follow-up to a randomized clinical trial.

OBJECTIVE: Caregivers of serious juvenile offenders often hold favorable attitudes about criminality and frequently have histories of involvement in antisocial behaviors themselves. In the present study, the authors examined the long-term criminal and noncriminal outcomes for caregivers of serious juvenile offenders who had participated two decades earlier in a randomized clinical trial of multisystemic therapy (MST; Borduin et al., 1995). METHOD: Participants were 276 caregivers of serious juvenile offenders who were originally randomized to MST or individual therapy (IT). Criminal and civil suit data for caregivers were obtained during a 20.7-year follow-up when caregivers were on average 61.5 years old. RESULTS: Caregivers in the MST condition had 94% fewer felonies and 70% fewer misdemeanors than did caregivers in the IT condition. In addition, caregivers in the IT condition were sentenced to 92% more days of incarceration and had 50% more family-related civil suits. Moreover, the favorable long-term effects of MST on caregiver criminality and civil suits were mediated by improved family relations during treatment. CONCLUSION: The present study represents the only follow-up to date of caregivers in an MST clinical trial and demonstrates the broader clinical benefits of a family-based treatment for serious juvenile offenders. Implications of the findings for policymakers and researchers are discussed. (PsycINFO Database Record

Depression and dissociation as predictors of physical health symptoms among female rape survivors with posttraumatic stress disorder.

OBJECTIVE: To investigate the relative contributions of depression and dissociation, as well as posttraumatic stress disorder (PTSD), to physical health symptoms and to examine the relationships among somatic symptoms, PTSD, depression, and dissociation in relation to childhood and adult trauma exposure. METHOD: Cross-sectional data are from 132 female rape survivors with PTSD assessed before engaging in a study of trauma-focused cognitive therapy for PTSD. Measures included the Pennebaker Inventory of Limbic Languidness, Clinician Administered PTSD Scale, Beck Depression Inventory, Trauma Symptom Inventory-Dissociation Subscale, Childhood Sexual Abuse Exposure Questionnaire, and Assessing Environments-III-Physical Punishment Scale. RESULTS: Hierarchical regression analyses revealed that only dissociative and depression symptoms contributed significantly to physical health symptoms. Similarly, among the subsample of women with either childhood sexual or physical abuse, depression and dissociation were significant predictors of somatic symptoms. However, among women without childhood abuse, only dissociation significantly predicted somatic symptoms. CONCLUSION: Understanding the psychological and biological mechanisms that link childhood versus adult trauma exposure, PTSD, and comorbid depression or dissociation to physical health symptoms may aid development of individualized treatments for the physical and psychological consequences of trauma. (PsycINFO Database Record

The impact of dissociation on PTSD treatment with cognitive processing therapy.

BACKGROUND: This secondary analysis of data from a randomized controlled trial of cognitive processing therapy (CPT) and its constituent components investigated whether dissociation decreased over the course of treatment primarily targeting symptoms of posttraumatic stress disorder (PTSD) and explored whether levels of dissociation predicted treatment outcome differentially by treatment condition. METHODS: An intention to treat sample of 150 women were randomized to CPT, cognitive therapy only (CPT-C) or written trauma accounts only (WA). Dissociation was measured by the dissociation subscale of the Traumatic Stress Inventory and the Multiscale Dissociation Inventory. RESULTS: Multilevel regression analyses revealed significant decreases in dissociation that did not vary as a function of treatment condition. Growth curve modeling revealed significant treatment condition by dissociation interactions such that the impact of pretreatment levels of dissociation impacted the treatment conditions differently. CONCLUSIONS: Women who endorsed low pretreatment levels of dissociation responded most efficiently to CPT-C, whereas women with the highest levels of dissociation, in particular high levels of depersonalization, responded better to CPT.