The study was designed to elucidate underlying
neuropsychological and emotional regulatory mechanisms in variable
responses to a cognitive-behavioral therapy (CBT) program among prison
inmates. The purpose of this project was to assess (1) the role of
neuropsychological and emotional deficits in behavioral problems and
misconduct among inmates, (2) the usefulness of neuropsychological and
emotional regulatory measures in characterizing recalcitrant and
unresponsive inmates, and (3) the ability of these measures to predict
treatment response in prison.
This study tested the hypotheses that
performance deficits in executive cognitive function (ECF) tasks and
emotional responses will characterize aggressive and disruptive
inmates and predict treatment response. All subjects were examined
using noninvasive behavioral, psychological, ECF, and hormone
tests. Adjustments were made for age in all analyses.
The data contain a total of 232 cases. Inmates volunteering to
participate in the cognitive-behavioral therapy (CBT) program
(Thinking, Deciding, Changing, Communications, Relationships) offered
by the Maryland correctional system were recruited from three
facilities using a pseudo-random selection procedure during intake
into the program. Several characteristics were exclusionary, including
illiteracy, low IQ (less than 70), over age 49, and active mental illness.
Consenting inmates received an extensive baseline testing battery
of several complementary dimensions of higher order neuropsychological
functions as well as conditions that influence them: (1) three ECF
tasks (the Cambridge Decision Making Task, the Logan Stop-Signal Task,
and the Stroop Interference Task) and one emotional perception task
(Emotional/Facial Expression Task), (2) collection of salivary
cortisol during an acute stress task (public speaking) and the Symptom
Checklist 90 (SCL-90) taken beforehand to determine present
psychological state, (3) a short general neuropsychological test: the
Multidimensional Aptitude Battery (MAB), (4) three psychological
questionnaires: the Levenson Self-Report Psychopathy (LSRP) scale, the
Reactive-Proactive Questionnaire (RPQ), and the Early Trauma
Questionnaire, (5) an historical inventory: a revised version of the
Addiction Severity Index (ASI) to assess prior drug use and child and
family background (e.g., family dysfunction, child abuse, and family
history of psychopathology), and (6) a treatment readiness,
responsivity, and gain scale. An events inventory and a success
inventory were also administered. Salivary cortisol samples were
collected before and after administration of a stress (public
speaking) as a measure of stress reactivity. The test session took
about 2 to 2.5 hours to complete. The Director of Health Services in
the Department of Public Safety and Correctional Services provided
approval to survey their Management Information System: the Maryland
Offender-Based State Correctional Information System (OBSCIS) during
this study to characterize inmates in terms of their history of crimes
and institutional infractions and segregations. These instruments were
assessed for their ability to characterize inmates into clinically
relevant subtypes (e.g., history of violence, drug abuse, impulsive or
nonimpulsive aggression, psychopathy, etc.).
Several additional tests were administered repeatedly throughout
treatment. After each treatment group, inmates completed the Novaco
Reaction to Provocation Questionnaire (NAS), which is sensitive to
change in aggressive orientations in response to treatment, and social
workers completed an evaluation of each inmate participating in the
research. These evaluations produced a treatment responsivity score
and a gain score. One neuropsychological test, the Cambridge Decision
Making Task, was readministered to assess change in executive decision
making. Following baseline assessments, inmates from the three prisons
received similar CBT programming. A record review was conducted after
program completion to ascertain incidents of institutional misconduct
as well as treatment performance outcomes.
Three medium/maximum facilities in the State of Maryland
were selected by the Department of Corrections for participation in
this study: Roxbury Correctional Institution, Western Correctional
Institution, and the Maryland Correctional Training Center. Selection
of these facilities was based on programmatic similarities to ensure
continuity and uniformity of treatment, duration, type and modality of
the program, treatment provider staff, and other environmental factors.
The sample of 232 male inmates was recruited using a pseudo-random
procedure over a 2.5-year period. Inmates who volunteered for
participation in the cognitive-behavioral therapy (CBT) program called
"Thinking for a Change," as part of the routine "treatment-as-usual"
procedure in the prisons, constituted the subject pool. Those who met
eligibility criteria for study participation were recruited from
identification numbers provided by the facility to include only
inmates who were between 21 and 49 years old with a minimum of 18
months left on their sentences (to avoid the stress of pre-release
preparations and potential for transfers), and who reflected the
ethnic diversity of the offender population in the state study.
Inmates who volunteered were first consented to complete an IQ test
(Multidimensional Aptitude Battery), and those with an IQ below 70
were excluded. Older subjects were excluded due to the cognitive
decline that occurs naturally over time and the effects of chronic
drug abuse on executive cognitive function (ECF). Those with mental
retardation, dementia, amnesia, or delirium and those who were
illiterate were excluded because these conditions interfere with
performance and because of inability to understand the implications of
consent. The sample was ethnically diverse and representative of the
offender population in the state, however race was not expected to
affect results of this study. Those eligible were scheduled for
testing, signed the full consent form, and took a consent test to
ensure comprehension.
All inmates volunteering to participate in the
cognitive-behavioral therapy (CBT) program (Thinking, Deciding,
Changing, Communications, Relationships) offered by the Maryland
correctional system who were housed at either the Roxbury Correctional
Institution, Western Correctional Institution, or the Maryland
Correctional Training Center between March 2003 and December 2005.
individual
Data were obtained from three executive cognitive
function (ECF) tasks and one emotional perception task, a collection
of salivary cortisol during an acute stress task and the Symptom
Checklist-90 taken beforehand, a short general neuropsychological
test, three psychological questionnaires, an historical inventory, and
a treatment readiness, responsivity, and gain scale. An events
inventory and a success inventory were also administered. Additional
data were obtained from the Maryland Offender Based State Correctional
Information System (OBSCIS) and the administration of a reaction to
provocation questionnaire.
administrative records data, clinical data, and survey
data
record abstracts
cognitive assessment test
face-to-face interview
paper and pencil interview (PAPI)
self-enumerated questionnaire
on-site questionnaire
Variables include IQ, demographics, background
information, prior drug use, early trauma, psychopathy, aggression,
stressful events, success, reactions to provocation, treatment
readiness, emotional perception/regulation, executive cognitive
performance, cortisol measures, treatment gain, treatment
responsivity, treatment completion, Maryland Offender Based State
Correctional Information System (OBSCIS) data, institutional
infractions, segregations, and several other computed variables.
IQ variables from the Multidimensional Aptitude Battery (MAB)
include verbal IQ, performance IQ, and full scale IQ. Demographic
variables from the revised version of the Addiction Severity Index
(ASI) (McLellan et al., 1992) include age, race, religion, marital
status, weight, height, and handedness. Background variables from the
ASI include prison, months in prison, years of education, occupation,
hospitalizations, chronic medical problems, current medications,
history of head injury/black outs, and how long for black outs. Prior
drug use variables also from the ASI include history, and age started
and ever used the following substances: alcohol, heroin, methadone,
opiates, depressants, cocaine, stimulants, marijuana, hallucinogens,
inhalants, and ecstasy. Other drug use variables in the ASI measure
drug of choice, DTs, ODs, treatment, months of last voluntary
abstinence, family history, and extended family history.
Variables included from the Early Trauma Inventory pertain to
stressful events, physical abuse, emotional abuse, and sexual
abuse. Primary and secondary scores from the Levenson Self-Report
Psychopathy (LSRP) scale (Levenson et al., 1995), proactive and
reactive scores from the Reactive-Proactive Questionnaire (RPQ) (Raine
et al., in press), events inventory scores, and success inventory
scores are also included as variables. Other variables include scores
from the Reaction to Provocation Questionnaire (NAS) (Novaco, 1990)
measured at four times, scores from the Treatment Readiness Scale
developed by Ralph Serin (Director of Programs Research, Correctional
Service of Canada), scores on the Symptom Checklist 90 (SCL-90), and
scores on the Treatment Responsivity and Treatment Gain scales
developed by Ralph Serin.
Additionally, performance scores from the following tasks are
included: the Cambridge Decision Making Task (CDMT: Rogers et al.,
1999a, and 1999b), the Logan Stop-Change Task, the Stroop Interference
Task, and the Emotional/Facial Expression Task. Cortisol Assessment
measures are included as variables as well as OBSCIS data such as
offense data, institutional infractions, and segregations.
Furthermore, several other computed variables are also included.
Not applicable.
Scales used were the Multidimensional Aptitude Battery
(MAB), a revised version of the Addiction Severity Index (ASI)
(McLellan et al., 1992), the Early Trauma Questionnaire (Bremner, et
al., 2000), the primary and secondary psychopathy scales developed by
Levenson et al. (1995), the Reactive-Proactive Questionnaire (RPQ)
(Raine, et al., in press), Reaction to Provocation Questionnaire (NAS)
(Novaco, 1990), the Treatment Readiness Scale and the Treatment
Responsivity and Treatment Gain scales developed by Ralph Serin
(Director of Programs Research, Correctional Service of Canada), and
the Symptom Checklist 90 (SCL-90). In addition to scales, the specific
neuropsychological instruments used in this study were three executive
cognitive function (ECF) tasks (Cambridge Decision Making Task (CDMT:
Rogers, et al., 1999a, and 1999b), the Logan Stop-Signal Task, and the
Stroop Interference Task), and one emotional perception task
(Emotional/Facial Expression Task).