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Cognitive behavioral therapy (CBT) (for individuals classified as high- or moderate-risk)

Adult Criminal Justice
Benefit-cost methods last updated December 2023.  Literature review updated December 2016.
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Cognitive behavioral therapy (CBT) include various components, such as cognitive restructuring, behavioral activation, emotion regulation, communication skills, and problem-solving. Treatment is goal-oriented and generally of limited duration. CBT emphasizes individual accountability and teaches participants that cognitive deficits, distortions, and flawed thinking processes cause criminal behavior. For this broad grouping of studies, a variety of “brand name” programs (e.g., Enhanced Thinking Skills, Moral Reconation Therapy, Reasoning and Rehabilitation, and Thinking 4 a Change) were delivered to adults in either an institutional or community setting for an average of 2.5 months. Studies evaluating CBT delivered specifically as sex offender treatment were excluded from this analysis.

Using multivariate regression analysis of the effect sizes, we investigated additional policy questions about CBT, including whether the program was manualized; delivered in the community or during incarceration; incorporated the correctional principles of “Risk Need Responsivity” (RNR) or performed quality of assurance. We did not detect any statistically significant differences in the results based on these factors.
For an overview of WSIPP's Benefit-Cost Model, please see this guide. The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2022). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $3,209 Benefits minus costs $8,736
Participants ($26) Benefit to cost ratio $6.31
Others $6,414 Chance the program will produce
Indirect $784 benefits greater than the costs 98%
Total benefits $10,382
Net program cost ($1,646)
Benefits minus cost $8,736

^WSIPP’s benefit-cost model does not monetize this outcome.

^^WSIPP does not include this outcome when conducting benefit-cost analysis for this program.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases. See Estimating Program Effects Using Effect Sizes for additional information.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Treatment age No. of effect sizes Treatment N Adjusted effect sizes(ES) and standard errors(SE) used in the benefit - cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
29 42 32830 -0.109 0.029 32 -0.109 0.029 42 -0.147 0.001
29 6 3375 -0.010 0.042 29 n/a n/a n/a 0.025 0.727
29 1 23 0.108 0.349 29 n/a n/a n/a 0.108 0.757
29 2 480 0.150 0.194 29 0.000 0.187 32 0.163 0.161
29 1 10 -0.743 0.616 29 n/a n/a n/a -0.743 0.227
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Affected outcome: Resulting benefits:1 Benefits accrue to:
Taxpayers Participants Others2 Indirect3 Total
Crime Criminal justice system $3,249 $0 $6,446 $1,625 $11,319
Illicit drug use disorder Labor market earnings associated with illicit drug abuse or dependence ($9) ($21) $0 $0 ($29)
Health care associated with illicit drug abuse or dependence ($31) ($5) ($32) ($15) ($83)
Mortality associated with illicit drugs $0 $0 $0 ($2) ($2)
Program cost Adjustment for deadweight cost of program $0 $0 $0 ($823) ($823)
Totals $3,209 ($26) $6,414 $784 $10,382
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Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $1,395 2016 Present value of net program costs (in 2022 dollars) ($1,646)
Comparison costs $0 2011 Cost range (+ or -) 10%
Per-participant cost estimate provided by the Washington State Department of Corrections.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Benefits Minus Costs
Benefits by Perspective
Taxpayer Benefits by Source of Value
Benefits Minus Costs Over Time (Cumulative Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in discounted dollars. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

Citations Used in the Meta-Analysis

Armstrong, T.A. (2003). The effect of Moral Reconation Therapy on the recidivism of youthful offenders: A randomized experiment. Criminal Justice and Behavior, 30(6), 668-687.

Austin, J., Robinson, B., Elms, B., & Chan L. (1997). Evaluation of two models of treating sentenced federal drug offenders in the community (Document No. 179976). Washington, DC: National Council on Crime and Delinquency.

Barnes, G.C., Hyatt, J.M., & Sherman, L.W. (2016). Even a little bit jelps: An implementation and experimental evaluation of cognitive-behavioral therapy for high-risk probationers. Criminal Justice and Behavior.

Berman, A.H. (2004). The Reasoning and Rehabilitation Program: Assessing short- and long-term outcomes among male Swedish prisoners. Journal of Offender Rehabilitation, 40(1/2), 85-103.

Bleick, C.R., & Abrams, A.I. (1987). The Transcendental Meditation program and criminal recidivism in California. Journal of Criminal Justice, 15(3), 211-230.

Bonta, J., Wallace-Capretta, S., & Rooney, J. (2000). A quasi-experimental evaluation of an intensive rehabilitation supervision program. Criminal Justice and Behavior, 27(3), 312-329.

Cann, J. (2006). Cognitive skills programmes: Impact on reducing reconviction among a sample of female prisoners (Research Findings No. 276). London: Home Office.

Cann, J., Falshaw, L., Nugent, F., & Friendship, C. (2003). Understanding what works: Accredited cognitive skills programmes for adult men and young offenders (Research Findings No. 226). London: Home Office.

Culver, H.E. (1993). Intentional skill development as an interventional tool. Dissertation Abstracts International, 54(06), 2053A.

Duwe, G., & Clark, V. (2015). Importance of program integrity: Outcome evaluation of a gender-responsive, cognitive-behavioral program for female offenders. Criminology & Public Policy, 14(2), 301-328.

Falshaw, L., Friendship, C., Travers, R., & Nugent, F. (2004). Searching for 'What Works': HM Prison Service accredited cogintive skills programmes. British Journal of Forensice Practice, 6(2), 3-13.

Friendship, C., Blud, L., Erikson, M., Travers, R., & Thornton, D. (2003). Cognitive-behavioural treatment for imprisoned offenders: An evaluation of HM Prison Service's cognitive skills programmes. Legal and Criminological Psychology, 8(1), 103-114.

Golden, L.S., Gatchel, R.J., & Cahill, M.A. (2006). Evaluating the effectiveness of the National Institute of Corrections' 'Thinking for a Change' program among probationers. Journal of Offender Rehabilitation, 43(2), 55-73.

Hatcher, R.M., Palmer, E.J., McGuire, J., Hounsome, J.C., Bilby, C.A.L., & Hollin, C.R. (2008). Aggression Replacement Training with adult male offenders within community settings: A reconviction analysis. The Journal of Forensic Psychiatry and Psychology, 19(4), 517-532.

Henning, K.R., & Frueh, B.C. (1996). Cognitive-behavioral treatment of incarcerated offenders: An evaluation of the Vermont Department of Corrections' cognitive self-change program. Criminal Justice and Behavior, 23(4), 523-541.

Hollin, C., McGuire, J., Hounsome, J., Hatcher, R., Bilby, C., & Palmer, E. (2008). Cognitive skills behavior programs for offenders in the community. Criminal Justice and Behavior, 35(3), 269-283.

Hubbard, D.J., & Latessa, E.J. (2004). Evaluation of cognitive-behavioral programs for offenders: A look at outcome and responsivity in five treatment programs (Final report). Cincinnati: University of Cincinnati, Division of Criminal Justice, Center for Criminal Justice Research.

Kownacki, R.J. (1995). The effectiveness of a brief cognitive-behavioral program on the reduction of antisocial behaviour in high-risk adult probationers in a Texas community. In R. R. Ross & R. D. Ross (Eds.), Thinking straight: The Reasoning and Rehabilitation program for delinquency prevention and offender rehabilitation(pp. 249-257). Ottawa, Ontario, Canada: Air Training & Publications.

Larson, K.A. (1989). Problem-solving training and parole adjustment in high-risk young adult offenders. In S. Duguid (Ed.), The yearbook of correctional education, (pp. 279-299). Burnaby, BC: Simon Fraser University, Correctional Education Association.

Little, G.L., Robinson, K.D., Burnette, K.D., & Swan, E.S. (2010). Twenty-year recidivism results for MRT-treated offenders. Cognitive Behavioral Treatment Review, 19(1), 1-5.

Lowenkamp, C.T., Hubbard, D., Makarios, M.D., & Latessa, E.J. (2009). A quasi-experimental evaluation of thinking for a change: A 'real-world' application. Criminal Justice and Behavior, 36(2), 137-146.

Martin, A.M., Hernandez, B., Hernandez-Fernaud, E., Arregui, J.L., & Hernandez, J.A. (2010). The enhancement effect of social and employment integration on the delay of recidivism of released offenders trained with the R & R programme. Psychology, Crime & Law, 16(5), 401-413.

Ortmann, R. (2000). The effectiveness of social therapy in prison—a randomized experiment. Crime & Delinquency, 46(2), 214-232.

Palmer, E.J., McGuire, J., Hounsome, J.C., Hatcher, R.M., Bilby, C.A.L., & Hollin, C.R. (2007). Offending behaviour programmes in the community: The effects on reconviction of three programmes with adult male offenders. Legal and Criminological Psychology, 12(2), 251-264.

Porporino, F.J., & Robinson, D. (1995). An evaluation of the Reasoning and Rehabilitation program with Canadian federal offenders. In R.R. Ross & R.D. Ross (Eds.), Thinking straight: The Reasoning and Rehabilitation program for delinquency prevention and offender rehabilitation (pp. 155-191). Ottawa, Ontario, Canada: Air Training and Publications.

Raynor, P., & Vanstone, M. (1996). Reasoning and rehabilitation in Britain: The results of the Straight Thinking on Probation (STOP) programme. International Journal of Offender Therapy and Comparative Criminology, 40(4), 272-284.

Robinson, K., Little, G., & Burnette, K.D. (1993). 5 recidivism results on MRT-treated DWI offenders released. Cognitive Behavioral Treatment Review, 2(4), 2.

Robinson, D. (1995). The impact of cognitive skills training on post-release recidivism among Canadian federal offenders (Research Report No. R-41). Ottawa, Ontario, Canada: Correctional Service Canada, Correctional Research and Development.

Ross, R.R., Fabiano, E.A., & Ewles, C.D. (1988). Reasoning and rehabilitation. International Journal of Offender Therapy and Comparative Criminology, 32(1), 29-36.

Sadlier, G. (2010). Evaluation of the impact of the HM Prison Service Enhanced Thinking Skills Programme on reoffending outcomes of the surveying prisoner crime reduction sample. London: Ministry of Justice.

Travers, R., Wakeling, H.C., Mann, R.E., & Hollin, C.R. (2011). Reconviction following a cognitive skills intervention: An alternative quasi-experimental methodology. Legal and Criminological Psychology. Advance online publication.

Van Voorhis, P., Spruance, L.M., Ritchey, P.N., Listwan, S.J., & Seabrook, R. (2004). The Georgia Cognitive Skills Experiment: A replication of Reasoning and Rehabilitation. Criminal Justice and Behavior, 31(3), 282-305.

Van Voorhis, P., Spruance, L.M., Ritchie, P.N, Johnson-Listwan, S., Seabrook, R., & Pealer, J. (2002). The Georgia Cognitive Skills Experiment outcome evaluation phase II (Final report). Cincinnati, OH: University of Cincinnati, Center for Criminal Justice Research.

Wilkinson, J. (2005). Evaluating evidence for the effectiveness of the Reasoning and Rehabilitation Programme. The Howard Journal of Criminal Justice, 44(1), 70-85.

Yessine, A.K., & Kroner, D.G. (2004). Altering antisocial attitudes among federal male offenders on release: A preliminary analysis of the counter-point community program (Research Report No. R-152). Ottawa, Ontario, Canada: Correctional Service Canada, Correctional Research and Development.

Zlotnick, C., Johnson, J., & Najavits, L.M. (2009). Randomized controlled pilot study of cognitive-behavioral therapy in a sample of incarcerated women with substance use disorder and PTSD. Behavior Therapy, 40(4), 325-336.