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Cognitive behavioral therapy (CBT) (during incarceration) for individuals convicted of sex offenses

Adult Criminal Justice
Benefit-cost methods last updated December 2024.  Literature review updated March 2025.
This analysis includes evaluations of cognitive behavioral therapy (CBT) treatment programs using Risk-Needs-Responsivity (RNR) principles delivered during incarceration to individuals convicted of sexual offenses.

CBT targets cognitive deficits, distortions, and flawed thinking processes that can trigger criminal behavior through a structured, goal-oriented process with a trained or licensed specialist. Program components often include cognitive restructuring, behavioral activation, emotion regulation, communication skills, and problem-solving.

Using RNR principles, corrections and treatment staff align the level of services with the individual’s risk for re-offense (risk principle), provide types of services based on the individual's unique needs (need principle), and determine a treatment method that is appropriate for the individual based on unique abilities and motivation levels (responsivity principle).

Studies included in this analysis required that treatment had at least one programmatic component of CBT and mentioned utilization of RNR principles or used risk/need assessments to prioritize individuals to treatment. We excluded evaluations of non-CBT programs and programs that do not use RNR principles.

Programs in this analysis varied in length and intensity, with many lasting approximately two years. Individuals included in studies either volunteered or were mandated to participate during confinement to address the behaviors associated with their current offense. In some studies, participants are in a separate secured living unit, forensic psychiatric facility, or secured residential treatment center with other individuals convicted of sex offenses with the aim of fostering a therapeutic environment.

Evaluations of integrated prison-to community sex offense treatment programs, and evaluations of treatment in the community only, are reported in separate analyses.
 
ALL
BENEFIT-COST
META-ANALYSIS
CITATIONS
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 (2023).  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 $3,311 Benefits minus costs $12,044
Participants $0 Benefit to cost ratio $5.65
Others $10,960 Chance the program will produce
Indirect $361 benefits greater than the costs 100%
Total benefits $14,632
Net program cost ($2,588)
Benefits minus cost $12,044

^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 to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the program impacts measured in the research literature (for example, impacts on 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 on how we estimate effect sizes.

The effect size may be adjusted from the unadjusted effect size estimated in the meta-analysis. Historically, WSIPP adjusted effect sizes to some programs based on the methodological characteristics of the study. For programs reviewed in 2024 or later, we do not make additional adjustments, and we use the unadjusted effect size whenever we run a benefit-cost analysis.

Research shows the magnitude of effects may change 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. 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 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
Crime
Involvement in the criminal justice system (e.g., arrests, charges, convictions, incarceration) measured through administrative records (e.g. court records, arrests) or self-report.
 34 6 2128 -0.213 0.045 35 -0.213 0.045 43 -0.213 0.001
Sex offense^
Arrests, charges, convictions, or incarcerations for a sex offense.
 34 6 4459 -0.119 0.099 37 n/a n/a n/a -0.119 0.232
Technical violations^^
Violations of the conditions of an individual’s terms of probation, parole, or supervision.
 34 3 569 -0.213 0.305 36 n/a n/a n/a -0.213 0.485
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 $3,311 $0 $10,960 $1,655 $15,926
Program cost Adjustment for deadweight cost of program $0 $0 $0 ($1,294) ($1,294)
Totals $3,311 $0 $10,960 $361 $14,632
Click here to see populations selected
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $2,588 2023 Present value of net program costs (in 2023 dollars) ($2,588)
Comparison costs $0 2023 Cost range (+ or -) 30%
The per-participant cost estimate was provided by the Washington State Department of Corrections (DOC). The estimate is based on delivering a 300-hour program at a rate of $69 per hour (salary and benefits) by DOC staff (Sex Offender Treatment Specialist). It assumes the average group size of eight participants in each session. These programs either solely involve CBT or use CBT in addition to other treatments.
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

Buttars, A., Huss, M.T., & Brack, C. (2016). An analysis of an intensive supervision program for sex offenders using propensity scores. Journal of Offender Rehabilitation, 55(1), 51-68.

Duwe, G., & Goldman, R. (2009). The impact of prison-based treatment on sex offender recidivism. Sexual Abuse: A Journal of Research and Treatment, 21(3), 279-307.

Grady, M.D., Edwards, D.J., & Pettus-Davis, C. (2015). A longitudinal outcome evaluation of a prison-based sex offender treatment program. Sexual Abuse: A Journal of Research and Treatment.

Mews, A., Di Bella, L., & Purver, M. (2017). Impact evaluation of the prison-based core sex offender treatment programme. London: Ministry of Justice.

Nicholaichuk, T., Gordon, A., Gu, D., & Wong, S. (2000). Outcome of an institutional sexual offender treatment program: A comparison between treated and matched untreated offenders. Sexual Abuse: A Journal of Research and Treatment, 12(2), 139-153.

Perez, D.M. (2007). An outcome evaluation of the Brunswick correctional center sex offender residential treatment (SORT) program. University of Maryland, College Park.

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.