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Cognitive behavioral therapy (CBT) (integrated prison-to-community programs) for individuals convicted of sex offenses

Adult Criminal Justice
  Literature review updated March 2025.

This analysis includes evaluations of cognitive behavioral therapy (CBT) treatment programs using Risk-Needs-Responsivity (RNR) principles for individuals convicted of sexual offenses, with one component delivered during incarceration and a second component during community supervision.

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. Components often in these programs 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).

Individuals volunteered to participate in an intensive, two-year long inpatient treatment and continued that treatment upon release into the community for one additional year to address the behaviors associated with their current offense. In the study, participants were placed in a secure forensic treatment facility with other individuals convicted of sex offenses with the aim of fostering a therapeutic environment. Upon release, contract clinicians provided aftercare treatment in the individual’s community.

Studies included in the 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 treatments. We excluded evaluations of non-CBT programs and programs that do not use RNR principles.

Further, treatment had to begin during incarceration and continue upon release into the community. Evaluations of sex offense treatment programs delivered during incarceration only, or treatment in the community only, are reported in separate analyses.
 
ALL
META-ANALYSIS
CITATIONS

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 No. of effect sizes Treatment N Effect sizes (ES) and standard errors (SE) Unadjusted effect size (random effects model)
ES SE Age ES p-value
Sex offense
Arrests, charges, convictions, or incarcerations for a sex offense.
 35 1 259 -0.076 0.132 43 -0.076 0.565

Citations Used in the Meta-Analysis

Marques, J.K., Wiederanders, M., Day, D.M, Nelson, C., van Ommeren, A. (2005). Effects of a relapse prevention program on sexual recidivism: Final results from California's Sex Offender Treatment and Evaluation Project (SOTEP). Sexual Abuse: A Journal of Resarch and Treatment, 17(1), 79-107.