Effects of a relapse prevention program on sexual recidivism: final results from California's sex offender treatment and evaluation project (SOTEP). Treatment of sex offenders with imaginal desensitization and/or medroxyprogesterone. Persistent exhibitionism: short-term response to aversion, self-regulation, and relaxation treatments. Masturbation prohibition in sex offenders: a crossover study. Expectancy, covert sensitization and imaginal desensitization in compulsive sexuality.
Final results from a longitudinal investigation of the effectiveness of cognitive-behavioral treatment with sexual offenders are presented. The study was a randomized clinical trial that compared the reoffense rates of offenders treated in an inpatient relapse prevention (RP) program with the rates of offenders in two (untreated) prison control groups. No significant differences were found among the three groups in their rates of sexual or violent reoffending over an 8-year follow-up period. This null result was found for both rapists and child molesters, and was confirmed in analyses using time to reoffense as the outcome and those controlling for static risk differences across the groups. Closer examination of the RP group's performance revealed that individuals who met the program's treatment goals had lower reoffense rates than those who did not. Although our results do not generally support the efficacy of the RP model, they do suggest a number of ways in which this kind of treatment program can be improved. This study also emphasizes the importance of including appropriate control groups in treatment outcome research. Additional controlled investigations are needed to address the many questions that remain about when and how treatment works for sexual offenders. Thirty sex offenders were randomly allocated: 10 to receive medroxyprogesterone therapy (M), 10, imaginal desensitization (ID) and 10 both (ID + M). Twenty-four responded for one year though 3 subsequently relapsed. There were no significant differences in response to the 3 treatments. Four patients who did not respond to the initial treatment and the 3 who relapsed responded to further treatment. Most treated with M maintained heterosexual intercourse at pretreatment frequency. Self-reported reduction in anomalous sexual urges in patients receiving M correlated with reduced testosterone levels one month following treatment, demonstrating that the response was specific and validating the assessment by patients' self-reports. Where cost-effectiveness or time constraints are factors influencing treatment of sex offenders, one of these therapies warrants consideration. nan Some self-help groups for individuals with aberrant sexual interests (e.g., Sexaholics Anonymous and Sex and Love Addicts Anonymous) maintain that a period of "sexual sobriety" is necessary for treatment. The hypothesis was tested that sexual urges during a 30-day period of voluntary abstinence from masturbation would be less frequent and intense than during a period when masturbation was not avoided. Outpatient pedophiles were randomly assigned to either refrain from masturbating or make no attempt to alter their masturbation frequency for a period of 30 days. All participants were crossed over to the other treatment condition at the start of the 2nd month. Sexual urges and behavior were measured using weekly self-reports. A repeated measures ANOVA failed to show a difference in reported intensity of sexual urges, F(7, 91) = 1.15, p = 0.34; masturbation urges, F(7, 91) = 1.73, p = 0.11; adult sex urges, F(7, 91) = 1.82, p = 0.09; or child sex urges, F(7, 91) = 1.58, p = 0.15, in Masturbation Allowed vs. Masturbation Not Allowed conditions. Of 17 participants, 3 (18%) were able to retain completely from masturbating for 1 month, 4 participants (25%) thought it was helpful not to masturbate; 1 participant (7%) thought therapists should recommend avoidance of masturbation. This study suggests that sexual sobriety from masturbation does not aid in the control of pedophilic fantasies. This may be because the technique is ineffective, or because so few participants are willing to engage in it. Twenty subjects were randomly allocated to receive either imaginal desensitization (ID) or covert sensitization (CS) to reduce compulsive anomalous sexual behaviours. It was predicted from a behavioural completion model of compulsive urges, that patients' response to ID would be at least as good as their response to CS and would correlate with reduction in their general levels of tension following treatment. These predictions were supported. Correlations between patients' expectancies of treatment success and their response were of moderate strength for expectancy measures taken following the first session of both treatments, but much stronger for expectancy measures following the last session of ID. It was suggested that patients experienced a specific response during the further sessions of ID, which enabled them to improve their prediction of response. As aversive therapies remain the standard behavioural therapy for sexual paraphilias, the finding of the present study that imaginal desensitization without traumatic imagery or aversive physical stimuli is at least as effective would seem to require urgent replication, if only on ethical grounds.
The inescapable conclusion of this review is the need for further randomised controlled trials. While we recognise that randomisation is considered by some to be unethical or politically unacceptable (both of which are based on the faulty premise that the experimental treatment is superior to the control – this being the point of the trial to begin with), without such evidence, the area will fail to progress. Not only could this result in the continued use of ineffective (and potentially harmful) interventions, but it also means that society is lured into a false sense of security in the belief that once the individual has been treated, their risk of reoffending is reduced. Current available evidence does not support this belief. Future trials should concentrate on minimising risk of bias, maximising quality of reporting and including follow-up for a minimum of five years 'at risk' in the community.