The Effects of the GPS Program in Offenders

University of Coimbra

Status: Completed

Conditions: Male Prison Inmates

Treatments: Other: Treatment As Usual; Behavioral: Growing Pro-Social Program

Study type: Interventional

Funder types: Other

Identifiers

NCT03013738

SFRH/BD/89283/2012 (Other Grant/Funding Number)

CINEICC-1-NB

Details and patient eligibility

About

This randomized controlled trial aimed to assess the efficacy of a 40-session cognitive-behavioral group program, Growing Pro-Social (GPS), in reducing early maladaptive schemas and cognitive distortions (primary outcomes), as well as anger, shame and paranoia (secondary outcomes). The GPS's impact on behavioral change (e.g., in the reduction of disciplinary incidents and prison records) was also tested, in order to ascertain if changes observed in cognitive and emotional variables were reflected in a more adjusted behavioral pattern. Personality Disorders were also tested as moderators of treatment effects.

Full description

This was a randomized controlled trial with blind assessments, carried out in nine prisons in three city areas in mainland Portugal (Lisbon, Oporto and Coimbra) and in the Madeira Island.

After the study was approved by the Head of the General Directorate of Reintegration and Prison Services of the Portuguese Ministry of Justice, a list of potential participants who did not meet the exclusion criteria was made available to the research team by psychologists from the justice system. Next, a large sample of participants was randomly selected using a random number table by a research assistant who was blind to any personal information about each inmate. Then, a first meeting between the research team and the randomized inmates occurred, in which researchers invited inmates to participate voluntarily. In this meeting, researchers explained the goals of the study and presented a brief overview of the intervention program. It was also explained to inmates that their participation in the study would not impact their sentencing in any way.

Participants who agreed to participate, gave written informed consent, completed the baseline assessment, and were randomly assigned to treatment conditions (treatment and control groups) using a random number table by a research assistant who was blind to any information about each participant. Afterwards, the research team informed the psychologists in each prison of the result of the randomization so that GPS could be initiated. Participants in the control group were informed that they would be offered the GPS treatment after the study's completion (including the follow-up period).

Besides baseline assessment, participants completed the mid-assessment (after the 20th session of the program), post-treatment assessment (at the end of GPS) and follow-up assessment (12 months after GPS completion). Staff who conducted randomization did not serve as therapists or accessors, and accessors were blind to condition assignment. Respondent-specific codes were used to link the data from one time-point to the next one.

GPS's facilitators were chosen among the psychologists who already had training and experience in delivering the program with inmates (who were not selected for this study). In order to assure program integrity and consistency, facilitators received regular supervision by the research team (including the program's main author) during the time GPS was run in prisons. Moreover, the program's structured and manualized design ensures integrity, at least partially.

Enrollment: 270 patients

Sex: Male

Ages: 18 to 40 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

1. male prison inmates aged between 18 and 40 years old
2. remaining in prison for at least 24 months (taking into account GPS's 12-month length and 12-month follow-up assessment), since the beginning of the program.

Exclusion criteria

1. presence of cognitive disabilities (because GPS is not suitable for the cognitively-impaired)
2. psychotic symptoms (the experiential exercises used in the program are contraindicated for psychotic patients)
3. being treated for drug abuse/dependence (cessation or at least substantial reduction of drug or alcohol use must precede GPS treatment)
4. being sentenced exclusively for sexual offenses (sex offenders would benefit from more specific intervention programs)

NOTE: Female offenders were also excluded from the sample because women represent less than 6% of the total inmates in Portugal, and any possible idiosyncrasies from this cohort would be underrepresented.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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270 participants in 2 patient groups

Growing Pro-Social (GPS) program

Experimental group

Description:

The Growing Pro-Social (GPS) program is a cognitive-behavioral group program for offenders. GPS is based on schema therapy, which conceptualizes aggressiveness as a result of a distorted view of the self and of the others. The ultimate goal of the GPS is to promote change in dysfunctional core beliefs about the self and the others. GPS consists of 40 sessions, each lasting about 90 minutes. Sessions must be carried out by two therapists who should be skillful in schema therapy. Sessions are grouped into five modules: (1) human communication, (2) interpersonal relationships, (3) cognitive distortions, (4) function and meaning of emotions, and (5) early maladaptive schemas. The treatment group attended the GPS program in addition to the Treatment AsUsual (TAU) delivered at Portuguese prisons.

Treatment:

Other: Treatment As Usual

Behavioral: Growing Pro-Social Program

Treatment As Usual

Other group

Description:

Subjects in this group received Treatment As Usual in Portuguese prisons (supervision of school frequency, occupational and job-related tasks and sentence planning supervision over time) and did not attend the GPS program or any other structured program during the research period.

Treatment:

Other: Treatment As Usual