Skip to main content
    • Aa
    • Aa

Cognitive behaviour therapy for violent men with antisocial personality disorder in the community: an exploratory randomized controlled trial

  • K. M. Davidson (a1), P. Tyrer (a2), P. Tata (a3), D. Cooke (a4), A. Gumley (a1), I. Ford (a5), A. Walker (a5), V. Bezlyak (a5), H. Seivewright (a2), H. Robertson (a1) and M. J. Crawford (a2)...

Little information exists on treatment effectiveness in antisocial personality disorder (ASPD). We investigated the feasibility and effectiveness of carrying out a randomized controlled trial of cognitive behaviour therapy (CBT) in men with ASPD who were aggressive.


This was an exploratory two-centre, randomized controlled trial in a community setting. Fifty-two adult men with a diagnosis of ASPD, with acts of aggression in the 6 months prior to the study, were randomized to either treatment as usual (TAU) plus CBT, or usual treatment alone. Change over 12 months of follow-up was assessed in the occurrence of any act of aggression and also in terms of alcohol misuse, mental state, beliefs and social functioning.


The follow-up rate was 79%. At 12 months, both groups reported a decrease in the occurrence of any acts of verbal or physical aggression. Trends in the data, in favour of CBT, were noted for problematic drinking, social functioning and beliefs about others.


CBT did not improve outcomes more than usual treatment for men with ASPD who are aggressive and living in the community in this exploratory study. However, the data suggest that a larger study is required to fully assess the effectiveness of CBT in reducing aggression, alcohol misuse and improving social functioning and view of others. It is feasible to carry out a rigorous randomized controlled trial in this group.

Corresponding author
*Address for correspondence: Professor K. M. Davidson, Faculty of Medicine, University of Glasgow, Gartnavel Royal Hospital, Great Western Road, Glasgow G12 0XH, UK. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

RK Brooner , M Kidorf , VL King , K Stoller (1998). Preliminary evidence of good treatment response in antisocial drug abusers. Drug and Alcohol Dependence 49, 249260.

J Coid , M Yang , A Roberts , S Ullrich (2006 b). Violence and psychiatric morbidity in the national household population of Britain: public health implications. British Journal of Psychiatry 189, 1219.

J Coid , M Yang , P Tyrer , A Roberts , S Ullrich (2006 a). Prevalence and correlates of personality disorder in Great Britain. British Journal of Psychiatry 188, 423431.

WM Compton , KP Conway , FS Stinson , JD Colliver , BF Grant (2005). Prevalence, correlates, and comorbidity of DSM-IV antisocial personality syndromes and alcohol and specific drug use disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry 66, 677685.

K Davidson , J Norrie , P Tyrer , A Gumley , P Tata , H Murray , S Palmer (2006). The effectiveness of cognitive behaviour therapy for borderline personality disorder: results from the BOSCOT trial. Journal of Personality Disorders 20, 450465.

C Duggan , N Huband , N Smailagic , M Ferriter , C Adams (2007). The use of psychological treatments for people with personality disorder: a systematic review of randomized controlled trials. Personality and Mental Health 1, 95125.

N Eastman (1999). Who should take responsibility for antisocial personality disorder? British Medical Journal 318, 206207.

PMG Emmelkamp , A Benner , A Kuipers , GA Feiertag , HC Koster , FJ van Apeldoorn (2006). Comparison of brief dynamic and cognitive-behavioural therapies in avoidant personality disorder. British Journal of Psychiatry 189, 6064.

DR Gavin , HE Ross , HA Skinner (1989). Diagnostic validity of the Drug Abuse Screening Test in the assessment of DSM-III drug disorders. British Journal of Addiction 84, 301307.

N Messina , D Farabee , R Rawson (2003). Treatment responsivity of cocaine-dependent patients with antisocial personality disorder to cognitive-behavioral and contingency management interventions. Journal of Consulting and Clinical Psychology 71, 320329.

P Moran (1999). The epidemiology of antisocial personality disorder. Social Psychiatry and Psychiatric Epidemiology 34, 231242.

JB Saunders , OG Aasland , TF Babor , JR de la Fuente , M Grant (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption. II. Addiction 88, 791804.

S Scott , M Knapp , J Henderson , B Maughan (2001). Financial cost of social exclusion: follow-up study of antisocial children into adulthood. British Medical Journal 323, 15.

BF Shaw , I Elkin , J Yamaguchi , M Olmsted , MT Vallis , KS Dobson , A Lowery , SM Sotsky , JT Watkins , SD Imber (1999 a). Therapist competence ratings in relation to clinical outcome in cognitive therapy of depression. Journal of Consulting and Clinical Psychology 67, 837846.

J Shaw , L Appleby , T Amos , R McDonnell , C Harris , K McCann , K Kiernan , S Davies , H Bickley , R Parsons (1999 b). Mental disorder and clinical care in people convicted of homicide: national clinical survey. British Medical Journal 318, 12401244.

H Skinner (1982). The Drug Abuse Screening Test. Addictive Behaviours 7, 363371.

H Steadman , EP Mulvey , J Monahan , PC Robbins , P Appelbaum , T Grisso , LH Roth , E Silver (1998). Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Archives of General Psychiatry 55, 393401.

H Steadman , E Silver , J Monahan , P Appelbaum , PC Robbins , EP Mulvey , T Grisso , LH Roth , S Banks (2000). A classification tree approach to the development of actuarial violence risk assessment tools. Law and Human Behavior 24, 83100.

P Tyrer , U Nur , M Crawford , S Karlsen , C McLean , B Rao , T Johnson (2005). Social Functioning Questionnaire: a rapid and robust measure of perceived functioning. International Journal of Social Psychiatry 51, 265275.

AS Zigmond , RP Snaith (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 67, 361370.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 39
Total number of PDF views: 272 *
Loading metrics...

Abstract views

Total abstract views: 830 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 29th June 2017. This data will be updated every 24 hours.