m_d_n (m_d_n) wrote,

Обзор исследований по терапии посягателей

Международная система доказательной медицины начала развиваться в 1990-е годы, и в настоящее время общепризнанной является рейтинговая система, где наиболее качественные исследования относятся к первому уровню. На I (A) уровне находятся контролируемые большие двойные слепые плацебо- исследования, а также данные, полученные при мета-анализе нескольких рандомизированных исследований. На II (B) уровне находятся контролируемые небольшие рандомизированные (где респонденты случайным образом выбраны) исследования. На III (C) уровне располагаются нерандомзированные исследования, на IV (D) уровне – выработка группой экспертов консенсуса по определённой проблеме.

Вот пример статьи, на которую уместно сослаться в суде, обосновывая свою точку зрения. Она 2013 года (то есть за последние три года - пять лет опубликована)
В ней изучены 944 мужчины в возрасте от 16 до 72 лет, все сексуальные преступники.
Дизайн исследования уровня В (большая рандомизированная выборка, то есть случайным образом выбирались люди для сравнения)

Психологические интервенции, которые оценивались по эффективности, - CBT и психодинамическая терапия продолжительностью в год.

Результат: психологические интервенции не уменьшают риск повторного совершения деликта у педофилов, насильников, эксгибиционистов и фетишистов.

Со страницы http://ebmh.bmj.com/content/16/3/68.full

Evid Based Mental Health 2013;16:68 doi:10.1136/eb-2013-101236

Review: evidence does not support a reduction in sexual reoffending with psychological interventions, but further high-quality trials are needed

Question: Do psychological interventions reduce sexual offences in adults who have offended before or are at risk of offending?

Outcomes: Primary outcome: reoffending, as measured by further charge, caution or self-report of sexual offence. Secondary outcomes: cognitive distortions, sexual obsessions or sexually anomalous urges, anxiety, anger, treatment withdrawal and adverse events.

Design: Systematic review and meta-analysis.

Data sources: CENTRAL, MEDLINE, Allied and Complementary Medicine (AMED), Applied Social Sciences Index and Abstracts (ASSIA), Biosis Previews, CINAHL, COPAC, Dissertation Abstracts, EMBASE, International Bibliography of the Social Sciences (IBSS), ISI Proceedings, Science Citation Index Expanded (SCI), Social Sciences Citation Index (SSCI), National Criminal Justice Reference Service Abstracts Database, PsycINFO, OpenSIGLE, Social Care Online, Sociological Abstracts, UK Clinical Research Network Portfolio Database and ZETOC were searched up to October 2010. Authors and experts in the field were contacted for unpublished data and ongoing studies, and reference lists of identified studies were hand searched.

Study selection and analysis: Randomised controlled trials (RCTs) in adults convicted, cautioned or seeking help for sexual offences that compared psychological interventions with each other or controls were included. Meta-analyses were carried out using Review Manager V.5 software. Heterogeneity was assessed using forest plots, χ2 test and I2 statistic. Risk of bias was estimated using the Cochrane Collaboration Tool. Insufficient data were identified for funnel plots, subgroup analysis or sensitivity analysis to be carried out.

Main results
Ten RCTs met inclusion criteria (n=944 men, aged 16–72). Sexual offences included paedophilia, rape, exhibitionism and fetishes. Settings included prisons, forensic units, inpatients and outpatients. None of the included studies were blinded and in most cases there was little or no follow-up beyond institutionalisation and into ‘at-risk’ periods in the community. Five trials of cognitive behavioural therapy (CBT) versus no intervention or standard care were identified but only one trial reported on reoffending. This trial (n=484) found that 2 years of weekly group and individual CBT had no effect on the rate of reoffending compared with no intervention over 14 years of follow-up (risk ratio 1.10, 95% CI 0.78 to 1.56). Four small behavioural intervention studies compared aversion techniques (n=12), imaginal desensitisation (n=20 and n=21), or masturbation prohibition (n=17) versus another behavioural intervention or with wait list control. Reoffending was either not reported for the individual treatment groups or statistical comparisons were not reported. One study (n=231) compared 1 year of group psychodynamic psychotherapy versus probation. A non-significant trend for increased risk of rearrest for sexual offence over 10 years of follow-up was seen for the psychotherapy group (risk ratio 1.87, 95% CI 0.78 to 4.47). Limited data were available for secondary outcomes.

Currently RCT evidence does not support that psychological interventions reduce the risk of sexual reoffending. High-quality RCTs with minimal bias and long-term follow-up in the community are required to identify interventions that can reduce sexual reoffending rates.

Abstracted from
Dennis JA, Khan O, Ferriter M, et al. Psychological interventions for adults who have sexually offended or are at risk of offending. Cochrane Database Syst Rev 2012; 12:CD007507.
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Sources of funding: Nottinghamshire Healthcare Trust UK, NHS Cochrane Collaboration Programme Grant Scheme, UK.
Tags: Профессия, Экспертиза

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