Clinical and forensic psychology (year two)

Question 1

give the medical defintion of abnormality

Answer 1

abnormal is something that worsens health and well-being

Question 2

give the statistical definition of abnormality

Answer 2

abnormal is something that is unusual in the population

Question 3

give the social definition of abnormality

Answer 3

abnormal is something that is disapproved in specific times and places, something that needs to be changed

Question 4

Explain why mental distress is not the same as medical illness

Answer 4

SYMPTOMS

• Subjective/ Functional diagnosis
• What the individual feels/observes
• Often cannot be objectively verified by tests
• In mental “illness”, there are only symptoms

SIGNS

• Objective/Organic diagnosis
• What the doctor/medical professional observes after biomedical testing (scans, blood tests, etc)
• In mental distress, signs

Question 5

Give arguments for and against the biomedical model for depression being genetic

Answer 5

FOR: Twin-based heritability around 37% (Sullivan et al, 2000, Genetic epidemiology of major depression: review and meta-analysis. Am J Psychiatry 157, 1552–1562). Replicated studies with similar heritability estimates cannot be brushed away by methodological criticism
AGAINST: Problems with Equal Environment Assumptions (EEA) and twin-study methodology.
FOR: Studies have found short variants of serotonin transporter gene 5-HTTLPR in depression- serotonin influences mood, and this gene variant may lead to less serotonin uptake- low mood
AGAINST: Many of these studies poorly conducted, small sample sizes, findings not replicated, publication biases, big pharma involvement (See also Van Der Auwera et al 2019 failing to find GXE in depression).

Question 6

Explain how co-morbidity causes issues for the biomedical model

Answer 6

Are forms of distress really separate entities? For example, co-morbidity for anxiety and depression - 70% (Carter et al., 2001). Anxiety and depression are also characteristics of MANY other forms of distress too.
If there is large amount of overlap, makes no sense to view distress categories as distinctively separate biological disorders
Also, sufferers that have the same label have heterogeneous symptoms- people with the same diagnosis can have VERY different experiences

Question 7

Describe the work of Emil Kraepelin

Answer 7

German psychiatrist
ideas firmly rooted in the German experimental psychology tradition
was one of the founding people in devising a systematic classification system for mental disorders.
Kraepelin believed that mental distress has it’s origin in the malfunctioning of the brain, and that observable symptoms can reveal the underlying mental disorder (a bit like the DSM system does today).
Kraepelin used a scientific, systematic approach, and collected over 1000 case studies (many of his own patients), and used them to test and refine his classification system. T
he existence of large captive populations in mental asylums enabled the establishment of a new professional discipline, psychiatry, as part of a medical profession

Question 8

Define aetiology

Answer 8

Study of factors that cause mental distress

Can happen anytime before conception (epigenetics), prenatally during pregnancy, during birth and at any time during life

Should also learn HOW mechanisms function

Question 9

Define necessary cause

Answer 9

Necessary cause: Y never occurs without the prior occurrence of X (but X can also occur without leading to Y)

Question 10

Define insufficient cause

Answer 10

Insufficient cause: Y occurs only after X occurs with another variable, Z. Y does not occur when X occurs alone

Every factor is bidirectional

Question 11

Give some difficulties in studying causality

Answer 11

Most studies are retrospective studies

Many studies are cross-sectional (rather than longitudinal)

Large number of variables, complicated relationships

Important influences difficult to manipulate experimentally

Sensitive variables hard to investigate

Participants may have difficulties in identifying/expressing feelings

Variables can be mediated by meaning – difficult to study

Lack of validity of diagnostic categories

Question 12

Define epidemiology

Answer 12

The study of determinants and distribution of health-related topics

Question 13

Define deductive and inductive approaches

Answer 13

Deductive approach: test a theory of causality using pre-determined variables (e.g surveys, experiments)

Inductive approach: explore experiences, and link them to causal theories or devise new causal theories (case studies, interviews, focus groups etc)

Question 14

Give some advantages and disadvantages of case studies

Answer 14

Advantages

Good for rare occurrences

Can be useful for generating new ideas

Give some meaning to complex quantitative findings

Disadvantages

Impossible to generalise to whole population

Question 15

Give some advantages and disadvantages of qualitative studies

Answer 15

Advantages

Brings new meaning to experiences

Can generate new hypotheses for quant studies

Can establish some causality

Disadvantages

Can’t be generalised to whole population

Question 16

give some advantages and disadvantages of surveys

Answer 16

Advantages

Potential to have large, ecologically valid samples

Disadvantages

Reliance on self-reports

Often cross-sectional samples

Can have biased sampling

Based on potentially unreliable measures

Question 17

Give some advantages and disadvantages of experiments

Answer 17

Advantages

May have some control over causality

Control over variables

Disadvantages

May not be possible to manipulate relevant variables

Low ecological validity

Samples may not be representative

Based on potentially unreliable measures

Question 18

Give some issues of the biomedical model

Answer 18

We can’t measure serotonin; studies use different proxies, e.g how fast serotonin is synthesized in the brain (impossible to measure activity, synthesized rapidly and constantly)

No objective signs

We don’t know the function of mechanisms of serotonin in the brain

60+ years of research and millions of publications still cannot discover mechanisms

Question 19

Describe research issues with the biomedical model

Answer 19

Guardian (2019): Systematic review, “The drugs do work: antidepressants are effective, study shows”

Authors and affiliations: lots of pharmaceutical interaction, by funding or by studies being run by people who are employed by pharmaceutical companies

Blind randomised controlled trials: not actually blind: antidepressants have other side effects, e.g nausea, lethargy, anhedonia, apathy – results in a reporting bias

Short-term studies: average duration is 6 weeks (myth about antidepressants kicking in within 2 weeks of use) – not a long enough time to measure, would be more beneficial to look after a long period of time e.g a year

Different antidepressants increase and decrease serotonin have the same effect : both act as same placebo

Any differences are meaningless in peoples life : Hamilton’s scale, 50 items and can score between 0 and 100 and a MDD cut off. A statistically significant score is meaningless to peoples lives when comparing before antidepressants and after antidepressants (scoring 2 points lower after taking SSRIs would be classed as significant, but that could make very little difference to a persons life

Eleanor longden : the voices in my head

Question 20

Give some historical approaches to classification

Answer 20

• Kraepelin: attempted to reclassify mental conditions into dementia praecox contrasted with depression
• Group of schizophrenia’s encompassed dementia praecox
• Kraepelin’s approach assumes that symptoms covary and area part of a syndrome with common aetiology and course

Question 21

Describe the ICD-10 and DSM5

Answer 21

1. ICD-10
   o Technically universal standard classification
   o Recommended for admin/epidemiology purposes
   o Forms basis UK NHS procedures
2. DSM-5
   o APA
   o Widely used in USA
   o Recommended for epidemiology/statistical/research purposes
   o Standard for researchers

Question 22

Give arguments for the reliability of mental health diagnosis

Answer 22

• In the 1930’s and 1940’s a significant difference was observed between the schizophrenia diagnosis rates in the United Kingdom and the United States (Bellack, 1958).
• Comparison of the frequency and circumstances of schizophrenia diagnoses in Europe and America, suggested that the term ‘schizophrenia’ was being used in different ways in different places.
• The statistical reliability of the diagnosis of schizophrenia was found to be poor (kappa = 0.6, Spitzer & Fliess, 1974)
  o Only 32% of the disagreement being due to poor measurement of symptoms
  o 63% due to unclear criteria (Beck, Ward, Mendelson, Mock, & Erbaugh, 1962).
• Kreitman (1961) suggested five different sources of error in diagnosis that could lead to unreliable diagnosis:
• The psychiatrists (the raters or diagnosers) might differ,
• the psychiatric examination might be different each time
• the patients might differ (they might mention different things, behave differently or even that their problems might have changed over time),
• the method of analysis might alter (there might be different rules for combining symptoms) and
• there could be different systems of names and styles of reporting.

Question 23

Give arguments for the validity of diagnosis

Answer 23

• Diagnostic classifications should also be valid - scientifically meaningful and representing real ‘things’.
• Outcome (prognosis) for people with a diagnosis of schizophrenia, for example, is extremely variable (Bleuler, 1978; Ciompi, 1984) and attempts to define a diagnostic group with a more predictable outcome have not been very successful (Boyle, 1990).
• Diagnoses should also indicate what treatments will be effective.
  o However, it appears that it is difficult to predict what treatment people will receive even on the basis of the diagnosis they receive (Heather, 1976).
  o Bannister and colleagues (1964) found that in fact treatments often appear to be given for reasons other than the diagnosis.
  o Responses to medication for “schizophrenia” and “bipolar disorder” vary. Medication response is irrespective of diagnosis (Moncrieff, 1997).

Question 24

Describe research findings of race and culture in diagnosis

Answer 24

• Considerable evidence that Black people in UK are more likely to be diagnosed as having mental illnesses and to be detained in secure hospitals (Commander et al, 1997)than Asian and White people.
• People from ethnic minority groups tend to receive more medical and physical treatments, and are under-represented in less coercieve forms of treatment, such as counselling and psychotherapy services (Ahmed, 1995; Littlewood and Lipsedge, 1997

Question 25

Describe research findings of diversity and difference on diagnosis

Answer 25

• Some individuals have strange experiences (visions, auditory hallucinations, or profound spiritual experiences) but see them as spiritually enriching, not illness (Jackson & Fulford, 1997).
• Huge diversity in what is considered an appropriate expression of distress in different cultures.
  o Cochrane & Sashidharan (1995) - diagnostic systems can label behaviours as problems because they differ from what is normal in white, western, male, middle-class culture. In some cultures behaviours and experiences are common which are considered very abnormal in others.

Question 26

Define predictive validity

Answer 26

• Diagnosis does not predict the course or outcome of psychotic illnesses
• .Diagnosis does not predict response to medication (Kendell, 1988).

Question 27

Give some practical consequences of diagnosis

Answer 27

• Avoidance – people want to create social distance (Mehta & farina, 1997)
• Harsh treatment – Mehta & Farina (1997) people gave more electric shocks to those with problems understood as being due to mental illness compared to childhood events.
• Unemployment & Social Disadvantage - Less likely to get jobs (Farina & Felner, 1983) Excluded from some professions & life insurance etc.
• Loss of rights - Forced treatment Exclusion from driving / jury service

Question 28

Give some psychological effects of diagnosis

Answer 28

• Hopelessness and decreased confidence
• Identifying with label of ‘mental patient’ (self fulfilling prophecy)
• Disempowerment
• Decreased ownership of experiences
• Denial of the meaning of experiences and relevance to current environment
• Denial of positive aspects of experiences

Question 29

Give some professional implications of diagnosis

Answer 29

• Gives a misleading impression of certainty – syndromes and labels become real entities
• Promotes ‘us’ and ‘them’ thinking
• Narrow understanding of people’s problems
• Does not see people as able to change
• Places problem within individual rather than environment
• Fosters dependency in patients
• Narrows conceptualisations of treatment and treatment effectiveness
• Narrows the focus of research (it is about diagnosis rather than need, vulnerability and risk)

Question 30

Explain case formulation and the process of developing a case

Answer 30

• “The case formulation is a hypothesis about the nature of psychological difficulty underlying the problems on the patients’ problem list” (J. Persons 1989)
• The way in which you understand the problem.
• Application of the applied scientist approach
  o 1) Collect information that will help understand the client’s difficulties and highlight areas in which change may be possible (develop a hypothesis).
  o 2) Assess the level of severity of the problems in order to assess the impact of any interventions. This will allow you to test your hypotheses regarding the nature of the problem. i.e.. measure change
  o 3) To inform the client about the psychological approach(es) to be used in therapy.

Question 31

Explain how psychiatric labelling can contribute to stigma

Answer 31

Language from biomedical model means difficulties seen as problems within an individual
o Pathologizes normal responses
o Contributes to power imbalance between client and clinician
- Labelling MH as illness is associated with predictions of dangerousness, unpredictability and fear and desire for social distance (Read et al., 2006)

Question 32

Explain how race bias comes into play in psychiatry

Answer 32

Fernando 1991: Psychiatry is ethnocentric

• Garb 1997: AA/Hispanic patients more likely to receive a diagnosis of schizophrenia than white patients
• Neighbors et al 2003: white psychiatry inpatients are more likely than AA to be diagnosed with bipolar disorder
• NHS Digital 2018: Black people four times more likely to be detained under the mental health act

Question 33

. Explain how gender bias affects psychiatry

Answer 33

DSM-5, 2000: 75% of people diagnosed with BPD are AFAB

• Ball and Links, 2009: Evidence of causal relationship between childhood trauma and later diagnosis of BPD (particularly sexual trauma)
• Some researchers have therefore argued that instead of seeing women’s distress as symptoms of a ‘borderline personality disorder’ we should understand their difficulties as a response to societal sexual violence and oppression (e.g. Shaw & Proctor, 2005)

Question 34

Explain how comorbidity is an issue in psychiatry

Answer 34

Usual rather than unusual - more than 50% of people diagnosed with a mental disorder in a given year meet criteria for multiple disorders (Kessler et al., 2005)

• 23% of sample of psychiatric patients have three or more diagnoses (National Comorbidity Survey)
• Problem of comorbidity raises significant questions about the underlying structure & assumptions of classification (Hyman, 2010)

Question 35

. Explain research findings of heterogeneity in psychiatry

Answer 35

• Heterogeneity: consisting of lots of different parts or elements
• Using specifiers and extra criteria increases heterogeneity
• 80,000 symptom combinations for PTSD diagnosis in DSM-IV compared with 600,000 combinations in DSM-5 (Galatzer-Levy & Bryant, 2013)
• Allsopp et al (2019): Explored the heterogeneity of mental health difficulties & experiences, and how diagnostic systems attempt to cope with this
• Timescales – e.g. discrete episodes vs. minimum time requirements
• Comparators – some experiences compared with ‘normal’ functioning (e.g. low mood) vs. others implicitly seen as inherently disordered (e.g. paranoia, hearing voices)
• Role of trauma only acknowledged in specific categories e.g. PTSD

Question 36

Define homogeneity

Answer 36

Heterogeneity: consisting of lots of different parts or elements

• Using specifiers and extra criteria increases heterogeneity
• 80,000 symptom combinations for PTSD diagnosis in DSM-IV compared with 600,000 combinations in DSM-5 (Galatzer-Levy & Bryant, 2013)
• Allsopp et al (2019): Explored the heterogeneity of mental health difficulties & experiences, and how diagnostic systems attempt to cope with this
• Timescales – e.g. discrete episodes vs. minimum time requirements
• Comparators – some experiences compared with ‘normal’ functioning (e.g. low mood) vs. others implicitly seen as inherently disordered (e.g. paranoia, hearing voices)
• Role of trauma only acknowledged in specific categories e.g. PTSD
• Homogeneity: consisting of parts or elements that are all the same.

Question 37

Give research findings into adverse or traumatic life experiences

Answer 37

The majority of people using mental health services have been exposed to adverse or traumatic life experiences (Mauritz et al., 2013)
- Multiple meta-analyses have demonstrated a robust association between traumatic experiences and mental health difficulties including:
o Depression (Mandelli et al, 2015; Nelson et al., 2017)
o Anxiety (Lindert et al., 2013)
o Obsessive compulsive disorder (OCD) (Miller & Brock, 2017)
o Suicidal behaviour (Zatti et al., 2017)
o Self-harm (Liu et al., 2016)
o Psychosis (Varese et al., 2012)
o Bipolar disorder (Palmier-Claus et al., 2016)
- Preventing childhood trauma would reduce cases of psychosis by a third (Varese et al, 2012)
- Typical psychological therapies are not as effective for people who have had traumatic life experiences:
o increased risk of recurrent and persistent depression (Nanni et al)
o a lack of response/remission during depression treatment (Nanni et al)
o twice as likely to develop chronic or treatment-resistant depression (Nelson et al., 2017)

Question 38

Explain alternatives to diagnosis for accessing treatment

Answer 38

Using ICD psychosocial codes (Allsopp & Kinderman, 2017)
o neglect, abandonment, other maltreatment (Y06 and Y07)
o homelessness, poverty, discrimination, and negative life events in childhood, including trauma (Z55-Z65)
- ICD code analysis in mental health services (Kinderman et al., under review)
o Diagnosis only used in 21.5% of patient records (N=21,701)
o Codes for possible social determinants were used on only 43 occasions, <1% of almost 5000 people who were given a diagnosis
- GP records showed 1.8% of a sample of 11m had officially confirmed childhood maltreatment (Chandan et al., 2019)
o Those who had been maltreated were over 2x more likely to develop a mental health problem
- Organise services based on need & the severity/ complexity of distress
- Use a ‘complaints- or problem-based approach’: Descriptions without implication of “a disorder” (e.g. ICD codes; Kinderman & Allsopp, 2018)
- The Power Threat Meaning Framework
- Trans-diagnostic approaches
- Psychological formulation

Question 39

Give some characteristics of BPD

Answer 39

• Borderline personality disorder: Characterised by impulsivity, unstable/intense relationships, suicidal/self-harm behaviour, marked reactivity of mood

Question 40

Describe the three clusters of personality disorders

Answer 40

• Three clusters of personality disorders:
  o A: Odd/eccentric (paranoid, schizoid, schizotypal)
  o B: Dramatic/erratic (Antisocial, borderline, histrionic, narcissistic)
  o C: Anxious/fearful (Avoidant, dependent, obsessive-compulsive)

Question 41

Give come contentious issues associated with diagnosing personality disorders

Answer 41

• Personality disorders very closely associated with childhood abuse
• Diagnosis is: disempowering, ignores trauma/blame, locates blame in a ‘disorder’
  o Also misogynistic

Question 42

Give an overview of the dark triad

Answer 42

In the DSM system- Narcissistic Personality Disorder (NPD); Anti-Social Personality Disorder (ASPD)

Diagnostic systems rely on arbitrary cut-off points between “normal” and “abnormal” personality

In personality literature, this variation is considered as normal

From evolutionary perspective, different levels of these traits could be adaptive (e.g., fast life history; short-term mating strategy)

Question 43

Give some of the domains of the psychopathy checklist-revised

Answer 43

Superficial charm

2. Grandiose sense of self-worth
3. Easily bored
4. Pathological lying
5. Manipulative
6. Lack of remorse or guilt
7. No emotional depth
8. Callous
9. Parasitic lifestyle
10. Poor behavioural control
11. Early behaviour problems
12. No long-term planning
13. Impulsive
14. Irresponsible
15. External locus
16. Frequent marital failures
17. Delinquent as a juvenile
18. Re-offending criminal
19. Promiscuous sexual behaviour
20. Versatile as a criminal

Question 44

Give physiological theories of depression

Answer 44

monoamine hypothesis: norepinephrine, dopamine & serotonin disturbances are responsible for depression. These are important for sleep, appetite & emotion. Most antidepressants increase levels of these. Evidence is still equivocal after 20 years.

More recently, an imbalance between monoamines & acetylcholine has been suggested as the cause (Janowski et al, 1983). Also, an increase in cholinergic activity due to stress is thought to effect the incentive function of the brain’s reward system by reducing sensitivity (Willner, 1985).

Question 45

Describe psychodynamic and behavioural theories of depression

Answer 45

Psychodynamic

‘Frozen anger’ directed at self following some real/imagined loss.

Behavioural

Lewinsohn (1974)~ a low rate of response contingent positive reinforcement is the causal & maintaining factor in depression. Also linked with inadequate social reinforcement. Evidence is mainly correlational.

Seligman (1975)~ learned helplessness model developed to account for deficits in dogs exposed to uncontrollable shocks. Assumes that a person learns that outcomes are independent of their response and thus uncontrollable.

1. Inadequate or insufficient reinforcement Lazarus (1968)

Depression can result from a lack of reinforcement

Unclear whether reduced frequency or quality of reinforcement is the important factor

2. Reduced frequency of social reinforcement; Lewinsohn (1975)

People drop reinforcing activities due to extinction by a low rate of response contingent positive reinforcement (they can’t make good things happen)

3. Loss of reinforcible behaviour (Ferster, 1973)

Depressed person does not receive reinforcement because they do not have the responses which would elicit it.

Loss of reinforcer effectiveness (Costello, 1972)

Although same behaviours and consequences occur, they have lost their reinforcement potency.

Could be due to changes in biochemical mechanism underlying motivation, or

Breakdown in behavioural chain due to loss of 1 reinforcer (eg. Rewards are dependent upon one central component such as work).

Question 46

describe beck’s cognitive model

Answer 46

It is not a situation in and of itself that determines what people feel but how they construe a situation (Beck, 1964; Ellis, 1962)

Early life experiences

ê

Core beliefs

ê

Conditional assumptions/rules for living

ê

Activating event

ê

Negative Automatic Thought

ê

Symptoms of Depression (emotional, physical, behavioural)

Suggests that vulnerability to depression arises from certain kinds of schemas/ beliefs that a person holds about themselves, the world or others, and the future (negative cognitive triad)

When a core belief is activated we interpret situations through the lens of this belief even though the interpretation may not be valid

Common core beliefs

The self

“I’m incompetent”

“I’m worthless”

Other people

“No nobody loves/cares for me”

“Others always let you down in the end”

The world

“The world is a cruel place, there is no point trying”

“The world is full of pain, life is about suffering”

Question 47

Describe and give examples of cognitive bias

Answer 47

Identifying automatic thoughts allows you to evaluate their validity

See Unhelpful Thinking Styles handout

All or nothing

Over-generalizations

Mental filter disqualifying the positives

Jumping to conclusions

Magnifying & minimising

Emotional reasoning

Labeling

Personalisation

Should, must, ought to

Question 48

Describe different approaches to mental health across cultures

Answer 48

Post-(European) enlightenment ideas (17-18th C) led to development of:

Western Psychiatry focused on ‘abnormal’ mind  mental illness & medical therapies

Western Psychology focused on ‘normal’ mind  ’scientific’ psychological therapies

Non-western medical systems mainly holistic and often embedded in philosophy, religion etc. Examples:

Ayurveda in Indian sub-continent

Chinese traditional medicine

Traditional healing

Faith healing

Question 49

Give some cultural factors which influence illness, duration and illness behaviour

Answer 49

Religious practices

Traditional medicines

Provision and resources– poverty – emigration

Stigma

Many more! i.e. Politics, human rights laws, science, etc

Question 50

Describe how religious practices can influence attitudes towards MH and illness

Answer 50

Understanding causation – withcraft, curses, spiritual influences

i.e. Campbell et al. (2017): Looked at the content of delusions in a sample

of South African Xhosa people with schizophrenia. 72.5% believed others had bewitched them

2. Acceptance of treatment - fasting, praying
3. Content of delusions or paranoia

“Most are religious with much emphasis on prayer. Ethiopians are not serious about depression or sophisticated sickness. We believe in religion and holy water as a cure” (Palmer, 2007)

Question 51

describe the role of traditional medicines

Answer 51

Describe the role of tradition medicines

More accessible- location, language

Cheaper

Added spiritual influence on treatment- make treatment more effective and faster?

More accepting of theory of causation

Question 52

Describe the use of traditional complementary and alternative medicine in the UK

Answer 52

Evidence is varied

Systematic review conducted by Posadzki et al (2012) showed:

Most surveys were of poor methodological quality.

The average prevalence of use of CAM was 20.6% (range 12.1–32%).

The average referral rate to CAM was 39% (range 24.6–86%)

CAM was recommended by 46% of physicians (range 38–55%).

Self-report survey conducted by Sharp et al. (2018) showed:

16% of respondents had seen a CAM practitioner in the last 12 months

Question 53

Describe how education can influence attitudes towards MH

Answer 53

Impacts views towards mental illness

Literate individuals are more likely to exhibit positive feelings towards individuals with mental disorders

Can also impact help seeking behavior and treatment choice

Formal vs. Informal education

“the people from the developing countries… many people cannot realize it (…) for some people, they have very limited education or knowledge, they won’t see the seriousness of the mental illness.”

(Donnelly et al., 2011)

Question 54

Describe how stigma can affect attitudes towards MH

Answer 54

1. Ostracised from community
2. Impacts employment/business
3. Impacts housing
4. Impacts ‘marriageability’ of patient and family members
5. Self-stigma?

Question 55

Describe critical perspectives in a cross-cultural view of mental illness

Answer 55

Surveys and check-lists are practical and low-cost, but ‘the fatal error of community studies was to define all symptoms as pathological without considering the context in which they arose and persisted’ (Horwitz and Wakefield, 2007, p. 129).

By shifting focus away from context, reported rates of disorders, such as depression, are inflated, meaning that ‘the extraordinarily high rates of untreated mental disorder reported by community studies are largely a product of survey methodologies that inherently overstate the number of people with a mental disorder’ (Horwitz and Wakefield, 2006).

Such tools enable a “massive pathologization of normal sadness” that has made “depressive diagnosis less rather than more scientifically valid” (2007:103).

Question 56

Describe some issues with cross-cultural research

Answer 56

1. Category Fallacy

“the reification of a nosological category developed for a particular cultural group that is applied to members of another culture for whom it lacks coherence” (Kleinman, 1987).

2. Potential biases
3. Others including traditional practices, communication, service provision, illness behavior, etc.

Question 57

Describe findings on experiences of distress

Answer 57

OVERVIEW OF SOURCES OF DISTRESS:

Poverty and a ‘broken economy’

Housing and ‘homelessness’

‘More important than exams, if you don’t have a place of your own to live in what good is school?’

Domestic violence and marginalisation

Ill-health (physical and emotional) i.e. Jighar Khun (liver-blood; regret, depression)

Educational provision

Governance and social justice

Question 58

Explain operant/instrumental conditioning

Answer 58

Method of learning that occurs through rewards and punishments for behaviour.

Through operant conditioning, an individual makes an association between a particular behaviour and a consequence (Skinner, 1938).

Learned consequences modify the type and frequency of behaviour

Question 59

Describe the work and views of behaviourism

Answer 59

Published Psychology from the Standpoint of a Behaviorist in 1919

Classical (Pavlovian) and instrumental conditioning can explain much, if not all, behavior.

Inferring internal states is redundant and unnecessary

Cognitive explanations are not scientific

Question 60

Give operant conditioning techniques

Answer 60

POSITIVE REINFORCEMENT

Increasing a behaviour through reward

e.g. an extra 30 minutes TV for helping with clearing up

NEGATIVE REINFORCEMENT

increasing a behaviour by removing an aversive stimulus

e.g. leaving for work early to avoid being stuck in traffic

EXTINCTION

decreases a behaviour slowly due to NOT experiencing an expected positive stimulus.

e.g. Pavlov’s dog no longer salivates when hears bell as not provided with food

Question 61

Describe the components of obsessive compulsive disorder

Answer 61

Obsessions

Recurrent & persistent thoughts, images or urges that are experienced as intrusive and unwanted and cause marked anxiety or distress.

Compulsions

Repetitive behaviours (e.g. hand washing, checking) or mental acts (e.g. praying, counting) that the person feels driven to perform in response to an obsession to reduce distress or preventing some dreaded event or situation.

Question 62

Describe the behavioural theory of OCD

Answer 62

Two stage theory of the acquisition & maintenance of fear and avoidance behaviour (Mowrer, 1939; 1960).

Stage 1 Acquisition – Thoughts, images, objects can acquire distressing properties through association e.g. an obsession is linked to distress e.g. thought of hurting an animal.

Stage 2 Maintenance – Avoidant, escape responses i.e. RITUALS develop because they decrease anxiety/distress and are maintained through negative reinforcement.

Question 63

Explain exposure and response prevention as a treatment for OCD

Answer 63

Expose people to obsessional stimuli

Prevent compulsions used to lessen distress associated with the obsessional stimuli

Repeated exposure to the obsessions while using strict response prevention leads to habituation

1. Generate a list of feared situations (external/internal)
2. Teach “subjective units of distress” (SUDS) and get a rating for each situation
3. Hierarchies typically need 10-20 steps
4. Refinement to hierarchy often required during treatment

Question 64

Give some successful for the behavioural model of OCD

Answer 64

Foundation for experimental investigation of OCD

2. Provided some support for Mowrer’s Model (at least for the maintenance phase)
3. Delineated between forms of compulsive behaviour
4. Development of an effective therapy (ERP)

Question 65

Give some limitations of the behavioural model of OCD

Answer 65

1. Little evidence supporting acquisition stage
2. Does not adequately explain the cognitive aspects of OCD
3. Not all obsessions provoke anxiety/distress
4. Compulsions can elevate anxiety
5. Doesn’t differentiate between anxiety disorders

Question 66

Describe Beck’s cognitive theory of emotional disorders

Answer 66

(Beck, 1967; 1976)

Emotional disorders maintained by ‘distorted thinking’

Distorted thinking characterised by frequent negative automatic thoughts (NATs)

NATs are a product of beliefs and assumptions stored in memory i.e. Schemas

Beliefs & assumptions represent knowledge structures, which are relatively stable constructs termed schemas (Bartlett, 1932)

Schemas guide behaviour and shape interpretation of events.

Behaviour and thinking follows logically from the beliefs and assumptions.

Early Experience

Dysfunctional Schemas

↓

Critical Incident

↓

Schema Activation

↓

Negative Automatic Thoughts

↓

Symptoms

↓

Behavioural Motivational Affective Cognitive Somatic

Question 67

Describe what schemas are

Answer 67

Focus of therapy; based on the content of schemas
Beliefs

Unconditional in nature perceived as reflecting the truth about the self and world.

Declarative statements; ‘I’m worthless, I’m a failure, I can’t cope’

2. Assumptions

Conditional in nature- guide behaviour

‘If I don’t achieve success in everything I am a failure’

Question 68

Explain the relationship between schemas and negative automatic thoughts

Answer 68

Specific schemas/NATS are associated with specific disorders. ‘Content specificity hypothesis’

Schemas can arise from early experience, or develop subsequently to the development of the disorder.

Negative Automatic Thoughts

Reflect the activation of schemas

Appraisals/interpretation of events

Automatic, rapid, involuntary, plausible, thoughts/images, systematic errors

Question 69

Describe reasoning biases

Answer 69

Selective abstraction: Draw conclusions based on limited evidence without considering wider evidence

Catastrophizing: Overestimating the significance of events

Dichotomous thinking: Black & white thinking /all bad or all good

Overgeneralisation: Applying a belief based on one situation to all situations

Question 70

Describe benefits and limitations of the cognitive theory

Answer 70

Provided the impetus for disorder specific models

Useful heuristic to explain anxiety/psychological difficulties.

Notion that information stored in long term memory influences processing.

Clinically relevant & effective treatments

Question mark over the validity of the theory

Clinical, rather than a scientific theory- developed from practical experience

Negative thoughts might be a consequence not an antecedent of anxiety

Focus is only on one level of cognition

Question 71

Describe the influence of cognitive psychology on cognitive therapy

Answer 71

Led to theories and therapies for clinical disorders.

Provides more empirical evidence than can be obtained within therapy

Casts light on the causal role of cognitive processes in the development of psychological disorders

Research in cognitive psychology of direct relevance for treatment strategies

Question 72

Give the diagnostic criteria for social phobia

Answer 72

A. Marked & persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny by others.

B .Exposure to the situation almost always provokes anxiety, which can take the form of a panic attack

C .Person recognises the fear is excessive/unreasonable

D. Situation avoided or endured with intense anxiety/distress.

Question 73

Describe Clark’s cognitive model of panic

Answer 73

Question 74

Give symptoms of a panic attack

Answer 74

Panic attacks: surge of intense fear/intense discomfort that reaches a peak within minutes

Symptoms:

Nausea

Heart pounding

Sweating

Sensations of choking

Palpations/pounding heart

Feeling dizzy/lightheaded

Feel of losing control

Chills/heat sensations

Defined by 4 or more symptoms from list of 13

Often accompanies with hypervigilance about bodily sensations e.g counting heart rate, monitoring thoughts

Overestimate extent to which symptoms are visible

Question 75

Describe the DSM-5 criteria for panic disorder

Answer 75

Recurrent or multiple panic attacks

1 attack has been followed by 1 month or more than 1 or more of following

Persistent concern about additional attacks

Worry about implication of attack/consequences

Significant change in behaviour related to the attack

Symptoms not due to medical condition

Not attributable to another psychiatric disorder

Question 76

Define and describe agoraphobia

Answer 76

Marked fear/anxiety about 2 or more of following 5 situations

Using public transport

Being in open spaces

Being in closed spaces

Standing in a line/ in a crowd

Being outside the home alone

Situations are avoided or else are endured with marked distress or with anxiety about having a panic attack or panic-like symptoms, or require the presence of a companion

Question 77

Describe treatment for panic disorder

Answer 77

Develop case formulation

Walk through CF with patient

Show that misinterpretation is false – where models/theories can help to design appropriate experiments

Induce symptoms of when you’re anxious – e.g start hyperventilating, drink coffee

If patient uncomfortable, psychologist does this first

Inducing symptoms bans safety behaviours e.g standing up, not allowing water, not allowing something to prop up/crutch

Disconfirmation maneuverer: make the symptoms worse e.g if dizzy, stand on one leg

What does this tell you about belief you’ll faint? Proves belief is false

Do experiment again not in a safe place e.g psychologist stands further and further away so they can’t help, etc

80% remission rate

Question 78

Describe the stages in developing a new psychological treatment

Answer 78

Question 79

Give research findings on treatments for OCD

Answer 79

CBT or ERP - recommended psychological approaches for OCD (NICE, 2006)

Multiple meta-analyses conclude that CBT or ERP are effective interventions (Abramowitz et al., 2002; Eddy et al., 2004; Gava et al., 2007; Jónsson and Hougaard, 2009; Olatunji et al., 2013; Öst et al., 2015; Pearcy et al., 2016; Romanelli et al., 2014; Rosa-Alcázar et al., 2008; Schwartze et al., 2016; Skapinakis et al., 2016; Wootton, 2016).

Question 80

Describe the findings of fisher et al., 2020: A Clinical Significance Analysis of Psychological Interventions for OCD

Answer 80

To determine the efficacy treatment for OCD

Applied Jacobson criteria to individual patient data on the “Gold Standard” outcome measure i.e. Yale Brown Obsessive Compulsive Scale (Y-BOCS)

Two fold criterion for recovery on Y-BOCS

Statistically significant improvement following Tx

Post-treatment score closer to a functional rather than dysfunctional population

Asymptomatic criterion: 7 points or less on Y-BOCS

Question 81

Describe the findings of Fisher et al., 2020

Answer 81

Approximately 60% of people continue to experience symptoms following psychological interventions.

However there are other issues to consider when interpreting results

Therapist competency

Inclusion/exclusion criteria of the RCTs

Treatment Adherence

15% of eligible people refused psychological Tx

16% of treatment starters dropped out of psychological Tx (Leeuwerik, Cavanagh, & Strauss, 2019)

Question 82

Explain Wells’ (1997) Meta cognitive model of OCD

Answer 82

Question 83

Describe the roots in criminological psychology

Answer 83

Question 84

Describe the legal issue of mens rea

Answer 84

Mens rea: must be shown that the person acted with criminal intent, exercising free will = criminally responsible.

R v. M’Naughten (1843) - Lead to the M’Naughten Rule (legal test of responsibility)– not criminally responsible if:

At the time of committing the act, the party accused was labouring under such a defect of reason from a disease of the mind, as not to know the nature and quality of the act he was doing; or if he did know it, he did not know he was doing wrong.

“The Tories in my native city have compelled me to do this. They followed me to France, into Scotland and all over to England. In fact, they follow me wherever I go… They have accused me of crimes of which I am not guilty; they do everything in their power to harass and persecute me. In fact they wish to murder me.” M’Naughton, as cited in Asoken (2007)

Question 85

Describe the link between mental health and offending

Answer 85

↑ levels of offending among psychiatric populations (compared with general populations)

↑ levels of offending among patients with psychosis compared with the general population in Sweden (Fazel et al., 2009)

↑ prevalence of mental disorders amongst criminal populations

Systematic review of 62 studies (23,000 prisoners) from 12 ‘western’ countries (Fazel & Danesh, 2002)

4828 offenders (given a community sentence) in Sweden who were assessed by a psychiatrist (Grann et al., 2008)

diagnosis of substance abuse & personality disorders = risk of subsequent violent offending

90.8% of male juvenile detainees in South Korea had at least one psychiatric diagnosis (N = 173, Kim et al., 2017)

Question 86

Describe the link between personality disorders and aggression

Answer 86

Lack of empathy/callousness, inappropriate responses to others’ emotions

Antisocial personality disorder (Richard-Devantoy, Olie, & Gourevitch, 2009)

Dark Triad Traits (Ali & Chamorro-Premuzic, 2009; Del Gaizo & Falkenbach, 2008; Jonason, et al., 2017; Lyons & Brockman, 2017; Wai & Tiliopoulos, 2012; Watson & Morris, 1991; Watts et al., 2017)

Impulsivity

Secondary psychopathy (Hughes et al., 2012)

Aggression + cognitive bias

Psychosis (Park et al., 2018)

Emotional instability and aggression

Borderline personality disorder (Herpertz et al., 2016)

Cognitive disruption + lack of inhibition

Substance abuse disorder (Richard-Devantoy et al., 2009)

Question 87

Give other factors that could link to offending an aggression

Answer 87

Individual differences:

Gender: Males & anger attacks in depression (Winkler et al., 2005)

Age: Younger people more aggressive than older people

Social differences

Inadequate resources (Swanson et al., 2002)

Dysfunctional families (Matejkowski & Solomon, 2008)

Lack of social support (Silver & Teadale, 2005)

Stressful life events (e.g. being unemployed, legal issues, sacked) (Silver & Teadale, 2005)

Question 88

Describe the link between schizophrenia and offending

Answer 88

No link with violence (e.g. Quinsey et al., 2006)

Negative association (e.g. Appelbaum et al., 2000)

Offending in less than 1% of general population (Simeone, et al., 2015)

3.6% of male, 3.9% of female offenders (systematic review of 84 studies, 24 countries) (Fazel & Seewald, 2012)

Various risk factors for violence & schizophrenia (e.g. age Andrew & Bonta, 1998)

Question 89

Describe how schizophrenia could cause, be correlated with or be consequence of crime

Answer 89

Cause

Paranoid ideas, command hallucinations, other delusions cause offending; ‘psychotic drive’ (Smith (2000) → offending (Persecutory delusions? Perceiving the world as threatening?)

Disinhibiting effect of psychosis in sex offending (Phillips et al., 1998)

Consequence

Association with violent offending and self-harm/suicide in those with schizophrenia (e.g. Nicholls et al. 2006)

Correlation

Stressful life events can lead to both

Co-morbidity of substance misuse (e.g Van Dorn et al., 2012)

Question 90

Describe a link between major depression an offending

Answer 90

8% of general population

10.2% of male, 14.1% of female offenders (systematic review of 84 studies, 24 countries) (Fazel & Seewald, 2012)

Anger & depression (short-term) in imprisoned offenders (Kelly et al., 2019)

Question 91

Explain how depression could cause, be correlated with or be a consequence of offending

Answer 91

Causes

Offend because they are depressed (e.g. anger attacks)

Consequence

Triggered by guilt

Due to incarceration (in women – Fagan & Western, 2003)

Correlation

Precursors to depression

Losing job or relationship

Question 92

Describe research findings of public perception of mental health

Answer 92

Stigma attached to those with mental health issues (e.g. China, Yin et al., 2020)

Stigma attached to schizophrenia is often greater than for depression (e.g. Turkey; Utz et al., 2019)

Unpredictable, uncontrollable, violent (e.g. Germany; Angermeyer & Matschinger, 1994)

Question 93

Describe media perceptions of “psychokillers”

Answer 93

Owen (2012) Portrayals of schizophrenia by entertainment media: a content analysis of contemporary movies.

1990-2010, 41 characters

83% displayed violent behaviour towards themselves or others

1/3 of violent characters committed a homicide

Question 94

Describe the case of Seung-Hui Cho

Answer 94

Moved to the US when 8

Didn’t know much English

At 12, diagnosed with social anxiety disorder

Not good relationship with his father

Counselling for a number of years

Strong support at school

Ok for a couple of years at Virginia Tech

Stopped writing home

Arguing with classmates

Harassing female students

Statements that caused concern

Killed 32 students then himself

Question 95

Describe research findings of factors associated with mass shootings

Answer 95

Question 96

Describe the history of probation

Answer 96

Started in late 19th, early 20th centaury.

Developed between 1930’s and 1970’s.

Changed again in the 1990’s.

Question 97

Define desistance

Answer 97

McNeill 2006

Desistance is the word for how people with a previous pattern of offending come to abstain from crime. Desistance is a journey. It is influenced by someone’s circumstances, the way they think, and what is important to them (www.gov.uk, 2019)

Used as a foundation in probation for working with all offenders.

Criminogenic need

Different types of desistance

Question 98

Give a brief timeline of forensic psychology

Answer 98

1800: James Hadfield found not guilty by reason of insanity
1843: Daniel McNaughton found not guilty by reason of insanity
1876: Cesare Lombroso
1879: Francis Galton facial composites

Question 99

Describe R v Hadfield (1800)

Answer 99

James Hadfield – head injury in battle

Attempted to murder King George III

Tried for high treason

Was acquitted on grounds of insanity

Question 100

Describe R v. McNaughten (1843)

Answer 100

Lead to the McNaughten Rule (legal test of responsibility)– not criminally responsible if:

At the time of committing the act, the party accused was labouring under such a defect of reason from a disease of the mind, as not to know the nature and quality of the act he was doing; or if he did know it, he did not know he was doing wrong.

“The Tories in my native city have compelled me to do this. They followed me to France, into Scotland and all over to England. In fact, they follow me wherever I go… They have accused me of crimes of which I am not guilty; they do everything in their power to harass and persecute me. In fact they wish to murder me.” McNaughton, as cited in Asoken (2007)

Question 101

Describe biological theories of criminal behaviour

Answer 101

Lombroso (1876) – Biological Positivism

Criminality is inherited, someone ‘born criminal’ can be anatomically identified by such items as a sloping forehead, ears of unusual size, asymmetry of the face, prognathism, excessive length of arms, asymmetry of the cranium and other ‘physical stigmata’

Underlying theoretical supposition that criminality is innate and that it is expressed in (or related to) physical characteristics.

Painstaking measurements

“The appearance of a single great is more than equivalent to the birth of a hundred mediocrities” (Lombroso)- Social Darwinism, application of ideas to support stereotypes, e.g. racial biases, eugenics movements

Theories lack credibility, though should be remembered for developments in research methods

Predominant view in both early clinical and criminal psychology through phrenology studies, work of Caesare Lombroso and Francis Galton

Question 102

Describe the constitutional approach

Answer 102

Sheldon (1942) - These were associated with three types of personality characteristics:

Endomorph - Viscerotonia (pleasure loving, dependent)

Mesomorph - Somatotonia (exercise loving, aggressive)

Ectomorph - Cerebrotonia (withdrawing, unsociable)

It was argued that (mesomorph) would be most likely to have traits related to delinquency; such as aggression, impulsivity, and risk taking.

Question 103

Give a summary of the History of Forensic Psychology

Answer 103

Early to mid1800s

Early legal precedents around ‘insanity’

Biological focus

Late 1800s, early 1900s

Emphasis on experimental methods

Early to mid 1900s

Further work on biological models

Stunted growth of legal psychology

1950s to 1970s

Shift to include social factors

Question 104

Describe the demographics of the Czech Republic

Answer 104

Centre of Europe

Slightly smaller than the UK, around a sixth of the population

Landlocked

2004, member state of Europe Union

2005, 3,44060 criminal acts (police) (2005, England and Wales = 5,63511)

Property crimes around 66.6% of all crimes; violent crimes around 6.3%

Question 105

Describe forensic psychology in Czech Republic

Answer 105

Since 1990s, increase in:

Research and academic literature

Roles for FPs in government and Czech police

Courses forensic psychology at universities

Psychologists being judiciary experts

Tool for police officers (recruitment and dealing with trauma) or studies on crime prevention (societal level).

Question 106

Define culture and cultural diversity

Answer 106

Culture is a social pattern that is heritage within a society. It determines what is important and unimportant, right and wrong, acceptable and unacceptable. Culture encompasses explicit and tacit values, norms, attitudes, beliefs, behaviours and assumptions.

Cultural diversity (also known as multiculturalism) is a group of diverse individuals from different cultures or societies. Usually, cultural diversity takes into account language, religion, race, sexual orientation, gender, age and ethnicity.

Question 107

Describe cultural bias in psychology

Answer 107

Cultural bias occurs when people of one culture make assumptions about the behaviour of people from another culture based on their own cultural norms and practices.

Unconscious Bias – For race and ethnicity we need to understand that we (rightly or wrongly) are representing structures where we are aware that there is a vulnerability to bias

Question 108

Should forensic risk assessments consider cultural diversity?

Answer 108

A Canadian Federal court challenged the administering of 5 risk assessment instruments with Canadian Aboriginal prisoners.

Fujii et al (2005) found some risk measures showing good cross cultural validity but it is important to recognise the unique ethnic differences in prediction of violence risk.

Effectively, forensic clinicians and researchers can no longer overlook the role of culture in risk assessment (Shepherd et al, 2016)

Multicultural groups are diverse not only in their beliefs and expectations, but also in their assumptions about what the clinician can do for them (Katz & Algeria, 2009)

Question 109

Describe responsiveness to differences

Answer 109

Ethnic and racial minority families from the US may also differ in their explanations about mental illness and treatment (Novins et al., 1997).

For example, African American and Native American families may have alternative explanations of mental illness such as supernatural or spiritual forces that lead youth to undesirable behaviors (Cheung & Snowden, 1990)

In order for clinicians to work in culturally sensitive ways with offenders within the forensic treatment process, this may even include working collaboratively with cultural representatives in order to develop a more responsive treatment process (Andrews & Bonta, 2007). Consider own cultural competence (Weiss & Rosenfeld

Question 110

Give an example risk assessment

Answer 110

Request to complete risk assessment for honour based violence (HBV)

Need to use interpreter (consider working with intepreters, guidelines for psychologists, November 2017, BPS)

Identify limitations to assessments

Refer to the literature to guide formulation and understand culture of client

Example

“Given that issues concerning culture and religion form an important part of black, and minority ethnic women’s identities, those who are religiously observant can experience feelings of further distress, anxiety and shame if public agencies do not meet their need. This can lead some to feel that they are being treated with a lack of dignity and respect as well as feelings of lessened value and a sense of “double victimization” (Gill, 2004). Services must therefore be culturally sensitive and this would be relevant

Question 111

Give an intervention/therapy example

Answer 111

Nigerian Prisoner undertakes the Prison Core Sex Offender Treatment Programme

Western values did not apply to his – saw sex differently

Issues related to cultural constraints in talking about sex and also how an individual’s identity and personal change are construed. The ways in which non-western cultures approach issues of gender and how sex is (or not) discussed may affect how willing a person may be to participate in groups where there is an expectation that the detail of sex offences is shared and discussed.

Whilst the BME sex offender may successfully learn the language of Western cognitive-behavioural therapy, the question of how relevant this will be to his survival in a non-western community is yet to be asked.

Question 112

Give a research example of diversity

Answer 112

Research samples should reflect the diversity of the population

Consider language or literacy barriers and other practicalities such as avoiding running groups at prayer time and being sensitive to global events that may impact on individuals

Research and those pursuing it should respect the diversity of human culture and conditions and take full account of ethnicity, gender, disability, age, and sexual orientation in its design, undertaking, and reporting. Researchers should take account of the multicultural nature of society. It is particularly important that the body of research evidence available to policy makers reflects the diversity of the population.( Research Governance Framework for Health and Social Care, 2001)

Question 113

Give the HCPC standards of proficiency

Answer 113

5. be aware of the impact of culture, equality and diversity on practice
6. 1 understand the impact of differences such as gender, sexuality, ethnicity, culture, religion and age on psychological wellbeing or behaviour
7. 2 understand the requirement to adapt practice to meet the needs of different groups and individuals

Question 114

Describe the key points of biological explanations of crime

Answer 114

Criminals biologically different to non-criminals – either from birth or brain injury

Biological differences lead to inability to learn and follow rules, which leads to criminal behaviour

Growing body of evidence that suggests a link between predisposition to offend and genetic, hormonal or neurobiological factors (Beech et al., 2018)

Question 115

Describe neurological explanations of crime

Answer 115

Activation of brain areas associated with emotional regulation differ between criminals and non-criminals

Reduced activity in left amygdalae of conduct disordered males shown negative pictures (Kleinschmidt & Poustka, 2005).

Neuropsychological deficits

Lower verbal IQ (Brennan et al., 2003) and executive dysfunction (Moffitt, 1993).

Increased delinquent behaviour in youths with history of traumatic brain injury

Executive functioning and impulse control (Carswell et al., 2004)

Findings indicate that offenders are less sensitive to punishment and more sensitive to possible rewards.

Less able to plan, act in a rationally self-interested manner, control impulses or respond flexibly to problems encountered in daily life.

However…Participants mostly male, small sample sizes.

Offender populations – possible neurological differences between offenders who are caught and those who evade detection?

Question 116

Describe genetic explanations of crime

Answer 116

Meta-analysis of 100+ behavioural genetic studies - 40-50% of variance in antisocial behaviour due to genetic inheritance (Rhee & Waldman, 2002).

Study of 862 Swedish male adoptees - genetic influences are the most significant contributor to later criminal behaviour (Cloninger et al., 1982).

However…Growing evidence to suggest gene/environment interaction, e.g. ‘warrior gene’ (MAO-A) has no overall effect on antisocial behaviour but low MAO-A activity + childhood abuse = increased adult aggression (Frazzetto et al., 2007).

Also, similar biological predispositions can be associated with very different behavioural outcomes.

E.g. Both bomb disposal experts and those with a capacity to violence (males and females) have lower resting heart rates – suggesting physiological under arousal (Raine, 2013)

ISSUES WITH GENETICS

Determinism

Do we lock people with criminal genes up before they commit a criminal act?

Question 117

Describe the personality theory model of crime

Answer 117

Links with biological explanations in terms of underlying mechanisms that contribute toward personality are believed to be biological – impulse control

According to Eysenck (1996), offending is natural and rational as human beings are hedonistic, seek pleasure and avoid pain

Delinquent acts essentially pleasurable and beneficial for the offender - e.g. theft, violence, vandalism

Most people do not offend because of their conscience – a conditioned fear response, which opposes hedonistic tendencies

Conscience built up in childhood through punishment for disapproved acts – classical conditioning links the fear of punishment to the act

Offenders are people who have not developed strong consciences due to poor conditionality. More likely in people:

High on extraversion due to low cortical arousal (stops punishment from having as big an impact as rewards)

High on neuroticism as high resting levels of anxiety interfere with conditioning, and reinforce existing behavioural tendencies

High on psychoticism (low empathy, impulsive, emotionally cold, hostile, egocentric) - more likely to offend because these traits are typical of criminals

Question 118

Describe the link between mental health and crime

Answer 118

Increased prevalence of mental disorders amongst criminal populations compared to general population, and higher levels of offending (Steadman et al., 2009).

Mental disorders can include:

Illnesses such as schizophrenia and depression

Intellectual disabilities

Personality disorders

However…

Questions raised as to whether disorders cause offending or association caused by other factors (Van Dorn et al., 2012).

Studies conducted with convicted offenders – difference between convicted and non-convicted?

Question 119

Define psychopathy

Answer 119

A severe personality disorder strongly linked with antisocial behaviour - callous disregard for others, lack of behavioural controls.

Suggestion that psychopathy be viewed as a dimension rather than taxonomy as psychopathic traits can be observed in the general population (Hare & Neumann, 2008).

CU (callous unemotional) traits in children are stable through to adolescence, and predictive of psychopathy in adulthood (Burke et al., 2007).

Argument - limited ability to learn when one’s actions are causing distress in childhood compromises early moral socialisation, resulting in greater aggressive behaviour and crime in later life (Gao et al., 2010).

Inability to detect facial expressions that signal distress in others leaves psychopaths open to repeatedly behaving in fear inducing ways (Blair, 2001).

Evidence that psychopaths have compromised ability to make aversive conditioned associations, related to abnormal amygdala functioning (Birbaumer et al., 2005).

Estimated prevalence of psychopathy in the UK is 0.6% but approx. 7-8% in UK prison populations (Coid et al., 2009).

Psychopathy associated with high levels of general, violent and sexual recidivism (Hemphill et al., 1998).

Psychopathy in adults (Blair, 2001) and CU in children (Frick et al., 2003) are particularly associated with instrumental aggression to achieve a goal (rather than reactive)

Majority of murders committed by psychopaths were for instrumental reasons (Woodworth et al., 2003).

Aggression committed to achieve a goal

However… Debate regarding whether antisocial behaviour represents a core psychopathic personality trait or is a behavioural consequence of a collection of traits (Skeem & Cooke, 2010).

Most crimes are not committed by psychopaths and not all psychopaths are criminals (Mahmut et al., 2008).

Causes of psychopathy are not yet fully understood but…

Evidence suggests biological differences in areas of brain associated with empathy/morality (Gregory et al., 2012).

Environmental factors such as parental separation, lack of parental supervision, and parental conviction also linked to amoral characteristics of psychopathy (Raine, 2013).

Question 120

Describe learning theories of attachment

Answer 120

ATTACHMENT

Primary attachment figure acts as a secure base for exploring the world (mother viewed to be key) (Bowlby, 1969).

Attachment relationship leads to development of an internal working model – cognitive framework of mental representations to understand the world, self, others.

This internal working model influences contact with others and evaluation of these interactions.

Model of others as being trustworthy

Model of the self as valuable

Model of the self as effective when interacting with others

Disrupting primary attachment relationship for a prolonged period is likely to have irreversible negative effects on cognition, social interactions and emotions.

Long-term consequences could include:

Delinquency

Reduced intelligence

Increased aggression

Depression

Affectionless psychopathy - acting on impulse with little regard for others, lack of guilt, inability to form meaningful and lasting relationships

Comparison of 44 juvenile thieves / 44 controls (Bowlby, 1951)

Almost 40% of juvenile thieves separated from mothers for 6+ months during first 5 years compared with 4.5% of control

1/3 had affectionless character compared to 0 controls

However…

Recall data – memories may not be accurate

Potential experimenter bias

Bowlby concluded that maternal deprivation caused affectionless psychopathy – correlational data

Other external variables not measured may have affected behaviour, e.g. family conflict, income, education etc.

Loss of mother a stronger predictor of delinquency than loss of father (Juby & Farrington, 2001).

History of abuse and disturbed attachment associated with lack of empathy and violent criminality (Saltaris, 2002).

However…

Separation from either biological parent during first 5 years linked to higher levels of offending (Kolvin et al., 1988).

Not just a broken home, parental conflict also a factor

Offending higher for boys from broken homes with affectionless mothers (62%) and unbroken homes with conflict (52%).

Lower for unbroken homes without conflict (26%) and broken homes with affectionate mothers (22%) (McCord, 1982).

Question 121

Describe the SLT model of crime

Answer 121

Criminal behaviour is learned. Attitudes that support offending and behaviours for committing crimes learned within the family or peer group.

40% of sons with criminal fathers also had criminal conviction by age 18 compared to 13% of sons with non-criminal fathers (Osborne & West, 1979).

Juvenile delinquents more likely to report having peers who engage in criminal activity than non-delinquents.

Question 122

Describe Patterson’s model of crime

Answer 122

Parents of antisocial children demonstrate deficiencies in child rearing practices (Patterson et al., 1992).

Fail to tell children how they are expected to behave, monitor behaviour, or enforce rules at appropriate time and unambiguously with appropriate rewards and sanctions.

Parents use more punishment but inconsistently and do not make it contingent on child’s behaviour.

Children raised in coercive families learn to use coercive behaviour

Parent shouts at/threatens child, child shouts back, parent stops being coercive. Child learns to use hostile reactions to end hostile situations.

Skilful parents use rewards for positive behaviours and ignore or use time out for undesirable behaviours.

Consistent and contingent parental reactions + careful monitoring of children’s behaviour prevent delinquency (Snyder et al., 2003).

Poor parental supervision a strong predictor of offending (Smith & Stern, 1997).

Parental reinforcement also a predictor.

Physical punishment at age 7 and 11 predicted later convictions – 40% offenders smacked/beaten at age 11 vs. 14% non-offenders (Newson & Newson, 1989).

Harsh or erratic parental discipline and cruel, passive or neglecting attitudes predicted convictions for original sample and their sons – 2 successive generations of males (Farrington et al., 2015).

However… Much of the supporting evidence is based on self-reflections of childhood – accuracy of memory?

Not all offenders recall parental upbringing as problematic and not all children raised with poorer parental practices end up committing offences.

For SLT in general, patterns linking parent and peer influences to offending tend to be for petty acts (e.g. vandalism).

Data tends to be correlational – problems inferring causality.

Question 123

Define and describe the integrated cognitive antisocial potential theory

Answer 123

Farrington’s Cambridge Study

411 South London boys

Prospective longitudinal methods

Personal interviews from age 8-46

Tests of individual characteristics, intelligence, attainment, personality and impulsivity

Parental details of background, child rearing practices

Teachers and CRB checks

By age 40, 40% convicted – commonly for theft, burglary, vehicle theft.

Peak age of offending 17; peak age for prevalence of offending 14; peak age for decreased offending 23.

ICAP theory influenced by results of Cambridge study – looking at risk factors for crime.

Designed to explain offending by lower class males.

Integrates aspects of several theories – strain, control, learning, labelling and rational choice (Cote, 2002).

Key construct is antisocial potential (AP) – potential to commit anti-social acts.

Transferring from antisocial potential to behaviour depends on cognitive processes that consider opportunities and victims – decisions to turn the potential into reality.

People can be placed on a continuum from low to high AP.

Few people have high AP, but those that do are more likely to commit crimes.

Primary factors that influence high AP are desire for material gain, peer status, excitement and sexual satisfaction.

Whether factors influence behaviour depends on if the person can use legitimate means to satisfy them.

Males from low-income families with low academic attainment who are unemployed are more likely to engage in antisocial behaviour and crime.

Long-term (LT) between-individual and short-term (ST) within-individual variations in AP.

LT –poorer families, socially impulsive and sensation seeking, poorly socialised and have a low IQ.

Ordering of people tends to be consistent over time but levels vary with age – peak in teenage years due to changes in factors that influence LT AP (e.g. increased importance of peers, decreased importance of parents).

ST – situational factors such as frustration, anger, boredom or alcohol.

Whether a crime is committed depends on cognitive processes - considering subjective benefits, costs and probabilities of different outcomes.

Immediate situational factors – material goods that could be stolen, likelihood and consequences of being caught.

Social factors – disapproval by parents or partner, encouragement and reinforcement from peers.

Stored behavioural repertoires/scripts (Huesmann, 1997).

Consequences of offending may lead to changes in LT AP and future decision-making processes

Reinforcing consequences, e.g. gaining material goods and peer approval.

Punishing consequences, e.g. legal sanctions, parental approval.

If consequences involve labelling, ability to achieve aims legally may be reduced, leading to increased AP (Farrington & Murray, 2014).

Also focuses on preventative factors – individual and social.

People get less impulsive and frustrated with age

Life events such as marriage, steady employment, moving home – shifts in interactions from peers to partner and children

Decreased offending opportunities (e.g. less drinking with male peers).

Increased informal controls (e.g. family and work responsibilities).

Changes decision making by reducing subjective rewards of offending – risk of getting caught higher (e.g. disapproval from partner, incarceration and losing family).

Identifies different factors that could influence future offending and antisocial behaviour, both in the short and long term.

Findings of Cambridge study have been very influential in the development of programmes to try to reduce offending.

However…

Research also shows that many people with these risk factors do not go on to offend (Webster et al., 2006).

Focuses on risk factors related to family, parenting and peer groups – ignores wider issues such as the neighbourhood (Webster et al., 2006).

Most of research focuses on males from working-class backgrounds – explanations for females, those from middle and upper classes, rural areas who offend?

Question 124

Describe YOS practice evidence base

Answer 124

Researchers find the evidence

Academics shape the theory and the practitioners’ tools

ASSET and ASSET Plus = YOS assessment tools, based on latest research evidence

ASSET – originally looked at criminogenic and protective factors

ASSET Plus assesses desistance factors

Question 125

Describe her majesty’s inspectorate for probation

Answer 125

2016

Context – move away from criminogenic to desistance

In preparation, HMIP in 2016

Inspection “to assess effectiveness of practice in YOS across eight domains which desistance research has highlighted as being significant in supporting children and young people’s journeys away from offending” (2016, p.7)

Question 126

Describe YOS readiness for desistance-based practice

Answer 126

Eyre, Jamieson & Yates (2016)

Three YOS in North England

Questionnaires to YOS staff

Focus groups on incoming Asset Plus

Asked on challenges of new system and changes required

Asked to provide a young offender ‘success story’

Narrative analysis of the success stories conducted

Question 127

Describe UK reoffending rates

Answer 127

Ministry of Justice (2018)

October-December 2016, adults and juveniles

Overall reoffending rate = 29.4%

Adults = 28.6%

Juveniles = 40.4%

Reoffending rates for violent offenders higher than non-violent offenders (Motiuk & Belcourt, 1997);

Reoffending rates for sexual offenders ranges from 11-14% (Hanson & Morton-Bourgon, 2005, 2009)

Question 128

Describe the considerations for treating violent offenders

Answer 128

Different treatment needs?

Offenders often have a history of a violent offence (general offending: Bourgon & Armstrong, 2005; Sex offenders: Newman, 2011)

Heterogeneous nature of violent offenders

Same treatment rules may not apply

Responsivity to treatment (Howells & Day, 2000)

Question 129

Describe anger management

Answer 129

Anger  violence

Limitations

But some studies show no relationship

Mills and Kroner (2003)

Might be exhibited under certain conditions

Some violence exists without anger (e.g. sadism)

Need for other aspects to be addressed too (multi-faceted)

Question 130

Describe the cognitive skills programme

Answer 130

Think First (McGuire, 2005)

Violent offending = anti-social cognitions

Anti-social cognitions  pro-social thinking and problem-solving

Groups, 3 months  3 years

Limitations: might not work for serious high-risk offenders – cognitions too engrained (Ward & Nee, 2009)

Question 131

Describe research findings around intimate partner violence

Answer 131

Range of different interventions

Typically differentiate this type of behaviour from other types of violent offender – some can be violent towards partners but not others

Usually focus on power, control, coercion – based on feminist viewpoints on IPV

Limitations

IPV offenders found to have some of the same characteristics, including anti-social cognitions, as other violent offenders.

Women also perpetrate IPV against men, same sex partnerships, feminist approaches not relevant? (e.g. Dixon, Archer, & Graham-Kevan, 2012)

The role of alcohol abuse needs to be examined (Norlander & Eckhardt, 2005)

Question 132

Describe multi-modal programmes

Answer 132

High-risk, serious violent offenders

More intense, examine an array of issues

More individualised, responsive to the needs of the person

Violence may be caused by multiple issues.

Multi-disciplinary teams (psychologists, custodial staff, educational and programme staff)

At least 12 months, treatment usually in a group (individually if needed)

Question 133

Describe the violence prevention unit a Rimutaka prison

Answer 133

Rimutaka Prison, near Wellington, NZ

Intervention programme for violent offenders (voluntary, length of sentence not effected)

High risk offenders

Targets ‘hypothesised criminogenic needs of violent offenders’ (p.1616)

VPU – 30 medium security beds

Programme – closed groups of 10 men

Therapist team = a psychologist and rehabilitation worker

On arrival, 4 week assessment period to gain comprehensive understanding of

Social history, background, family and support systems

How each may function in a group (including motivation to change)

Offending history, risk factors, current offence

Reintegration needs on release

Assessment data collected by

Interviews

Questionnaires

Psychometric tests

Three programmes running at a time

Approx. 330 hours of treatment

Four, 3 hour group meetings

Weekly, for 28 weeks

Individual intervention for psychological issues

To plan for release – meetings with family members

Post-release follow-up – routine support from probation officers

Question 134

Explain the use of CBT to treat sex offenders

Answer 134

Most common treatment for sex offenders (for a review, see Moster, Dorota, Wnuk & Jeglic, 2008)

Cognitive aspects

Cognitive distortions (e.g. blaming the victim, denial and minimisation, rape myth acceptance)

Other thinking patterns that might effect mood and behaviour

Coping with negative emotions

Empathy for others

Therapy aims to encourage offenders to

Identify their own thinking patterns

Tools to re-evaluate these beliefs/thinking patterns

Behavioural aspects

Overt and covert behaviour

Procedures to alter behaviour through reward and punishment

Modelling (demonstrating a particular behaviour)

Skills training (through rehearsal) (e.g. interpersonal skills such as assertiveness and communication)

Question 135

Describe and explain relapse prevention

Answer 135

Adapted from the addiction field (e.g. Marshall & Laws, 2003)

Addition to CBT approaches

Self-management approach

How to anticipate and cope with relapsing (having thoughts about offending, and re-offending)

Control over time across high-risk situations in the community

Limitations

Presumes all offenders have the same pathway to offending (Laws & Ward, 2006)

Negative focus on treatment, must avoid certain situations (avoidant v. approach strategy)

Question 136

Describe risk needs responsivity

Answer 136

Andrews & Bonta, 1998

Four principles (as outlined in Ward & Stewart, 2003)

Risk principle

Match level of risk with level of treatment

High risk = more treatment (at least 100 hours of CBT over 3-4 month period)

Need principle

Target criminogenic needs

Responsivity principle

Is the treatment appropriate for that person? May impede learning?

Gender, learning styles, culture, diversity, motivation

The principle of professional discretion

Clinical judgement should override the above principles if needed (flexibility, innovation)

Question 137

Explain RNR and sex offender

Answer 137

Risk level – using assessment tool (Lecture 11)

Criminogenic needs

4 domains (Thornton, 2002, 2003) relate to recidivism

Deviant sexual interests

Distorted attitude

Low levels of socio-affective functioning (e.g. intimacy issues)

Problems in self-management (lack of control over emotions and behaviour)

Responsivity

Internal factors

Motivation

External factors

Therapeutic characteristics

Therapeutic context

Question 138

Describe the limitations of risk management approach

Answer 138

Failure to motivate and engage offenders in the process (e.g. Ward & Beech, 2015)

External motivators such as parole might make people more likely to follow a treatment programme (Jones, Pelissier & Klien-Saffran, 2006)

Attrition rates high (30-50% e.g. Ware & Bright, 2008)

People who drop out, more likely to reoffend than completers (e.g. Hanson et al., 2002)

People who most need the treatment might be more likely to drop out?

Differs from other therapeutic models

Orientation of treatment goals

Rely on avoidant goals, rather than approach goals

Limited collaboration between therapist and client

Treatment goals enforced by therapist

Limited attention to non-criminogenic needs (e.g. personal distress)

Focussing on these might improve treatment outcomes

Minimal focus on reintegration into society

Crucial to have environmental systems such as relationships and employment

Question 139

Describe and explain the good lives model

Answer 139

General assumptions

Grounded in the ethical concept of human dignity and universal human rights; strong emphasis on agency

Rehabilitation needs to 1) reuse risk but also 2) promote human needs and values through approach goals

11 classes of ‘primary goods’ (offenders have value certain states of mind, personal characteristics and experiences) (Ward & Gannon, 2006; Ward et al., 2007)

Question 140

Describe the use of GLM to treat sex offenders

Answer 140

Two routes to offending

Direct

Attempts to achieve primary goods through offending (e.g. establishing a relationship)

Indirect

Something goes wrong whilst trying to achieve primary goods and a ripple effect means that offending occurs (e.g. trying to have friendship and agency leads to distress, which is alleviated by drinking, which leads to offending)

Criminogenic needs

Internal and external obstacles to acquiring primary goods

Impulsivity might impact on agency

Substance abuse might impact on living a healthy life

Treatment aimed at working on knowledge, skills and competence to have a successful, non-criminal life.

Working out individual’s priorities/weightings and how to get secondary goods

Good Lives Treatment plan devised, individual to the person, identifies criminogenic needs that might be blocking achievement of the goods.

Also may include developing internal and external skills, maximising external resources and social supports

Question 141

Define and explain criminogenic needs

Answer 141

Dynamic risk factors

Andrews & Bonta, 2006

“Features of individuals associated with the risk of involvement in crime that change over time and are susceptible to change by direct effort, thereby reducing risks of criminal activity.”

(Davies & Beech, 2018, p692)

Anger

Negative/antisocial attitudes

Hostility

Substance abuse

Impulsivity

Active symptoms of major mental illness

Interpersonal and problem-solving skill deficits

Antisocial personality

Social-information deficits

Education/employment

Antisocial companions

Need for more research into this for serious, violent offenders (Polaschek, 2006)

Question 142

Define and explain criminogenic needs

Answer 142

Dynamic risk factors

Andrews & Bonta, 2006

“Features of individuals associated with the risk of involvement in crime that change over time and are susceptible to change by direct effort, thereby reducing risks of criminal activity.”

(Davies & Beech, 2018, p692)

Anger

Negative/antisocial attitudes

Hostility

Substance abuse

Impulsivity

Active symptoms of major mental illness

Interpersonal and problem-solving skill deficits

Antisocial personality

Social-information deficits

Education/employment

Antisocial companions

Need for more research into this for serious, violent offenders (Polaschek, 2006)

Question 143

Describe the costs of sexual offending

Answer 143

Recognised as an international public health problem by World Health Organisation

Costs of sexual abuse to victim

physical and psychological harm

teenage pregnancy

problematic parenting behaviours

adjustment problems in the victim’s later offspring

Other costs include to public health and criminal justice services, loss of work days, reduced productivity

Rehabilitation is important, aim to reduce risk and protect society

Question 144

Describe the costs of sexual offending

Answer 144

Recognised as an international public health problem by World Health Organisation

Costs of sexual abuse to victim

physical and psychological harm

teenage pregnancy

problematic parenting behaviours

adjustment problems in the victim’s later offspring

Other costs include to public health and criminal justice services, loss of work days, reduced productivity

Rehabilitation is important, aim to reduce risk and protect society

Question 145

Describe risk factors for sexual offending

Answer 145

Risk factors: factors that help to predict recidivism, that is, whether a person convicted of a sexual offence will commit another offence in the future

Four domains of risk factors that predict sexual offence recidivism:

Socio-affective function (e.g., intimacy deficits, emotion-regulation)

Self-management (e.g., impulsivity, recklessness)

Offence supportive attitudes (e.g., children enjoy sex)

Deviant sexual interests (e.g., sexually attracted to minors)

Risk, Need, Responsivity

Treatment should be proportionate to risk, treatment should target needs related to offending, consider how responsive people are to diff. treatment

Question 146

Describe sex offender treatment

Answer 146

Aim: to reduce the risk that an individual will commit another offence again in the future

Sex Offender Treatment Program (SOTP)

Delivered to sexual offenders in England and Wales

Other similar programs delivered in other countries

Typically cognitive behavioural in approach

Focus on reducing ‘risk factors’ related to sexual offence

Question 147

does sex offender treatment work?

Answer 147

Unclear!

Meta-analyses suggest that sex offender treatment does reduce sexual recidivism

10.1 % in treated vs. 13.7 % in untreated offenders (Schmucker & Lösel, 2015)

A recent report for the Ministry of Justice suggests that sex offender treatment may increase sexual recidivism (10.0% compared with 8.0%)

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Question 148

Describe the role of emotional regulation in treating sexual offenders

Answer 148

Ability to implement intentional cognitive control over emotions

Known risk factor for sexual offence recidivism

Theory and research suggests a causal role of emotion regulation in sex offending

What are emotions?

Spontaneous, not consciously provoked

Provide positive and negative valence

Goal directed

Involve multi-system changes (behavioural, autonomic, physiological)

Question 149

Describe the two main strategies in rehabilitating sex offenders

Answer 149

Reappraisal

Form of cognitive change, think in different way about same situation

Dependent on higher order brain processes

e.g., an interview = an opportunity, not a test

Emotion Suppression

Form of response modulation, inhibit emotionally expressive behaviours

Effects on expressive behaviour and physiology

e.g., poker face

Question 150

Describe the potential role of mindfulness

Answer 150

Recommended for inclusion in sex offender treatment (Gillespie et al., 2012)

Origins in Buddhism and Eastern traditions

Paying attention in the present moment, non- judgementally (Jon Kabat-Zinn, 1994)

Three interacting components contribute toward enhanced self-regulation

Question 151

Do sex offenders show specific or generalised impairment?

Answer 151

Sex offenders showed specific impairment in acceptance of emotional states

More pervasive difficulties in the violent group

Higher levels of anger

Greater emotional non-acceptance

Evidence of alexithymia, difficulties identifying emotions

Some mindfulness problems, non-judgement, acting with awareness

Homicide group may be relatively in charge of emotions

Question 152

Describe existing research findings from mindfulness based studies

Answer 152

Fix and Fix (2013)

Review reported benefits of meditation but noted methodological limitations

Samuelson et al. (2007)

2000 offenders took part in mindfulness based stress reduction

Exercises include body scan, stretching exercises, sitting meditation

Reported benefits across hostility, self-esteem and mood

Verheul et al. (2003)

Benefits of Dialectical Behavior Therapy in borderline personality disorder

Mindfulness represents important component of DBT

Development of acceptance based techniques for regulating emotions

Question 153

Describe considerations in introducing mindfulness

Answer 153

Potential difficulties introducing meditative practices

Unfamiliarity with meditation

Discomfort meditating in groups

People may be differentially sensitive to mindfulness

Serotonin genes differentiate those who benefit most

Definition, measurement and operationalisation

Only clear measurement technique = self-report

Limited by understanding, measurement validity

Difficult to evaluate change

Question 154

Should treatment programs include mindfulness?

Answer 154

Biggest barrier = lack of evidence, need for rigorous evaluation

Meta-analyses show support for mindfulness in treating various forms of psychological distress but few studies in forensic samples

Best evidence: change in recidivism rates following mindfulness interventions

Question 155

Define risk

Answer 155

In general terms the criminal justice system has defined risk as:

the risk of future re-offending & reconviction - the probability that an offender / prisoner will offend, be arrested, and be reconvicted within two years; and

the risk of serious harm - if reconvicted, the probability that the offence will be one of “serious harm”

Section 224 of the Criminal Justice Act 2003 defines serious harm (in the sentencing context, when determining whether an offender presents a significant risk to the public of serious harm by the commission of further offences) as “death or serious personal injury, whether physical or psychological”.

Question 156

Define a risk assessment and give some of the dimensions that are assessed

Answer 156

What is a risk assessment?

Systematic effort to estimate and evaluate adverse outcomes

Try to make predictions about future behaviours

Forensic risk assessments draw on information about the offender and their circumstances in order to reach judgements about their future behaviour

Concept of risk encompasses “the nature, severity, imminence, and frequency or duration of harm – as well as its likelihood” (Litwack et al., 2006, pp.493)

What is likelihood?

Probability of the occurrence of an event

What is seriousness?

Predicted future behaviours can differ in their level of seriousness

What is dangerousness?

Adverse outcomes

How undesirable these would be

Offender may be labelled as dangerous:

on the basis of a high probability of committing many offences OR

because of the potential to perpetrate a small number of very serious offences OR

more commonly an unknown mix of the two

The risk of harm posed by offenders to others can be seen as having two key dimensions:

1. the relative likelihood that an offence will occur; and
2. the relative impact or harm of the offence - what exactly might happen, to what or whom, under what circumstances, and why.

It is important to understand these two dimensions of risk. Some crimes (eg shoplifting) have relatively little impact or harm but, statistically, are the most common.

Others (eg homicide) are rare but cause maximum damage.

It is important to identify the person or groups of people who are specifically at risk; this allows resources and protective measures to be applied effectively.

Risk is categorised as risk to:

the public: either generally or a specific group such as the elderly, vulnerable adults (for example, those with a learning disability), women or an ethnic minority group;

a known adult: such as a previous victim or partner;

prisoners: within a custodial setting;
children: either specific children or children in general
staff: anyone working with the individual whether from Probation, the Prison Service, police or other agency (eg. health);
self: the possibility that the individual will commit suicide or self-harm.

Question 157

Define levels of risk in offenders

Answer 157

LOW: current evidence does not indicate a likelihood of causing serious harm;

MEDIUM: there are identifiable indicators of serious harm. The offender has the potential to cause such harm, but is unlikely to do so unless there is a change in circumstances - for example, failure to take medication, loss of accommodation, relationship breakdown, drug or alcohol misuse;

HIGH: there are identifiable indicators of serious harm. The potential event could happen at any time and the impact would be serious;

VERY HIGH: there is an imminent risk of serious harm. The potential event is more likely than not to happen as soon as the opportunity arises and the impact would be serious.

Question 158

Give the components of a risk assessment

Answer 158

make a prediction of risk along both dimensions - likelihood and impact of harm;

identify the likelihood of re-offending;

identify the risk of harm (what harm and to whom?); and

identify the key risk factors that led to the offence under consideration and that should be addressed

to reduce the likelihood of further offending.

Question 159

Describe the outcomes of a risk assessment

Answer 159

Assess likelihood that someone will:

Reoffend and for what type of offence

Cause harm to themselves

Cause harm to others

Treatment needs of that person

Individuals treatability and treatment readiness

Identify the particular conditions in which a specific individual will behave violently or criminally.

Risk assessments are used by:

Police

Courts

Prisons

Treatment providers

Risk assessments are carried out at various stages of an offender pathway

During investigation (Research focused lecture with Prof Laurence Alison)

Pre-sentence

at admissions

Pre treatment

Post treatment

Pre-release

Post-release

Question 160

Give the possible outcomes of a risk assessment

Answer 160

Question 161

Describe the consequences of a false negative outcome

Answer 161

Non-custodial sentence or released from prison early

Leads to more victims

Additional costs to society

Question 162

Describe the consequences of a false positive outcome

Answer 162

Parole is rejected, in prison for longer than necessary

Infringement of human rights

Damage to the individual

Waste of public resources

Question 163

Describe risk factors in a risk assessment

Answer 163

STATIC FACTORS

Static factors cannot be changed or influenced and are based on historical events or characteristics such as the offender’s gender, age, offending history, and previous convictions.

Family background

Previous offending behaviours

Offence history

Victim characteristics

DYNAMIC RISK FACTORS

Dynamic risk factors relate to the attitudes, circumstances and behaviours that underpin or support offending.

Can change through interventions (theoretically!)

Psychological

Cognitive distortions, empathy, problem solving, decision making

Social

Peer groups, employment status, relationship status

Behavioural

Impulsivity, anger issues, risk taking, drug taking

Question 164

describe types of risk assessments

Answer 164

CLINICAL RISK ASSESSMENTS

Clinicians use their own experience and intuition

Collect background information

Observations of the offender by professionals

Interviews with the offender

Comes from medical field and seen as diagnostic method of assessment

STRENGTHS/WEAKNESSES

the debate centres on the accuracy of the clinician’s ability to predict violence.

the clinician can assess emotional state throughout the interview. For example, emotional traits such as lack of empathy and anger (Menzies, Webster, & Sepejak, 1985) and physiological and behavioural traits such as chanting, flared nostrils, flushed face and clenching of the jaw/hands (Berg, Bell, & Tupin, 2000

Thornberry and Jacoby (1979) 65% who were subsequently released into the community, only 11% were re-arrested for violent offences.

Monahan’s (1984) claim that two thirds of all clinical predictions of violence are incorrect

Susceptible to decision-making heuristics and biases

Question 165

Define and explain actuarial risk assessments

Answer 165

Uniform rules and strict decision making criteria are applied

Based on longitudinal studies which assess associations between risk factors at the outcome being measured

These require analysis of substantial samples from which

generalisations are to be drawn.

Use algorithms or statistical equations

Give risk score or risk level

STRENGTHS/WEAKNESSES

Eliminate the subjective errors present in clinical judgement

Douglas, Ogloff, and Hart (2003) have criticised actuarial tools for being rigid, lacking sensitivity to change and failing to aid risk management and the prevention of violence.

Difficulty in generalising from a group to an individual (Scott & Resnick, 2006),

Oversimplify the complexity of factors involved because cases are diverse in nature

rely solely on an actuarial tool could cause potentially important indicators of violent behaviour to be missed.

Question 166

Describe structured clinical judgement

Answer 166

Hanson and Thornton (1999), the predictive accuracy of professional risk assessments (both actuarial and clinical) is only slightly better than chance.

Combining empirically established risk factors with clinical judgement

The use of both actuarial tools and of structured risk assessment instruments in conjunction with clinical interviews has therefore been judged to be most effective (Scott & Resnick, 2006).

This recommendation harvests the benefits of both actuarial tools and clinical judgement (structured or unaided) while minimizing their limitations in practice.

clinician is given some level of flexibility and discretion for when cases contain idiosyncrasies but yet they can still provide an empirically based individual risk assessment

Completing risk assessments with a person results in a far more meaningful and better adhered to plan of action

Popular measures:

Offender Assessment System (OASys)

Level of Service Inventory - Revised (LSI-R)

Primary actuarial measure for non-mentally ill offenders (usually used for sentencing and parole decisions)

Psychopathy Checklist - Revised (PCL-R)

Primary measure for psychopathy, which is highly correlated with recidivism and risk of violence

Structured Assessment of Violence Risk in Youth (SAVRY)

For adolescents 12-18 years old

HCR-20 (Historical, Clinical, and Risk Management)

Primary risk assessment measure for mentally ill offenders

Pros:

Grounded in actuarial variables

Good validity

Combination of static and dynamic factors increases power

More useful than purely actuarial as can help define strategies to manage risk

Useful in identifying specific factors that increase or decrease risk

Does have a ‘clinical override’ component

Risk assessment informs risk management

How to keep this person and other people safe?

Cons:

Need more research

outcome studies

Problems trying to combine actuarial & clinical measures, particularly if they contradict each other (Dawes et al, 1989)

HCR-20 good at predicting risk in ‘high scorers’ but less good in the ‘middle or low’ range scorers (Strand et al, 1999)

Question 167

Describe hare’s psychopathy checklist

Answer 167

The Psychopathy Checklist – Revised (PCL-R) was published by Robert Hare in 1991.

This is a 20-item checklist that purports to measure Psychopathy

It requires the administration of a semi-structured interview that can last between 90 and 120 minutes.

Assesses a range of demographic, criminological, social and psychological information in a systematic manner.

The PCL-R has been shown to be a strong predictor of recidivism and violence in

offenders and psychiatric individuals, even though it is not a risk assessment device.

However, it is heavily oriented towards the forensic context and tells us nothing about risk to self, mental instability or vulnerability

Question 168

Give some issues with risk assessments

Answer 168

The assessment of risk is different from the assessment of dangerousness

Can be high risk but low dangerousness or low risk but high dangerousness

Risk and dangerousness are not fixed parameters but will change with context and over time

Different risk factors have different levels of influence

The rate of reoffending is determined by the criteria employed

Grentekord (2003) sample of mentally disordered violent/sexual offenders

Over 8 year period from release; 44% committed an offence, 30% returned to prison or forensic hospital, 13% committed a violent of sexual offence.

Question 169

Describe the role of the internet in IIOC (Indecent images of children)

Answer 169

What are the key features of internet offending and IIOC?

There is no regulatory body to ‘police’ the internet (Bainbridge & Berry, 2011).

Control of the enormous amount of available content is limited (Beech et al., 2008).

Global usage of the internet recently topped 4 billion users in 2017, which is over 50% of the worlds population (Internet World Stats, 2017).

The Internet…

Provides Accessibility, Affordability & Anonymity – ‘Triple A Engine’ (Cooper 2002).

Allows individuals to engage with others who share the same pro-offending attitudes and enables easy access to IIOC (Quayle & Taylor, 2002).

Question 170

Describe the use of IIOC in offending

Answer 170

Three prevailing ideas regarding the use of IIOC:

Diverts from contact abuse: ‘compensatory’ model

Use of IIOC acts as a diversion to contact offending (Riegel, 2004).

This model suggests that viewing and reaching arousal to IIOC enables offenders to use this as a means to inhibit the urge to act upon fantasies (Babchishin et al., 2011).

However, this model has little empirical support.

Encourages contact abuse: ‘facilitation’ model

IIOC facilitates the ‘spiral of sexual abuse’.

Offenders begin with lower level images and progress through the levels from grooming/inciting/producing to the contact sexual abuse of a child (Sullivan, 2002).

In occurrence alongside contact abuse: ‘concurrent’ model

IIOC is used as part of an already established paraphilic lifestyle (Bourke & Hernandez, 2009).

Individuals use IIOC to justify their paedophilic interests (i.e. if it exists it must be ok to view) rather than them becoming a paedophile because they have viewed IIOC (Sheenan & Sullivan, 2010).

Question 171

Describe the prevalence of dual offenders within IIOC samples

Answer 171

Key question: What proportion of IIOC offenders are also committing contact sexual offences (or have previously)?

A meta-analysis that considers a wide range of research suggests that contact sexual offending against children among IIOC offenders ranges from:

As low as 5% (Seto & Eke, 2008);

55% when using self-report data;

To as high as 84.5% - but this is considered a statistical outlier (Bourke & Hernandez, 2009);

Research conducted as part of the FIIP & FIIP 2 projects suggests a best guess of 1 in 6.

Source: (Seto, Hanson & Babchishin, 2011).

Question 172

Describe the key features of IIOC and dual offending

Answer 172

There are number of factors found to differentiate between offenders according to risk (IIOC vs. dual):

1) Previous behaviour
- is an indicator of future behaviour;

• anti-social tendencies;
• previous criminal history (not just sexual offences).

2) Access to children
- greater opportunity for contact offending.

3) Behavioural facilitators
- engaging in risky behaviours.

Question 173

Describe and explain IIOC risk prioritisation tools

Answer 173

Operation Ore

Commenced in 1999 and was the UK’s biggest ever computer crime investigation of its time.

Referrals sent to the UK from the US containing details of individuals who had paid for access to IIOC online using credit cards.

Leading to 7,250 suspects identified, 4,283 homes searched, 3,744 arrests, 1,848 charged, 1,451 convictions, 493 cautioned and 140 children safeguarded.

Following Operation Ore

Continually growing number of IIOC investigations and access to the internet.

Inconsistencies in workload prioritisation and risk assessment.

Absence of an academically validated way to prioritise the most dangerous offenders (i.e. those most likely to also commit contact sexual abuse against a child).

Lead to the idea to develop a risk prioritisation tool.

The Kent Internet Risk Assessment Tool (KIRAT) was developed.

KIRAT

KIRAT applies to…

Individuals suspected of possessing, making, taking and/or distributing indecent images of children (IIOC).

Only applies in investigations involving IIOC.

What does it do?

Prioritises the most dangerous offenders (i.e. those most likely to also commit hands-on sexual offences against children).

Uses known intelligence to assess risk.

Allows police to take action to protect children.

Assists with resource/workload management

KIRAT contains four steps, each step contains a series of questions related to:

Previous Offending Behaviour

Access to Children

Behavioural Facilitators

Other Factors

Responses to these questions will result in a final risk score for the suspect.

Four risk scores; Low, Medium, High, Very High.

Risk scores indicate risk the suspect poses of committing/have committed hands-on sexual offences against children (as well as IIOC offences).

Risk scores linked to police action response times.

KIRAT contains four steps, each step contains a series of questions related to:

Previous Offending Behaviour

Access to Children

Behavioural Facilitators

Other Factors

Responses to these questions will result in a final risk score for the suspect.

Four risk scores; Low, Medium, High, Very High.

Risk scores indicate risk the suspect poses of committing/have committed hands-on sexual offences against children (as well as IIOC offences).

Risk scores linked to police action response times.