Summary of findings 1. Cognitive behaviour therapy + treatment‐as‐usual versus treatment‐as‐usual alone for antisocial personality disorder.
| Cognitive behaviour therapy + treatment‐as‐usual versus treatment‐as‐usual alone for antisocial personality disorder | ||||||
| Patient or population: adults with antisocial personality disorder Setting: outpatient Intervention: cognitive behaviour therapy + treatment‐as‐usual Comparison: treatment‐as‐usual alone | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with treatment‐as‐usual alone | Risk with cognitive behaviour therapy + treatment‐as‐usual | |||||
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Aggression (any act of physical aggression) Assessed by: number reporting any act of physical aggression measured with the MacArthur Community Violence Screening Instrument (MCVSI) (9 behavioural items, rated yes/no; higher score = greater number of violent behaviour reported) Timing of assessment: 12 months |
Study population | OR 0.92 (0.28 to 3.07) | 52 (1 RCT) | ⊕⊕⊝⊝ Lowa | ‐ | |
| 296 per 1000 | 279 per 1000 (17 fewer per 1000; from 191 fewer to 268 more) | |||||
| Reconviction | ‐ | ‐ | ‐ | ‐ | ‐ | No data available |
| Global state/functioning | ‐ | ‐ | ‐ | ‐ | ‐ | No data available |
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Social functioning Assessed by: Social Functioning Questionnaire (range of possible scores = 0‐24; higher score = poorer outcome) Timing of assessment: 12 months |
The mean social functioning score in the control group was 11.6 points | The mean social functioning score in the intervention group was 1.6 points lower (5.21 lower to 2.01 higher) | ‐ | 39 (1 RCT) | ⊕⊝⊝⊝ Very lowb | ‐ |
| Adverse events | ‐ | ‐ | ‐ | ‐ | ‐ | No data available |
| *The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; OR: odds ratio; RCT: Randomised controlled trial. | ||||||
| GRADE Working Group grades of evidence (Schünemann 2013) High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect | ||||||
aEvidence downgraded two levels overall. We downgraded one level due to limitations in the design/implementation suggested possible risk of bias ('blinding of participants' bias and possible risk of 'blinding of personnel' bias), and one level for imprecision due to optimal information size criterion not being met. bEvidence downgraded three levels overall. We downgraded one level due to limitations in the design/implementation suggested possible risk of bias ('blinding of participants' bias and possible risk of 'blinding of personnel' bias), one level for imprecision due to optimal information size criterion not being met, and one level for indirectness as the outcome was measured by a questionnaire.