Summary of findings 5. Schema therapy versus treatment‐as‐usual for antisocial personality disorder.
| Schema therapy versus treatment‐as‐usual for antisocial personality disorder | ||||||
| Patient or population: adults with antisocial personality disorder Setting: forensic psychiatric clinic Intervention: schema therapy Comparison: treatment‐as‐usual | ||||||
| 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 | Risk with schema therapy | |||||
| Aggression | ‐ | ‐ | ‐ | ‐ | No data available | |
|
Reconviction Assessed by: number of participants documented to have recidivated (documented as a global negative outcome) Timing of assessment: over the 3 years |
Study population | OR 2.81 (0.11 to 74.56) | 30 (1 RCT) | ⊕⊝⊝⊝ Very lowa | ‐ | |
| 0 per 1000 | 63 per 1000 (0 fewer to 0 more) | |||||
| Global state/functioning | ‐ | ‐ | ‐ | ‐ | No data available | |
|
Social functioning Assessed by: mean number of days until unsupervised leave grantedb Timing of assessment: over the 3 years |
The mean number of days to unsupervised leave in the control group was817.13 days | The mean number of days to unsupervised leave in the intervention group was137.33 fewerdays (271.31 fewer to 3.35 fewer) | ‐ | 30 (1 RCT) | ⊕⊝⊝⊝ Very lowa | ‐ |
|
Adverse events Assessed by: number of participants with a global negative outcome (e.g. dropping out of therapy, recidivism or being transferred to another facility due to poor treatment response) overall Timing of assessment: over the 3 years |
Study population | ‐ | ||||
| 357 per 1000 | 189 per 1000 (168 fewer per 1000; 315 fewer to 192 more) | OR 0.42 (0.08 to 2.19) | 30 (1 RCT) | ⊕⊝⊝⊝ Very lowa | ||
| *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). AsPD: antisocial personality disorder; CI: confidence interval; df: degrees of freedom 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 was downgraded three levels overall. We downgraded one level due to limitations in the design/implementation suggested high risk of bias (‘selective reporting’ bias; possible risk of ‘blinding of participants’ bias, ‘blinding of personnel’ bias, ‘blinding of outcome assessors’ bias and ‘other’ bias), one level for indirectness (only 87% of the population had a diagnosis of AsPD and subgroup data for AsPD only were not available), and one level for imprecision due to optimal information size criterion not being met. bWe chose to report 'days to unescorted leave' (rather than 'days to escorted leave'), as the measure of social functioning, as this reflects the person gaining a higher level of independence and progress. The results for 'days to escorted leave' (at both two and three years) are reported in the Effects of interventions section.