PROPOSITION 5: EVIDENCE

Rehabilitation of offenders - they said it couldn't be done. Many say it still can't be done.
Some say it shouldn't be done. But it can be done. It has been done. It is being done. We hope
it will continue to be done. The question we need to ask is can it be done better?

NOTHING WORKS?
More than thirty years have passed since professionals involved in the treatment of
juvenile and adult offenders were brought to their knees by Robert Martinson’s (1974)
conclusion that his review of research on programs for the rehabilitation of offenders
demonstrates that “in the treatment of offenders, almost nothing works”. Martinson’s widely
publicized indictment of rehabilitation were echoed by the conclusions of several others. They
‘informed’ the criminal justice system, the government, the media, the politicians, the general
public (and probably the offenders themselves) that rehabilitation is not possible. The research,
it was asserted, indicated that offender treatment “is impotent“.Rehabilitation fell into disrepute.
Many rehabilitation naysayers think it should remain there.

Somethings Work…Sometimes...Somehow

More than forty years of pre and post-Martinson research has established that
there are, indeed, a substantial number of programs that have achieved success in
reducing recidivism. Many controlled studies have found positive outcomes for some
rehabilitation programs that have been conducted in some institutional or community
settings with a large number and a wide variety of types of adolescent and adult
offenders.
There are no panaceas. Programs which work with some types of offenders may
be dismal failures with other types of offenders. Programs which are successful in the
community may be inoperable, unproductive, or even harmful in an institution (and vice-
versa). A program that is beneficial when implemented by well-qualified, well-motivated
and well-supervised staff may be an impressive waste of resources when implemented
by other less capable, less enthusiastic or poorly managed staff. Programs that have
been demonstrated to be effective when implemented in a social, political, or economic
environment that is supportive of the program's philosophy, goals, practices and
facilitators may be doomed to failure or have a very short shelf-life in a non-supportive
context. Programs which fail to respond to the psychological, ecological, situational or
cultural factors that are functionally related to the participant's antisocial behavior are
unlikely to be a good investment of taxpayers' dollars.

Whether a program does or does not work seems to depend on who does what to
whom, why, where, when, how often, and for how long.

Sometimes some programs work; sometimes they fail; sometimes they make
things worse. Some programs when delivered by some practitioners, to some offenders,
in some settings, reduce re-offending somewhat, sometimes.
 A substantial number of analyses point to a positive treatment outcome (e.g.
Andrews & Bonta, 2006; Antonowicz & Ross, 1994; Aos, Miller & Drake, 2006; Lipton,
1998; Lösel, 1995; McGuire, 1995). However, the range of the magnitude of reductions
in recidivism they have achieved vary greatly – from zero (sometimes less than zero) to
above 50% (Lipsey & Cullen, 2007). The average magnitude of the positive outcomes is
considerably less than rehabilitation advocates would wish. Although Lipsey and
Cullen's (2007) investigation of nineteen statistical analyses of programs found some
reductions above 50%, eight of the nineteen found less than 20% reductions; nine
reported reductions in the 20% range; but only two persuasive studies found reductions
above 20%.

The most optimistic interpreters of the literature estimate that when

appropriate interventions are applied, effects sizes above 0.30 can be
expected. This translates into between 10 to 15% differences in recidivism
rates between treated and untreated controls (for example, 40%
recidivism rates as opposed to 50% or 55%).
McGuire, 1995

From "What Works" to "Which Work"

There is no shortage of studies that have examined the characteristics of

programs that have been most successful in reducing recidivism. They have been
identified using the statistical technique of metanalysis. Metanalysis is a technique that
has enabled researchers to aggregate, integrate and quantitatively analyze the
practices and outcomes of more than two thousand program evaluations of
rehabilitation programs in order to ascertain the principles and techniques that are most
strongly associated with success and failure. Considerable progress has been made in
our understanding of what we should do and, equally important, what we should not do
in attempting to decrease offending behavior. One principle is basic: good programs
are based on good theory.

How one attempts to change antisocial behavior is determined, or should be

determined by how one accounts for antisocial behavior. A conceptual model of
antisocial behavior can serve as a guide for program planners and practitioners by
identifying the appropriate targets for their program efforts - the particular
factors known to be associated with such behavior that can be changed in order to
prevent the persistence of the behavior. Programs which derive from faulty
conceptualizations of antisocial behavior are unlikely to have much impact in reducing
such behavior. Everybody has a theory of crime and what needs to be done about it.
Many are based on gut reactions or arm-chair philosophizing. Most are based only on
political platforming. One of the few empirically-based models is the cognitive behavioral
model.

THE COGNITIVE MODEL

The "cognitive model of offender rehabilitation and delinquency prevention” was
first presented in the early 1980’s (Ross, 1980; 1982a; 1982b) and later elaborated in
the book, “Time To Think” (Ross & Fabiano, 1985). The model proposed that a
reduction in offending among juvenile delinquents and adult offenders could be
achieved by training them in cognitive skills and values that are antagonistic to
antisocial behavior and are essential to prosocial competence.

The original cognitive model was based on two bodies of empirical research:

1. Research that indicated that a key to the success of programs that had been
demonstrated to be effective in reducing re-offending was their use of techniques
which could be expected to have an impact on the offenders' thinking. They
improved the offenders’ sensitivity to the consequences of their behavior; taught
them to stop and think before acting; increased their problem solving skills, and their
social skills; broadened their view of the world; helped them to develop alternative
interpretations of social rules and obligations; and helped them to comprehend the
thoughts and feelings of other people.

2. Research that indicated that many juvenile and adult offenders evidence inadequate
development in the cognitive and behavioral skills that are required for prosocial
competence: self-control; social perspective-taking; problem solving; critical reasoning;
creative thinking; social skills; and values.

The Cognitive Behavioral Monopoly

Recent research, including a substantial number of metanalyses, have since

established that most programs that have been successful in reducing the recidivism of
offenders have been based on a cognitive/behavioral model (e.g., Pearson, Lipton,
Cleland & Yee, 2002; Andrews, Zinger, Hoge, Bonta, Gendreau & Cullen, 1990; Garrett,
1985; Gottschalk, Davidson, Mayer & Gensheimer, 1987; Izzo & Ross, 1990; Lipsey,
1992; Gendreau, Goggin, & Paparozzi, 1996; Losel, 1995; McGuire, 2002; Redondo,
Sanchez-Meca & Garrido, 2002).

Cognitive-behavioral programs are more likely to reduce re-offending than are

non-cognitive behavioral programs. They also can yield greater reductions in recidivism
than the 10-20% average for all programs. For example, Lipsey, Chapman &
Landenberger (2001) found that the likelihood of offenders recidivating was 55% lower
for those treated in a cognitive behavioral program than for control groups. Pearson, et
al., (2002) found that cognitive-behavioral programs yielded a average recidivism
reduction of about 30%. More recently, Wilson, Bouffard & MacKenzie (2005) found
recidivism reductions of 20-30%. Lipsey, Landenberger & Wilson (2007) reported that
their systematic review found an average recidivism reduction of 25%.

The average re-offending rate for offenders released from prison or after
completing a community sentence in the U.K. is approximately 58% (Cuppleditch &
Evans, 2005; Cunliffe & Shepherd, 2007). Thus, the achievement of an average
reduction of ten or twenty or even 30% per cent by cognitive behavioral programs is not
only statistically significant but fiscally significant in terms of the cost of criminal justice
processing1. It is also socially significant in terms of the suffering of potential victims.
However, it may not be good enough to be politically significant.

Many years have passed since the research was conducted on which the
cognitive model was based. The model has never been revised to accord with
the substantial body of research that has been conducted since 1985.

Our review of research that has been published since the cognitive behavioural
model was originally stated covered the following areas

• research on the relationship between antisocial

behavior and cognition
• research on the relation between cognition and emotion
• research on the role of emotion in prosocial
competence
• research on moral reasoning and values
• research on “emotional values”
• research on empathy
• research on desistance from a criminal lifestyle
• research on the development of prosocial competence
• research on “automatic thinking and feeling”
• research on social cognitive neuroscience.

Social cognitive neuroscience is an interdisciplinary field that combines the tools

of neuroscience with knowledge from various social sciences such as developmental
and social psychology. Social cognitive neuroscience research is yielding new
knowledge of the brain at a remarkable pace that has major implications for our
understanding of how biological, environmental, and experiential factors sculpt the
brain's architecture in a way that can lead to the development of an antisocial life-style.

The availability of structural magnetic resonance imaging (sMRI) in the 1990s

has enabled neuroscientists to obtain detailed images of the anatomic structure of the
brain. More recent technological advances such as positron emission tomography
scanning, and functional magnetic resonance imaging (fMRI), electroencephalography,
magnetoencephalography, near infrared spectroscopy, and single photon emission
computed tomography have increased neuroscientists' ability to measure changes in
brain activity and have enabled them to measure and actually visually observe human
brain function during mental activity.

1
The cost-benefit of even small reductions in recidivism is quite significant. An analysis by the
Washington State Institute for Public Policy of the findings from 25 well-researched cognitive behavioral
treatment programs for adult offenders found that, although on average, these programs reduced
recidivism rates "only" by 8.2 percent (i.e. from 49% to 45% over an eight year follow-up), implementation
of such programs could avoid a significant level of future prison construction thereby saving taxpayers
about two billion dollars (Aos et al.,2006).
 Neuroscience has not just produced pretty pictures of the brain. Neuroscientists
can now correlate what is happening in the brain with many behaviors at the precise
time that these behaviors are going on. Functional MRI (fMRI) enables us to obtain a
picture of the neural mechanisms associated with complex human activities including
cognition. Neuroscientists can even study the function of parts of the brain by
temporarily inactivating that part of the brain so they can observe how behavior
changes.

However, the neuroscientists' brains have not yet fully figured out the brain.
Neuroscience is 'a work in progress'. Conflicting interpretations of laboratory findings
are by no means rare. Moreover, there are substantial conceptual and methodological
challenges in interpreting such findings (e.g. Petersen, 2003). What we now know
about how the brain works is still rudimentary relative to what we need to know. What
we have not yet learned about the complex organ is probably much more important than
what we have learned. However, the findings of social cognitive and affective
neuroscience are already contributing to our understanding of the mind, emotions and
behavior (Camerer, Loewenstein & Prelec, 2004) and how to reduce antisocial
behaviour and offending.

Development of an Antisocial Brain

Throughout our lives, our brains register our experiences, our observations, our
thoughts and our feelings by forming new connections among neurons in our brain.
Neurons are highly specialized, electrically excitable nerve cells that send and receive
signals from other neurons by means of chemical transmitters that travel across
synapses and axons that connect the neurons. These neural connections, without our
awareness, determine how we perceive, how we interpret, how we feel about and how
we react to our physical and social environment. How one feels, how one thinks, and
how one behaves both reflects and creates the connections among neurons in the
brain. The patterns of connections between the neurons form paths that guide our
journey in life. The particular networks of connections that are shaped in our brain by
our history of interaction with our environment give rise to our own unique thoughts and
feelings, our unique personality and our unique self-identity. They form the script for the
story of our life that tells us who we are and what roles we will play, should play, and
even must play.

There is abundant evidence that neurodevelopment is an experience dependent

process. Many, perhaps most of our neural connections are created by our social
experiences. These connections continue to direct our emotions, our thoughts and our
behavior unless and until alternative connections are developed. Our neuroanatomy is
formed by what happens to us. Our neuroanatomy is also activity dependent – it is
formed by what we happen to do. Our neuroanatomy is also observationally dependent.
All the observations we make create neuronal connections in our brain. Environmental
and experiential factors continue to impact the development of the brain during
childhood, during adolescence and, indeed throughout life. Our brain is a unique record
of our past.
 Neuroscience studies have determined that the adverse effects on the
developing brain of being exposed to adverse socio-environmental conditions can be
long-term. Inadequate nutrition, poverty, low social status, abuse, deprivation, neglect,
victimization, oppression, racism, social isolation, alienation, and other cultural, ethnic,
racial, class influences that have been identified by many studies as criminogenic risk
factors can permanently impact the development of the brain and the functioning of
particular neurotransmitters and their receptor sites (Farah, Noble & Hurt, 2006).

The brains of children who, for example, are raised in a socially toxic
environment of isolation; poverty; rejection; hostility; neglect, abuse and maltreatment;
or who experience consistent failure in school or in their interpersonal relations have
those experiences seared in their brains in neural networks that can trigger deep
feelings of anxiety, fear, anger and hostility that can engender antisocial behavior (Dahl,
2004; Pedersen, 2004; Pollak, 2003; Lewis, Granic, & Lamm, 2006). Enduring antisocial
patterns can be developed deep in the brain early in brain development in childhood
and adolescence.

However, the brain is malleable. The brain is like the foundation of a house that is
continually being built but is never finished. New connections are continually being
created as our observations and experiences strengthen old connections or form new
connections and confirm our identity or revise it. As Ramachandran (2003) suggests,
"your brain is already being replaced every few months". Social cognitive neuroscience
has developed an understanding of how such new neural connections are formed; an
understanding that can enable us to guide the formation in a prosocial direction.

Development of a Prosocial Brain

Research conducted over the past 20 years has identified not only factors that
put the individual at risk of developing an antisocial lifestyle - the risk factors (e.g. Nagin
& Tremblay, 2005; Depue & Lenzenweger, 2005). It has also has identified protective
factors that lead individuals to refrain from or desist from antisocial behavior – what we
refer to as "prosocial growth factors". They include not just cognitive factors but also
environmental, social, familial, educational, emotional and neural factors. Such research
suggests how we can help antisocial individuals develop new neural pathways that will
engender not antisocial but prosocial feelings, thoughts, attitudes, values and
behaviors.

The brain's plasticity and its potential for life-long development means that
although early criminogenic risk factors launch a trajectory toward an antisocial life-
style, experience dependent plasticity can yield a change in the direction of brain
development. Experiential factors can impact the development of the brain such that the
trajectory is re-directed toward a prosocial life-style and what we refer to as a "prosocial
brain" (cf. Laub & Sampson, 2003). Our review of the neuroscience research indicates
how that can be achieved by particular forms of program interventions designed to
influence brain development such that even individuals with long histories of anti-social
and criminal behavior can be led to acquire prosocial competence and a prosocial
identity.
 Imaging studies have found that when people are exposed to situations where
they might consider or actually engage in antisocial behavior such as aggression or
violence the heightened activity is not only in the neo-cortex. It is not just in that area of
the brain where we consciously and rationally make decisions. It is also deep in the
brain. This suggests that antisocial behaviors may not be readily amenable to the
rational discourse (or deterrence) strategies we take as a basis for much of our way of
dealing with antisocial individuals. The growing neuroscience evidence that our actions
are rooted not so much in our conscious rational thoughts as in our deeply embedded
automatic thoughts and feelings raises serious questions about the wisdom of relying on
cognitive behavioral treatment alone.

Automatic Thinking and Feeling

We like to think that we are in control of our thoughts, that we are rational beings.
However, research has made it clear that we do not always operate in a deliberative
manner. Much of the time we function on autopilot – in an automatic default mode which
is neither deliberative nor even conscious. More than cognitive training or counselling or
punishment… is required to strongly influence the automatic antisocial thoughts and the
automatic emotions that are triggered in brain areas deeper than the prefrontal cortex.

It's Not All In Your Head

A systemic view of antisocial behavior recognizes that such behavior is

influenced by a whole range of internal and external factors. Antisocial behavior occurs
within a predisposing social context and is responsive to situational and precipitating
events. Therefore, cognitive training alone is unlikely to be effective unless applied in
concert with other interventions that address such predisposing and precipitating
conditions. As Pollak (2003) noted, it is not only what is in their heads, but what their
heads are in.

Cognitive-Behavioral and Beyond

The neurocriminology model may not seem to fit the prevailing cognitive
behavioral zeitgeist. However, we believe that incorporating the findings of
neuroscience can embellish and refine the cognitive-behavioral model. It does not reject
it. It does not replace it. It extends it.

The neurocriminology model does not assume that executive functions are
unimportant. Our executive functions monitor and can exert significant, though not
complete control of our thoughts and actions, including self-regulation, planning,
cognitive flexibility and response inhibition. The development of cognitive skills enables
some "top-down" control of our behavior and our feelings. Top-down control
mechanisms in the brain can control unconscious processing somewhat even though
we have no awareness of what is being controlled.
Changing Brains

It may seem to be a considerable cognitive leap to assume that we can change

the brain by treatment programs. However, there is evidence that we can. There is
persuasive evidence that psychotherapy does change the brain (Kumari, 2006;
Roffman, Marci, Glick, Dougherty & Rauch, 2005; Gabbard, 2000; Liggan & Kay, 1999;
Linden, 2006). Indeed different psychotherapies may change different parts of the brain
(Etkin, Pittenger, Polan & Kandel, 2005). Cognitive Behavior therapy has been shown to
change the brain in some cases of Obsessive Compulsive Disorder and Depression and
to do so in different ways than pharmacotherapy (Butler et al.,2006; Goldapple, Segal,
Garson, Lau, Bieling, Kennedy & Mayberg, 2004; Chambless & Ollendick, 2001;
Gloaguen, Cottraux, Cucherat & Blackburn;1998). Cognitive-behavioral programs in
which participants learn to think about their thoughts differently can help "rewire" the
brain.

The cognitive behavioral model is based on the principle that our thoughts shape
our behavior. That principle also underlies the neurocriminology model. However, the
neurocriminology model is based on additional principles.

"My Amygdala Made Me do It"

The neurocriminology model we propose assumes that antisocial and criminal

behavior are a function of interactions among multiple neurocognitive and
neurobehavioral systems that are shaped by environmental, situational and experiential
events. Thus, the model does not hold brains or neurotransmitters or synpases
responsible for antisocial behavior. We hold individuals responsible for their behavior as
do other explanations of criminal behavior such as psycho-dynamic, socioeconomic or
social learning models. We have free will but we also have "free won't…our brains don't
just 'make us do it', they also have specialized systems for stopping us from doing it"
(Farah et al.,2006). We are not automatons.

The neurocriminology model does not assume biological determinism. There are
many factors outside the brain that influence how we behave. We are not prisoners of
our genes. Our genes do not simply predetermine our neuroanatomy so that it
unavoidably ripens like blossoms on a tree. Our genes do shape our neural
development, but we do not simply inherit criminality – "what children inherit are toxic
environments" (Pollak, 2003).

We still can choose to behave prosocially even though our environment, our
experience or our inadequate neurological development severely limits the nature,
number, variety and quality of prosocial alternatives from which we can choose.
Unfortunately, even when they have choices many antisocial individuals have not learned,
or do not choose to make the best ones.

REASONING & REHABILITATION

One of the programs that was based on the cognitive model that must be
substantially revised in the light of the recent research is the Reasoning & Rehabilitation
Program (R&R) (Ross, Fabiano & Ross, 1986; Ross & Ross, 1988). R&R was designed
to teach cognitive skills and values to offenders that could enable them to withstand
pressures toward antisocial behavior and to achieve success in legitimate pursuits. It is a
cognitive-behavioral program that was created through a major revision of a program
developed in the mid-sixties (Ross & McKay, 1979), then field-tested with high-risk
probationers in Canada. A revised version subsequently became the core curriculum for
rehabilitation programs in forty-seven penitentiaries across Canada for the nation's most
serious offenders (Ross & Ross, 1988). The program has since been delivered to more
than seventy thousand juvenile and adult offenders in twenty countries around the
world. Its efficacy in reducing re-offending has been demonstrated in several
international independent evaluations. In metanalyses and in cost-benefit analyses.

R&R2
Rehabilitating Rehabilitation presents a description of a new edition of the R&R
program that we have titled “R&R2”. The new edition is based on the recent research
referred to above. R&R2 operationalizes the neurocriminology model by incorporating
specific techniques that neuroscience research indicates can foster prosocial
neurodevelopment.

The new edition provides several versions that, in accord with the need for
differential treatment ("different strokes for different folks"), are specifically designed not
only for particular groups of offenders but also for youths and adults who engage in
antisocial behavior but have not (or not yet) engaged in offending behavior:

• R&R2 for Adults

• R&R2 for Antisocial Youth
• R&R2 for Youth and Adults With Mental Health Problems
• R&R2 for Girls and Young Women
• R&R2 for ADHD Youths and Adults
• R&R2 for Families and Support Persons

These programs have been field tested in Scotland, England, Connecticut, or Estonia.
Some have been tested with the most serious offenders – mentally disordered offenders
in secure hospital settings in England. Further information can be obtained at
www.cognitivecentre.ca or by email: cogcen@canada.com

Excerpted from Rehabilitating Rehabilitation (Ross & Hilborn, 2008) Cognitive Centre
of Canada. www.cognitivecentre.ca Email: cogcen@canada.com