Washington State Institute for Public Policy
Cognitive Behavioral Therapy (CBT) (for high- and moderate-risk offenders)
Adult Criminal Justice
Benefit-cost estimates updated December 2016.  Literature review updated August 2014.
Cognitive Behavioral Therapy (CBT) emphasizes individual accountability and teaches offenders that cognitive deficits, distortions, and flawed thinking processes cause criminal behavior. For this broad grouping of studies, CBT was delivered to adults in either an institutional or community setting. We excluded studies from this analysis that evaluated CBT delivered specifically as sex offender treatment. CBT programs delivered included a variety of “brand name” programs (e.g. Enhanced Thinking Skills, Moral Reconation Therapy, Reasoning and Rehabilitation, and Thinking 4 a Change). We investigated additional policy questions about CBT using multivariate regression analysis for the 40 effect sizes and found some variation in effectiveness across this broad grouping of programs. We found no statistically significant difference between brand and non-brand programs (p = 0.513). We also found that CBT programs delivered in an institutional setting performed marginally better than those delivered in the community (p = 0.058).
BENEFIT-COST
META-ANALYSIS
CITATIONS
The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2015). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $3,079 Benefits minus costs $10,050
Participants $0 Benefit to cost ratio $24.19
Others $6,083 Chance the program will produce
Indirect $1,322 benefits greater than the costs 100 %
Total benefits $10,483
Net program cost ($433)
Benefits minus cost $10,050
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Benefits from changes to:1 Benefits to:
Taxpayers Participants Others2 Indirect3 Total
Crime $3,078 $0 $6,082 $1,539 $10,699
Adjustment for deadweight cost of program $0 $0 $0 ($217) ($216)
Totals $3,079 $0 $6,083 $1,322 $10,483
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $412 2011 Present value of net program costs (in 2015 dollars) ($433)
Comparison costs $0 2011 Cost range (+ or -) 10 %
Per-participant cost estimate provided by the Washington State Department of Corrections.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Estimated Cumulative Net Benefits Over Time (Non-Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in non-discounted dollars to simplify the “break-even” point from a budgeting perspective. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Primary or secondary participant No. of effect sizes Treatment N Adjusted effect sizes (ES) and standard errors (SE) used in the benefit-cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
Crime 40 32062 -0.136 0.038 30 -0.136 0.038 40 -0.151 0.001
Citations Used in the Meta-Analysis

Armstrong, T.A. (2003). The effect of Moral Reconation Therapy on the recidivism of youthful offenders: A randomized experiment. Criminal Justice and Behavior, 30(6), 668-687.

Austin, J., Robinson, B., Elms, B., & Chan L. (1997). Evaluation of two models of treating sentenced federal drug offenders in the community (Document No. 179976). Washington, DC: National Council on Crime and Delinquency.

Berman, A.H. (2004). The Reasoning and Rehabilitation Program: Assessing short- and long-term outcomes among male Swedish prisoners. Journal of Offender Rehabilitation, 40(1/2), 85-103.

Bleick, C.R., & Abrams, A.I. (1987). The Transcendental Meditation program and criminal recidivism in California. Journal of Criminal Justice, 15(3), 211-230.

Bonta, J., Wallace-Capretta, S., & Rooney, J. (2000). A quasi-experimental evaluation of an intensive rehabilitation supervision program. Criminal Justice and Behavior, 27(3), 312-329.

Cann, J. (2006). Cognitive skills programmes: Impact on reducing reconviction among a sample of female prisoners (Research Findings No. 276). London: Home Office.

Cann, J., Falshaw, L., Nugent, F., & Friendship, C. (2003). Understanding what works: Accredited cognitive skills programmes for adult men and young offenders (Research Findings No. 226). London: Home Office.

Culver, H.E. (1993). Intentional skill development as an interventional tool. Dissertation Abstracts International, 54(06), 2053A.

Falshaw, L., Friendship, C., Travers, R., & Nugent, F. (2004). Searching for 'What Works': HM Prison Service accredited cogintive skills programmes. British Journal of Forensice Practice, 6(2), 3-13.

Friendship, C., Blud, L., Erikson, M., Travers, R., & Thornton, D. (2003). Cognitive-behavioural treatment for imprisoned offenders: An evaluation of HM Prison Service's cognitive skills programmes. Legal and Criminological Psychology, 8(1), 103-114.

Golden, L.S., Gatchel, R.J., & Cahill, M.A. (2006). Evaluating the effectiveness of the National Institute of Corrections' 'Thinking for a Change' program among probationers. Journal of Offender Rehabilitation, 43(2), 55-73.

Hatcher, R.M., Palmer, E.J., McGuire, J., Hounsome, J.C., Bilby, C.A.L., & Hollin, C.R. (2008). Aggression Replacement Training with adult male offenders within community settings: A reconviction analysis. The Journal of Forensic Psychiatry and Psychology, 19(4), 517-532.

Henning, K.R., & Frueh, B.C. (1996). Cognitive-behavioral treatment of incarcerated offenders: An evaluation of the Vermont Department of Corrections' cognitive self-change program. Criminal Justice and Behavior, 23(4), 523-541.

Hollin, C., McGuire, J., Hounsome, J., Hatcher, R., Bilby, C., & Palmer, E. (2008). Cognitive skills behavior programs for offenders in the community. Criminal Justice and Behavior, 35(3), 269-283.

Hubbard, D.J., & Latessa, E.J. (2004). Evaluation of cognitive-behavioral programs for offenders: A look at outcome and responsivity in five treatment programs (Final report). Cincinnati: University of Cincinnati, Division of Criminal Justice, Center for Criminal Justice Research.

Kownacki, R.J. (1995). The effectiveness of a brief cognitive-behavioral program on the reduction of antisocial behaviour in high-risk adult probationers in a Texas community. In R. R. Ross & R. D. Ross (Eds.), Thinking straight: The Reasoning and Rehabilitation program for delinquency prevention and offender rehabilitation(pp. 249-257). Ottawa, Ontario, Canada: Air Training & Publications.

Larson, K.A. (1989). Problem-solving training and parole adjustment in high-risk young adult offenders. In S. Duguid (Ed.), The yearbook of correctional education, (pp. 279-299). Burnaby, BC: Simon Fraser University, Correctional Education Association.

Little, G.L., Robinson, K.D., Burnette, K.D., & Swan, E.S. (2010). Twenty-year recidivism results for MRT-treated offenders. Cognitive Behavioral Treatment Review, 19(1), 1-5.

Lowenkamp, C.T., Hubbard, D., Makarios, M.D., & Latessa, E.J. (2009). A quasi-experimental evaluation of thinking for a change: A 'real-world' application. Criminal Justice and Behavior, 36(2), 137-146.

Martin, A.M., Hernandez, B., Hernandez-Fernaud, E., Arregui, J.L., & Hernandez, J.A. (2010). The enhancement effect of social and employment integration on the delay of recidivism of released offenders trained with the R & R programme. Psychology, Crime & Law, 16(5), 401-413.

Ortmann, R. (2000). The effectiveness of social therapy in prison—a randomized experiment. Crime & Delinquency, 46(2), 214-232.

Palmer, E.J., McGuire, J., Hounsome, J.C., Hatcher, R.M., Bilby, C.A.L., & Hollin, C.R. (2007). Offending behaviour programmes in the community: The effects on reconviction of three programmes with adult male offenders. Legal and Criminological Psychology, 12(2), 251-264.

Porporino, F.J., & Robinson, D. (1995). An evaluation of the Reasoning and Rehabilitation program with Canadian federal offenders. In R.R. Ross & R.D. Ross (Eds.), Thinking straight: The Reasoning and Rehabilitation program for delinquency prevention and offender rehabilitation (pp. 155-191). Ottawa, Ontario, Canada: Air Training and Publications.

Raynor, P., & Vanstone, M. (1996). Reasoning and rehabilitation in Britain: The results of the Straight Thinking on Probation (STOP) programme. International Journal of Offender Therapy and Comparative Criminology, 40(4), 272-284.

Robinson, K., Little, G., & Burnette, K.D. (1993). 5 recidivism results on MRT-treated DWI offenders released. Cognitive Behavioral Treatment Review, 2(4), 2.

Robinson, D. (1995). The impact of cognitive skills training on post-release recidivism among Canadian federal offenders (Research Report No. R-41). Ottawa, Ontario, Canada: Correctional Service Canada, Correctional Research and Development.

Ross, R.R., Fabiano, E.A., & Ewles, C.D. (1988). Reasoning and rehabilitation. International Journal of Offender Therapy and Comparative Criminology, 32(1), 29-36.

Sadlier, G. (2010). Evaluation of the impact of the HM Prison Service Enhanced Thinking Skills Programme on reoffending outcomes of the surveying prisoner crime reduction sample. London: Ministry of Justice.

Taylor, R. (2000). A seven-year reconviction study of HMP Grendon therapeutic community (Research Findings No. 115). London: Home Office.

Travers, R., Wakeling, H.C., Mann, R.E., & Hollin, C.R. (2011). Reconviction following a cognitive skills intervention: An alternative quasi-experimental methodology. Legal and Criminological Psychology. Advance online publication.

Van Voorhis, P., Spruance, L.M., Ritchey, P.N., Listwan, S.J., & Seabrook, R. (2004). The Georgia Cognitive Skills Experiment: A replication of Reasoning and Rehabilitation. Criminal Justice and Behavior, 31(3), 282-305.

Van Voorhis, P., Spruance, L.M., Ritchie, P.N, Johnson-Listwan, S., Seabrook, R., & Pealer, J. (2002). The Georgia Cognitive Skills Experiment outcome evaluation phase II (Final report). Cincinnati, OH: University of Cincinnati, Center for Criminal Justice Research.

Wilkinson, J. (2005). Evaluating evidence for the effectiveness of the Reasoning and Rehabilitation Programme. The Howard Journal of Criminal Justice, 44(1), 70-85.

Yessine, A.K., & Kroner, D.G. (2004). Altering antisocial attitudes among federal male offenders on release: A preliminary analysis of the counter-point community program (Research Report No. R-152). Ottawa, Ontario, Canada: Correctional Service Canada, Correctional Research and Development.

Zlotnick, C., Johnson, J., & Najavits, L.M. (2009). Randomized controlled pilot study of cognitive-behavioral therapy in a sample of incarcerated women with substance use disorder and PTSD. Behavior Therapy, 40(4), 325-336.

For more information on the methods
used please see our Technical Documentation.
360.664.9800
institute@wsipp.wa.gov