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Reasoning and rehabilitation cognitive skills programme reduces verbal aggression in violent offenders with psychotic disorders

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Question: Does a cognitive skill programme reduce violence and antisocial behaviour in offenders with a psychotic disorder?

Patients: Eighty-four men with a history of violence and a diagnosed psychotic disorder (bipolar disorder, schizophrenia, schizoaffective disorder or other psychotic disorder) who were not actively psychotic (Positive and Negative Symptom Scale (PANSS) score <4 on the P items) and who had not experienced similar treatment programmes. People with significant cognitive impairment (IQ<70), comorbid personality disorders and limited English speaking skills were excluded.

Setting: Six medium secure forensic hospitals, UK; time period not stated.

Intervention: Reasoning and rehabilitation (R&R) cognitive skill programme plus usual care versus usual care alone. The R&R programme targeted social problem-solving skills and thinking styles. Eight core modules (assertiveness skills, creative thinking, negotiation skills, social skills, values reasoning, problem-solving, emotion management and critical reasoning) were given over at least 36 sessions of 2 h durations (50% of R&R participants attended 30 or more sessions). Trained staff gave 2–3 sessions/week to groups of 5–8 men.

Outcomes: Any physical violence ranging from pushing to weapons use (MacArthur …

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  • Sources of funding: NHS National Research and Development Programme on Forensic Mental Health Science, UK.


  • Competing interests None.