A New Path for Treating Psychopathy

Whether it’s through books, movies, T.V, or study, most of us have at least heard of psychopaths, cold, emotionless and manipulative people who will do anything to get what they want without regards for others, master criminals and the apparently good fodder for crime television shows. But psychopathy isn’t as distant a problem as you may think. Psychopathy is present in about 1% of men in the US. That may not sound like a lot until you realize that’s something like 1,150,000 people, with about 93% of those incarcerated or on parole (Kiehl and Hoffmam, 2011). Furthermore, the cost of the recidivism of people with psychopathy alone is a jaw dropping 460 billion dollars a year in criminal social costs. That’s more than the societal cost of obesity and smoking combined. Because of their high prevalence in prison populations and the cost incurred on society, there is allot of good in providing an effective treatment method, and by effective I mean effective at reducing recidivism rates and violent crime, not necessarily at changing their indifferent personalities.

            Until very recently, the hope of finding any sort of treatment for psychopathy was very thin. People with psychopathy don’t respond well to the average talk therapy, in fact a few famous studies show that group and psychoanalytic therapy actually helps them to become better psychopaths learning instead how to better manipulate others (Kiehl and Hoffman, 2011). The fatal flaw in these treatments tends to be that they focus on changing personality factors, believing that the way to deal with someone who seemingly lacks feeling is to somehow get them to feel their own feelings better (Lewis, Olver & Wong, 2013). A second and more effective form of treatment is to address strictly violent behavior through cognitive behavioral approach addressing and changing violent attitudes and behaviors. Programs like these such as the Aggressive Behavior Control (ABC) program have been implemented in Canada for just over a decade. The unfortunate part about this program and others like it is that they tend to have a very small effect on recidivism if any. In fact ABC program participants fared no better than controls in terms of recidivism in general. Although, those who completed the program were less likely to commit violent crime in order to earn their new sentences (Lewis, Olver & Wong, 2013).

            Fortunately, there’s a new treatment in the works, or at least what may be the start of one’s development. A group of psychologists and neuroscienctist at Yale recently completed part of study that tests a new theory of psychopathy treatment. One of the less sensationalized consequences of psychopathy is that people afflicted have a peculiar attention problem. They suffer from a kind of attentional bottle neck, filtering out information that is irrelevant to the goal at hand. People with psychopathy are actually able to do moral decision making tasks just fine as long as they aren’t distracted by some other goal (Baskin-Sommers, Curtin &Newman, 2014). This helps explain why recidivism rates for people with psychopathy are so high. They might know they are on parole, but that information is pushed aside in the face of the opportunity to gain something they want at that moment. It’s theorized that this hyper focused attention it what leads people with psychopathy to not consider the consequences of their actions, (they are not “addicted to murder” as a certain ShowTime drama would have you believe).

            With this view of psychopathy in mind, it makes sense that fixing the attention problem would help fix the criminal behavior problem. In order to treat this attention problem, the Yale study enlisted the help of a treatment type called cognitive remediation, in which specific cognitive skills related to cognitive deficits are trained up. The training (which consisted of essentially computer games) focused on getting participants to pay attention to context cues like subtle rule changes and incorporating emotional information. The results? People with psychopathy who were treated did improve significantly in their ability to complete not only the tasks they trained for, but also other tasks that tested attention deficit. In other words, their attention bottle neck was widened somewhat. How do these results relate to recidivism? Well it’s far too early to tell not enough time has elapsed to know how these new skills will relate to behavior, but the results are incredibly promising.

A full cognitive remediation treatment is still a ways off on the horizon, but these results are certainly a good first step. Not only would these treatments be cheap, they would also be effective. In a country that loses so much money to an inefficient prison system any across the board reduction could potentially save millions of dollars and help thousands on the way to a better life.

Baskin-Sommers, A. R., Curtin, J. J, & Newman, J. P. (2014). Altering the Cognitive-affective dysfunctions of psychopathic and externalizing offender subtypes with cognitive remediation. Clinical Psychological Science.

Kiehl, K., & Hoffman, M. (2011).The criminal psychopath: history, neuroscience, treatment, and economics. Jurimetrics, 51, 355-397. 

Olver, M. E., Lewis, K., & Wong, S. C. P. (2013). Risk reduction treatment of high-risk psychopathic offenders: the relationship of psychopathy and treatment change to violent recidivism. Personality Disorders: Theory, Research, and Treatment, 4(2), 160-167.