Cognitive Remediation and Neuroplasticity in the Treatment of Psychopathic Cognitive Deficits

People have always been fascinated by the minds of psychopaths. Validation of this ranges from its prevalence in mainstream media, to the abundance of horror flicks produced each year, to the popularity of TV series like American Horror Story, featuring this season’s beloved psychopath, “Dandy.” And fascinated we should be, the impact psychopaths have on society and the criminal justice system is tremendous. According to an article by Kent Kiehl and Morris Hoffman (2011), “Psychopaths are twenty to twenty-five times more likely than non-psychopaths to be in prison, four to eight times more likely to violently recidivate compared to non-psychopaths, and are resistant to most forms of treatment.” This is why research on the mind of individuals with psychopathic personality is so imperative—the pursuance of developing successful treatment options. Moreover, not only does this research shed light on the mysteries of psychopathic tendencies, but also the functionality and underlying mental processes of the normal human brain.

Kiehl, who has been studying the neurology of psychopaths for decades, has found that many of the behavioral markers of psychopathy, such as a lack of empathy, moral conscious, and a poor response to fear, appear to be intimately linked with the paralimbic regions. Specifically, fMRI scans show reduced activity in the amygdala, and anterior and posterior cingulate, as well as increased activity in the lateral frontal cortex in comparison to non-psychopaths (Kiehl & Hoffman). In the words of Kiehl, “These findings dovetail nicely with the central paradox of the psychopath: he is completely rational but morally insane. He is missing the moral core, which seems to be largely connected to the paralimbic regions.”

(Figure above from "the fMRI of an Affective Memory Task in Criminal Psychopaths showing reduced activity in paralimbic regions—amygdala, anterior and posterior cingulate—and increased activity in the lateral frontal cortex, an area typically associated with cognition, not emotion" (Kiehl & Hoffman).

In light of their findings, and in combination with several other treatment theories, Kiehl and Hoffman developed a therapy program they termed “decompression treatment,” that focuses on mending the social deficits present in psychopaths. The treatment was significantly more effective than any previous treatment of psychopathy; however, this doesn’t necessarily mean that the effects of the treatment were particularly sizable. In fact, therapies until recent have proven time and time again that treatment of psychopaths is incorrigible. What is more, some treatments, such as group therapy, have the possibility of making matters worse, increasing psychopathic tendencies.

Because decompression treatment is very intense, requiring one on one therapeutic treatment that lasts several hours a day for a minimum of six months, the program is very costly. However, due to the high costs of incarceration, the initial high cost of the program was made up for by its effectiveness.

Nevertheless, there is still need for a less time consuming program that illuminates and targets the core functional neural mechanisms underlying the individual emotional, cognitive, and social markers of psychopathy, rather than a holistic top-down treatment approach.

One study that specifically focuses on the individual differences between psychopathological disorders and the underlying neural mechanisms responsible for these individual differences is a study conducted by Arielle Baskin-Sommers, John Curtin, and Joseph Newman (2014). In the study, Baskin-Sommers et al. used cognitive remediation; a type of therapy that exercises the brain using specifically developed cognitive tasks, in order to target the individual deficit a patient is suffering from. Here, Baskin-Sommers et al. is focusing on a technique that was mentioned by Kiehl in his research; because brain-scan imaging technology has allowed researchers to pinpoint regions with abnormal activity in specific psychopathological disorders, this information can be used to facilitate synaptic strengthening in deficient regions with such cognitive exercises.

In brief, the method of the study consisted of assessing male prison inmates for either psychopathy or externalizing personalities and those who met the criteria were then randomly selected and divided into different cognitive remediation groups that specifically targeted each disorder. The first group contained both psychopaths and inmates with externalizing personalities and they received “interpersonal and situational cues and changes in their environment,” which was designed to improve psychopathic cognitive deficits. The second group was hypothesized to improve externalizing personality disorder deficits by teaching inmates ”to engage in affective cognitive control by acting rather than over-reacting to affective information.”

As predicted, the results showed that psychopaths in the attention to context condition, which was specifically designed to target a cognitive impairment of psychopaths, yielded significant improvements in performance, while externalizing inmates’ performance did not improve. Externalizing inmates did improve in the second cognitive remediation condition, which focused on affective cognitive control, and psychopaths did not show any improvement.

In view of these findings, it’s evident that cognitive remediation is an effective method of targeting specific cognitive deficits that are markers of psychopathological disorders, such as cognitive attention to context in psychopathy. Specifically, Baskin-Sommers et al.’s research has demonstrated that specific underlying neural mechanisms of psychopathy can be targeted for neuroplasticity training with a less time consuming program than decompression treatment.

Taken together, the studies by Kiehl and Hoffman, and Baskin-Sommers et al. give hope that psychopathy can be effectively treated with continued research for targeted, thoughtful treatment design efforts. Further research should possibly focus on the effects such cognitive remedial therapies would have on juveniles.

Baskin-Sommers, A.R., Curtin, J.J., & Newman, J.P. (2014). Altering the Cogntive-Affective Dysfunctions of Psychopathic and Externalizing Offender Subtypes with Cognitive Remediation. Clinical Psychological Science.

Kiehl, K. A., & Hoffman, M. B. (2011). The criminal psychopath: History, neuroscience, treatment, and economics. Institute of National Health, 51, 355-397.