This randomized controlled trial aimed to assess the efficacy of a 40-session cognitive-behavioral group program, Growing Pro-Social (GPS), in reducing early maladaptive schemas and cognitive distortions (primary outcomes), as well as anger, shame and paranoia (secondary outcomes). The GPS's impact on behavioral change (e.g., in the reduction of disciplinary incidents and prison records) was also tested, in order to ascertain if changes observed in cognitive and emotional variables were reflected in a more adjusted behavioral pattern. Personality Disorders were also tested as moderators of treatment effects.
This was a randomized controlled trial with blind assessments, carried out in nine prisons in three city areas in mainland Portugal (Lisbon, Oporto and Coimbra) and in the Madeira Island. After the study was approved by the Head of the General Directorate of Reintegration and Prison Services of the Portuguese Ministry of Justice, a list of potential participants who did not meet the exclusion criteria was made available to the research team by psychologists from the justice system. Next, a large sample of participants was randomly selected using a random number table by a research assistant who was blind to any personal information about each inmate. Then, a first meeting between the research team and the randomized inmates occurred, in which researchers invited inmates to participate voluntarily. In this meeting, researchers explained the goals of the study and presented a brief overview of the intervention program. It was also explained to inmates that their participation in the study would not impact their sentencing in any way. Participants who agreed to participate, gave written informed consent, completed the baseline assessment, and were randomly assigned to treatment conditions (treatment and control groups) using a random number table by a research assistant who was blind to any information about each participant. Afterwards, the research team informed the psychologists in each prison of the result of the randomization so that GPS could be initiated. Participants in the control group were informed that they would be offered the GPS treatment after the study's completion (including the follow-up period). Besides baseline assessment, participants completed the mid-assessment (after the 20th session of the program), post-treatment assessment (at the end of GPS) and follow-up assessment (12 months after GPS completion). Staff who conducted randomization did not serve as therapists or accessors, and accessors were blind to condition assignment. Respondent-specific codes were used to link the data from one time-point to the next one. GPS's facilitators were chosen among the psychologists who already had training and experience in delivering the program with inmates (who were not selected for this study). In order to assure program integrity and consistency, facilitators received regular supervision by the research team (including the program's main author) during the time GPS was run in prisons. Moreover, the program's structured and manualized design ensures integrity, at least partially.
GPS is a structured cognitive-behavioral group program aimed to reduce the prominence of early maladaptive schemas
TAU in Portuguese prisons is primarily aimed to increase educational and professional qualifications
Early maladaptive schemas
Participants reported on a questionnaire of early mal-adaptive schemas (EMSs), the Young Schema Questionnaire - YSQ-S3 (Young, 2005). The YSQ-S3 is a widely-used self-report questionnaire including 90 items, measuring the 18 EMSs proposed by Young (1990). Each EMS is evaluated using a set of five items listed randomly, which the individual rates using a Likert-type scale from 1 (completely untrue to me) to 6 (describes me perfectly). This assessment was carried out by researchers, who received training in the self-report measure.
Time frame: From baseline to 12 months' follow-up
Cognitive distortions
Participants reported on a questionnaire of cognitive distortions, the Angry Cognitions Scale - ACS (Martin \& Dahlen, 2007). The ACS consists of 54 items distributed across nine scenarios (e.g., "You get home from the drive-thru and realized that you were given the wrong food"). Participants are asked to imagine that the situation described in each scenario had just happened. For each scenario, there are six items referring to different thoughts that could arise during the situation, which can be rated on a five-point Likert-type scale (1 = very unlikely to 5 = very likely). This assessment was carried out by researchers, who received training in the self-report measure.
Time frame: From baseline to 12 months' follow-up
Anger
Participants reported on a questionnaire of anger, the State-Trait Anger Expression Inventory - STAXI (Spielberger, 1988). The STAXI is a 44-item questionnaire divided into three parts: the first part assesses anger-state (how one feels in the present moment), the second part assesses anger-trait (how one generally feels), and the third part assesses anger-expression (how one generally reacts or behaves when feeling enraged or angry. Anger-trait encompasses two factors (temperament and angry-reaction), and anger-expression is composed by three factors (anger-in, anger-out and anger-control). Each item is rated on a four-point scale (1 = not at all to 4 = almost always). This assessment was carried out by researchers, who received training in the self-report measure.
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Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
270
Time frame: From baseline to 12 months' follow-up
External shame
Participants reported on a questionnaire of external shame, the Other as Shamer Scale - OAS (Allan, Gilbert, \& Goss, 1994). The OAS is an 18-item scale that assesses external shame (i.e., subject's perception of being negatively judged by others). Each item is rated on a five-point scale (0 = never to 4 = almost always) according to how frequently the individual feels s/he is being judged by others (e.g., "Other people seem me as small and insignificant"). This assessment was carried out by researchers, who received training in the self-report measure.
Time frame: From baseline to 12 months' follow-up
Paranoia
Participants reported on a questionnaire of paranoia, the Paranoia Scale - PS (Fenigstein \& Vanable, 1992). The PS is a 20-item self-report measure that assesses paranoid ideation. Items are rated on a five-point Likert scale (1 = not at all applicable to 5 = extremely applicable), where higher scores suggest high paranoid ideation. This assessment was carried out by researchers, who received training in the self-report measure.
Time frame: From baseline to 12 months' follow-up
Emotion Regulation
Participants reported on a questionnaire of emotional regulation, the Emotion Regulation Questionnaire - ERQ (Gross \& John, 2003). The ERQ is a 10-item scale designed to measure respondents' tendency to regulate their emotions in two ways: (1) Cognitive Reappraisal and (2) Expressive Suppression. Respondents answer each item on a 7-point Likert-type scale ranging from 1 (strongly disagree) to 7 (strongly agree). This assessment was carried out by researchers, who received training in the self-report measure.
Time frame: From baseline to 12 months' follow-up
Disciplinary incidents inside prison
For estimation of the frequency and type of disciplinary incidents and infractions, the individual records of each participant was collected from the prison records, describing their frequency and type during the research period.
Time frame: From baseline to 12 months' follow-up