Table 2. Main Characteristics of Research Reviewed Author(s) Aims Study Design Sample Sample Characteristics Measures Moore & Gudjonsson (2002) To survey attitudes towards the index offence, including attribution of blame. Quantitative Cross-sectional design. 90 patients who were admitted to a high secure hospital between February 1996 and February 1998 (including 13 who were admitted before February 1996, but had not engaged in admission assessments and were followed up in this period) and a medium secure hospital between February 1996 and October 1998. Characteristics are presented for all admissions, not just those who engaged in the study. Characteristics for all admissions during this time were: 143 males, 35 females. 63.5% White, 25.3% Black, 1.7% Asian, 9.5% Other/Mixed Race. 67.4% Mental Illness, 23.6% Psychopathic Disorder, 7.9% both categories, 1.1% Mental Impairment/not known. 57.9% homicide or violent offence, 10.7% sexual offence, 23.6% other offence, 7.8% no Index Offence. Gudjonsson Blame Attribution Inventory – Revised (GBAI; Gudjonsson & Singh, 1989). Other questionnaires were administered, but scores not reported in the results. Fox, De Koning & Leicht (2003) To investigate the relationship between attribution of blame for a violent act and Quantitative Cross-sectional design. 65 patients from medium and local secure settings who were male, over the age of 18, with an IQ above Mean age of 36.4. 63.1% diagnosis of schizophrenia, 18.5% personality disorder, 10.8% major mood disorder, 6.2% Revised GBAI, Eysenck Personality Questionnaire – Revised
Fox & Leicht (2005) To investigate the influence of familiarity of offender and victim on the attribution of blame for a violent act Quantitative Cross-sectional design. Participants were placed into three groups according to offence type: Victim well known to them, victim acquaintance and victim stranger. Offence severity was also ranked by a team of psychologists. Same sample as Fox, De Koning & Leicht (2003). Same sample characteristics as Fox, De Koning & Leicht (2003). Quick Test GBAI - R. Wright & Gudjonsson (2007) To develop and validate a measure of shame and guilt relating to a criminal act. Quantitative Cross-sectional design. 60 men residing in specialist forensic psychiatric units in the south of England with criminal convictions and mental health diagnoses. 90% schizophrenia or schizoaffective disorder, 6.7% personality disorder and 3.3% bipolar affective disorder. 87% violent offence conviction. Test of Affect – 3 (TOSCA-3; Tangney, Dearing, Wagner & Gramzow, 2000), State Shame and Guilt Scale (SSGS; Marschall, Sanftner & Conscious
Tangney, 1994), Offence Related Shame and Guilt Scale (ORSGS; Wright & Gudjonsson, 2007) and the GBAI-R. Wright, Gudjonsson & Young (2008) To investigate whether shame and guilt reactions to an offence are related to anger control. Quantitative Cross-sectional design. Same sample as Wright & Gudjonsson (2007). Mean age of 39.6. All other characteristics were the same as Wright & Gudjonsson (2007) sample. ORSGS, Anger Expression Inventory – II (STAXI-II; Spielberger, 1999). Crisford, Dare & Evangeli (2008) To investigate trauma symptomology related to committing a violent offence. Quantitative Cross-Sectional design. 45 residents of regional and secure unit in the UK, with an IQ of greater than 75 and convicted of a violent or sexual offence which the participants admitted to committing. 43 males and 2 females. Mean age of 39. 37.8% white and 62.2% 42.2% paranoid schziohrenia, 17.8% schizophrenia, 11.1% schizoaffective disorder, 11.1% personality disorder, 13.4% comorbid MI and PD, 2.2% refractory schizophreniform disorder and 2.2% delusional disorder. The QT, Detailed Assessment of Post-Traumatic Stress (DAPS; Briere, 2001), GBAI-R, Trauma Related Guilt Inventory (TRGI; Kubany, 2004) and Positive and Negative Affect Scale (PANAS; Trait
35.5% GBH, attempted murder, wounding, arson or rape, 24.5% manslaughter/murder, 17.8% indecent assault, 17.8% ABH or robbery and 4.4% attempted robbery or threats. Watson, Clark & Tellegen, 1988). Batson, Gudjonsson & Gray (2010) To investigate the relationship between attribution of blame for an offence and psychopathy in a sample of offenders with mental disorder. Quantitative Cross-sectional design. 67 male residents from 6 medium secure mental health units in the UK (taken from another study) with IQ above 70. Mean age of 34.7. 33% white, 46% black and 21% other ethnicity. 83% paranoid schizophrenia, 11% schizoaffective disorder, 3% delusional disorder and 3% depressive disorder. 84% violent offence, 9% acquisitive offence and 7% sexual offence. Psychopathy Checklist – Screening Version Hart, Cox & Hare, 1995) and the GBAI-R. Ferrito, Vetere, Adshead & Moore (2012) To explore the process of recovery and redemption in homicide offenders who were receiving treatment in psychiatric hospital. Qualitative Interpretative Phenomenological Analysis 7 men admitted to a secure forensic service, who had committed homicide, were engaged in therapy, with English as their first language and IQ above 80. Mean age 30.9. 42.8% black, 28.6% white and 28.6% mixed race. 57.1% schizophrenia, 28.6% comorbid MI and PD and 14.3% personality disorder. Interviewed using an interview schedule devised for the study.
Johnsson, Andersson, Wallinius, Hofvander, Stahlberg, Anckarsater, Billstedt & Radovic (2014) To identify correlations between attributions of blame and antisocial personality disorder and psychopathic traits in young violent offenders. Quantitative Case control design. Compared participants with mental disorder (antisocial personality disorder; ASPD) to offenders without a mental disorder diagnosis. 177 men in correctional facilities in the Western region of Sweden, with convictions of violent (including sexual offences) and aged between 18 and 25. Mean age of 22.4 years. 62.7% found to meet criteria for ASPD. GBAI-R, Psychopathy Checklist – Revised Hare, 2003) and Structured Clinical Interview for Axis II Disorders (SCID-II; First et al., 1997). Alemohammad, Wood, Tapp, Moore & Skelly (2016) To explore whether the internal factors of the MORM were associated with likelihood of engagement in group treatment in a sample of forensic inpatients Quantitative, Cross-sectional design. 118 adult male patients in a high secure hospital in England who had been referred to the group-work service for an assessment between 2001 and 2014. Mean age of 37.1 years. 65% white, 28% black, and <1% Asian. 58% had a diagnosis of chronic psychoses, 27% personality disorder, 6% other and 9% did not have a diagnosis recorded or yet determined. 64% had a history of violent offending, 20% sexual offences and 16% other type of offending behaviour (such as arson, robbery or kidnap). The Personality Assessment Inventory (PAI; Morey, 1991), the Clinical Outcomes in Routine Evaluation (CORE; Evans et al., 2000) and the Chart of Interpersonal Reaction in Closed Living Environments (CIRCLE; Blackburn & Renwick, 1996).
Table 3. Main Findings and Limitations of Research Reviewed Author(s) Main Findings Effect Size Limitations Moore & Gudjonsson (2002) There were no significant differences in GBAI subscale scores between offender type, but there was a non-significant trend for lower external attribution scores in participants who had committed a sexual offence, compared to those with violent or other offences. Those with a primary diagnosis of personality disorder had significantly lower scores on external attribution subscale than those with a primary diagnosis of mental illness. No inferential statistics presented and effect size therefore is not available GBAI External Attribution scores and diagnosis: t=2.2, df = 88, p≤.05 – effect size d = 0.48 Selection bias of sample (people diagnosed with PD were more likely to complete the questionnaires). Unclear about exact characteristics of the included sample. Difficult to ascertain exact sample as analysis was done on different groups and this was not clearly reported. Diagnostic complexities may affect the way the sample were grouped. Some oral administration of questionnaires. Not all participants had index offences. Large SDs in scores – heterogeneous.
Fox, De Koning & Leicht (2003) Guilt feelings scores were significantly negatively correlated with psychoticism scores, mental element scores were significantly positively correlated with neuroticism scores and external attributions were significantly positively correlated with psychoticism scores. There were no other significant correlations. GBAI Guilt and BDI-II Correlations: r=0.19, N=63, p≤0.1 – effect size d=0.39 GBAI Guilt and EPQ Correlations: EPQ Psychoticism r=-0.39, N=63, p≤0.001 – effect size d=0.85 EPQ Extraversion r=-0.06, N=63, n.s. – effect size d=0.12 EPQ Neuroticism r=0.10, N=63, n.s. – effect size d=0.20 Measures were verbally administrated. Unclear as to why authors used IQ score of 75 as a cut off. Sample are described as homogenous, but this is only in terms of their offence type. Other differences not well reported. Only used one measure of personality. Based on self-report and EPQ-Lie scores were fairly high. Gray, Carman, Rogers, MacCulloch, Hayward & Snowden (2003) 33% of the sample met the diagnostic criteria for PTSD. Those with murder convictions had significantly higher IES scores than those with other violent or sexual offence convictions. The relationship between the victim and offender did not significantly affect IES scores, but those who came to believe their actions were not justified had higher IES scores than those who believed the victim deserved to be assaulted. Offence type and IES scores: Murder versus other violent offences F(1,23)=2.43, p=0.065 – effect size d=0.76 Violent versus sexual offences F(1,31)=2.60, p=0.058 – effect size d=0.68 Relationship to victim and IES Scores: F(1,19)=7.10, p≤0.01– effect size d=0.90 The validity and reliability of the use of the questionnaires with this population is not stated. Small sample. Not all participants were able to complete all measures so not included in analysis. Heterogeneity of offences and mental health diagnoses. Based solely on self-report measures. III
Fox & Leicht (2005) There were no significant differences in GBAI-R scores between any of the three groups. There were higher guilt feeling scores in the victim well known group, but this was not significant. Guilt feelings were significantly higher in more severe offences (i.e. murder or manslaughter). GBAI guilt scores and victim relationship: F(2,62)=2.80, p=0.07 – effect size d=0.83 GBAI guilt scores and offence severity: F(4,62)=2.57, p=0.05 – effect size d=0.36 See limitations of Fox, De Koning & Leicht (2003; above). Some subjectivity in the ratings of offence type and severity. Wright & Gudjonsson (2007) Two subscales of the ORSGS had adequate internal consistency and moderate test-retest reliability. There was a significant positive correlation between the ORSGS measurement of shame and guilt, and shame and guilt measured by the TOSCA-3. Scores on the guilt subscale of the GBAI-R was significantly correlated with the ORSGS and TOSCA-3 Scores: Shame-proneness and ORSGS Shame r=0.39, N=60, p=≤0.01 – effect size d=0.85 Guilt-proneness and ORSGS Shame r=0.42, N=60, p=≤0.01 – effect size d=0.93 Shame-proneness and ORSGS Guilt Small sample and not all participants were included in each analysis.
ORSGS Guilt and STAXI-II scores: Trait Anger r=-0.04, N=60, p=0.39 – effect size d=0.08 Anger Expression – Out r=-0.21, N=60, p=≤0.05 – effect size d=0.43 Anger Expression – In r=-0.10, N=60, p=0.24 – effect size d=0.20 Anger Expression Index r=-0.36, N=60, p=≤0.01 – effect size d=0.77 Anger Control – Out r=0.26, N=60, p=≤0.05 – effect size d=0.54 Anger Control – In r=0.31, N=60, p=≤0.01 – effect size d=0.65 Crisford, Dare & Evangeli (2008) Participants who had unknown victims had significantly lower guilt scores on the TRGI than those who had known their victims. Higher levels of offence related guilt were significantly correlated with higher PTSD scores on the DAPS. Hierarchical regression analysis found guilt cognitions, negative affect and offence severity were TRGI scores and relationship to victim: t(41) = 2.03, p=0.05). Offence-related guilt and PTSD Scores: GBAI scores – r=0.42, N=45, p=0.004 – effect size d=0.92 TRGI scores – r=0.43, N=45, p=≤0.003 – effect size d=0.95 Small sample. Self-report only. Severity of offence was subjectively related. Shame was not measured and may have been a confounding variable. Large number of analyses were conducted so possibility of Type I errors.
Johnsson, Andersson, Wallinius, Hofvander, Stahlberg, Anckarsater, Billstedt & Radovic (2014) Guilt feeling and mental element scores on the GBAI-R were significantly negatively correlated with PCL-R scores, whereas external attributions were positively correlated with PCL-R scores. Those with ASPD diagnosis had significantly lower guilt feeling and mental element scores than those who did not meet the criteria. GBAI and PCL-R scores: Guilt feeling r=-0.44, N=117, p=≤0.01 – effect size d=0.98 Mental Element r=-0.35, N=117, p=≤0.01 – effect size d=0.75 External Attribution r=0.17, N=117, p=≤0.05 – effect size d=0.35 GBAI scores and ASPD: Guilt feeling– effect size d=1.17 Mental Element – effect size d=0.68 External Attribution – effect size d=0.30 Unclear as to why only young and violent offenders. Some items were missing from the GBAI-R and answers were then calculated based on factor means. Small correlations. Alemohammad, Wood, Tapp, Moore & Skelly (2016) There was a high number of refusals for group work (29.5%). 85% of patients included in the sample did complete at least one group they were referred to. Treatment refusal was positively correlated with negative affect towards self (such as experiencing shame). Treatment completions and drop outs were associated with other affective components, but not negative self-affect. Negative affect and treatment refusals: B=0.388 (1.47, 1 – 2.2) Small sample relative to the number of potential predictors. Predictors were strongly correlated with one another. Engagement was measured, rather than readiness or motivation being measured more directly. Engagement was only measure by treatment attendance and completion and treatment outcome was not considered. The authors discuss shame as a
Lewis, H. B. (1971). Shame and guilt in neurosis. Connecticut: International Universities Press. Lickel, B., Kushlev, K., Savalei, V., Matta, S. & Schmader, T. (2014). Shame and motivation to change the self. Emotion, 14 (6), 1049 – 1061. Marschall, D. E., Sanftner, J. L., & Tangney, J. P. (1994). The State Shame and Guilt Scale (SSGS). Fairfax: George Mason University. McGuire, J. (Ed). (1995). What works: Reducing reoffending: Guidelines from research and practice. Oxford: John Wiley & Sons. McMurran, M. & Ward, T. (2010). Treatment readiness, treatment engagement and behaviour change. Criminal Behaviour and Mental Health, 20 (2), 75 – 85. Doi: 10.1002/cbm.762. Moffitt, T. E., Caspi, A., Rutter, M. & Silva, P. A. (2001). Sex differences in antisocial behaviour: Conduct disorder, delinquency and violence in the Dunedin Longitudinal Study. Cambridge: Cambridge University Press. Morey, L. C. (1991). Personality Assessment Inventory: Professional Manual. Florida: Psychological Assessment Resources. Morgan, M. L. (2008). On shame. New York: Routledge. National Institute for Health and Care Excellence. (2014). Developing NICE guidelines: The manual. Retrieved from: http://www.nice.org.uk/article/pmg20 . Paulhus, D. L. & Vazire, S. (2010). “The self-report method”. In R. W Robins, R. C Fraley & R. F. Krueger. (Eds). Handbook of research methods in personality psychology. New York: Guilford. pp. 224-239. Prochaska, J.O., & DiClemente, C.C. (1982) Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: theory, research and practice, 19, 276-288.
Table 4 – Standard Multiple Regression and Backward Elimination Models PMI MOTIVATION Beta Sig R Square Adjusted R Square Sig Full Model TOSCA Shame ORSGS Shame TOSCA Guilt ORSGS Guilt .04 -.19 -.12 .46 .78 .21 .37 .00 .14 .08 .05 Model 2 ORSGS Shame TOSCA Guilt ORSGS Guilt -.19 -.11 .46 .21 .39 .00 .14 .10 .03 Model 3 ORSGS Shame ORSGS Guilt -.16 .42 .27 .00 .13 .10 .01 Model 4 ORSGS Guilt .33 .01 .11 .10 .01 TRQ READINESS Beta Sig R Square Adjusted R Square Sig Full Model TOSCA Shame ORSGS Shame TOSCA Guilt ORSGS Guilt -.02 .08 .18 .35 .87 .61 .16 .02 .21 .16 .01 Model 2 ORSGS Shame TOSCA Guilt ORSGS Guilt .07 .17 .35 .62 .15 .02 .21 .17 .00 Model 3 TOSCA Guilt ORSGS Guilt .16 .39 .17 .00 .21 .18 .00 Model 4 ORSGS Guilt .43 .00 .18 .17 .00 TRS READINESS Beta Sig R Square Adjusted R Square Sig Full Model TOSCA Shame ORSGS Shame TOSCA Guilt ORSGS Guilt -.01 -.09 .11 .41 .94 .67 .56 .05 .17 .06 .20 Model 2 ORSGS Shame TOSCA Guilt ORSGS Guilt -.09 .10 .41 .64 .55 .05 .17 .09 .11 Model 3 TOSCA Guilt ORSGS Guilt .12 .36 .47 .04 .16 .11 .05 Final Model ORSGS Guilt .38 .02 .18 .12 .02
and sexual offenders. Journal of Forensic Psychiatry and Psychology, 19(1), 86 – 107. Davison, G. & Neale, J. (2001). Abnormal psychology. 8th Edition. New York: John Wiley & Sons. Debidin, M. & Lovbakke, J. (2005). “Offending behaviour programmes in prison and probation”. In, G. Harper & C. Chitty. (Eds.). The impact of corrections on reoffending: A review of What Works. (3rd Edition). Home Office Research Study (291). Retrieved from: . DeVellis, R. F. (2012). Scale development: Theory and applications. 3rd Edition. California: Sage Publications. Drieschner, K. H. & Verschuur, J. (2010). Treatment engagement as a predictor of premature treatment termination and treatment outcome in a correctional outpatient sample. Criminal Behaviour and Mental Health, 20, 86 – 99. DOI: 10.1002/cbm.757. Drieschner, K. H., Lammers, S. M. M. & van der Staak, C. P. F. (2004). Treatment motivation: An attempt for clarification of an ambiguous concept. Clinical Psychology Review, 23, 1115 – 1137. Faul, F., Erdfelder, E., Lang, A. G. & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis for the social, behavioural, and biomedical sciences. Behaviour Research Methods, 39, 175-191. Feiring, C. & Taska, L. S. (2005). The persistence of shame following sexual abuse: A longitudinal look at risk and recovery. Child Maltreatment, 10 (4), 337 – 349. Ferrito, M., Vetere, A., Adshead, G., & Moore, E. (2012). Life after homicide: Accounts of recovery and redemption of offender patients in a high security hospital—A qualitative study. Journal of Forensic Psychiatry & Psychology, 23(3), 327-344. Field, A. (2013). Discovering statistics using IBM SPSS statistics. London: Sage Publications.