Mentalization-based therapy (MBT) for individuals with antisocial personality disorder

Pilot study and randomised controlled trial:
Frequency of aggressive acts will be measured using a self-report 5-item version of the Overt Aggression Scale Modified at baseline and at every 3 months during treatment (i.e., months 3, 6, 9, and 12) and every 3 months post-treatment for one year (i.e., months 15, 18, 21, and 24).

Pilot study:
Unless otherwise stated, the secondary outcome measures are collected at baseline and every 6 months during treatment (i.e., months 6 and 12) and every 6 months post-treatment for one year (i.e., months 18 and 24).

1. Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM). A self-report questionnaire designed to be administered before and after therapy. The client is asked to respond to 34 questions about how they have been feeling over the last week, using a 5-point scale ranging from 'not at all' to 'most or all of the time'. The 34 items of the measure cover four dimensions: Subjective well-being, Problems/symptoms, Life functioning, and Risk/harm.
2. Psychopathic Personality Inventory- Revised (PPI-R 154; Lilienfeld, 2005). The PPI-R is a 154-item self-report measure of both global psychopathy and the component traits of psychopathy. Like the original PPI, the PPI-R is construct valid, time efficient, and can detect response styles potentially relevant to psychopathy (i.e. positive or negative impression management, random or careless responding). Rather than focusing exclusively on antisocial or criminal behaviors, the PPI-R measures the continuum of psychopathic personality traits present in a range of individuals and can be used in both clinical (e.g. forensic) and non-clinical (e.g. student, community) settings.
3. MacArthur Community Violence Screening Instrument (MCVSI; Steadman et al., 1998; 2000): 18-item semi-structured interview to measure the frequency with which individuals have been subject to and/or have engaged in particular violent behaviours.
4. Offending behaviour structured interview for offending behaviour designed to record offending activity. Consists of 17 “yes” or “no” self-report response-type questions. Each question is related to a different type of offence (e.g., theft of motor vehicles, shoplifting, possession of an offensive weapon/firearms, and drug offences). Adapted from adapted from the self-report offending questionnaire from the Cambridge study by David Farrington (2006).
5. State Trait Anger Expression Inventory 2 (STAXI-2; Spielberger, 1999): 57-item self-report measure to investigate the experience, expression of anger and control of anger. Comprises of six subscales, including state anger, trait anger, anger expression out, anger expression in, anger control out and anger control in, and anger expression index.
6. Euroqol5 (EQ5D): Standardised self-report instrument for use as a measure of health outcome. Applicable to a wide range of health conditions and treatments, it provides a simple 5-item descriptive profile and a single index value for health status.
7. Brief Symptom Inventory (BSI; Derogatis, 1993; Derogatis & Melisaratos, 1983): A short form of the Symptom Checklist90Revised, is a 53-item self-report screening instrument used to assess the psychological symptom patters of the participants. Nine primary symptom scales: Somatization, Obsessive Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic Anxiety, Paranoid Ideation, and Psychoticism.
8. Social Functioning Questionnaire (SFQ; Tyrer et al., 2005): 8-item self-report scale, with items covering the domains of home, work, leisure, and relationships.
9. Barratt Impulsiveness Scale (BIS; Patton et al., 1995): The most widely used self-report measure of impulsive personality traits, consists of 30-items.
10. Alcohol Use Disorders Identification Test (AUDIT; Saunders et al., 1993): 10-item self-report test developed by the World Health Organization to determine if a person's alcohol consumption may be harmful.
11. Drug Use Disorders Identification Test (DUDIT; Berman et al., 2007): 11-item self-report test developed as a parallel instrument to the AUDIT for identification of use patterns and various drug-related problems.
12. Secure Facilities Service Use Schedule (SFSUS; Barrett & Byford, 2007): Researcher is able to collect meaningful individual level service use information for the economic evaluation of services provided within secure facilities. The schedule includes information on the service user’s accommodation, including time spent in a secure facility such as prison or secure NHS unit, use of all health, social, voluntary sector services, psychotropic medication and contact with the police, lawyers and the courts.
12. Service Engagement Scale (SES; Tait et al, 2002): 14-item clinician-rated measure consisting of statements that assess client engagement with services. The scale has high internal consistency and retest reliability, including discrimination between criterion groups, in an assertive outreach team (Tait et al, 2002).
13. Client Satisfaction Questionnaire (CSQ; Larsen et al., 1979): 8-item self-report statement of satisfaction with health services. This will be collected at 12 months only.
14. Suicidal Behaviours Questionnaire–Revised (SBQ–R; Osman et al., 2001): brief 4-item self-report measure of suicidal behaviour and past attempts.
15. Self Harm Inventory (SHI; Sansone, 1998): 22-item, yes/no, self-report questionnaire used to assess self harm and suicidal behaviour.

A subsample of the participants (50%) will also have the oppertunity to complete the following measures:
1. Reflective Functioning Questionnaire-54 (RFQ54; Luyten, under development): 54-item self-report scale to measure mentalization capacities with regards to self and others.
2. Movie for the Assessment of Social Cognition (MASC) is a sensitive video-based test for the evaluation of subtle mind reading difficulties.
3. Social Hierarchy game is interpersonal exchange game in which two players make decisions that determine which player has control of a monetary endowment and one which has no control of monetary endowments across a series of interactions. The paradigm tests how participants evaluate the benefits and costs of aggressive actions, as they learn, develop, and update expectations of social partners.
4. InvestorTrustee game (King Casas et al., 2008) is an interpersonal exchange game in which a player makes a series of decisions to either trust or repay trust in a social partner.

Randomised controlled trial:
Unless otherwise stated, the secondary outcome measures are collected at baseline and every 6 months post randomisation.
1. Violent behaviour is measured using the MacArthur Community Violence Screening Instrument (MCVSI) at baseline and every 3 months post randomisation until 24 months.
2. Health outcomes are measured using the Euroqol5 (EQ5D)
3. Psychological symptom patters are measured using the Symptom Checklist-90 Revised (SCL-90-R)
4. Alcohol use is measured using the Alcohol Use Disorders Identification Test (AUDIT)
5. Illegal drug use is measured using the Drug Use Disorders Identification Test (DUDIT)
6. Self-harm behaviours are measured using the Self-Harm Inventory (SHI)
7. Suicidal Behaviours are measured using the Suicidal Behaviours Questionnaire–Revised (SBQ-R)
8. Levels of service engagement is measured using the Service Engagement Scale (SES)
9. Individual level service use is measured using the Secure Facilities Service Use Schedule (SF-SUS)
10. Psychological Personality traits are measured using the Personality Inventory for DSM-5 Brief Form (PID-5-BF)
11. Mentalization capacities with regards to self and others is measured using the Brief reflective function Questionnaire (B-RFQ)