Dr. Arielle Baskin-Sommers is an Associate Professor of Psychology and Psychiatry at Yale University. She also is affiliated with the Child Study Center, Law School, and Wu Tsai Institute at Yale. Her research focuses on identifying and specifying the cognitive, emotional, and environmental mechanisms that contribute to antisocial behavior (e.g., substance use, criminal activity, aggression). She uses findings from her research to develop novel experimental tasks, assessments, and intervention strategies aimed at developing more humane (and scientific) approaches to mental health and crime. For access to her publications, please see her website.
In her answers, Dr. Baskin-Sommers:
- clarifies how psychopathy and antisocial personality disorder differ in regards to emotional processing
- discusses an intervention strategy that takes into account the cognitive dysfunction seen in individuals with many psychopathic traits
- discusses the research on whether individuals with psychopathy can learn from their mistakes.
1. How did you get involved in the area of psychopathy research?
I got into psychopathy research a bit by accident. When I was applying to graduate school, I was looking for mentors who studied people who seemed to have problems with self-control. The people that constantly found themselves in trouble with the law and the people that despite the many consequences continued to act in a way that caused them or others distress. I was applying to graduate school before the time the term “psychopath” was on every TV show or plastered over the news headlines. So, I was not looking to study psychopathy per se. I ended up going to work with Drs. Joseph Newman and John Curtin at the University of Wisconsin-Madison, who had just started a joint project on mechanisms related to psychopathy. It turned out that the behaviors of people with psychopathy exemplified the types of behaviors I was interested in understanding better.
2. What are the distinct cognitive and affective deficits that are unique to offenders with psychopathic traits?
To start, individuals with psychopathic traits as compared to other offender subgroups, engage in antisocial behavior that is paired with callousness, low empathy, and low levels of emotions. These are distinctive characteristics that need to be considered when understanding the uniqueness of their behavior.
Let me use psychopathy and antisocial personality disorder as an example to illustrate the differences between these subtypes of antisocial offenders. Psychopathy and antisocial personality disorder represent two different disorders. Individuals with these disorders have a long history of antisocial attitudes and behaviors and have been involved in chronic lying, fighting, bullying, aggression, impulsivity, and irresponsibility. Despite the fact that the behaviors of the person with psychopathy and the person with antisocial personality disorder look very similar, the root causes are different.
Briefly, individuals with psychopathy are under-emotional and have difficulty paying attention to different parts of their environment at the same time; they hyperfocus on what they want rather than considering all the information. Individuals with antisocial personality disorder are overly emotional and have difficulty controlling their behavior; they overreact rather than just act even when such emotionality works against them. Just think about how a clinician might interact with someone who displays seemingly callous and unemotional behavior versus someone who easily flies off the handle. In the first instance, connecting to how the person with psychopathy might feel about the situation, the fact that they hurt others, or punishing behavior will not work. These individuals simply do not feel the emotional effects of punishments and have difficulty connecting their behavior to the larger context. Instead, they need to be shown, concretely, how their current behavior works for or against their own self-interests, their own goals. In the second instance, expecting the individual with antisocial personality disorder to “calm down” or “control” themselves will not work. Instead, tapping into the emotionality of the individual can be effective. For example, rewards can be used to exercise control, gain cooperation, and encourage behavioral change. In support of this, individuals with antisocial personality disorder are responsive to token economies, positive reinforcement, and behavioral contracts.
Any attempt to manage the behavior of these two subtypes of individuals must take into account the underlying mechanistic distinctions if they are to be effective. However, this can only be accomplished if early and accurate assessments of disorders are implemented. Once appropriate identification is made, then different strategies that match the causes of the disorder that someone has can be put into place. This two-step process has the potential to improve risk assessments, day-to-day operations of the prison, and the sorting of individuals into appropriate programming.
3. Are there any treatments that can reduce offending in individuals with psychopathy?
Mental health professionals have experienced great frustration when delivering treatment to clients with psychopathy, who appear to not respond, or regrettably, even worsen. There has been little incentive to focus on innovations for a population deemed largely “untreatable.” However, recent technological advances in individualized medicine have opened avenues for innovative approaches that integrate basic research with clinical practice. There is some early evidence that these new approaches may be effective, even in the treatment of psychopathy.
As I already have indicated, individuals with psychopathy have a fundamental problem with attending to information in their environment when it is peripheral to their personal goals. While some consider this picture of psychopathy to be evidence of its unreachability, I maintain that there is promise in taking this information regarding psychopathy-related dysfunctions and integrating it with our understanding of how the brain can change by targeting the proper underlying channels. Cognitive remediation is a treatment intervention that is rooted in the assumption that, if we can identify and understand the mechanisms of behavior, then we can improve functioning. Specifically, it emphasizes the training of individuals in particular skills related to thinking, decision-making, and attention to a broader range of environmental activities so that behavior can be modified.
I, along with colleagues at the University of Wisconsin-Madison, have designed an intervention to target the deficits associated with psychopathy and have examined the efficacy of this intervention in a sample of incarcerated, adult male offenders. We used computerized packages, computer games to be specific, to train inmates to attend to and integrate both emotional and non-emotional information that they may not notice due to its irrelevance to their own goals. After six weeks of computerized training, participants with psychopathy demonstrated significant improvement. They paid greater attention to a wider array of contextual cues beyond just what was personally relevant for them; they no longer showed deficits in fear; and they were more aware of and could align their behavior with rule changes.
These findings represent only a first test of the efficacy of a cognitive remediation approach to the treatment of psychopathy, but they are especially promising because they oppose the common notion that the deficits associated with psychopathy are intractable and that effective treatment is not possible. However, it is important to note that these tests were conducted in a laboratory setting, and it would be naïve to assume that psychopathy can be treated by playing six hours of focused computer games. We are now working towards whether this type of cognitive remediation training translates to real-word behavior and settings outside of the lab.
The research study just described built upon basic research findings that individuals with psychopathy are best understood as having a problem attending to contextual cues. The person with psychopathy ignores the feelings of others and the consequences of their behavior not because they do not care or are incapable, but because they have a diminished ability to notice and integrate all pieces of a situation at the same time. Ultimately, this type of training targets the fractionated view that individuals with psychopathy have of the world around them and trains them to develop a more unified representation of a given context.
By combining basic science and rehabilitation efforts, it is possible to change the brains of people most consider to be untreatable. Though research on novel approaches to treating psychopathy is in its infancy, clinicians can take steps to integrate knowledge of the causes underlying the behavior of individuals with psychopathy into their case conceptualization and treatment approach. For instance, clinicians can ask questions that highlight for the individual the need to attend to contextual cues (e.g., noticing the emotions of others, noting the consequences); they can read available empirical research that reports on strategies that go beyond traditional treatment (e.g., cognitive remediation / computerized training); they can critically evaluate the situations in which therapeutic skills work (e.g., when emotions are self-focused or central to the individual with psychopathy’s goal) and do not work (e.g., when situations are complex); and, they can consider the complex reasons for treatment success or failure.
4. Do individuals with psychopathy learn from their mistakes?
This is a complex question. The simple answer: yes and no. Most fundamentally, how I interpret this question is whether individuals with psychopathy are capable of learning from their mistakes. The answer to that is “yes.” There have been several studies that show if you focus individuals with psychopathy on punishment directly or on information signaling regret directly, they can use this information and learn from it. However, it is rare that we walk around being directed to focus on the punishment or the regret-inducing information shortly after we make a decision. So, the “no” in my answer is that individuals with psychopathy seem to struggle in their propensity to focus on and use this information. The fact though that these individuals have the ability to learn provides us with important clues into their cognitive-affective functioning and suggests possible targets for intervention.
5. What would you want victims or survivors to know about your research?
I think it is important for all to know that psychopathy represents a form of mental illness. This is not to excuse or deny the impact of the behavior of people with psychopathy. This is to acknowledge that there are substantive differences in how people with psychopathy view the world and that it is in everyone’s best interest to identify and treat those differences. We need to retire the myth that individuals with sychopathy are fundamentally violent, emotionless, and incapable of change. Instead, we should work harder to aid them, so that they can notice more information in their environment and use more of their emotional exp
