CBT

Cognitive behavioral therapy is a treatment that focuses on patterns of thinking and the beliefs, attitudes and values that underlie thinking. CBT has only recently come into prominence as one of the few approaches to psychotherapy that has been broadly validated with research, although it has been used in psychological therapy for more than 40 years. It is reliably effective with a wide variety of personal problems and behaviors, including those important to criminal justice, such as substance abuse and anti-social, aggressive, delinquent and criminal behavior.

Unlike other approaches to psychotherapy, CBT places responsibility in the hands of clients while supplying them with the tools to solve their problems, focusing on the present rather than the past. People taking part in CBT learn specific skills that can be used to solve the problems they confront all the time as well as skills they can use to achieve legitimate goals and objectives. CBT first concentrates on developing skills to recognize distorted or unrealistic thinking when it happens, and then to changing that thinking or belief to mollify or eliminate problematic behavior.

The programs, often offered in small group settings, incorporate lessons and exercises involving role play, modeling or demonstrations. Individual counseling sessions are often part of CBT. Clients are given homework and conduct experiments between sessions. These components are used to gauge the individual’s readiness for change and foster engagement in that change. A willingness to change is necessary for CBT or any other treatment to be effective in reducing further criminal behavior.

Brand name programs often limit clients to 20-30 sessions, lasting over a period of up to 20 weeks. The more treatment provided or the more sessions participants attend over time, the greater the impact on and decrease in recidivism.

The typical CBT program is provided by trained professionals or paraprofessionals. Training for non-therapist group facilitators often involves 40 hours or more of specialized lessons and skill building. Licensed and certified therapists are often part of cognitive programs, especially those involving individual counseling.

Characteristics of the counselor are important to a program’s effectiveness. Counselor honesty, empathy and sensitivity are helpful traits. Support and encouragement, partnership or alliance, and acceptance are necessary in establishing effective rapport, which is especially important in CBT because counselors often take on the role of coach. It is important that counselors be consistent in modeling and expressing the pro-social attitudes and behaviors, moral values and reasoning that are often part of CBT with criminal offenders.

Positive findings from research on CBT are common. Over the years, studies have shown the therapy is effective with various problems, including mood disorders, anxiety and personality and behavioral disorders. Unlike other traditional and popular therapies, CBT has been the subject of more than 400 clinical trials involving a broad range of conditions and populations. It has successfully addressed many issues experienced by children, including disruptive or noncompliant behavior, aggressiveness, oppositional defiant disorder and attention deficit hyperactivity disorder. For adults, CBT has been shown to help with marital problems, sexual dysfunction, depression, mood disorders and substance abuse. It has also been shown to be as useful as antidepressant medication for individuals with depression and appears to be superior to medication in preventing relapses.

One form of psychotherapy stands out in the criminal justice system.

Cognitive behavioral therapy reduces recidivism in both juveniles and adults.

The therapy assumes that most people can become conscious of their own thoughts and behaviors and then make positive changes to them. A person’s thoughts are often the result of experience, and behavior is often influenced and prompted by these thoughts. In addition, thoughts may sometimes become distorted and fail to reflect reality accurately.

Cognitive behavioral therapy has been found to be effective with juvenile and adult offenders; substance abusing and violent offenders; and probationers, prisoners and parolees. It is effective in various criminal justice settings, both in institutions and in the community, and addresses a host of problems associated with criminal behavior. For instance, in most cognitive behavioral therapy programs, offenders improve their social skills, means-ends problem solving, critical reasoning, moral reasoning, cognitive style, self-control, impulse management and self-efficacy.

Recently, Mark Lipsey of Vanderbilt University examined the effectiveness of various approaches to intervention with young offenders.[1] His review analyzed the results of 548 studies from 1958 to 2002 that assessed intervention policies, practices and programs.

Lipsey grouped evaluations into seven categories:

  • Counseling
  • Deterrence
  • Discipline
  • Multiple coordinated services
  • Restorative programs
  • Skill building
  • Surveillance

When he combined and compared the effects of these interventions, he found that those based on punishment and deterrence appeared to increase criminal recidivism. On the other hand, therapeutic approaches based on counseling, skill building and multiple services had the greatest impact in reducing further criminal behavior.

Lipsey also examined the effectiveness of various therapeutic interventions. In particular, he compared different counseling and skill-building approaches. He found that cognitive behavioral skillbuilding approaches were more effective in reducing further criminal behavior than any other intervention.

In a different research review, Nana Landenberger and Lipsey showed that programs based on cognitive behavioral therapy are effective with juvenile and adult criminal offenders in various criminal justice settings, including prison, residential, community probation and parole.[2] They examined research studies published from 1965 through 2005 and found 58 that could be included in their review and analysis. The researchers found that cognitive behavioral therapy significantly reduced recidivism even among high-risk offenders.

Perceptions Affect Behavior

Beliefs, attitudes and values affect the way people think and how they view problems. These beliefs can distort the way a person views reality, interacts with other people and experiences everyday life.

Cognitive behavioral therapy can help restructure distorted thinking and perception, which in turn changes a person’s behavior for the better. Characteristics of distorted thinking may include:

  • Immature or developmentally arrested thoughts.
  • Poor problem solving and decision making.
  • An inability to consider the effects of one’s behavior.
  • An egocentric viewpoint with a negative view or lack of trust in other people.
  • A hampered ability to reason and accept blame for wrongdoing.
  • A mistaken belief of entitlement, including an inability to delay gratification, confusing wants and needs, and ignoring the rights of other people.
  • A tendency to act on impulse, including a lack of self-control and empathy.
  • An inability to manage feelings of anger.
  • The use of force and violence as a means to achieve goals.

Therapy can help a person address and change these unproductive and detrimental beliefs, views and thoughts.[3]

Cognitive Behavioral Therapy and Criminal Offenders

Landenberger and Lipsey found that even high-risk behavior did not reduce the therapy’s effectiveness. For example, some of the greatest effects were among more serious offenders. It may be that the therapy’s enabling, self-help approach is more effective in engaging typically resistant clients, that it increases their participation and therefore the benefits of participation. The therapy is more effective in reducing further criminal behavior when clients simultaneously receive other support, such as supervision, employment, education and training, and other mental health counseling.

The cognitive behavioral therapy approach has recently been used in many prepackaged, brand name programs, such as “Reasoning and Rehabilitation,” “Aggression Replacement Therapy,” “Thinking for Change” and others. The National Institute of Corrections recently published a thorough and comprehensive review of cognitive behavioral therapy, which provides detailed descriptions of these and other programs.[4] Interestingly, although the Landenberger and Lipsey review showed these programs were effective, no single program was superior in reducing recidivism.

More research is needed to determine if it would be effective for offenders to receive cognitive behavioral therapy earlier in their criminal careers or as part of early intervention or parenting training programs.

 

Dr. Anthony Komaroff,
2012 San Luis Obispo Tribune, writes: 

“Cognitive Behavioral Therapy, or CBT, is the leading form of therapy for anxiety.  It attempts to correct ingrained patterns of negative thoughts and behaviors.  Some studies indicate that it is as effective or more effective than medication.
    As the name suggests CBT has two parts.  Cognitive therapy helps you change negative patterns of thinking.  Behavior Therapy works to change your reactions in situations that trigger anxiety.
    Negative thoughts and behaviors tend to crop up when you’re under stress, so the first step in CBT is to help you recognize when you’re stressed.
    Your therapist will ask you to record your thoughts and anxiety levels in certain situations.  Then you and the therapist will discuss your thoughts.  You’ll evaluate how realistic they are.  And you’ll work together to substitute more productive thoughts.
    The behavioral component of CBT has two main strategies.  The first involves having you face your fears directly.  The reasoning is that avoiding anxiety-causing situations reinforces fears or false beliefs.  In real life situations you can practice substituting more realistic thoughts for your negative ones.  With repeated exposure, you should become desensitized to fear-provoking situations.
    The other main strategy is teaching practical skills to help you feel more in control.
    For many people with anxiety, two treatments are better than one.  In particular  many doctors recommend both CBT and medication.  This dual approach can offer longer-lasting results than either medication or therapy alone.