CMJR; Chapter 9

Chapter 9: Cognitive Interventions

INTRODUCTION

·         Cognitive interventions focus on the ways in which people think. The cognitive model proposes that it is dysfunctional thinking that influences feelings and behavior, and when individuals think in a more realistic and adaptive way, they experience fewer problems behaviors

·         thinking involves a broad array of processes and skills. Cognitive skills includes things like social or coping skills, problem solving skills, anger control, and conflict resolution skills.

o   The cognitive model is also concerned with what we think, or the content of our thoughts. This involves identifying specific thoughts and corresponding beliefs that lead to maladaptive actions

·         cognitions represent a constant stream of thoughts used to interpret our day-to-day situations. Given this, cognitions are also known to play a major role in psychological problems such as depression, anxiety disorders, and personality disorders

o   people who repeatedly commit crimes often possess very limited problem solving and other cognitive skills

·         cognitive therapy was developed by Aaron beck in the 60s

o   beck and Ellis are identified as forefathers in developing the cognitive model

o   Cognitive behavioral therapy (CBT): uses a structured, short term, present oriented approach that targets dysfunctional thinking to change behavior, and as noted, are used to treat an array of psychological and behavioral disorders

·         Cognitive behavioral therapy includes elements of both cognitive and behavioral therapies

COGNITIVE INTERVENTIONS IN CORRECTIONAL SETTINGS

·         during the past few decades, cognitive behavioral treatment modalities have become a preferred approach to counseling and therapy

o   cognitive therapies are viewed as here and now approaches that are among the most efficient and expedient therapies available. There's also ample evidence to support the effectiveness of cognitive models

·         the growing interest in cognitive therapies for justice involved juveniles and adults is equally understandable

o   first, numerous meta analysis of cognitive interventions in correctional settings have shown the programs to be highly effective

o   second, like the behavioral strategies, cognitive interventions deal with client characteristics that are identifiable (thoughts and feelings) and observable (behavior)

§  agencies have found that they can efficiently train non clinical staff to use cognitive methods

·         programs delivered by non clinicians tend to follow structured, often script and manuals, looking more like classrooms than therapy sessions

o   corrections is not the only field that has trained non clinical practitioners and cognitive interventions. CBT interventions can be found in places such as medical offices, schools, vocational programs, and self help groups, and are delivered by a range of trained professionals, para professionals, and peer specialists

o   a third reason for the popularity of cognitive behavioral programs has to do with what we know about individuals and engage in criminal behavior

§  a consistent finding is that anti social cognitions is a major risk factor for criminal behavior

·         individuals who engage in behaviors such as aggression, drug use, and theft often puts us to antisocial cognitions that justify these behaviors, as well as negative thinking about laws and law enforcement in general

COGNITIVE RESTRUCTURING APPROACHES

·         cognitive and cognitive behavioral approaches generally fit into one of two models

o   cognitive restructuring: change the content of thoughts, attitudes, and beliefs (what we think)

o   cognitive skills: intervention seek to improve cognitive processes (how we think)

Cognitive Therapy

·         in his clinical practice, beck found that his depressed patients often had negative and distorted cognitions, leading to his development of cognitive therapy as a treatment

o   he proposed that dysfunctional thinking was common to all psychological problems, and by teaching individuals to evaluate their thinking, and develop more realistic and adaptive thought patterns, their mood and behaviors would improve

·         beck argued that situations do not cause individuals to feel or respond in a particular way, rather it is how they construe or interpret the situation

o   automatic thoughts: the spontaneous, almost reflective words or images that go through a person's mind as a situation arises

o   core beliefs: global or overgeneralized ways that individuals sees the world, foundational to the way in which individuals interpret situations

Rational Emotive Behavioral Therapy (REBT)

·         rational emotive behavior therapy (REB t ) was initially devised by Ellis and is concerned with emotions and thoughts that impair our existence

·         The ABCs:

o   activating event: a situation, external event, or triggering event

o   beliefs: a thought sequence that follows the event

o   consequences: emotions and behaviors that result from the beliefs

·         in an unhealthy thought sequence, an irrational belief follows an activating event and several troubling emotional states may result from this sequence

·         in a healthy box sequence, the activating event is followed by a rational belief

·         According to Ellis, rational beliefs increase positive feelings and minimize pain

o   in most cases, irrational beliefs are distorted perceptions of the activating event

·         like cognitive therapy, REBT teaches the client that emotional states are not a result of the activating events, but the result of irrational beliefs

·         in similar vein, burns listed some common irrational ways of thinking

o   all or nothing: things are viewed in black or white

o   over generalization: one negative event is seen as a never ending pattern of defeat

o   catastrophizing: individuals exaggerate the importance of something

o   shooting: individuals either beat themselves up for what they should be doing, or it could be applied to others

·         the RBT counselor is active, persuasive, educational, directive, and at least in the Ellis model, hard headed

o   REBT involves disputing the clients irrational beliefs based on logic alone the counselor may seem confrontational but in being confrontational, he or she confronts the beliefs, not the client

o   such early experiences affect clients in the present only because the clients themselves perpetrate them

§  the goals of REBT are to leave clients with a minimum of anxiety and hostility, and to give them methods of self observation and self-assessment that will ensure they continue to be minimally anxious and hostile

The Cognitive Model in Corrections

·         anti social cognitions consist of pro criminal beliefs that go against the norms and rules of society

o   some assert that those with a pattern of criminal behavior simply think different from others

o   same now as 52 thinking errors

·         the psychological inventory of criminal thinking styles is used to assess criminal attitudes

o   Walters considered the content of thoughts important in explaining behavior, arguing that negative attitudes towards authority, positive attitudes toward deviance, and criminal identity predict criminal behavior

·         He  conceptualize that criminal thought processes were either proactive (planned and goal directive) or reactive (impulsive)

o   within these subtypes, Walters identified 8 specific criminal thinking styles

o   proactive: modification, entitlement, power orientation, super optimism

o   reactive: cut off, cognitive indolence, and discontinuity

Three Steps to Cognitive Restructuring:

1.      identify antisocial thinking

2.      challenge antisocial thinking

3.      replace antisocial thinking with pro social alternatives

·         The technique of cognitive restructuring is particularly important for correctional clients whose criminal behavior appears to be driven by an excess of antisocial attitudes

o   some individuals find themselves constantly in trouble because they cannot control their anger or addiction, or cannot successfully manage antisocial peers, or they struggle to handle problems in their lives and revert to criminal behavior

§  in these instances, cognitive skills training becomes especially useful

·         programs of this nature are effective among high risk clients, but often make matters worse for low risk ones

COGNITIVE SKILLS APPROACHES

·         Cognitive skill programs seek primarily to change the structure or process of one's reasoning

o   cognitive skills programs target the process of thinking- how thoughts are formulated

o   common cognitive skill deficits for those who engage in anti social behavior include failure to think through the consequences of the behavior or limited awareness of alternatives to stealing

§  place a greater emphasis on what clients are not thinking than what they are thinking

·         deficits and cognitive skills are not the same as deficits and intelligence

Cognitive Skills Programs in Corrections

·         individuals who engage in a pattern of anti social behavior are more likely than not to have a range of skilled deficit areas. These include factors such as impulsivity, poor problem solving, low self-control, and poor social, coping, or emotional regulation skills

o   proactive criminal thinkers engage in criminal behavior to mean a specific goal. Reactive criminal thinkers are more impulsive, spontaneous, and reactionary to high risk situations

·         nearly all these curricula have a tool for identifying risky thoughts, so that those thoughts can be targeted for change

o   examples of these tools are thinking errors and behavior chains

o   both of these tools have similar components. The clients are taught to identify higher situations, which are similar to the activating event

o   identify thoughts evoked from high risk situations ( b )

o   feelings, action, and consequences would be encompassed in consequences

·         tools such as behavior chain are thinking report can be used in multiple ways

o   first, it helps the client to identify which high risk situations are problematic for them

o   secondly, it identifies the specific thoughts that lead to antisocial behaviors

§  clients can then be taught micro skills, for instance simply thinking through the consequences of a choice before acting

·         Arnold Goldstein wrote a series of skills training curricula including the equip program, skill streaming the adolescent, and the prepared the curriculum

o   model adopted by many commonly used curricula, such as the aggression replacement training, thinking for a change, and the ICCI curricula

·         examples of social and emotional regulation skills taught in correctional settings can be useful for individuals to manage high risk situations include:

o   understanding the feelings of others

o   apologizing

o   asserting yourself

o   deciding to say no

o   dealing with peer pressure

o   responding to criticism

o   recognizing your feelings

o   dealing with anger

o   using self-control

·         These skills are often broken down into distinct steps, some of which are thinking steps (steps that would occur internally) while others are action steps (steps others can see the individual doing)

Teaching Cognitive Skills

·         in a cognitive skills group, the facilitator often focuses on a single skill for clients to practice during the session. Client selected situation personal to them then still applies to the skill being taught, and they practiced the skill using the identified skill steps

o   these skills can and are taught in individual settings as well. This might include an individual therapy session with the correctional or substance abuse counselor, a case management session with the social worker, or during a visit with the probation officer

§  Several models have been developed to teach probation officers how to use cognitive interventions, as well as other evidence based core correctional practices, when working with those on community supervision

o   whether in a group or 1 to one setting, the following steps are generally used to teach clients cognitive skills

§  introduce: discuss why the skill is important and how it would be beneficial in staying out of trouble

§  teach: review the skill steps, differentiating thinking from action steps

§  modeling: the practitioner models the steps using a relatable scenario to demonstrate how the skill steps should be followed

§  role play: clients practice the skill

§  feedback

§  graduated practice school and clients are assigned additional practice opportunities through homework or advanced practice sessions

·         skill acquisition: learning the skill

·         skill application: ensures that the client can generalize the cognitive skills to a variety of situations

·         instructors ask that participants practice the skills using scenarios specific to their own situations

·         one advanced cognitive skill that many curricula use is the skill for problem solving

o   Juliana taymans has been instrumental in developing problem solving

1.      Find the problem and identify goals

2.      brainstorm options for addressing the problem

3.      choose the best solution by considering the pros and cons of the options

4.      implement the solution

5.      evaluate how well the solution worked

·         A crazy experiment evaluation of problem solving found that the program reduced disciplinary infractions committed by both community and institutionalized participants

·         in some cases, cognitive skills curricula used in correctional settings are augmented by other types of programming. In these programs, clients often participate in a cognitive skills program to form a foundation, but get referred to additional programming to address alternative needs to or life skills such as money management, vocational skills, parenting, or community reintegration

o   some of these skills can be taught through role-playing and modeling ascribed by the social learning approach, and then used in combination with the cognitive models

VR

·         virtual reality can be defined as a computer generated environment that uses 2D or 3D visualization software and transmission devices to provide user input with a virtual world

·         although the facilitator was able to successfully use the virtual environment for teaching, role-playing, and providing feedback, other features in the software were not used that may have increased the effectiveness of the treatment

·         one key benefit cited for the use of VR was the ability to have members in the group who were physically in different locations

·         another was the ability to record a session so that role plays could be replayed for participants

·         finally, resources for expanding VR were explored

o   considerations included cost, room availability, and ongoing training needs

Mindfulness Interventions

·         mindfulness interventions are used to treat a broad range of health and mental health conditions, such as chronic pain, depression, anxiety, and substance use disorders

·         3rd wave approach to cognitive behavioral treatment interventions and can be defined as a process of openly attending, with awareness, to one's present moment experience

·         two important features of mindfulness common grounding and acceptance

o   grounding: paying attention to the present body sensations, emotions, mental images, thoughts, or other perceptual experiences

§  approaches like cognitive restructuring are not used, as the intent is not to identify and replace negative self talk, rather it is to accept that it is present, and simply observe rather than respond to it

·         Mindfulness interventions have been shown to reduce depression and anxiety, by turning awareness toward one thoughts, feelings, and body experiences, diminishing rumination and self judgment

o   in substance abuse programs, mindfulness strategy known as urge surfing it's used to observe the rise and fall of cravings for drugs or alcohol. Rather than react to these cravings, the physical sensations, thoughts and feelings associated with the cravings are observed and accepted, until the craving dissipates

§  and correctional treatment settings, mindfulness interventions are often incorporated as a component of a treatment program, usually within programs that use a cognitive behavioral framework as the primary model

·         examples include acceptance and commitment therapy (ACT) and dialectical behavioral therapy (DBT)

Moral Development Approaches

·         humans, according to piaget, kohlberg, Warren,and others, progress from the relatively concrete cognitive reasoning structures of children that to the more flexible thinking of adults

o   immature forms of reasoning creates situations in which the answers are either yes or no, problems are viewed from single rather than multiple perspectives, one's capacity to understand the perspectives of others is seriously constrained, and moral decisions depend solely on concerns about external rewards and punishments.

·         Lawrence kohlberg's stages of moral development form a cognitive developmental classification system that classifies individuals according to the ways in which they think about the justice, fairness, and “right” courses of action

o   moral judgment theory shares assumptions common to several other ego and cognitive developmental theory set forth by love anger, piaget, Sullivan, grant, and grant. These theories maintain that cognitive development:

§  involves changes in the qualitative thought process that describes the way one thinks

§  occurs through a developmental sequence of stages that is the same for all people

§  occurs in the direction of increasing complexity

§  represents an underlying logic at each developmental stage that appears to be consistent across situations

§  occurs through stages that are hierarchical integrations that enable individuals to comprehend all stages below and one stage above their diagnosis stage of moral reasoning

·         3 levels of reasoning in the moral development continuum: preconventional, conventional, and postconventional

o   preconventional reasoning:

§  stage 1: moral decision making involves blind obedience to authority to avoid punishment, deter to power prestige, and avoid trouble. The interest of others are not recognized

§  stage 2: a “right” course of action at this stage is predicated upon such instrumental considerations as the avoidance of punishment in the furtherance of one's own self interests

o   conventional reasoning:

§  stage 3: moral reasoning is eternally motivated by loyalty to other people and by a desire to live up to what is expected by significant others. Golden rule philosophy

§  stage 4: decisions reflect a desire to maintain such social institutions as the family, the community, and the country as social systems

o   postconventional reasoning:

§  stage 5: moral reasoning adheres to utilitarian notion

§  stage 6: such ethical principles of justice as the right to life and respect for the dignity of other persons as ends rather than means are used to generate moral decisions

·         stage 2 individuals demonstrate an external locus of control- a right course of action is determined by what is occurring in the external environment, where the individual scans the situation to determine whether he or she will be rewarded or punished

·         in correctional treatment programs that emerge from kohlberg's stages of moral judgment, the most important goal is to try to achieve growth from stage 2, proof of conventional reasoning, to the conventional reasoning of at least stage 3. This is because pro social, empathic orientations begin at stage 3, as just the notion of an internalized value system or conscience

o   moral judgment stages are significantly lower among system impacted juveniles and among those who are not involved in the system

·         moral education programs assume that growth in moral judgments is most likely to occur when an individual interacts with the pro social environment factors that encourage growth

o   fair and participatory environments promote moral development

§  moral education groups expose participants to moral dilemmas that are then discussed in groups of individuals who are each thinking through the various issues at different stages of moral judgment

Cognitive Interventions in Corrections that Incorporate Moral Education

·         current applications of moral education use the moral discussion groups and the kohlberg developmental theory and multimodal approaches, combined with the other cognitive behavioral or social learning components

o   learned behaviors and cognitions, on the other hand, are vulnerable to the competing rewards associated with anti social behavior; Because crime can be so rewarding, 1 might be more likely to use a new pro social skill if it is supported by an internalized moral argument

§  Goldstein and his associates apply this concept in a cognitive behavioral program called aggression replacement training (art)

·         ART consists of three components:

o   skills streaming. This is the first module teaches a wide range of social skills, using the model for teaching skills discussed above, as originally developed by Goldstein and glick

o   anger controlling training (ACT) this module teaches participants to recognize signs of anger and time to control it

§  participants identify physiological cues, self statements, and cognitive skills called reducer (deep breathing and visualization)

o   moral reasoning. The programs used for moral education is similar to kohlberg's original model. Clients discussed an attempt to resolve moral dilemmas

·         an additional example of a program that integrates the cognitive model with moral education is moral recognition therapy period MRT uses several group and workbook exercises designed to develop and improve moral reasoning through 16 graded moral and cognitive stages

o   somewhat less structured than other cognitive behavioral curricula. The flexibility of this curriculum allows facilitators to conduct open groups, where participants can enter at any time, as each member is working on their own stage

§  this intervention is most likely to be used in general correctional settings or substance abuse treatment facilities

WIDESCALE APPLICATION OF THE COGNITIVE MODEL

·         there is evidence to suggest that a cognitive behavioral model works with women, juveniles, and those with chronic mental illness

o   the use of CBT is not exclusive to the United states. In fact, the risk, need, responsivity model was conceptualized by a group of Canadian scholars

Application to System Involved Women

·         even in the largest meta analysis conducted to date, mark lipsey cautions that the vast majority of studies available to his review were programs attended by males

o   women are less likely than men to possess the prototypical antisocial thinking

o   gilligan's research suggested that women's moral development was more likely to revolve around concerns for their relationships and their own decisions in the context of a relationship            

§  antisocial thinking does not appear to be as strong a risk factor among women as among men

§  other cognitions, such as self efficacy, empowerment / responsibility, and anger, are consistently related to women's recidivism

·         gender responsive programming initiatives in that both the United States and Canada note that correctional programs for women should target the risk factors that more accurately describe woman's pathways to crime

o   instead of placing a priority on whether women are blaming their victims, a more productive focus of a cognitive behavioral treatment might target self efficacy, healthy relationships and family issues, parental stress, from an abuse, environmental safety

·         moving on, a cognitive curriculum does eloped by Marilyn van dieden, integrates cognitive behavioral techniques with social learning, ecological, and relational approaches

o   the primary goal of the program is to provide women with crime free alternatives and choices by assisting them to recognize and mobilize both personal and community resources

§  specific modules in the program include: ( a ) women identify negative self talk and substitute it with positive cognition; (be) teach women valuable decision making, problem solving, social, self management, and stress relief skills; And ( C ) assist women's the integration into the community

·         seeking safety is another cognitive behavioral program for individuals who have experiences trauma, abuse, PTSD, and substance use

o   used with both men and women, it is especially relevant to female clients because they suffer from these comorbid disorders at a higher rates than men

§  very well researched among male and female veterans, low income urban women, incarcerated women, and in other settings

Application Across the Globe

·         the responsivity principle within this model calls for evidence based models of intervention, namely, behavioral and cognitive strategies

o   international survey of European correctional treatment programs for young clients found that, similar to North America, many different approaches were used, and adherence to effective practice principles varied widely. Yet, also like North America, the majority of program surveyed reported adopting a cognitive behavioral approach to treatment

·         consistent with findings from meta analysis conducted in the United States and Canada, they found that ( 1 ) overall treatment worked, ( 2 ) cognitive behavioral models increase the treatment effect, and ( 3 ) models that adhered to RNR revealed the strongest effect

THE EFFECTIVENESS OF COGNITIVE BEHAVIORAL PROGRAMS – ROLE OF PROGRAM INTEGRITY

·         two meta analysis of cognitive behavioral programs note that the most effective treatment programs were small demonstration projects, studied, in some cases, by the very individuals who developed the curricula. When the programs were expanded to entire agencies and evaluated by outside researchers, however, the treatment effect diminished considerably

o   the likely explanation for such finding faults the treatment integrity of the expanded programs

o   understandably, some of the initial focus on quality was lost when these programs were implemented agency wide to larger groups of participants, and by individuals not directly involved with the development of their program

·         some of the reasoning and rehabilitation programs worked better than others

o   groups in which leaders maintained good classroom control (structure) achieved their set of some rights of 19% instead of the 36% achieved by all the participants. Use of appropriate cognitive behavioral techniques (practice and feedback) increase the effectiveness of the program. Groups in which participants had the opportunity to practice in all of the sessions wants to reset of ISM rate of 24% instead of 36%

o   those who completed the program in general had much lower recidivism rates

·         finally, lowen camp and colleagues conducted a study using over 3000 justice involved clients and 38 residential treatment programs

o   they found a modest 4% reduction in recidivism across the 38 programs for those who successfully completed treatment

§  using the correctional program assessment inventory (CPA I ) as a measure of program integrity, they found a strong correlation between program fidelity and a reduction in recidivism