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Paul John Griffiths
What is "Cognitive behavioral modification"? Discuss the theory and practice of self-instructional training and Social Problem Solving Training.
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INTRODUCTION: Back to top
This essay was originally submitted to the University of Birmingham for the Master of Science in Criminological Psychology. Clinical problems can be described as disorders of thoughts and feelings (Meichenbaum 1977); and since behavior is to a large extent controlled by the way we think, the most logical and effective way of trying to change maladaptive behavior is to change the maladaptive thinking which lies behind it. This is not a recent concept; Dollard, Doob, Miller, Mowrer and Sears (1939), were early proponents of the "Frustration–Aggression" hypothesis. Konecni (1975) described anger in terms of psychological arousal and cognitive labeling of that arousal which is a function of the internal and external cues and of the person’s overt and covert behaviors in the situation.
The intention of this essay is to provide a clear working definition for "Cognitive Behavioral Modification" and special attention will be given to its implementation within the Criminal Justice System. The first section will give an historical overview and establish how cognitive behavioral modification evolved and what models are currently in use. In the second section, the theory and practice of Self Instructional Training and Social Problem Solving Training are discussed, with positive and negative attributes highlighted. The final section concludes by illustrating an overview of what the important common ingredients of these therapies are and the implications to the criminal justice system.
HISTORICAL CONTENT: Back to top
Punishment and reward have been techniques available to society for centuries. People offend, society punishes them, some will never re-offend, whilst others return time and time again. One behavioral intervention is the Token Economy, where correct behavior is rewarded. However, by merely attempting to correct inappropriate behavior by these extrinsic methods, we miss the intrinsic drive and interpretation of events from the offender’s own perspective.
The most successful studies highlighted in a review of treatment literature conducted by Gendreau & Andrews (1990) identified that the most successful studies, while behavioral in nature, included a cognitive component in order to focus on the attitudes, values, and beliefs that support anti-social behavior. Cognitive behavioral programs draw on the Social Learning Theory and Cognitive Theory to inform practice (Hollin 1992). Research conducted by Izzo & Ross (1990), into Juvenile Rehabilitation Programs found that those that contained a cognitive component were twice as effective as those without.
Social Learning Theory and Cognitive Behavioral methods have yielded significant reductions in recidivism. (Rice & Chapman 1978). Cognitive Behavioral approaches to offender treatment can be divided into those that change cognitions of the violent individual and those that change behavior (Hollin 1993). Sexual offenders reflect at least some degree of sexual attraction to inappropriate partners or acts, often associated with relative lack of appropriate sexual arousal (Epps 1996). The distorted thinking and belief systems of sexual arousal and behavior serving to justify and rationalize their antisocial acts. Therefore, the aims of cognitive behavioral intervention for sexual offenders are to normalize, enhance social functioning and improve life management skills. The goal of sex offender treatment is to reduce the probability of future offending.
The client’s resistance to change can significantly create barriers to success. However, Miller (1985) suggests that clients’ motivation and ability to engage in treatment can be encouraged by specific attention to the following: client characteristics, environmental factors and therapist characteristics. The approach to a particular client is derived from a thorough assessment of the particular case. The approach should be collaborative i.e. building trust, be proactive, based on open-ended questioning and be highly structured and focussed (Beck, Wright, Newman and Liese 1993). The cognitive-behavioral approach helps individuals to understand the underlying problems that can lead to emotional distress thus leading to a better understanding of their offending behavior.
The work of Prochaska, DiClemente and Norcross (1992) with clients addicted to nicotine furnishes us with a model that illustrates the "Five Stages to Change" namely: pre-contemplation, contemplation, preparation, action and maintenance. This model assists us to visualize the relationship of change within addictive or offender populations. In the pre-contemplation stage, clients are not yet concerned with overcoming their problems and are unmotivated to change addictive or offending behaviors. In the contemplation stage individuals are willing to examine the problem associated with their behavior and consider the implication of change, although they may not take any constructive action. They are also likely to respond more positively to confrontation and education, although they may still be indecisive. In the preparation stage, clients wish to make actual changes and therefore desire help with their problems, although they may feel at a loss as to how to deal with what is necessary to adapt or change their behavior. In the action stage clients have made a commitment to change and they have begun to actually modify behaviors. Finally in the maintenance stage, clients attempt to continue the process begun in the contemplation and action stages. Prochaska et al (1992) suggest that not all clients will go linearly through the stages but offer a "revolving door model", where individuals may make many attempts through the stages of change before achieving their long term goals. Some clients may actually get stuck in the earlier stages of change and require extra assistance, some will never move on and others will die.
Goldstein, Glick, Carther and Blancero (1994), concerning their work with street gangs in New York have put forward encouraging results in the implementation of Aggression Replacement Training within a community setting. But limitations to the use of cognitive behavioral modification are illustrated in the research of Remington & Remington (1987). They looked at the implementation of this with Probation Officers and suggested that initial receptiveness of such methods was not always welcomed and also training needed to be thorough.
THEORY & PRACTICE: Self Instructional Training and Social Problem Solving Training. Back to top
The work of Goldstein and Keller (1987) with clients who display aggressive behavior, suggest that an increase in client’s self control could be achieved by modifying their self-statements, for example being less critical of their own performance and by making more positive self-statements. This used the framework of the technique, known as Self-Instructional Training.
The underlying explanation for Self Instructional Training came from the work of Donald Meichenbaum (1977). He designed a procedure that teaches clients cognitive restructuring through modeling and cognitive behavioral rehearsal. The research of Meichenbaum and Goodman (1991) clearly illustrates this method. Impulsive and hyperactive children were trained to administer self-instructions for tasks on which they had previously made frequent errors, first by talking aloud, then secretly, without talking, but still moving their lips and, finally without lip movement. This "silent speech" is the basic nature of verbal thought.
The modification of self-statements to achieve increased self-control can be attempted through Self Instructional Training (Goldstein and Kellar 1987). Some studies have employed self-instructional training with young offenders and these too, have found that it increases self-control, which accordingly decreases aggressive behavior (Snyder and White 1979). This idea has already been developed further to some extent and can be found in existing interventions, principally in the form of Anger Control Training (Hollin 1996). The work of Feindler, Marriott and Iwata (1984) that investigated the use of Self Instructional Training in "Group Anger Control Training" for Junior High School Delinquents found that it was especially beneficial, when used within community settings.
Solving personal problems is, in some form, central to all psychotherapies. The Social Problem Solving Model, assumes that some persons are unskilled or de-skilled, therefore, losing proficiency at problem solving because of a lack of opportunity to learn or practice such problem solving in various social settings, or loss of confidence brought about by various circumstances (Shure 1981). Several cognitive problem-solving skills have to be present in order to facilitate successful social interaction. Spivack, Platt and Shure (1976), suggest that these cognitive skills should include: sensitivity to interpersonal problems, the ability to choose the desired outcomes of a social exchange, considering the likely outcomes of one’s actions and generating different ways to achieve the desired outcome.
A number of studies (e.g. Slaby and Guerra 1988) have shown that compared to non-delinquents, offenders use a more limited range of alternatives to solve interpersonal problems, and rely more on verbal and physical aggression. In Social Problem Solving Training, a variety of different methods are used; these include Discussion, Modeling, Role-play etc. and are blended with cognitive techniques, especially Self-Instructional Training. Research conducted by Hains (1984), into the skills training of delinquents, using Social Problem Solving Training, provides us with clear evidence, that this method of intervention, can enable young offenders to generate a greater number of solutions to social problems. This research produced data that illustrates a reduction in the offending behavior of individuals within the study.
Social Problem Solving Training for it to be effective should concentrate on two areas (D’Zurilla & Goldfried 1971). Firstly, the making available of a variety of potentially effective response alternatives for dealing with the problematic situation and secondly, increasing the probability of selecting the most effective response from among these various alternatives. Within a framework of Social Problem Solving Training, offenders who are selected to participate in such a course of intervention learn a series of steps: firstly, the offender defines the dilemma as a problem to be solved; then he decides on the desired outcome and generates many different possible solutions, without actually evaluating their potential merit at this stage. Thirdly, the offender evaluates the pros and cons of each alternative and ranks the outcome. He then selects and tries the chosen solution. Finally, a decision is made as to whether the solution will alleviate the problem and meet the original goal selected. However, if this is not successful, then the offender is asked to work out what went wrong. In other words, which of the steps within the offender’s ability to solve problems needs to be reworked (Liebert and Spiegler (1990).
Problem-solving deficits are very common amongst substance users involved in Social Problem Solving Training which have been found to be effective in reducing substance use and misuse. Husband and Platt (1993) reviewed the use of cognitive skills training, with respect to "substance abuse with offender populations" and suggest that the inclusion of this method of intervention is doubly important.
Most programs can be divided into three distinct overlapping parts: Assessment, Intervention and Relapse Prevention (Epps 1996). Miner, Marques, Day and Nelson (1990) conducted research with sex offenders into the impact of relapse prevention. They suggest that Cognitive–behavioural programs that incorporate a range of ingredients, especially those that are focussed towards a number of separate change "targets", offer the best prospects of reducing re-offending amongst this particular group. This study highlights the importance of community based relapse prevention work.
Hollin (1996), notes that efforts are being made to bridge the research-practice divide by distilling the complexities of the meta analysis into blueprints for the design of effective programs. Garrett in 1995 compared 111 studies between 1960 and 1983. These were based on young offenders in residential treatment programs. He found that residential programs did have a small effect on outcomes and that cognitive behavioral methods were significantly more productive than Psychodynamic and life skills programs. With respect to the type and style of service, Andrews, Zinger, Hoge, Bonta, Gendreau and Cullen (1990a) suggest that some therapeutic approaches are not appropriate for general use with offenders. Specifically, they argue that traditional Psychodynamic and non-directional client-central therapies are to be avoided within general samples of offenders because of their devious, manipulative behavior in "traditional" affective groups.
It’s unfortunate that implementation of new interventions are seldom met without resistance. Richard Laws (1974) reported the failure of a residential "token economy". He found that the very institution that is to benefit could create its own barriers to setting up behavioral programs. This is highlighted by Burchard & Lane (1982), who comment "…behavior-modification advocates who do not recognize that much of their time will be spent trying to change behavior of staff and policy and administrators are in for a rude awakening." Paul Gendreau (1996) in his recent paper on "Offender Rehabilitation" illustrates several hurdles to future progress in the field of effective treatment of offenders. He identifies these as theoreticsm, failure to effect technology transfer and a deficiency of suitable training programs.
Treatment integrity is a vital ingredient for any intended program. Therefore, any treatment can only be successful if it is rigorously and properly implemented. Hollin (1996), states "solid and effective treatment programs do not magically appear overnight: they require planning for both content, and resources: trained personnel to conduct assessments and deliver treatment; and the flexibility to cope with the varying demands and problems presented by different clients". In other words there is effective management of a sound rehabilitation program (Hollin 1992).
We are fortunate that the reviews conducted by various researchers using meta analysis (Garrett 1985, Gendreau and Andrews 1990, etc.), allow a fresh look at the data and from the findings, it should be possible to make positive recommendations for the design of successful rehabilitation programs aimed at reducing offending behavior. There is now a firm base from which to design effective treatment programs (Hollin 1996). Cognitive Behavioral Therapy is not in opposition to "12-Step" or psychobiological models of substance abuse; in-fact, Beck et al (1993) have found that the alternative systems may be actually complementary. Andrews et al (1990a) identified cognitive behavioral approaches to be most effective. However, treatment programs conducted in the community have a stronger effect on delinquency than residential programs. While residential programs can be effective, they should be linked structurally with community based interventions (Hollin 1992) and particularly involving the family (Hollin 1992).
Not all interventions are productive in reducing offending behavior. Most commonly these consist of Psychodynamic and non-directive client-centered therapies as well as those that emerged from sociological theories of crime e.g. subculture and labeling. Programs that concentrate on punishment or sanctions e.g. Boot Camps, Drug Testing, Tagging, Restitution or Shock Incarceration seldom work without an element of Cognitive Behavioral Modification. Finally, any program, including behavioral ones, that targets low risk offenders or which does not focus on the multiple causes of crime is seldom effective.
Treatment programs that manage to reduce re-offending are usually quite intensive, lasting only a few months and are based on understanding the interpersonal relationships and social learning methodologies of criminal behavior. The programs themselves are either cognitive behavior or modeling based and target serious offending behavior. Treatment has to be delivered in a way that facilitates the growth of new skills, these being introduced and maintained in a firm but supporting atmosphere. Positive reinforcement should be the goal, as opposed to the use of punishment. Staff members should be rigorously selected, highly trained, supported and supervised, irrespective of their position or job description. The treatment structure within the program must enhance the re-socialization of the offenders’ back into mainstream society.
Andrews, D. A., Zinger, I., Hoge, R. D., Bonta, J., Gendreau, P. Cullen, F. T. (1990a) Does correctional treatment work? A clinically relevant and psychologically informed meta-analysis. Criminology. 28, pp. 369-404.
Beck, A. T., Wright, F. D., Newman, C. F. and Liese, B. (1993). Cognitive Therapy of Substance Abuse. Guildford: New York.
Burchard, J. D. and Lane, T. W. (1982). Crime and delinquency. In A. S. Bellack, M. Hersen and A. E. Kazdin (Eds). International Handbook of Behavioral Modification and Therapy. Plenum: New York.
Dollard, J., Doob, L. W., Miller, N. E., Mowrer, O. H. and Seres, R. R. (1939). Frustration and Aggression. Yale University Press: New Haven.
D’Zurilla, T. J. and Goldfried, M. R. (1971). Problem solving and behavior modification. Journal of Abnormal Psychology. 78, pp.107-126.
Epps, K. (1996). Sex Offenders. In C. R. Hollin (Ed). Working with Offenders. Wiley, Chichester. 6, pp.150-187.
Feindler, E. L., Marriott, S. A. and Iwata, M. (1984). Group anger Control Training for Junior High School Delinquents. Cognitive Therapy and Research. 8, pp. 299-311.
Garrett, (1995). Effects of residential treatment of adjudicated delinquents: A meta analysis. Journal of Research in Crime & Delinquency. 22, pp. 287-309.
Gendreau, P. and Andrews, D. A. (1990). Tertiary prevention: What the meta-analyses of the offender treatment literature tells us about "what works". Canadian Journal of Criminology. 32, 173-184.
Gendreau, P. (1996). Offender rehabilitation: What we know and what needs to be done. Criminal Justice and Behavior. 23, pp. 144-161.
Goldstein, A. P. and Keller, H. (1987). Aggressive Behavior: Assessment & Intervention. Pergamon: New York.
Goldstein, A. P., Glick, B., Carther, W. and Blancero, D. A. (1994). The Pro-social Gang: Implementing Aggression Replacement training. Sage Publications: Thousand Oaks.
Hains, A. A. (1984). A preliminary attempt to teach the use of social problem solving skills to delinquents. Child Study Journal. 14, 271-285.
Hollin, C. R. (1992). Criminal Behavior: A Psychological approach to explanation and prevention. Falmer Press: London.
Hollin, C. R. (1993). Contemporary Psychological research into violence: an overview. In P. J. Taylor (Eds). Violence in Society. Royal College of Physicians: London. Pp. 55-67.
Hollin, C. R. (1996). Working with Offenders. Wiley: London.
Husband, S. D. and Platt, J. J. (1993). The cognitive skills component in substance abuse treatment in correctional settings: a brief review. Journal of Drug Issues. 23, pp. 31-42.
Izzo, R. L. and Ross, R. R. (1990). Meta-analysis of rehabilitation programs for juvenile delinquents. Criminal Justice and Behavior. 17, pp. 134-142.
Konecni, V. J. (1975). The mediation of aggressive behavior arousal level verses anger and cognitive labeling. Journal of Personality and Social Psychology. 32, pp. 706-712.
Laws, D. R. (1974). The failure of a token economy. Federal Probation. 38, 33-38.
Liebert, R. M. and Spiegler, M. D. (1990). Personality. Brooks Cole: California.
Meichenbaum, D. (1977). Cognitive behavior modification: An integrative approach. Plenum: New York.
Miller, W. R. (1985). Motivational for treatment: A review with special emphasis on alcoholism. Psychological Bulletin. 98, pp. 84-107.
Miner, M. H., Marques, J. k., Day, D. m. and Nelson, C. (1990). Impact of relapse prevention in treating sex offenders: Preliminary Findings. Annals of Sex Research. 3, pp. 165-185.
Remington, B. and Remington, M. (1987). Behavior Modification in Probation Work: a review and evaluation. Criminal Justice And behavior. 14, 156-174.
Rice, M. E. and Chapman, T. C. (1979). Social Skills training for hospitalised male arsonists. Journal of Behavior Therapy and Experimental Psychiatry. 10, pp. 105-108.
Shure, M. B. (1991). Social competence as a problem solving skill. Cited in K. Browne and M. Herbert (1997). Preventing Family Violence. Wiley: Chichester.
Slaby, R. G. and Guerra, N. G. (1988). Cognitive Mediations of aggression in adolescent offenders. Assessment Developmental Psychology. 24, pp. 580-588.
Snyder, J. J. and White, M. J. (1979). The use of cognitive self-instruction in the treatment of behaviourally disturbed adolescents. Behavior Therapy. 10, pp. 227-235.
Spivack, G., Platt, J. J. and Shure, M. B. (1976). The problem solving approach to adjustment: A guide to research and intervention. Jossey Bass: San Francisco.
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