Tag Archives: Cognitive behavioral therapy

Can you teach children to think before acting violently


NPR’s Morning Edition has a piece this morning on the problem of impulsive acts of violence by adolescents with guns and an attempt at a prevention plan. You can read and/or listen to the segment here. The researchers discovered that most of the violent gun crimes by teens were not premeditated. Instead, the shooters were in possession of a gun and when the problem became heated, they made the choice to use their gun to solve the problem–they failed to consider the consequences as they “solved the problem” with a weapon.

The intervention used in Chicago schools is a form of Cognitive Behavior Therapy to increase prosocial decision-making strategies. These interventions are not particularly new. The basis of this type of intervention assumes that if a person would pause before acting, step back and make an evaluation of the problem and consider alternatives, then the person would likely make a better decision. In previous research, these interventions are found not to generalize well from session to real life.

But, the research discussed in this piece seemed to point less to impulsive decision-making and more to the base assumptions they assumed others would make of them if they used polite speech to ask for something they wanted.

In one exercise, Ludwig says, the students were grouped into pairs, and one member of each pair was given a ball. The other was told to get the ball out of his partner’s hand. This invariably led to a fight, Ludwig says, as the kids brawled over the ball. After watching the fight, the program leader would ask the student who was trying to get the ball a question: “Why didn’t you ask the other kid to give you the rubber ball?”

None of the adolescents, Ludwig says, ever thought to ask their partners for the ball.

“The kids will say things like, ‘Oh, if I would have asked, he would have thought I was a punk,’ ” Ludwig says. “Then the group leader will turn to the partner and ask, ‘What would you have done had this other kid asked you to give him the rubber ball?’ And usually this other kid will say, ‘I would have just given him the rubber ball. What do I care?’ ”

The goal of such exercises, Ludwig explains, is to help the teens understand that their strong, negative reactions during confrontations are often based on what they falsely imagine is happening in other people’s minds.

Does it work?

You can read in the linked essay that those who received the intervention were FAR less likely to engage in violent crime. But notice that on 1 year follow-up after the intervention, the differences between those who received the intervention and those who didn’t were insignificant. In other words, the intervention works while it is being received, but is not a permanent change. So, one wonders what makes the program work at all. Is it the positive relationship between the students and those doing the teaching leading to more gracious responses to others?

In the past, I’ve read about stop-think-observe-plan interventions and assumed they were worthless since the students didn’t retain the skills to make better decisions after the intervention concludes. But note that the essay concludes with the researching noting that the benefits during the program are worth it in terms of cost-benefit. Maybe it would be good to see a 5 year program and whether the benefits really do continue during a longer program.

 

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Filed under Cognitive biases, conflicts, news, Relationships

The “End of Worry” in a dangerous world?


In light of the recent bombing in Boston, I thought I would use today’s post as a timely book note. Will van der Hart (Anglican vicar) and Rob Waller (Psychiatrist) have written a small but helpful book entitled, The End of Worry: Why We Worry and How to Stop (2011, Howard Books). What makes this book interesting is the fact that Will freely discusses his own struggle with worry, made more evident after the 2005 bombings in his city of London. While the bombings were the final straw to panic attacks, Will also explores some of the early roots of worry in his life.

If you struggle with worry, there are several reasons why this little book might be a comfort to you.

  1. The authors write as if they know worry and fear.
  2. It is not, as they say, “triumphalistic.” Meaning, they do not believe the right beliefs/prayers/faith will automatically solve the problem
  3. Worry is portrayed not only as a spiritual problem but also explored through lenses of psychology, biology, and habit formation.
  4. It is written to the worrier, not about the worrier
  5. Each chapter gives you opportunity to engage in a few key exercises
  6. They differentiate between solvable worry and floating worry (and the tyranny of the “what ifs…”)
  7. Their solutions are practical but do not pretend to be simplistic. In fact, they devote some space to the notion that you should “stop trying not to worry.” Sound radical?
  8. A number of their solutions are helpful for those who ruminate (OCD, scrupulosity)

The book sits firmly in the cognitive behavioral model of intervention. Therefore, much of it encourages readers to explore belief systems about self and world and to begin challenging faulty thinking and to work to replace with more appropriate cognitions, meditations, and self-talk. CBT is not the only therapeutic model but offers anxious people something to do.

If you would like to work through a book that describes the process of worry and perfectionism and then gives you some ideas to examine and change your own struggle, this might be the book for you.

*I received a free copy of this book without any obligation to write this post.

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Filed under Anxiety, christian counseling, Cognitive biases, Good Books, Uncategorized

Can you change your nightmares?


Blogging has been much harder this fall with a busy teaching and traveling schedule. I’ve been doing a lot of reading and thinking about best practices to deal with trauma in international settings–specifically in the Great Lakes region of Africa. Diane Langberg and I have been consulting with a Christian organization to help develop those practices with a local, sustainable mindset.

One of the recent items I read had to do with attempts to address repetitive “posttraumatic nightmares.” Bret Moore and Barry Krakow published, “Imagery Rehearsal Therapy: An Emerging Treatment for Posttraumatic Nightmares in Veterans” in the September 2010 issue of Psychological Trauma: Theory, Research, Practice, and Policy (v. 2, 232-238).

Imagery Rehearsal Therapy (IRT) attempts to alter nightmares by changing the storyline of the nightmare. The authors view nightmares as learned behavior such as insomnia. The CBT style treatment entails

  1. education about the relationship between nightmares and insomnia.
  2. education about cognitive restructuring via imagery
  3. client selects a particularly disturbing nightmare (maybe not the most disturbing one first)
  4. Client then instructed to “change the nightmare anyway you wish” (notice they are not asked to make it positive or even less distressing)
  5. Client then rehearses (over sessions) the new dream through imagery techniques

Previous controlled studies indicate a reduction in nightmare frequency and intensity. This particular summary article reports that the evidence is there that veterans find it helpful even at 12 months post treatment with 4 sessions.

A couple of things to note. There may be some effect of desensitization from rehearsal of the initial dream (exposure therapy) though the exposure is brief. Also, the client does not spend time rehearsing the actual traumatic events in this therapy–only the nightmares.

Some thoughts:

  1. This treatment makes sense. Ever have a dream that seems to go on and on, or one that you go back to upon waking up in the middle of the night. Often we may find ourselves trying to make the dream turn out okay. This treatment uses our fully awake brains to rehearse something we want to think about.
  2. If nightmares are the result of a collection of anxieties then it stands to reason that repeating new thoughts and images will begin to make associations in the brain that might compete with the anxieties.
  3. Christian living emphasizes re-telling the truth to ourselves. Consider how OT authors remind readers of the Exodus or Paul reminds the Ephesian readers of their prior state (chapters 1-3). What we rehearse does have an impact on our brains.
  4. Finally, some of our nightmares seem written in indelible ink. Do you still have test anxiety nightmares 20 years after your last class? I do. But I feel differently about them now than I might have back when I was still worried about school. It may be that we begin to feel differently about the nightmares. The less we are bothered by them the more infrequent they will be.

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Filed under counseling, counseling science, counseling skills, Psychology