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WW Module 06 Cognitive-Behavioral Interventions word version

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1. Cognitive Behavioral Interventions_7.17.16_KS +MS Edits

1.1 Cognitive Behavioral Interventions

Notes:

Welcome to the e-learning training module on What Works in Changing Offender Behavior with a specific focus on Cognitive-Behavioral Interventions. Research has shown that when program staff correctly use cognitive-behavioral interventions, they are effective at reducing participant recidivism. In order to deploy these interventions correctly, however, staff must have a good understanding of the theories that underlie these interventions as well as the specific strategies that can be used within cognitive-behavioral models of services and supervision.

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1.2 How to Use This Module

Notes:

Before we begin, please take a few moments to review how the presentation works. The core concepts and visuals in this module are intended for use with accompanying in-depth explanations of each slide topic. The in-depth information can be accessed in three ways, depending on learner preference: Module Notes, Audio, and Module Script. Each option contains the same information. Once the audio for each slide has ended, use the navigational buttons located at the bottom of the module presentation window to advance to the next slide.


1.3 Table of Contents

Notes:

Cognitive-behavioral interventions are techniques used to change participant behavior in a way that teaches individuals to understand and modify thoughts and behaviors. The first section of this module will provide a general introduction to cognitive-behavioral interventions. The second section will discuss theories associated with cognitive-behavioral interventions. The third section will discuss and review the components of the cognitive-behavioral treatment model. The fourth section will discuss specific intervention tools that can be deployed to targeted criminogenic factors of participants. The fifth section will discuss behavioral skills that facilitators should incorporate in various correctional settings. Finally, the sixth section will summarize the module by reviewing each of the following learning objectives.


1.4 Learning Objectives

Notes:

Upon completion of this module you will; have a thorough understanding of what actually constitutes a cognitive-behavioral intervention, learn the theories that encompass cognitive-behavioral interventions, recognize the components of the cognitive-behavioral model, review the common cognitive-behavioral intervention tools, and learn behavioral skills that should be incorporated into cognitive-behavioral correctional settings.


1.5 Introduction To Cognitive-Behavioral Interventions

Notes:

Section 1: Introduction to Cognitive Behavioral InterventionsWhy do we emphasize the use of cognitive-behavioral interventions? How effective are cognitive-behavioral interventions in reducing participant recidivism? Section one of this module provides a general overview of cognitive-behavioral interventions and their effectiveness.

1.6 Effective vs. Ineffective Interventions


Notes:

First, effective interventions intentionally target client attributes and circumstances that are related to criminal behavior for change. While we will discuss these types of factors in more detail in a later slide, some examples of such risk factors include antisocial thinking, antisocial peers, and lack of problem-solving skills. Research has shown that programs that target a higher density of crime-producing needs are more effective at reducing recidivism. Non-crime producing needs include such things as self-esteem, medical needs, and mental health. While these can be targets for change with participants, programs that focus the majority of their efforts targeting these types of needs are not effective at reducing recidivism.Second, effective interventions are directive. What do we mean by this? Directive approaches are structured and controlled by the staff person delivering the intervention. The staff person chooses the topic and strategies to be used rather than the participants. Client-driven approaches, on the other hand, allow the participants to guide the discussion. When participants guide the discussion, the focus is typically not on the most relevant factors that contribute to their risk to reoffend.Third, research shows that programs are more effective when they use manualized approaches. This is why more interventions are now delivered via structured curricula. These curricula identify the topic for each section, key talking points and discussion items, in-session practice activities, and homework. Use of such curricula ensures that the organization is delivering the same intervention to all participants regardless of the staff person delivering the intervention to any given participant on any given day. Finally, effective interventions use behavioral techniques such as modeling, role-playing, and reinforcement. In other words, they are action-oriented and focused on building skills. Behavioral interventions teach new prosocial skills, create practice experiences to allow participants to refine the new skills, and intentionally reinforce the use of the new skills in order to increase the likelihood that the participants will use the skills outside of the program. Behavioral techniques are different than process orientated approaches, which can spend the majority of time simply having participants process or discuss their general thoughts and feelings. These discussions, which can include thoughts or feelings about past actions and why the individual engaged in those actions, serve as an attempt to gain insight in order to discourage future criminal behavior. However, these techniques are actually ineffective with offender populations because insight alone, even if achieved, is insufficient to change antisocial behavior. High risk participants must also learn important behavioral skills to stay crime-free. Examples of such skills include problem-solving, coping skills, anger management skills, how to avoid trouble with others, and so forth.


1.7 Most Successful Types of Approaches

Notes:

Keeping in mind the characteristics of effective interventions that we discussed on the previous slide, the most successful types of approaches include: cognitive-behavioral, social learning, radical behavioral, and family-based therapies. Cognitive-behavioral therapy, or CBT, is a form of treatment that focuses on changing how a person thinks to change their actions or behaviors. The core concept surrounding CBT is that our thinking controls our behaviors and without targeting the thought and belief systems that go into a behavior, we are not likely to change that behavior. CBT also incorporates social learning principles. Social learning suggests that learning occurs in a social context and is established through observational learning. In this way, learning is achieved through observing the consequences or outcomes of others’ behaviors and then displaying a similar behavior and experiencing consequences or outcomes.Please note that these consequences or outcomes can be both positive and negative. For the purpose of this module, we will use the term consequences. Some agencies or program may refer to these as reinforcements and punishments, or rewards and sanctions.According to one theory in psychology literature regarding behavioral change, radical behaviorism looks at the impact of conditioning on human behavior. It is believed that behavior is either directly caused by a stimulus, or reinforced or extinguished by consequences. Therefore, it does not focus on cognitions like CBT does. This theory focuses on consequences (positive or negative) that serve as triggers for behavior. Family based therapies train family members on such things as effective communication skills, how to effectively reinforce the positive behavior of their loved one, how to effectively disapprove of or punish the negative behavior of their loved one, and how to effectively manage conflict within the family. Many of these family approaches incorporate CBT, social learning, and radical behavioral strategies.


1.8 Reduction in Violent Reoffending by Treatment Approach

Notes:

When choosing an approach to rehabilitate participants, corrections agencies must consider whether or not empirical research shows that the approach works to reduce recidivism. In other words, compared to clients who do not participate in the intervention, do the program clients reoffend less?In 2000, Andrews and Dowden conducted a meta-analysis of 35 studies of correctional treatment for adult male offenders. The meta-analysis examined whether cognitive-behavioral programs were more successful in reducing violent recidivism than other types of correctional interventions. Each of the studies included in the meta-analysis compared violent recidivism rates for a treatment group to violent recidivism rates for a non-treatment group. This meta-analysis found that on average, cognitive-behavioral programs reduced violent recidivism by 19%, while non-cognitive-behavioral programs had an average reduction in recidivism of just 1%. Much like this finding, favorable results have been found in programs that apply cognitive-behavioral interventions to a host of criminal behaviors and offender populations. For example, research indicates that cognitive-behavioral interventions are effective at reducing violent offending, non-violent offending, substance abuse, and sexual offending. Cognitive-behavioral approaches have also been shown to work with adults and adolescents, males and females.


1.9 Criminogenic Needs

Notes:

Much like risk factors, there are top tier criminogenic needs. Those that fall above the red line are the top three. You may recall that criminogenic needs are those attributes that are changeable - or dynamic - and that directly influence someone’s probability of committing a crime. The list on the slide is the current list of major criminogenic needs and should be the primary targets for change in most interactions with your population. This is true whether you provide treatment or supervision.While all of the items are appropriate targets for correctional interventions, the items above the red line represent those criminogenic needs that are most strongly associated with recidivism. These are antisocial thinking, hanging out with antisocial others, and antisocial personality traits such as recklessness, egocentricity, impulsivity, risk-taking, and lack of problem-solving skills.So, how do we go about changing antisocial attitudes or how someone thinks? How do you begin to identify their antisocial thought processes and then actively intervene to change them? How do we help people change or manage their peer associations other than trying to enforce rules that they not hang out with certain people who are risky or engaging in illegal behavior themselves? How do we help them improve their problem-solving skills? Trying to change all of these factors requires staff to actively engage in teaching strategies that directly target such attributes. The same strategies are required when targeting the criminogenic needs that are below the line. Family, vocational skills and employment, substance abuse, and free time are critical to target for change as well and cannot be ignored. And, the good news is that cognitive-behavioral approaches can address all these areas!We will spend the rest of this training learning how we might target these attributes for change through use of cognitive-behavioral interventions.


1.10 Goodness of Fit

Notes:

Over the past decade, many meta-analyses have found that cognitive-behavioral interventions are among the most effective methods to reduce recidivism. These approaches also fit easily within a variety of correctional settings.First, as discussed during the last slide, cognitive-behavioral interventions can easily address major criminogenic needs. Second, cognitive-behavioral interventions are relatively short-term compared to many other therapies. This is important as many correctional programs are designed to be relatively short in duration - typically 3 to 6 months. Similarly, probation and parole officers who are delivering cognitive-behavioral interventions during their contact sessions may only see someone once per month and may only have 20-30 minutes for the session; therefore, interventions used in corrections must be relatively brief and goal oriented. This is why the third bullet is so important - focusing on the here and now. The focus of cognitive-behavioral interventions is on the client’s current situation and constellation of risk factors. Use of cognitive-behavioral interventions does not require us to delve into a client’s past to resolve past issues.Fourth, cognitive-behavioral interventions can be delivered in outpatient settings, community-based residential settings, and institutional-based settings. Fifth, cognitive-behavioral interventions can be easily applied to both individual and group settings. Given the current staffing patterns of correctional programs, group delivery is essential in maximizing resources while providing effective services. However, these interventions can easily be adapted to be delivered by a probation officer, parole officer, case manager, or therapist in an individual session with a client. Finally, most staff are capable of delivering effective cognitive-behavioral interventions provided they have been properly trained and receive appropriate, ongoing supervision for fidelity to the interventions. This means that someone does not need a specific clinical license or college degree to deliver the interventions. In fact, across the country these interventions are delivered by counselors, case managers, probation officers, parole officers, and even security staff.


1.11 Where Cognitive-Behavioral Programs Go Wrong

Notes:

So far we’ve talked about some reasons why cognitive-behavioral programs tend to be effective. Unfortunately, not all programs that call themselves cognitive-behavioral actually meet these standards. There are two broad areas where programs typically go awry: (1) they apply cognitive concepts incompletely; and/or (2) they omit the behavioral part of the cognitive-behavioral intervention. The first references the fact that many programs do not fully address how thoughts affect behavior. For example, they might have participants learn about their cognitive distortions or thinking errors, but they do not have them practice replacing those antisocial thoughts with more prosocial thoughts. This means that these programs miss opportunities to apply cognitive restructuring techniques and participants then miss a huge opportunity to see how much their thoughts impact their behaviors. This takes us into the next point. While cognitive components may be in place in a program (cognitive restructuring) the behavioral components (social skill building) may not be consistently used throughout the program. Social skill building includes modeling, practice, and reinforcement. It should be evident across both group and individual sessions that staff are using these techniques. Later in the module, we will further discuss the importance of facilitators modeling skills, applying reinforcement, also known as positive consequences, and the importance of participants practicing and applying the new skills.


1.12 Section 2

Notes:

Cognitive-Behavioral TheoriesWhy do theories matter? Why not just jump into covering the strategies used in cognitive-behavioral models? The underlying theory of the program tells us a number of things. First, theory identifies what the program is targeting for change. For example, cognitive-behavioral programs strive to change key aspects of thinking and behavior that are related to criminal behavior.Second, it identifies how the program targets are related to the ultimate program outcome - in the case of corrections, our ultimate outcome is recidivism reduction.Third, theory explains how the specific strategies to be used should be expected to change our intermediate targets (e.g. thinking and behavior) and therefore our ultimate outcome. In other words, they connect the program’s interventions to its expected outcomes.Finally, programs that are not based on a sound theoretical foundation have been found to be ineffective. Therefore, we are going to spend some time in this section of the training reviewing the theories that comprise cognitive-behavioral programs.


1.13 Basic Formula

Notes:

Programs should follow the basic formula of cognitive-behavioral interventions to achieve the desired effects of reducing recidivism. Cognitive-behavioral interventions are a combination of cognitive theories and behavioral theories, such as operant conditioning and social learning. Cognitive theories state that cognitions, or thoughts, drive behaviors or actions. Behavioral theories look at how behaviors are initially acquired and then maintained through the ongoing experience of personal consequences, both positive and negative, for specific behaviors, as well as observing others’ behaviors and consequences. We’ll go more into detail about these theories later. However, the point here is that cognitive-behavioral programs consist of a blend of both cognitive and behavioral theories - both are necessary to fully explain (and therefore modify) human behavior.


1.14 Central Concepts of Cognitive Theories

Notes:

Let’s start with the central concept of cognitive theories. Cognitive theories of human behavior state that people engage in specific behaviors because their basic cognitions, or thoughts, are supportive of such behaviors. We all interpret situations, or think about situations, differently. This is why we don’t all behave the same way even in identical circumstances.Let’s take the situation of having your friend show up late for dinner. If your thoughts are “how rude”, “she is so inconsiderate”, “she does this to me every time” - how might you act when she finally shows up? One possible outcome is that you yell at her and accuse her of being a bad friend.But what if your thoughts are “this isn’t like her”, “she wouldn’t run late and not call me”, “I wonder if something bad has happened”? With these thoughts, you might hug her and tell her how worried you were when she does finally show up.Finally, what if your thoughts are “I am so glad she is late, since I still have a few things I need to do before we leave”? With this thought, you simply go about your business until she arrives, and may not even mention that you noticed she was late.Notice how the scenario was identical each time. What was different? The person’s thoughts and behaviors were different. Each set of thoughts led to a different behavior.We also see this with criminal behavior. This is why different people can see an unlocked car with the keys on the seat, and one person will use the keys to steal the car, while another will just pass on by, and yet another will go back into the store to see if he can alert the owner.The bottom line is that it is not the situation that dictates a person’s behavior, but rather it is a person’s thoughts that will lead to their behavior. Linking thoughts to specific behavior is the central concept of cognitive theories.


1.15 The What and How of Cognitions

Notes:

Cognitive theories are concerned both with what people think, and how they think when faced with certain situations.What someone thinks refers to the actual content of his or her thoughts, while how someone thinks refers to his or her thinking process. Such examples of the thinking process include problem solving, interpreting social cues, and engaging in cost-benefit analyses. Both what someone thinks and how someone thinks impacts his or her likelihood of involvement in criminal behavior. Therefore, interventions based on cognitive theories attempt to change or restructure the content of a person’s thoughts. The goal is to change the thought content to be more prosocial in nature, as well as attempt to change the person’s thinking processes by teaching critical thinking skills such as those already mentioned.


1.16 Operant Conditioning Theory

Notes:

Operant conditioning is typically associated with B.F. Skinner and his research with rats. Recall that he trained rats to push a lever through the use of reinforcements. One strategy that he used was to reward them with food each time that they pushed the lever. Over time, they began to associate the lever with food, so they learned to push the lever when hungry. Humans respond in the same way to such use of reinforcements or rewards. Punishments obviously are used to decrease behavior, but Skinner focused more heavily on reinforcements as there are a number of limitations to using punishments alone to change behavior.Operant conditioning requires that the response to the behavior, which is the conditioning stimulus or the reward, occurs after demonstration of the behavior. While operant conditioning theory takes into account observable actions such as behaviors and responses, it does not consider how thinking impacts behaviors. This is why this theory alone does not fully explain human behavior. For that, we need social learning theory. While including the role of conditioning, social learning also examines other learning mechanisms involved in modifying behaviors.


1.17 Social Learning Theory

Notes:

Social learning theory acknowledges that learning new behaviors does not just occur in response to directly experiencing certain outcomes. Learning behaviors can also occur indirectly through the observation of others. In other words, people typically learn behaviors and continue to engage in them because they see others doing them, and they observe the consequences, either positive or negative, that others experience when engaging in those behaviors. If they see that another person experiences a positive outcome after engaging in a specific behavior, then he/she will be more likely to try that behavior. If, after trying the behavior, the person also experiences their own positive outcome (remember operant conditioning), then they will be more likely to engage in that behavior in the future. So, the observation of others’ behavior and outcomes influences whether we will adopt new behaviors, while experiencing similar positive outcomes from the behavior explains why we maintain the behavior over time.These processes are applicable to most human learning, and explain how we learn and adopt both prosocial and antisocial behaviors.


1.18 Learning Initial Behaviors from Role Models

Notes:

One of the most meaningful ways of learning is through direct observation and imitation. In many correctional settings, participants observe behavior that could be influential to their needs. They see others acting or expressing themselves in a particular manner and see the consequences of these behaviors. Depending on the outcome, this will dictate their probability of engaging in similar behaviors in the future.For example, when a child observes a sibling sneaking out the house after curfew, he learns how to sneak out of the house. If the sibling is not punished for breaking the rules and returns home to tell the child exciting stories about the adventures of the evening, the child also is informed of the consequences of the sneaking out of the house; in this case, he sees that there are no negative sanctions for the behavior and that sneaking out can result in having a fun time. In such a scenario, the child is likely to want to perform the behavior of sneaking out himself. Modeling also serves a disinhibitory function. Behavior that may otherwise seem inappropriate or ‘off limits’ becomes normative, or at least acceptable. Seeing others engage in an act loosens restraints or inhibitions that an individual may have which normally would prohibit him or her from behaving in such a manner. If the consequences witnessed during the modeling experience are compelling enough, it is likely that a person will imitate the modeled behavior.


1.19 Maintaining Behaviors

Notes:

Behaviorism involves the balances of positive and negative consequences for behavior. In general, people’s attitudes are driven by the good and the bad consequences of others or their own actions. If the positive consequences outweigh the negative consequences of certain behaviors, a person is more likely to maintain future engagement in that precise behavior. Consequences, the balance of positive and negative, regulate behavior by informing people of what results to expect from similar behavior in the future. In essence, today’s consequences are tomorrow’s expectations. So, if a person performs an act and is rewarded for that act, he or she comes to expect that rewards will result when performing that behavior in the future. When behaviors are rewarded as opposed to punished, future use of a behavior increases.


1.20 Summary of Cognitive and Behavioral Theories

Notes:

Let’s take a minute to review what we have covered. Cognitive theory maintains that the content of participants’ thoughts lead to their criminal behaviors, participants’ thinking processes or skills also lead to their criminal behaviors, and changes in thinking result in changes in behavior. Social learning theory maintains that people’s thoughts and behaviors are influenced by observing other people’s behaviors, observing the consequences of other people’s behaviors, and the direct experience of consequences for their own and others’ thoughts & behaviors.


1.21 Implications of Theories to Treatment

Notes:

Cognitive theory and social learning theory work together to form the “cognitive-behavioral” approach. Together, they dictate what about participants should be targeted in order to change their behaviors and how to go about making the changes. Therefore, these theories present clear program implications to correctional practitioners.The integration of cognitive theory with behaviorism/social learning processes yields cognitive-behavioral interventions. From cognitive theories we see that how and what a person thinks affects his or her behavior. To change people’s behavior from antisocial to prosocial, cognitive theory tells us that we need to change participants’ thoughts and thinking patterns. Social learning theory presents the processes underlying how a person comes to adopt and maintain thoughts and behaviors. By using these same learning processes through tools like prosocial modeling, practice, and determining consequences, we can teach and reward the cognitive skills and prosocial cognitions that will foster a crime-free life.


1.22 Principles of Cognitive-Behavioral Programming

Notes:

This slide presents the four principles of cognitive-behavioral programming. The core concept behind cognitive-behavior therapy, or CBT, is that thinking changes behavior, and without targeting the thought and belief systems that go into a behavior, we are not likely to change that behavior. Thus far, we’ve discussed that thinking affects behavior and, if thoughts are supportive of criminal behavior and lack prosocial skills, antisocial behavior will most likely follow. When specific interventions are appropriately applied, we can assist in a participant’s process of influencing their thinking patterns. We teach participants new cognitive skills in order for them to choose more prosocial, less risky thoughts. When crime supporting thoughts are replaced with prosocial thoughts, prosocial behaviors are likely to follow.Informed by these principles, cognitive-behavioral programs have participants identify their distorted and irrational thoughts and examine how such thoughts lead to irresponsible behaviors. Participants learn that they have control over their thoughts and choices and that external circumstances don’t “make” them behave in particular ways. By learning to replace irrational thoughts with alternative, realistic thoughts, the participants’ behavior changes.It is important for participants to be aware of how these four principles can apply to their daily life and their decision making. We want to make sure that participants learn to think about the following questions before they act. How does their thinking lead to specific behavior? How does antisocial thinking lead to unproductive behavior or negative consequences? What internal or external factors could influence their thinking? How can we take all of this and change the way we feel and behave by turning negative thoughts into prosocial thoughts? In this way, they are putting the cognitive portion of cognitive behavioral programing into action.


1.23 Section 3

Notes:

Section 3: The Cognitive-Behavioral Intervention ModelThis section focuses on the cognitive-behavioral intervention model. Cognitive-behavioral interventions represent the general responsivity principle in action. As you may recall, general responsivity refers to the overall approach that most offenders respond best to or learn most effectively from in terms of recidivism. In other words, it tells us the general approach that works best with most offenders most of the time to reduce crime. Specifically, it states that the more effective approaches to changing participant behavior are cognitive-behavioral interventions. Therefore, we will focus on the cognitive-behavioral model in this section.


1.24 Defining Themes and Characteristics

Notes:

There are a number of characteristics that define cognitive-behavioral interventions.First, these interventions are scientific. This means two things. One, there is strong scientific evidence to support using cognitive-behavioral interventions to reduce recidivism. Two, the success of the interventions and participants can be measured as the model incorporates behavioral measures of change. For example, staff can rate a participant’s proficiency at using a skill and then continue to rate that skill to see whether and how the participant’s proficiency increases over time. Second, these interventions are action oriented. This model is not based on “talk therapy”. Participants are required to practice skills by engaging in role plays and practicing skills in real life scenarios, completing homework, and providing feedback to peers.Third, cognitive-behavioral interventions are focused on the present rather than the past. Current need factors are identified and the focus is on targeting those current needs by teaching coping/management skills and identifying and restructuring attitudes related to those needs. In cognitive behavioral interventions, past circumstances are not brought into the picture unless they are impacting or driving the current behavior.Cognitive-behavioral interventions are also based on theories of learning. These theories are not just about people learning how to engage in criminal behavior but rather how we all learn to engage in behaviors. Because of this, cognitive-behavioral interventions can be generalized in all life domains and to all people, not just to people involved in the criminal justice system.Cognitive-behavioral interventions also use what we call stepwise progression. This means that the teaching process starts with simple skills and teaching methods, and progressively becomes more difficult as participants are taught more complex skills. These skills are then are expected to be used in increasingly more difficult situations. For example, when a child learns to ride a bike, he might start with a big wheel before moving to a tricycle, then moving on to a bike with training wheel, and eventually to a bike without training wheels and further multiple gears. Similarly, the child goes from riding the bike in his driveway, to the sidewalk, to the road, and possibly to even more difficult environments (such as trails or race tracks).Finally, cognitive-behavioral interventions are designed to be brief. Because the target is on current needs, the treatment objectives are defined and measurable, and the treatment is action-oriented, it typically does not take as long as traditional psychotherapy to change behavior. This is good news for corrections as there is often limited time allowed for treatment interventions.


1.25 Cognitive-Behavioral Model

Notes:

Let’s use the illustration of an iceberg to help us better understand the cognitive-behavioral model. You’ll notice that all we see above the water is “behaviors” as this is the only aspect we can perceive as apparent and observable. As with an iceberg, the bulk lies below the surface. This is where our thoughts, feelings, attitudes, and beliefs systems lie. These things are not readily apparent and observable by others, yet they comprise the majority of the iceberg. Traditionally, the criminal justice system has only focused on the observable; offender behavior. But we know that the foundation of that behavior is in the thoughts, feelings, attitudes, and beliefs. This means that the foundation of criminal behavior is not readily observable, or in other words lies below the surface. Therefore, if we want to change behaviors, we must focus our efforts on changing thoughts, feelings, attitudes, and beliefs.Right below the surface of our behaviors lie our thoughts and feelings. Our thoughts are the way we interpret situations and how our core beliefs are reflected in these situations. Feelings are the emotions or sensations associated with our thoughts. Under thoughts and feelings, lie attitudes, values, and beliefs. Notice that attitudes, values, and beliefs are the largest part of the iceberg, making up the foundation. Attitudes, values, and beliefs affect the way we think in every situation, which in turn affects our behaviors. Let’s look at an example of someone stealing a car. The act of stealing a car is an observable behavior. Before this action, the person had specific thoughts making it more likely that they would do it. These thoughts might have been, “the owner probably has insurance”, “they shouldn’t have left the car unlocked if they didn’t want someone to take it”, or “I really need the money that I could get from selling the parts.” These thoughts, while specific to this situation, also reflect core values and beliefs such as “It’s okay to take things from others”, “Life isn’t fair”, and “I deserve nice things”.


1.26 Cognitive Distortions

Notes:

Cognitive distortions - also known as thinking errors or thinking barriers - are thoughts people use to justify the behaviors in which they engage. These thoughts precede a behavior, encouraging the person to engage in that specific behavior. They may also occur after the behavior, encouraging the individual to maintain that behavior. Let’s review some cognitive distortions participants may possess. The first cognitive distortion is minimizing. Minimizing is downplaying the significance of the behavior. In other words, it is believing that the behavior is less important than it is. Examples of such thoughts include: “I barely touched him” or “it’s not that big of a deal”. Rationalizing is when one admits the behavior, but justifies why the behavior was okay. Some participants might say things like “at least I didn’t kill anybody” or “smoking weed is better than doing heroin.” Blaming others is when one completely removes responsibility from oneself and places it all on someone else. In other words, it’s not his/her fault, it’s the other person’s fault. A participant might say any of the following to remove the blame from himself: “They shouldn’t have left their keys in the car.”, “She shouldn’t have been walking alone at night.”, or “It’s not my fault he left his garage door open.”In addition, participants often neutralize their behavior. Neutralizations are a set of verbalizations, which function to say that, in particular situations, it is okay to violate the law. There are several neutralization techniques. The first is denial of responsibility, where criminal acts are due to factors beyond the control of the individual like “I was drunk” or “some guy told me I could borrow his car.” Denial of injury is where the participant admits responsibility for the act, but minimizes the extent of harm or denies any harm was done. “Yeah, I beat him up, but he


wasn’t hurt that bad and now he gets to collect unemployment.”Denial of the victim, which reverses the role of the participant and victim, blames the victim. Participants might say “She knows not to nag me; I wouldn’t have ended up here if she had just left me alone.”System bashing occurs when those who disapprove of the participant’s act are defined as immoral, hypocritical or criminal themselves like, “The cops are just out to get me”, “Everyone knows the system is rigged”, or “I am only here because I got the hanging judge.” The last neutralization technique is appeal to higher loyalties. This is where the demands of larger society are sacrificed for the demands of more immediate loyalties, such as those to gangs or other criminal networks. Participants might say, “Me and my crew have a different set of rules we live by” or “Honor among thieves.”

1.27 Cognitive-Behavioral Components

Notes:

Earlier, we briefly discussed the two cognitive-behavioral components. On the next couple of slides, we will discuss these components in more detail. The two core concepts of CBT are cognitive restructuring and cognitive-behavioral coping skills. Cognitive restructuring is where we not only identify cognitive distortions or “thinking errors”, but also provide a replacement for problematic thoughts that are more likely to lead to healthy/prosocial behavior. When a person has an excess of antisocial thoughts, it is important to identify ways to help replace those thoughts with more prosocial alternatives.Cognitive-behavioral coping skills involves teaching individuals alternative approaches to managing difficult situations. This approach is used when there seems to be a lack of adaptive thinking, for example the inability to problem solve or make good decisions. Here we teach participants improved social and coping skills.


1.28 Cognitive Restructuring

Notes:

Thoughts and beliefs are really about how we interpret certain situations and what we tell ourselves about those situations.When working with a participant to change behavior through cognitive restructuring, we assist the participant in identifying the risky thinking that supported their antisocial behavior. At this point, we may lightly challenge that thinking by pointing out the inconsistencies between the thought and reality, or how that thought might be harmful to others or to achieving desired goals.Next, we will help the participant replace that risky thought with a more rational and prosocial thought. For example, a participant tells herself that it’s ok to use cocaine because she won’t get caught. We might challenge that thinking by training the participant to tell herself “I could get caught because they drug test people on probation.”, and “If I get caught, I’m going to jail.”Once we have helped her to identify prosocial replacement thoughts, she can then identify a new behavior that likely would result from the prosocial thoughts, along with the outcomes that would result from the replacement behavior.


1.29 Coping Skills

Notes:

Often participants do not have the skills needed to respond appropriately to high risk situations. To change behavior through coping skills, one has to learn new skills and apply them to the risky situations that they encounter. For example, in a “Thinking for a Change” group, the participants learn social skills that they can apply to those high risk situations that may result in them committing an antisocial act. Some of the skills learned are “Avoiding Trouble with Others”, “Using Self-Control”, and “Dealing with Someone Else’s Anger”


1.30 Cognitive-Behavioral Programs

Notes:

Today there are a number of the cognitive-behavioral curricula that have been developed to target or change antisocial attitudes and behaviors. Here are some of the more common curricula that are used with participants:Thinking for a Change is a curriculum developed by the National Institute of Corrections. The program is an integrative cognitive-behavioral change curriculum that includes cognitive restructuring, social skill development, and development of problem solving skills. Aggression Replacement Training® targets aggressive behavior by focusing on cognitions, emotional states, and new behaviors. While originally developed for adolescents, the curriculum has been applied with adult participants as well.Strategies for Self Improvement and Change (also called Criminal Conduct and Substance Abuse Treatment) targets substance abuse and includes motivation to change, cognitive restructuring, and social skills. Moving On is a curriculum designed specifically for female participants.Both Reasoning and Rehabilitation and Moral Reconation Therapy are cognitive curriculum that target antisocial attitudes, values and beliefs as well as controlling anger and learning to manage it.

The University of Cincinnati’s Effective Practices in Community Supervision (EPICS) applies the principles of effective intervention, cognitive-behavioral strategies and other core correctional practices to community supervision practices.The University of Cincinnati has four Cognitive Behavioral Interventions (CBI) group treatment curricula. The Comprehensive curriculum provides a thorough intervention that broadly targets all criminogenic needs. CBI for Sexual Offending targets the needs of adult males who are moderate to high risk. CBI for Substance Abuse is for those moderate to high risk in the area of substance abuse, and with both an adult and a juvenile version, is well suited for a variety of criminal justice populations. Finally, CBI for Offenders Seeking Employment integrates CBI with more traditional employment approaches, placing heavy emphasis on skill building activities.


1.31 Section 4

Notes:

Section 4: Cognitive-Behavioral Tools There are a number of specific strategies or tools that can be utilized with participants to help change behavior. In this section, we will focus on a few of these tools.

1.32 Tools for Changing Behavior


Notes:

There are many tools that can be used to change behavior. In the next section of this module, we will review the application of the behavior chain, thinking reports, cost-benefit analysis, social skill building, problem solving, emotional regulation, and self-control strategies.

1.33 Behavior Chain

Notes:

Before looking at specific tools, it is vital to take the time to emphasize the link between thoughts, feelings, behaviors, and consequences so that we can better understand the following concepts. First, we cannot control situations, but we can control how we respond to situations, i.e., our thinking. Second, thoughts dictate behaviors, this means we need to recognize what we are thinking before we act. Third, behaviors are based on thoughts, and feelings, which makes our thoughts responsible for how we behave. Lastly, consequences are not random but rather are a direct result of our chosen behaviors. Participants can choose their thinking in the moment, therefore they choose their actions and consequences based on the type of thinking in their heads. Now let’s take a look at some tools commonly used with Cognitive behavioral interventions


1.34 Behavior Chain

Notes:

A great tool that can be used to restructure thoughts and change behavior is the use of a behavior chain. The behavior chain is one way to help participants identify and understand the link between thoughts, feelings, actions, and consequences. It helps participants understand how actions are driven by internal interpretation rather than outside circumstances. Traditionally, in corrections we have focused only on the situation and the consequences. However, we now know that our thoughts and feelings are what link a situation to our actions. This is an important distinction for our clients to learn as they often blame their involvement in the criminal justice system on their behavior, rather than connecting it back to their thoughts or choices. Therefore, when working with participants, it is important for us to acknowledge all aspects of the behavior chain.First, the behavior chain begins with an external situation, or an activating event. The situation is generally categorized as something that involves a person, place, or thing. The situation teaches participants to recognize those things that may pose some sort of threat or risk to them. The next link in the behavior chain are thoughts. These define how we interpret a given situation. Some thoughts are based on a core set of values that we hold, while other thoughts are based more on our interpretation of a situation. Core beliefs consist of thought patterns that define how we see the world - such as “it’s a dog eat dog world”, “survival of the fittest, or “I get them before they get me.” Because thoughts are the driving force behind our behavior, correctional staff can target the thinking component of the behavior chain to help participants better manage risky situations, people, places, thoughts, and things. Feelings are those emotions that occur as a result of our thoughts. For example, if I am having thoughts about someone else that include “She’s a jerk” or “She’s always taking advantage of me”, then I am likely to experience negative emotions. The extent to which those negative emotions increase or decrease over time is dependent on the thoughts that I continue to have. Knowing this, staff can target this component of the behavior chain through coping techniques or emotional regulation strategies to help participants better manage risky emotions. Actions are the behaviors participants choose to engage in. These actions are the result of thoughts and feelings. Staff can target the actions of participants to help them better manage risky situations by teaching participants alternative behaviors through social skills development and practice.As we know, actions always have consequences. Consequences are the result of the action a participant chooses to engage in and can also influence whether a behavior will occur again. Consequences can be either positive or negative and serve as maintaining conditions to specific behaviors. Correctional staff can reinforce positive behavior and apply sanctions for negative behaviors to help encourage prosocial behavior.


1.35 Tim’s Behavior Chain

Notes:

Let’s walk through a behavior chain using the following situation: Tim is waiting in line for a concert that he wants to see with his girlfriend. He’s been waiting in line and someone comes and cuts in front of him. What might Tim, the participant, do in this situation?The situation, or activating event, is someone cuts in line in front of Tim. When working with participants, make sure the behavior chain is in first person to make sure that the participant understands that these would be his/her real thoughts. Also make sure to create an environment for the participant to be as honest as possible. You would not want him/her to make up something he/she thinks we want to hear. So based on this example, what thoughts might Tim have in this situation?He might have thoughts like: “He did it on purpose”, “He’s trying to make me look bad”, or “He should wait his turn like everyone else” What do you think Tim is feeling in this example? Tim might be feeling frustration, anger, and rage. If Tim is having these thoughts and feelings, what is he likely to do?Tim is likely to call the other person a nasty name. Let’s look at both consequences for his choice. What do you think are the possible consequences Tim will face if he calls the other person a nasty name? Some of the positive consequences could be that Tim feels better about getting his feelings out and the other people might nod in agreement with what he said. Some of the negative consequences could be that his girlfriend gets mad, a child could overhear the nasty name that Tim used, or Tim and his girlfriend could be asked to leave. As you can see, the negative consequences outweigh the positive consequences. As correctional staff, we want to make sure that we are reinforcing positive behavior and providing consequences for negative behavior. The next slide will walk through the same situation, but this time, we will restructure Tim’s thinking patterns.


1.36 Tim’s Restructured Behavior Chain

Notes:

We will not change the situation because Tim cannot control that someone has cut in front of him in the line. Tim can only control how he will react to the situation. So, with this same situation: Tim is waiting in line for a concert that he wants to see with his girlfriend. He’s been waiting in line and someone cuts in front of him. We have to figure out a way to help Tim recognize the risk he is taking so that he will not call the other person a nasty name. What could Tim tell himself so he will not be rude to the other person?Tim might have thoughts like: “He should wait his turn like everyone else” “Maybe he doesn’t realize this is not the end of the line”, or “Maybe he’s looking for someone.” As you’ll see, we left an antisocial thought because while a realistic thought, Tim might not act on it, especially if his prosocial thoughts outnumber or counteract the antisocial thought. If Tim is having these thoughts, what do you think Tim is feeling in this example?Tim might be feeling anger, concerned, or helpful. If Tim is having these thoughts and feelings, what is he likely to do?Tim is likely to ask the person if he needs help or may politely tell him where the end of the line starts. Let’s look at both consequences for the alternative choice of asking the other person if he needs help. What do you think are the possible consequences Tim will face if he offers to help the other person?Some of the positive consequences could be that Tim feels better about helping the other person, he gets to stay for the concert, and he might feel good about not responding negatively. Some of the negative consequences could be that he might still feel disrespected and he won’t have the immediate release of negative feelings.As you can see, the positive consequences outweigh the negative consequences. With the restructured behavior chain you want to focus on the new and prosocial thoughts to help participants change their actions. Again, as correctional staff, we want to make sure that we are reinforcing positive behavior and providing sanctions for negative behavior.


1.37 Components of a Thinking Report

Notes:

Our next cognitive-behavioral tool is the thinking report. Similar to the behavior chain, thinking reports are another way for participants to recognize risk in their thoughts or feelings in written form. It helps them identify their thoughts, feelings, behaviors, and consequences related to a situation so they can then identify ways to change their thinking and thus the outcome. This slide provides examples of what should be included in a thinking report. You’ll notice, the first five questions are the same as those of the behavior chain. When using a behavior chain, question six and seven would be completed by walking through a second behavior chain with the new thoughts, feelings, and outcomes identified. In a thinking report, these would be included in the overall narrative of a single thinking report. With the thinking report, we want to focus on the behavior that we want to target for change. Some participants will want to use a consequence for the situation; for example, “Staff wrote me up for returning late from my home pass”. What is the behavior we are trying to target for change? It is not getting written up by staff, but rather it is the behavior of violating curfew at a halfway house that is the target for change. We start with the situation that led to a late return, and then identify the thoughts and feelings associated with that situation which in turn led to the behavior of violating curfew. To help participants focus on the behavior you are trying to target for change, sometimes it’s helpful to start with the behavior- What did you do?- and then backtrack from there. This is also true when completing behavior chains.


1.38 Tim’s Thinking Report

Notes:

Let’s look at the previous example, Tim’s situation, using a thinking report. Notice that the report is filled out in first person, or from the perspective of the client. As a reminder, the only difference between a behavior chain and a thinking report is that to achieve steps 6 and 7, Tim would need to complete two behavior chains. The first would describe the event and how he actually handled it. The second would describe the same event, and how he could have changed his thoughts and behaviors to achieve a different set of outcomes. Again, there are numerous tools that help participants learn how to restructure their thinking and make better choices.


1.39 Cost Benefit Analysis

Notes:

The cost benefit analysis, or CBA, is a tool that is useful when someone needs to make a difficult choice. This tool is similar to another tool called a Decisional Balance. While they are different tools, they’re similar enough that we’ll just walk through a Cost Benefit Analysis. The CBA helps the participant recognize both pros and cons of a specific behavior or decision. Specifically, it helps the person to weigh both short-term and long-term costs and benefits of target behaviors or options. The tool also recognizes both the positive and negative outcomes associated with antisocial behaviors or choices. In corrections, we have typically only focused on the negative consequences of antisocial behaviors. This is short-sighted, however, as participants obviously experience some positive outcomes from antisocial behaviors - or else they wouldn’t continue to engage in them. Failing to include the positive consequences in a CBA harms our credibility as teachers and impairs the learning process as it prohibits the participant from learning how to make fully informed decisions on their own. Through use of the cost benefit analysis, participants can typically see that antisocial options tend to have far more negative consequences than positive consequences, and that these negative consequences often impact a variety of life domains, such as relationships, school, work, life goals, and so forth.The CBA also looks at the entire picture of the situation. Specifically, it helps the user to examine a number of alternative choices. This is helpful because participants tend to get caught up in the immediate or short-term costs and benefits of a situation, rather than looking at the long-term impact of their choices. This often results in them only seeing one possible choice or option. The CBA allows them to examine each alternative choice and its corresponding short- and long-term consequences. The tool is most powerful when participants can come up with the costs and benefits of each choice on their own. As the correctional staff, you may need to assist participants in recognizing short- and long-term costs and benefits of their behavior, especially prosocial behavior. It is often particularly difficult for them to identify long-term benefits as they are used to living their lives in the moment, only considering short-term consequences if they consider them at all. When using a CBA with participants, we need to emphasize that they are the only ones who can really make a change in their lives. The cost benefit analysis is a way for them to take greater control of their decisions. Use of the CBA does not guarantee that someone will choose the prosocial behavior. However, it does make it more likely that the person will have to acknowledge up front the cons of moving ahead with the antisocial or less responsible option.



Notes:

Let’s complete a full Cost Benefit Analysis together, keeping in mind to always use a first person approach so you can see how it works.Let’s pick a situation where a participant wants to skip treatment group sessions.Starting with the first quadrant, what are the short-term positive consequences of skipping group sessions? Some benefits include: I can hang out with my friends, I won’t be bored, I won’t have to complete homework and I can watch more television.Now let’s look at the short term negative consequences of skipping group sessions. Potential answers could be: I won’t get credit for attendance, the facilitator will want to know why I'm not coming, and I won’t complete group.Next, what are the long-term positive consequences of skipping group sessions? A potential response might be: I don’t have to go to a group every other day.Moving on to the last empty box, what are the long-term negative consequences of skipping group sessions? Answers may include: I won’t get help for any of my problems, I won’t complete probation, I may end up going to prison for violating probation terms and conditions.As you can see, the long-term negative consequences outweigh the short-term positive consequences. By completing a Cost Benefit Analysis on engaging in the antisocial behavior, the participant can see the long-term consequences for him/herself and others by continuing to skip group. On the next slide, let’s look at an alternative behavior the participant might choose.



Notes:

Let’s say this time, the participant decides to take part in treatment. Starting with the first quadrant, what are the short-term positive consequences of participating in treatment? Some benefits include: I’m on a good path to a healthy lifestyle, I won’t get in trouble, and it makes my probation officer happy.Now let’s look at the short term negative consequences of deciding to participate in treatment. Potential answers could be: I have to do homework, It takes up part of my day, I have to deal with other participants in the group.Next, what are the long-term negative consequences of participating in treatment? Responses could include: I am away from my family and friends, I can’t do what I want, Change is hard and I might fail.Moving on to last empty box. What are the long-term positive consequences of participating in treatment? Answers may include: I could get off probation sooner, my family will be proud of me, I will learn skills that keep me out of troubleAs you can see, the long-term positive consequences outweigh the short-term negative consequences. The participant can see the long-term benefits for him/herself and others by continuing to participate in treatment.


1.42 Social Skill Building

Notes:

We sometimes assume participants engage in inappropriate behavior simply because it’s what they want to do. In truth, participants are often motivated to change, but lack specific skills needed to assist them in that change. Simply put, they may have come from an environment where these skills were never present, therefore, they wouldn’t have been able to learn that skill set.Think of a behavior you have been unsuccessful in changing, either now or previously. Why was it so difficult to change the behavior? Was it your motivation or lack of skills in combating triggers; or was it both?To be best prepared to learn a new skill, it helps for the participant to be motivated to change and in a frame of mind to acknowledge some benefit to learning that particular skill. To learn a skill, a participant must be taught what to do and when to specifically do it. Finally, to become proficient at skill acquisition, a participant must have the opportunity to practice the skill in a safe environment.


1.43 Steps to Skill Building

Notes:

Let’s review the steps of skill building in further detail.Step one is introducing the skill. This means that we need to name the skill, such as Avoiding Trouble with Others or Recognizing the Feelings of Others. Step two is to sell the skill. It’s extremely important that the participant see the value of learning and using the social skill you’re attempting to teach them. Ways to sell the skill include engaging participants in a discussion about how the skill could benefit them in problematic situations and how it might result in better outcomes. Another option is to ask participants if there has ever been a time when they could have used the skill, and how things might have turned out differently if they had used the skill. Step three is teaching the skill, and elaborating on steps involved in learning that skill. Facilitators should explain each skill step and discuss possible responses using the participant’s situation. It is important to note that when teaching a skill, facilitators should help the participant identify what is a thought vs. what is an action. This helps to highlight how much thinking occurs prior to engaging in a behavior, and therefore reinforcing the link between the two. Step four is modeling the skill for the participants. This step involves showing the participant how to properly follow the skill steps learned to demonstrate prosocial behavior. If the facilitator does not do this, then when the participants role play, they will practice the incorrect behavior. Step five is when the participants role-play the skill. This step involves the participant demonstrating the skill back to the facilitator using the skill steps previously modeled. Everyone should get a chance to practice the skill.Step six is the facilitator providing feedback. With this step, it’s very important to reinforce first! It can be difficult and uncomfortable at times to role play, so participants should be reinforced for participating and practicing the skill being learned. Next, give feedback to the participant about how they did using the skill steps during the role play. This feedback should be constructive, and first focus on what they did well and then what they could improve.Finally, we should encourage the participant to practice the newly learned skill before the next group or individual session. Homework allows additional practice of the skill, as well as practical application when everyday risky situations are encountered. Then, in the next session, participants can report on how well they did using the skill and facilitators can help address any issues they had.


1.44 Problem Solving Skills

Notes:

Problem solving involves both cognitive and behavioral abilities. Often times, a participant’s reaction to a situation is emotionally driven. By slowing down the cognitive process, it allows us to think through a problem more rationally, giving us the time to consider a variety of possible choices, and link them to a desired outcome. The behavioral aspect comes into play when the chosen approach to handling the problem is put into action. Practicing in a slowed environment with staff helps participants to learn and internalize the steps to problem-solving, increasing the likelihood that they will be able to use the skill during times of stress. Problem solving can be broken down into three main steps.Identifying your problem and goal is the first step to problem solving. Once you realize that there’s a problem, it’s important to clearly identify what the problem is and how it connects with your overall goal. Your objective is to deal with the problem situation in a way that aligns with the outcome(s) or goal that you want to achieve. For example, a participant has been sober for a month but an old friend wants the participant to go to a party. The participant’s problem is that going to the party is a risky situation that could jeopardize his sobriety but not going could jeopardize his friendship. The goal could be to maintain the friendship while also maintaining sobriety.The second step to problem solving is brainstorming options and choosing the best one. Brainstorming is an important part of problem solving because the more options you come up with, the more likely you’ll find something that works. In our scenario, examples of possible options to handle the situation include: (1) going to the party and trying not to drink, (2) telling the person you can’t go and if they’re really a friend, they will simply understand, (3) lie to the friend and tell them you already have an obligation so you can’t go, and (4) propose another way that you can hang out with your friend where substances aren’t involved. Some of you may hear these options and have already identified that some of them clearly represent safer choices than the others in terms of sobriety and in terms of maintaining the friendship. When teaching problem-solving to someone else, we would ask them to think through the short-term and long-term positive and negative consequences of each option before deciding which option is best. Once you have chosen the best option, the final step is to plan and try your solution. After trying the solution, each of the three components should be reviewed and evaluated so that further learning can occur.Problem solving can be thought of as an advanced social skill. This skill can be particularly beneficial as its application can be used for both small and large problems and can be used for problems that may arise across all life domains.


1.45 Emotional Regulation

Notes:

In order to manage uncomfortable, unpleasant, or intense emotions, participants need to learn how to regulate their emotions. There are three key steps to emotional regulation: paying attention to emotions, labeling emotions, and managing emotions. Paying attention to emotions is the first step to having emotional awareness. This may seem like a simple step, but it involves recognizing when we are experiencing emotions and what’s happening in our bodies that tells us which emotions we are experiencing. In order to be in tune with what our bodies are experiencing, we need to identify what physical sensations and body language tend to accompany certain emotions. Identifying physical sensations would include those internal feelings that we experience with our emotion. Because they are internal, it is not easily seen. For example, your heart might start beating faster if you are upset or angry, your stomach may churn if you’re nervous, your ears may start burning if you’re angry, your face might flush if you are embarrassed, and so forth. Body language, on the other hand, is the nonverbal communication or physical behaviors that you experience with your emotions. For example, balling up your fists when you’re angry, rolling your eyes when you are annoyed, or crying when you’re sad.Labeling emotions is the second part of emotional regulation. Sometimes it’s hard to put a finger on what emotion you’re experiencing, or you’re limited to believing that you’re either angry, sad, happy, or nervous. There are a variety of emotions that one could experience beside the four just listed. It is important that everyone understands that there are a wide array of emotions that someone can experience and, further, to note that every person is an expert on their own emotions; no one can tell other people what they are feeling. Each person needs to figure out the emotions they are experiencing for themselves.Managing emotions is the last step to emotional regulation. There are some situations where uncomfortable emotions are a normal response to life’s difficulties. Examples of this may be when a loved one dies we feel sad, or when we are fired from a job we feel angry. In these situations, we don’t want to alter our emotions; rather, we want to manage them. In other words, we want to find more effective ways to cope with these situations by managing our emotions. For example, if a loved one dies, we want to learn how to cope with this loss instead of avoiding or ignoring the feeling, or attempting to suppress the emotion by engaging in an antisocial act.


1.46 Self-Control Strategies

Notes:

Self-control strategies can be used to help reduce the intensity of risky emotions. Using self-control teaches response options for participants to use when they feel their emotions begin to elevate. There are six different self-control strategies: paced breathing, counting backwards, pleasant imagery visualization, relaxation, self-talk and taking a break. Paced breathing involves timing the pace of your breathing, which helps to slow down the heart rate and refocus thinking. For example, inhaling for four seconds, holding your breath for four seconds, and then exhaling for four seconds.Counting backwards is also a simple technique that focusses the mind away from risky thoughts. Simply choose a number above 20 and slowly count backwards from there. Stop counting once you feel more relaxed. Counting backwards can also be done by twos or threes in order to make the task more challenging. The idea is to divert your attention away from risky thinking.Visualizing pleasant imagery is another technique that can be used to mentally remove yourself from the current situation or mood and mentally travel to a relaxing place. For this technique, simply close your eyes and imagine a peaceful scene. To be most effective, you should imagine the scene in detail. For example, if you are at a beach, pay attention to the brightness of the sun, the sounds and imaginary feel of the wind, the sound of the waves crashing, and the presence of other people. The purpose of the relaxation technique is to find a calm place where you can slowly relax the muscles of your body, which will help to reduce stress, increase control, and divert risky thoughts.Self-talk is similar to cognitive restructuring. You identify those risky thoughts and replace those thoughts with healthy self-talk to reduce the risk. If you change your thoughts about a situation, you can gain control. For example, if you had a stressful day at work you might want to partake in a risky behavior, like getting drunk after work. To reduce this risk, you might say: “I don’t need alcohol to feel calm”, “I’m stronger than this”, and “I’ve worked too hard to jeopardize everything by getting drunk.”Taking a break is removing yourself from a risky or potentially risky situation, and could even require you to move from the current physical space that you are in. Usually, this action will involve immediate risk. For example, if you run into old friends that you used to get in trouble with, you may need to leave that location to avoid them. If the situation is not as immediate, you can take a break by doing something positive, such as going for a walk or calling a support person.All of these strategies are great on their own. However, the situation may sometimes call for combining two or more of the techniques to help fully diffuse the situation. For example, you might incorporate self-talk with paced breathing. With every inhale and exhale, you might use a positive self-talk statement, which could help reduce the risky thoughts and emotions you are experiencing.


1.47 Section 5

Notes:

Section 5: Behavioral Skills for FacilitatorsSeveral different strategies are used in cognitive-behavioral interventions to foster change in participants. Some are common to a variety of treatment strategies in counseling, such as developing a collaborative relationship with the program participant. Due to space constraints, the current discussion focuses exclusively on the behavioral techniques introduced earlier in the module: modeling, practice, and consequences. As you recall, these techniques derive from social learning theory.To be effective, cognitive-behavioral interventions must provide participants with the skills relevant to being responsible, prosocial citizens. Furthermore, the participants must have opportunities to actually use the skills. Social learning techniques serve to expose our clients to modeled prosocial skills and cognitions, provide opportunities to practice and apply these skills and cognitions, enable participants to learn vicariously through other participants’ rehearsal and applications, and reinforce their progress. In short, the function of the social learning aspect of the program is to expose the participants to skills and concepts, engage them in practice, and reinforce their gains. At the same time, it is necessary to extinguish antisocial, procriminal behaviors by punishing such behaviors.


1.48 Overview of Behavioral Skills

Notes:

The next three slides will describe in detail modeling, practice, and reinforcement. Modeling exposes the participants to modeled prosocial skills and cognitions. Modeling can be both planned and unplanned. With unplanned modeling, participants will observe how you interact with other participants, staff, and outside contacts. For some participants, staff members may be the only prosocial people they have contact with, so modeling prosocial behavior is even more important. Planned modeling is also commonly referred to as skill building, and it provides a format for staff to teach participants prosocial behavioral responses to risky situations. Sometimes, problematic behaviors are caused by the participant’s lack of emotional coping skills or social skills. Skills are broken down into concrete steps for the participant to follow, allowing them to see a clear path to the desired end behavior. Practice provides opportunities to practice and apply these skills and cognitions. It is not enough to just discuss a new prosocial behavior for the participant to use in a risky situation, participants need to practice these skills to end antisocial behavior. Reinforcement reinforces a client’s progress. Reinforcers always involve increasing a target behavior. Positive and negative reinforcement are both used to increase behavior. Positive reinforcement involves giving the person something desirable for engaging in the target behavior, meaning you give them something they see as rewarding. Negative reinforcement involves removing something negative or aversive to increase the desired or target behavior, meaning you take away something they do not like.


1.49 Modeling

Notes:

Participants are exposed to the necessary skills through staff modeling the behaviors and cognitions. Effective models of prosocial behaviors and attitudes share common characteristics. Most importantly, they are considered likeable by the program participant. This does not mean that staff are to be friends with the participants or to violate professional boundaries, but they will be more effective if they have good rapport with the participant. Staff must also accurately demonstrate prosocial behaviors and attitudes. The absence of either of these conditions hampers the prosocial modeling process. When facilitators are charismatic but express antisocial sentiments and behaviors, the participants will imitate their antisocial characteristics. Similarly, if a facilitator engages in purely prosocial demonstrations but is cold and rigid, participants are unlikely to adopt the prosocial messages and behaviors.


1.50 Maximizing Effective Modeling

Notes:

Goldstein, Glick and Gibbs explain that the effects of modeling are maximized when individuals pay attention to the model, remember the modeled behavior, and expect rewards for the modeled behavior. The next few slides will further explain these concepts.

1.51 Modeling Exercise: Pay Attention to the Model


Notes:

To increase participants’ attention and engagement in the learning process, it is suggested that staff do the following when modeling a skill for a role play exercise.Write each step of the behavior to be modeled on a flip chart if done in a group setting or on a piece of paper in an individual session. This will provide a visual reminder of all of the steps in the skill. It is also important to avoid irrelevant detail in the modeling. Keep things basic for the participant to clearly see the steps being modeled. As the facilitator, ensure you are modeling the skills steps appropriately. By this, we mean make sure you model each step of the skill so that when the participants practice, they know how to successfully practice all of the skills. Keep the modeled material simple. If the model is too complicated, the participants will get confused and overwhelmed by the steps, and the steps may not be easily observed and understood. When the participants are uncomfortable and not confident with their practice, the role plays will not go as planned. Most important, clients will be less likely to attempt to use the skill in a real life situation if they were uncomfortable using it in a manufactured scenario and a controlled environment where actions and reactions are much more predictable.Use cards or a piece of paper with the skills listed on it so that the participants can hold it and use it to follow the steps being modeled. These cards will also reinforce or emphasize the skill that is being presented to them. During thinking steps, have the participants use “think out loud” statements to indicate to others their internal thoughts. Our thought processes occur silently inside our heads. However, to practice, we want participants to say their thoughts out loud so that they can more easily see the connection between their thoughts and behaviors. “Think out loud” statements also help other observers (such as staff or other participants in a group setting) to see the connection as well. We typically ask the client to point to his/her head when saying thoughts out loud to indicate that these are thoughts rather than verbal statements; this avoids confusion in a group setting so that others do not mistake when someone is practicing thinking out loud. Anything clients say once they have put their finger back down then indicates that they are actually speaking.

1.52 Remembering the Modeled Behavior

Notes:

Retention of the modeled behavior happens best when participants practice the behavior and rehearse how they will use the behavior in various situations. Role-playing as a form of practice will be discussed


shortly.

1.53 Expect Rewards for Modeled Behavior

Notes:

For participants to apply the modeled behaviors in their own lives, they must perceive that the modeled behavior is going to be rewarded. During planned practice sessions, facilitators should specify the benefits of applying the skills before participants practice. Participants are more likely to internalize the link between the use of the skill and the reward if they identify the possible rewards themselves rather than having the staff person simply tell them what the rewards will be. This can be achieved by having the staff person simply ask participants to brainstorm all the possible rewards for using the skill.


1.54 Practice

Notes:

Once you have successfully modeled the behavior for the participants, it is necessary for them to practice the skill. The natural process of learning requires that people are not only exposed to skills and behaviors through observation, but that people must also engage in the behaviors. Cognitive behavioral programs create situations, exercises, and scenarios through which the participants practice the skills, first in basic situations and then in more complex situations. Once they practice the skill, structured feedback is provided by the facilitator. Feedback allows the participants to learn, refine, and apply learned skills in future situations.


1.55 Role Playing and Treatment Effect

Notes:

Role playing is an excellent means for participants to practice skills. Role playing involves presenting participants with a situation and having them act out their response to that situation. Through such activities, the participants not only think about how they would engage in a particular skill, but they actually perform it. Role playing, as a technique for practicing skills, is empirically linked to reductions in recidivism. As can be seen in the slide, one statewide study of adult correctional programs showed that programs that used role playing either “almost every session” or “every session” produced a 7% lower recidivism rate than similar programs that “occasionally” or “never” use role playing. This difference in recidivism is statistically significant.


1.56 What Role Playing is Not

Notes:

Given the powerful results that occur when participants regularly engage in role plays, it is concerning how infrequently correctional agencies incorporate role playing. To be fair some organizations believe that they are using role play, when in fact, they are not. For this reason, it is important to discuss what role plays are not. Role plays are not group discussions about how to perform a skill or how to handle a difficult situation. Similarly, having individual participants engage in a verbal rehearsal of how they would handle a specific situation does not constitute a role play. For example, some facilitators might ask a participate to describe what he/she would tell their drug dealer to avoid using, while also providing examples of the dealer’s response as the participant continues to respond with new ideas. This constitutes a verbal rehearsal, and is not role play.Role play also does not occur when the facilitator models a new skill. The model is for the participants to see how to practice the skill steps. A role play has not occurred until the participants get a chance to practice and demonstrate the skill. Role plays occur when the participant demonstrates the new skill as if they were using the skill in a real life situation. Once the participants practice the skill, they will have a better idea how likely they will be able to utilize the skill outside of group.


1.57 Graduated Rehearsal

Notes:

To maximize the effectiveness of the role plays and other practice exercises, the scenarios should become increasingly more difficult as the participants’ skills improve. When the skills are new, the role play scenarios should not be too challenging. Then, as participants become more proficient in the specific skills, the scenarios should incorporate higher-risk situations. The increased difficulty of practice is often referred to as graduated rehearsal.For example, an initial role play scenario may require the participant to use refusal skills to tell a stranger he does not want to buy marijuana. When the participant refuses the drug, the stranger moves on. A more advanced role play, using refusal skills, would involve the participant’s best friend offering the participant some marijuana in front of several other friends who are all passing around the drug. In this scenario, the friends persist in offering the drug, pressuring the participant to get high. The first role play would be “easier” because the participant has no history or emotional involvement with the stranger, there are no other people present to create peer pressure, and the stranger walks away after being told “no” only one time.


1.58 Using Real Life Scenarios

Notes:

It is really important that the participants choose real life scenarios to practice. By acting out real life scenarios, participants can explore how other people are likely to respond to different approaches. They can get a feel for approaches that are likely to work, and for those that might be counter-productive. Participants will also get a sense of what other people are likely to be thinking and feeling in the situation. Also, by preparing for a situation using role play, participants build up experience and self-confidence with handling the situation in real life, and can develop skills more quickly that allow them to react in prosocial ways more instinctively when faced with high risk situations. This means that they'll react effectively as situations evolve, rather than making mistakes or becoming overwhelmed by events. In addition to the planned practice exercises, facilitators should use scenarios that are brought up during discussions in the program as opportunities for practice. For example, if a participant tells the group that a discussion she had with her boss turned into a heated confrontation, the facilitator could suggest that the participant discuss what happened and role play alternative ways of handling the situation. In this scenario, we would NOT have the participant role-play the confrontation with her boss. We would simply have her role-play the alternative response that she could have used instead.Why is this? Why not have her role-play the confrontation first followed by the alternative response? She has already shown us that she knows how to handle the situation in an antisocial or less responsible manner. Therefore, there is no reason to have her spend time practicing how to be antisocial. With our limited time, we need to focus only on practicing prosocial behaviors.


1.59 Practice Outside of Group

Notes:

When you were younger and participated in something like pee-wee football, you did not just show up on game day and play. Prior to the game, you would have to practice, either with the team or on your own. Through your own experiences, you know that in order to become proficient at any skill, you have to practice; and in some cases, you have to practice a lot. The same goes for our participants when we are teaching them something new like a social skill. We cannot assume that if we show them one time how to do something they will internalize that concept immediately and become proficient. They need to practice that skill, concept, or technique on their own. To increase the generalization of the skills, participants should be required to practice the skills outside of the treatment group or session. They can be required to role-play the skill with other people in their lives such as a family member or a spouse. Another goal is for the participant to be able to see the value of applying social skills to other life areas that are difficult to manage. For example, a participant may be able to utilize the skill of deciding to say “no” when he is being pressured to use drugs by a friend. This skill can also be used in other situations as well. For example, a coworker asks the participant to clock them in because they are going to be two hours late to work. This allows the participant to apply the skill of deciding to say “no” in both the employment and substance abuse domains. This variety increases the importance of the skill, which serves to strengthen the chance that the participant will experience the value of the skill and continue to apply it.Prior to practicing learned skills outside of the group, participants should first role play with correctional staff how they might handle various situations they will encounter. This gives them some experience applying the skill in a less stressful environment and the opportunity to receive feedback prior to using the new skill in a real life scenario.


1.60 Feedback Protocol

Notes:

Once the participant has completed the role play, homework assignment, or provided a report of the practical application of a skill, feedback should be provided. A brief feedback period should follow all exercises. Depending on the setting, the feedback protocol includes the following roles: co-actor, observers, main actor, and facilitators. If you are in a group setting, the participant’s co-actor should provide feedback first. The facilitator can ask the co-actor “How did it feel to receive that skill?” and/or “How did the main actor do?” These questions should be used to gauge how realistic the delivery of the skill was and how well the main actor developed the skill. Other participants not directly involved in the role play practice, or those simply observing the role play, would provide feedback next. If it is a social skill that is being practiced, the observers should pay attention to see if each step of the skill was followed. Also, they should provide feedback on how the main actor handled the situation. Assigning specific skill steps for the observers to look for also serves the purpose of providing continued repetition of the skill steps for them even though they are not the ones currently practicing the skill. Just like learning song lyrics, the more you repeat the steps, the more likely it will be ingrained in the participant’s mind.Next, the main actor, or the one specifically practicing the skill steps, should also provide feedback on how he/she thinks they performed in the role play. Questions like “How do you think you did?; “How did it feel to use that skill?”; or “Do you think that you would be able to use the skill outside of this group?” should be used. Finally, the facilitator's feedback should concern whether participants followed the steps. Feedback should also be given on how the main actor generally handled the situation with the co-actor since the role plays are as “real life” as possible. Use statements such as “I like how you…”, or “One suggestion would be to…”

We want to encourage the participants in additional practice on their own time outside of the group setting. In this way, they work to build self-reinforcement as they continue using the skills on their own time.

The structure of the feedback protocol is important. We want to ask the co-actor and observers for feedback first, followed by the main actor and then the facilitator. This way, after hearing all of the positive feedback, the main actor will have more confidence to continue using the skills outside of group for additional practice.


1.61 Feedback Protocol

Notes:

Sharing of feedback by the facilitator and participants serves a number of purposes. The feedback informs the participant who engaged in the exercise of the strengths and weaknesses of his or her practice. The feedback points out to the participants who are observing the exercise the strengths and weaknesses of the practice. The feedback provides positive reinforcement so that the participant will be more likely to use the behavior in real-life situations. Seeing the participant receive reinforcement will make the prosocial behaviors more attractive to the observing participants. By being responsible for offering feedback to the people engaging in the exercises, the observing participants are more involved in the exercise (as opposed to simply waiting for their turns to practice). By providing feedback on their own individual performances, the participants practice self-reinforcement.Finally, if a skills practice is occurring during an individual session, the order of the feedback would simply be to elicit feedback from the participant before having the staff person provide feedback.


1.62 Effective Reinforcement

Notes:

Effective reinforcement is used to increase a desired or target behavior. There are two types of reinforcement; positive and negative. We can target a behavior to increase by adding something desireable (a positive reinforcement) or removing something undesirable (a negative reinforcement). To further understand, let’s look at an example of a client choosing to participate in role play during a group session. Positive reinforcement for this behavior is awarding the client full participation points for this session, while a negative reinforcement would be that he does not have to stay after group with the other participants for an extra practice session. In a non-criminal justice example, such as a crying baby, a father hears the baby cry, picks up and hugs the child, and then the baby stops crying. Whose behavior has been reinforced in this scenario? Both! The baby received a hug when she cried - this is positive reinforcement. This makes it more likely that the baby will cry in the future when desiring comfort.On the other hand, the father no longer had to hear his baby cry - this is negative reinforcement. This makes it more likely that the father will pick up his baby in the future to stop the crying.


1.63 Section 6

Notes:

Section 6: Review of Learning ObjectivesBecause we have presented a good deal of material, Section 6 will review the learning objectives we established at the beginning of this module. These objectives included: examining what interventions are considered to be cognitive-behavioral, understanding the theories that underlie cognitive-behavioral interventions, recognizing the core components of the cognitive-behavioral model, reviewing the common tools that are used in cognitive-behavioral interventions, and finally, learning behavioral skills needed to facilitate cognitive-behavioral interventions in a correctional setting.


1.64 Review Learning Objectives

Notes:

Objective 1 examined what types of interventions are considered cognitive-behavioral. The most successful types of interventions include the merging of behavioral strategies, cognitive strategies, and cognitive processes. Examples of effective interventions include social learning, cognitive-behavioral therapy, radical behavioral approaches, family based therapies, and programs targeting criminogenic risk factors. A meta-analysis conducted showed that cognitive-behavioral programs were more successful in reducing violent recidivism than other types of correctional interventions. Next, we learned that the techniques of effective interventions should be incorporated into programming. These techniques include behavioral interventions, using staff-directed approaches and structured curricula, and target major risk factors. Finally, we discussed that cognitive-behavioral programs go awry for two reasons: they apply cognitive concepts incompletely and/or they omit the behavioral interventions.



Notes:

Objective 2 explored the theories that underlie cognitive-behavioral interventions. First, we learned that cognitive-behavioral interventions include a combination of cognitive theories and behavioral theories, such as social learning theory. Next, we discussed the central concepts of cognitive theories. Cognitive theories of crime state that people engage in criminal behavior because their cognitions (or thoughts) are supportive of such behaviors. We identified the four principles of cognitive-behavioral programming, which include: thinking affects behavior, antisocial thoughts lead to antisocial behavior, thinking can be changed, and changing how we think can change how we feel or behave. Finally, social learning theory explains how people learn initial behaviors and why they continue to engage in those behaviors.



Notes:

Objective 3 discussed the cognitive-behavioral model and its components. First, we learned that cognitive-behavioral interventions have specific defining characteristics. They are scientific, action-oriented, present-focused, based on theories of learning, brief, and use stepwise progression. We also learned that cognitive distortions are distorted thoughts that allow people to justify the behaviors in which they engage. We covered three broad types of distortions - minimizing, rationalizing, and blaming others. Next, we discussed the components of cognitive-behavioral interventions. These include cognitive restructuring, which is identifying and replacing antisocial thoughts, and coping skills, which involve teaching prosocial responses to high risk situations. Finally, we covered examples of cognitive-behavioral programs such as EPICS, Thinking for a Change, and Aggression Replacement Training, to name a few.



Notes:

Under Objective 4, we learned some common tools that are used with cognitive-behavioral interventions. Some of these tools include the behavior chain, the thinking report, the cost benefit analysis, and social skill building. The behavior chain helps participants understand how actions are driven by internal interpretations rather than by outside circumstances. The thinking report is another way for participants to work through the cognitive restructuring process in written form. Like the behavior chain, the thinking report helps participants identify their thoughts, feelings, behaviors and consequences related to a situation, and then ways to alter their thinking to change the outcome. The cost benefit analysis helps the participant recognize both pros and cons of a specific behavior so that he/she can better assess which option is the most effective or appropriate. Finally, social skill building teaches participants skills to better handle risky situations.



Notes:

Objective 5 covered the behavioral skills needed to facilitate cognitive-behavioral interventions. The behavioral skills covered included modeling, practicing, and reinforcement. We also learned the components of effective modeling. The effects of modeling are maximized when individuals pay attention to the model, remember the modeled behavior, and expect rewards for the modeled behavior. Cognitive behavioral programs create situations, exercises, and scenarios through which the participants perform the skills. This is followed by structured feedback, which allows the participants to learn, refine, and apply their skills in more difficult situations. Finally, whether we use positive or negative reinforcement, effective reinforcement is always used to increase the desired behavior.


1.69 Thank You!

Notes:

This concludes our module on cognitive-behavioral interventions. Thank you so much for your interest and participation. We hope that you found this information helpful to your work.


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