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Practice Profile

Cognitive Behavioral Therapy (CBT) for Antisocial Behavior in Youth in Residential Treatment

Evidence Ratings for Outcomes:

No Effects - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types

Practice Description

Practice Goals/Target Population
Cognitive behavioral therapy (CBT) is a problem-focused, therapeutic approach designed to help individuals identify and change dysfunctional beliefs, thoughts, and patterns that contribute to problem behavior. In general, CBT has been used to address a wide range of problems, including antisocial behavior (i.e., a wide variety of problem behaviors such as violence toward people or animals, destruction of property, deceitfulness, oppositional-defiance, theft, and/or serious rule violations).

This CBT practice, however, focuses specifically on youth within residential facilities with antisocial behavior who committed a serious crime or offense resulting in contact with the juvenile justice system (Armelius and Andreassen 2007; Dishion, Dodge, and Lansford 2006). The overall goal of CBT for youth in residential treatment (including both secure and non-secure settings) is to reduce recidivism and increase prosocial behaviors.

Practice Components
CBT focuses on teaching youth prosocial skills that will help them to interact positively with other people. CBT is based on the idea that thoughts, images, beliefs, and attitudes are closely related to behavior (Armelius and Andreassen 2007). Treatment may focus heavily on cognitive change, or it may incorporate several strategies such as interpersonal cognitive problem solving, social skills training, anger control, critical reasoning, values development, negotiation abilities, and creative thinking. Examples of these broader, more comprehensive CBT programs for offenders include Aggression Replacement Training (Goldstein and Glick 1987), Reasoning and Rehabilitation Program (Ross and Fabiano 1985), and Moral Reconation Therapy (Little and Robinson 1988).

CBT interventions for youth in residential facilities also include components that specifically focus on addressing criminogenic needs such as correction of criminal thinking errors. Criminal thinking errors include victim-stance, which refers to youth viewing themselves as victims rather than perpetrators and therefore refusing to take responsibility for their actions. CBT helps to correct this pattern by teaching youth to recognize and admit culpability for problem behavior while learning to adjust their self-perceptions (Greenwood and Turner 1993).

CBT programs vary in duration, ranging from shorter programs that last a week to longer programs that last for a year (Armelius and Andreassen 2007).

Meta-Analysis Outcomes

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No Effects - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types
Looking at the results from the six studies of cognitive behavioral therapy (CBT) used in residential facilities that included data on the 24-month follow-up period, Armelius and Andreassen (2007) did not find a statistically significant effect for recidivism among youth who participated in CBT for antisocial behavior compared with a control group of youth who did not receive CBT.
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Meta-Analysis Methodology

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Meta-Analysis Snapshot
 Literature Coverage DatesNumber of StudiesNumber of Study Participants
Meta-Analysis 11973 - 2005122692

Meta-Analysis 1
Armelius and Andreassen (2007) conducted a meta-analysis to assess the effectiveness of cognitive behavioral therapy (CBT) in reducing recidivism of youth placed in secure or nonsecure residential settings. Eligible studies included randomized controlled trials or quasi-experimental designs to evaluate CBT provided to youth, ages 12 to 22, who were in residential settings for antisocial behavior. Both published and unpublished studies were included in the literature search. Interventions that only included a behavioral or cognitive component, but not both, were excluded. Residential settings included out-of-home group settings with more than two members of staff, which excluded foster homes and family-like interventions. Secure settings included prison and similar restrictive placements, and nonsecure settings included training schools and treatment programs in open or semi-open areas with fewer restrictions (i.e., walls, bars, fences).

The authors searched numerous databases for studies that took place between 1963 and 2005. The final sample included 12 published studies conducted between 1973 and 2005. Of the 12, five used randomized controlled trial designs. A total of 4,820 participants were included across the 12 studies. Eight studies were conducted in the United States, two in Canada, and two in the United Kingdom. Eight studies included only males, and one included only females. The age of the youth at time of participation ranged from 12 to 21 with an average age of 15.5. One study focused specifically on CBT for youth with mental health problems.

The type of CBT intervention used in the studies varied. Nine studies used specific interventions, including Reasoning and Rehabilitation, enhanced thinking skills, Moral Reconation Therapy, social interactional training or social modeling, dialectical behavior therapy, cognitive mediation training, and situational decision making. The only interventions that were used by more than one study were Moral Reconation Therapy and Reasoning and Rehabilitation, which were each used twice. The remaining three studies evaluated a greater number of comprehensive programs with non-specific interventions. The total duration of the intervention ranged from 20 hours to 1 year of daily activities.

Data were obtained from official police or juvenile justice records. Six of the 12 studies reported recidivism rates at a 24-month follow up, which included data on 2,692 of the 4,820 participants in the original sample of studies. The data were analyzed using a random effects model. All analyses were conducted using odds ratios with a 95-percent confidence interval. Sensitivity analyses were performed on study design, intention-to-treat, and rate of retention.
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There is no cost information available for this practice.
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Other Information

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Armelius and Andreassen (2007) also looked at recidivism outcomes at 6 and 12 months. The authors found that the effect size at 6 months was not significant. In contrast, they found a statistically significant mean effect size of 0.69 at 12 months. Thus, there was a statistically significant reduction in recidivism for youth who received cognitive behavioral therapy (CBT), compared with control group youth who did not receive CBT 12 months after the intervention occurred.
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Evidence-Base (Meta-Analyses Reviewed)

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These sources were used in the development of the practice profile:

Meta-Analysis 1
Armelius, Bengt-Åke, and Tore H. Andreassen. 2007. “Cognitive-Behavioral Treatment for Antisocial Behavior in Youth in Residential Treatment.” Cochrane Database of Systematic Reviews 4:CD005650.
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Additional References

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These sources were used in the development of the practice profile:

Dishion, Thomas J., Kenneth A. Dodge, and Jennifer E. Lansford 2006. “Findings and Recommendations. A Blueprint to Minimize Deviant Peer In?uence in Youth Interventions and Programs.” In K.A. Dodge, T.J. Dishion, and J.E. Lansford. (eds.). Deviant Peer In?uences in Programs for Youth. Problems and Solutions. New York, N.Y.: The Guilford Press.

Goldstein, Arnold P., and Barry Glick. 1987. Aggression Replacement Training: A Comprehensive Intervention for Aggressive Youth. Champaign, Ill.: Research Press.

Greenwood, Peter W., and Susan Turner 1993. “Evaluation of the Paint Creek Youth Center: A Residential Program for Serious Delinquents.” Criminology 31(2):263–79.

Little, Gregory L., and Kenneth D. Robinson. 1988. “Moral Reconation Therapy: A Systematic Step-By-Step Treatment System for Treatment Resistant Clients.” Psychological Reports 62(1):135–51.

Ross, Robert R., and Elizabeth A. Fabiano 1985. “Time to Think: A Cognitive Model of Delinquency Prevention and Offender Rehabilitation.” Johnson City, Tenn.: The Institute of Social Sciences and Arts.
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Related Programs

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Following are programs that are related to this practice:

Equipping Youth to Help One Another (EQUIP) Promising - One study
This is a multicomponent treatment program administered in juvenile correctional facilities for youth with conduct disorders. This program is rated Promising. Program youth showed statistically significant improvements in social skills and had statistically significant fewer instances of self-reported and staff-reported institutional misconduct, compared with control group youth. However, there were no significant differences between groups on measures of moral judgment.

Aggression Replacement Training® (ART®) Effective - More than one study
A multidimensional psychoeducational intervention designed to promote prosocial behavior in chronically aggressive and violent adolescents using techniques to develop social skills, emotional control, and moral reasoning. The program is rated Effective. Among adolescents taking part in the intervention there was a statistically significant reduction in felony recidivism, improved social skills and a reduction in problem behavior among participants.

Aggression Replacement Training (ART) for Adolescents in a Runaway Shelter Promising - One study
A program that targets adolescents who live in a short-term facility (a runaway shelter) and exhibit signs of antisocial behavior problems (ASB). The program combines anger-control training, social skills training, and moral reasoning. The program is rated Promising. There was a 20 percent reduction in the rate of ASB incidents per client every week and a statistically significant reduction of 1.1 ASB incident per day.

Power Source Promising - One study
This is a group-based, cognitive-behavioral therapy and mindfulness training intervention targeted at male youth in high-security correctional facilities. The program is rated Promising. Results indicated a statistically significant reduction in the decline of attention skills for the treatment group, measured as accuracy and response variability on the Attention Network Test; however, there was no statistically significant effect on response time.

Juvenile Justice Anger Management (JJAM) Treatment for Girls Promising - One study
The program is a cognitive–behavioral, anger management treatment for adolescent girls in residential juvenile justice facilities, which is designed to reduce participants’ anger, physical aggression, and relational aggression. The program is rated Promising. Program participants showed statistically significant reductions in anger, physical aggression, and relational aggression scores, compared with the control group.
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Practice Snapshot

Age: 12 - 21

Gender: Both

Race/Ethnicity: Asian/Pacific Islander, Black, Hispanic, Other, White

Targeted Population: Prisoners, Young Offenders

Settings: Correctional, Residential (group home, shelter care, nonsecure)

Practice Type: Cognitive Behavioral Treatment, Individual Therapy, Residential Treatment Center

Unit of Analysis: Persons