Reducing Juvenile Recidivism with CBT and Cell Phone Technology

According to a recent study published in the International Journal of Offender Therapy and Comparative Criminology, cognitive behavior therapy (CBT) supplemented with cell phone technology may help reduce juvenile recidivism. The juvenile correctional system in the U.S. struggles to implement effective interventions for keeping supervised juveniles from re-committing crimes. Although research indicates support for CBT programs in decreasing recidivism, evidence-based programs have not been adequately incorporated into treatment.

Authors of the current study aimed to provide an appealing alternative for CBT treatment by using innovative cell phone technology. A total of 70 juvenile offenders from Utah were recruited by their probation officers. They were assigned to either the control group or one of two experimental groups, receiving CBT only, or CBT with cell-phone reinforcement. Cognitive behavior training consisted of six 90-minute interactive classes that used the Control Model, a method designed to teach juveniles to examine how their behaviors are influenced by their beliefs. The cell-phone reinforcement intervention involved daily phone calls with recordings from significant others to provide support for the participants and encourage them to reflect on their progress toward behavioral change.

A year after treatment ended, researchers conducted a follow-up study. They found significant effects that not only supported previous findings for the use of CBT, but also additional benefits of cell-phone technology. Perhaps the most important finding was that both experimental groups abstained from crime much longer than the control group: the median days to arrest was 106 for the control group, 191 for the class-only group, and 278 for the class plus cell phone group. There was also a significant intervention effect for total arrests: the experimental groups were about 51% lower in total arrests than the control group. Overall, these results indicate that CBT is effective for reducing juvenile recidivism. Further, the use of cell-phones may enhance treatment by providing a cost-effective method for reinforced learning and supplemental aftercare.

Burraston, B.O., Cherrington, D.J., & Bahr, S.J. (2012). Reducing juvenile recidivism with cognitive training and cell phone follow-up: An evaluation of the RealVictory program. International Journal of Offender Therapy and Comparative Criminology, 56(1), 61-80.

Online CBT Course Shows Promise in Treating Depression among Adolescents and Young Adults

According to a recent study published in the Journal of Medical Internet Research, internet-based cognitive behavior therapy (CBT) may help reduce depressive symptoms among adolescents and young adults. The current study aimed to determine the effectiveness of Master Your Mood (MYM), an internet based CBT intervention, for depressive symptoms among young people. Participants (244; ages 16-25) were randomly assigned to the online MYM course or to a wait-list control. The online MYM group focused on cognitive restructuring—participants were taught and encouraged to identify and respond to their own unhelpful and inaccurate thoughts; to engage in pleasant activities every day; and to measure their mood every day to help them understand the connection between pleasant activities and mood level. At a 3-month follow up, the MYM group showed significant improvements in depressive and anxiety symptoms. These promising results suggest that internet-based interventions may help reach adolescents and young adults who might otherwise remain untreated.

Van der Zanden, R., Kramer, J., Gerrits, R., & Cuijpers, P. (2012). Effectiveness of an online group course for depression in adolescents and young adults: a randomized trial. Journal of Medical Internet Research 14(3).

Tailored Internet-Based CBT is Effective for Depression

According to a recent study published in Plos One, tailored internet-based cognitive behavior therapy (CBT) may be helpful in the treatment of depression. In the current study, researchers compared individually tailored, internet-based self-help CBT to standardized (non-tailored) internet-based CBT and an active control (a monitored online discussion group). Participants included 121 individuals diagnosed with major depressive disorder and a range of comorbid symptoms. The standardized CBT (non-tailored) group received 8 self-help downloadable chapters with material on behavioral activation, cognitive restructuring, sleep management, general health advice and relapse prevention. The tailored CBT group received 25 self-help downloadable chapters with material on depression, panic, social anxiety, worrying and additional material (e.g., information on stress management and problem solving strategies) and each participant received an individual 10-week treatment plan. Both CBT groups (tailored and non-tailored) received email support from a therapist. At post-treatment and at a 6 month follow-up, both groups improved on measures of depression, anxiety, and quality of life. Subgroup analyses showed that the tailored CBT group had greater recovery rates as well as greater reductions in depressive symptoms among participants who presented with higher levels of depression and comorbidity at baseline. These results suggest that tailoring guided self-help treatments for depression may help make them more effective than standardized approaches.

Johansson, R., Sjoberg, E., Sjogren, M., Johnsson, E., Carlbring, P., Andersson, T., Rousseau, A., Andersson, G.  (2012).   Tailored vs. Standard Internet-Based Cognitive Behavior Therapy for Depression and Comorbid Symptoms: A Randomized Controlled Trial.  Plos ONE, 7(5) : e36905.  doi:  10.1371/journal.pone.0036905

CBT and Technology

In this video Dr. Aaron Beck discusses delivering Cognitive Behavior Therapy via various new technologies. Dr. Beck explains how using the phone, Skype, and computer programs for delivering treatment can be extremely useful in “reaching the unreachable.” He stresses the importance of the therapeutic relationship in a CBT session, and explains results from recent studies looking at the effects of technology integration. For more information about CBT training directed by Drs. Judith and Aaron Beck visit our CBT Workshops page.

Internet-Based CBT for Bulimic Symptomatology

A study published in Behaviour Research and Therapy found a significant improvement in eating disorder symptoms (behavior and cognitions), among adolescent participants (n=101) with bulimia nervosa (BN) or bulimic symptomatology following the completion of an internet-based cognitive behavior therapy (CBT) intervention. These findings suggest that an internet-based approach could serve as an initial intervention for adolescents with bulimic symptomatology.

Pretorius, N., Arcelus, J., Beecham, J., Dawson, H., Doherty, F., Eisler, I.,…Schmidt, U. (2009) Cognitive-behavioural therapy for adolescents with bulimic symptomatology: The acceptability and effectiveness of internet-based delivery. Behaviour Research and Therapy, 47(9), 729-736.

Internet-Based CBT Can Facilitate a Strong Working Alliance

A recent pilot study found that internet-based cognitive behavior therapy (CBT) may facilitate a working alliance that is comparable in quality to the alliance formed in face-to-face therapy settings. The working, or therapeutic, alliance is a key tenet of CBT, and research suggests that it is crucial to positive therapeutic outcomes. The current study compares the working alliance between client and therapist in an internet-based intervention and in face-to-face treatment for depression.

Participants were randomized into two groups; one group (n= 25) received the internet-based treatment and the second group (n=28) received face-to-face treatment. Both groups received 8 weeks of manualized CBT treatment for depression, which was based on a standard, evidence-based CBT manual for depression. Treatment was delivered by therapists trained in CBT specifically for this study, and involved an introduction to CBT, behavioral analysis, activity scheduling, cognitive restructuring, promotion of social competence, psychoeducation, relapse prevention, and a life review module. Patients in the face-to-face condition attended weekly one-hour sessions and were given weekly homework assignments. In the online condition, the treatment manual was adapted for use as a highly structured internet based treatment manual, and included writing and homework assignments based on the CBT approach. Writing assignments lasted 45-minutes and were scheduled regularly, two times per week. Therapists then provided written feedback within one working day. Working alliance was assessed with the Working Alliance Inventory (WAI) at mid-point and post-treatment.

Ratings of the working alliance between the internet condition and face-to-face condition did not differ significantly. At post-treatment, there were positive correlations between clients’ ratings of the working alliance and treatment outcome for the online group, and at both mid and post treatment for the face-to-face group. The results of this preliminary research suggest that internet-based CBT may promote a working alliance comparable to that which is found in face-to-face treatment and produce positive treatment outcomes.

Preschl, B., Maercker, A., Wagner, B. (2011). The working alliance in a randomized controlled trial comparing online with face-to-face cognitive-behavioral therapy for depression. BMC Psychiatry, 11(189), doi: 10.1186/1471-244X-11-189