Aggression “Aggression is primarily learned behaviour, learned by observation, imitation, direct experience and rehearsal” (Goldstein, 1998) gta3 I will talk about .Do we need a theory to work with ART? .Program integrity .Evolution of CBT “The three waves” .CBT common characteristics .“What works” principles .Ways to improve ART Threats to program integrity 1. Program is changing over time. Part of the method is changed or taken away 2. Program is done contrary. Staff is resistive and do the opposite 3. Program is lacking compliance When PI is dropping .Incomplete programs .washed-out .ineffective .Home-made .Crazy combos .Bad trainers .Bad reputation packning ARTAbracadabra Reincarnation Training .We offer a mixture of New Age therapies and other pseudoscientific miracle cures .We do tarot cards, reincarnation, rebirthing, healing and Feng Shui. *On request we can even arrange alien abductions Program Integrity .Program is delivered in intended way .The procedures (manuals) are followed .Clients are properly chosen (needs) .Staff are trained, skilled and motivated .Full support from management .Sufficiently enough recourses (money, facilities, time, material) .Supervision and implementation support Development of effective interventions is a process without end2besuccess3 ART is the beginning not an end .The development of ART should come from a constructive treatment strategy. Adding components to the treatment package. As research continues the programme changes (Goldstein, 1998). .Scientific studies/evidence is our guiding star Evolution of CBT 1. Respondent conditioning (Pavlov) S –R Operant conditioning (Skinner) S –R –C 2. Modeling (Bandura) Sm –R -C Cognitive Therapy (Beck) Moral Development Theory (Kohlberg, 1973) CT+BT=CBT Integration 3. DBT (Linehan), RFT, ACT (Hayes), Mindfulness (Kabat-Zinn) Classic Behavior Therapy .Respondent and Operant learning .Experimental pscyhology started as a contrast to Pscyhoanalysis (Freud) .Focus is on the interaction between the individual and the environment .Thoughts and feelings were not in focus (”Black box”) .The basic learning principles are still fundamental in CBT How it all beganPAVLOV Pavlov Unconditioned Stimuli (UCSs) and their associatedUnconditioned Reflexes/ Responses (UCRs) .UCS UCR .food or acid in the mouth salivation reflex .electric shock withdrawal reflex .change in illumination pupillary reflex .loud sudden noise startle reflex .air puff to the eye eye blink reflex .patella blow knee flexion .base of foot stroked Babinski reflex .pepper inhaled sneeze reflex classicaladvertising Operant conditioningBehavior is a function of it’s consequences The law of effect (Thorndike 1930):Responses that produce a satisfying or pleasant state of affairs in a particular situation are more likely to occur again Burrhus Frederic Skinner (1904-1991) ."The major problems of the world today can be solved only if we improve our understanding of human behavior" .About Behaviorism (1974) ”Dead-man´s test” If a dead man can do it, it isn’t behavior .Overt behaviors (speech, body language, motor function) .Covert behaviors (cognitions, inner speech, images .Physiologicalreactions (emotions) pulse, breathing, etc. ARTa multichannel method Component Response channel .Skillstreaming Behavior .Anger controlEmotion .Moral reasoningCognition Three-Term Contingency S .R .C (A .B .C) S = Stimulus, (Antecedent) R= Respons (Behavior) C= Consequence Possible consequences .Reinforcement -Behavior increases in strength and will be repeated .Punishment –Behavior supresses or stops and decreases in likelihood .Extinction–Behavior decreases in strength .Neutral –No effect Positive Reinforcement A .B .C+ Behavior increases in likelihood Tobacconist'sCommercial Buying a lottery ticket Win in the lottery Reinforcement R -C+ Positive reinforcement Response is followed by positive reinforcer __________________________________ R –C-Negative reinforcement Response is followed by removal of the negative reinforcer __________________________________ .Both types increases response strength Punishment R C-Positive punishment Response is followed by punisher ___________________________________ RC+Negative punishment Response is followed by removal of a positive reinforcer __________________________________ .Both types decreases the response Children who are exposed to violence they can relate to, imitates aggressive acts more On the Border to IRAKturkiska pojkar Social learning theory/modeling •Albert Bandura showed that learning can take place at a cognitive level through vicarious learning and reinforcement •Rapid learning of new behaviors by observation and imitation •Sm –R -C+Increased likelihood that the imitative response will be performed again The social learning approach .Behaviors, social as well as antisocial, is aquired through psychological learning principles in a social context .Changing behavior requires application and variations of the same principles – also in a social context (Stumphauzer, 1986) Aggression is primarely learned behavior .Instruction .Modeling .Operant learning (direct experience) .Shaping (repeated interaction) .Respondent learning (association with feelings and thoughts) Cognitive Therapy (CT) .1970ssaw a general "cognitive revolution" in psychology .Focus on how we perceive, interpret and attribute meaning .CT seeks to identify and change "distorted" or "unrealistic" ways of thinking .Thinking "errors" including, over- generalization, “black or white”, arbitrary inference, and so on. .Behavioural and cognitive therapy techniques became joined together, giving rise to CBT Thinking errors in ART .Self centered thinking .Assuming the worst (hostile intent) .Blaming others .Minimizing/mislabeling .False consensus .Anchoring Social and cognitive defiences .Perceives fewer social cues .Hypersensitive for possible threats .Describes events in antagonistic terms .Attributes hostile intents .Names arousal as anger .Sets hostile goals (revenge) .Do not seek claifying information .Generates fewer alternative solutions .Chooses direct and aggressive action .More aggressive ”back-up” solutions .Do not calculate on the consequences .Less socially competent (low confidence) .Values that support aggression ACT Acceptance and Commitment Therapy .Contextualism .Pragmatism (what works?) .Existentialism (normalisation of human conditions) .Mindfulness .Exposure .Behaviroal activation .ACT= Accept –Choose –Take action The six basic components in ACT: .Values .Committed action .Being in the present moment .Self as context .Acceptance .Defusion The Serenity Prayer God grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference. Things we may have to accept .Our existens .Death .Time .Our history .The future .The body .Pain .Illness .Feelings -negative and positive .Looks .Everyday life as it is .Tiredness .Bad weather .Thoughts, images and dreams .Other people .Crisis Acceptancemidsommarväder Dialectical Behavior Therapy (DBT) .Emotion dysregulation disorders .Suicidal borderline women + adolescents .CBT transactional model for the development of disorders (Interaction between person and milieu) .Combination of modern behavior therapy and oriental philosophy Core Dialectic .Acceptance .Validation .Mindfulness Eastern philosophy .Change .Confrontation .Problem- solving .Skills training and other CBT Western psychologgy MCj03188800000[1] Mindfulness”To fall awake”koncentration Chain analysis Stimuli/ triggers Vulnerability Problem behavior Concequenses Reinforcers/ Cognitions, feelings, acts CBT Some features(1) .CBT is an integrated psychotherapy based on academic science .Behavior is doing, saying, thinking and feeling .Way of working is systematic, structured, goal-oriented and time-limited .Goals are specific and measurable .Relation with client is collaborative and active .Effects of treatment are evaluated .Treatment is preceded by a behavior analysis CBT Some features(2) .Methods are concrete and often stepwise .Focus on current controlling factors and the future .Focus on the problem behaviour .Client is doing homework assignments .Cooperation with significant others .Methods develops concurrently with new research findings Common treatment methods .Anger (impulse) control .Behaviour activation .Cognitive restructuring .Contingency management .Exposure .Home work assignments .Problem-solving .Psycho-education .Relaxation .SIT .Skills training .Token economy Guidelines to ”What Works” .Prevention (”Catch it low”) .Individualized precription .Identify risk level .Responsivity (consideration for learning style) .CBT –treatment of choice .Focus on criminogenic needs and behavior targets .Type of treatment (multimodal, structured, skill building, etc. .Community and family context .Involvement of family and network .Academic and vocational training .High program and treatment integrity .Documentation and evaluation .Some methods are counterproductive ART has OK empirical support 1. The theoretical foundation 2. CBT methods in general 3. Skillstreaming, anger control training and moral reasoning separately 4. ART as a multimodal program 5. Guidelines from ”What Works” Ways to improve ART .Do it the right way! .Cross-fertilization of the components .Add Prepare courses .Standard CBT techniques .Improvements in related areas .Third Wave CBT (ACT, DBT) .Encourage and conduct research Standard CBT .Applied behavior analysis .Goal-setting .Home work assignements (generalilzation) ”Lasting change” .Motivation, ”Reducing resistance” combination with MI .Internet based CBT .Cognitive restructuring techniques Related areas .Multisystemic analysis and intervention .Parent management training .Guidelines for implementation of evidence based programs .Negative peer influences .Screening for neurops disorders Third wave CBT .Acceptance strategies .Existensial values in life .Mindfulnes/stress management .Theapeutic alliance (valildation) .Teamwork and problem solving support .DBT skills and dialectic workstyle .Experiential excercises, metaphors Move your ass and your mind will follow!j0283934 Bengt Daleflod Pscyhologist & psychotherapist with CBT orientation ”Research Director” for the ART network ICART (International Center for A R T) Correspondence to daleflod@telia.com Tvistur och Bengt