Cognitive Behavioural Therapy

What is it?

Cognitive Behavioural Therapy (CBT) is a type of talking therapy that has been used to address a range of psychological difficulties. When it is applied to violence prevention, it is based on the idea that negative or impulsive thoughts and behaviours might make someone more likely to lash out or act aggressively. These thought patterns will often be related to trauma accumulated through chronic experience of serious violence and other distressing events. They could include a tendency to misconstrue comments as disrespectful or provocative, be hypervigilant and always ‘on guard’, or seek revenge.

CBT aims to help children and young people become more aware of these negative thoughts and learn to change or manage them. The therapist might work with a child to explore how their assumptions relate to reality, better understand other people’s behaviour and motivations, and use problem-solving skills to cope with difficult situations.

CBT can be used with children who are demonstrating challenging behaviour, children in custody, or their families. It can be delivered in a range of community or custody settings, usually by trained psychologists who have post-graduate training or professional certification. It is typically an intensive intervention which takes place over a short period of time. On average, interventions last for 15 weeks with about 3 hours per week of support.

Is it effective?

On average, the impact of CBT on violent crime is likely to be high.

CBT is effective in both reducing crime overall and behaviours associated with crime and violence. The research suggests that, on average, CBT has reduced crime by 27% and reduced the prevalence of behavioural difficulties. It has tended to have greater impacts when working with children who had previously had more contact with the criminal justice system.

The research suggests that, on average, CBT has reduced crime by 27% and reduced the prevalence of behavioural difficulties.

How secure is the evidence?

Our confidence in the headline crime reduction estimate is moderate.

The estimate is based on a review including many studies. Our confidence is moderate because of our assessment of the review methodology and the high variation in the estimates provided by the underlying research. Some studies suggest that CBT can have a more positive impact while other studies suggest that the impact is smaller. Potential explanations for this variation are explored in the implementation section below.

There is promising evidence from the UK. One review included seven UK evaluations of the Reasoning & Rehabilitation programme and concluded that it was effective in reducing reoffending for both children and adults.

How can you implement it well?

Provide support for implementation

The research suggests that the quality of implementation was strongly associated with greater impacts. Programmes where fewer children dropped out, there was close monitoring of the quality of the therapy, and there was adequate training for therapists were more effective.

Consider increasing the number of sessions per week

While many CBT interventions use less than three therapy sessions per week, there are some that have a one or two sessions every day. Research suggests that running more sessions per week is associated with greater impacts.

What programmes are available?

Below is a list of programmes found in the Early Intervention Foundation’s (EIF) Guidebook. The Guidebook summarises the research on programmes that aim to improve outcomes for children and young people.

The Toolkit evidence review identified many more CBT programmes with slightly different emphasis and techniques. Some examples of programmes include:

• Reasoning and Rehabilitation aims to help participants stop and think before acting, consider the consequences of their behaviour, and think of alternative ways of responding to conflict.
• Moral Reconation Therapy (MRT) focuses on moral reasoning. It uses a series of group and workbook exercises to influence how people think about moral issues and make moral judgments.
• Aggression Replacement Therapy has three components:
  • Skillstreaming teaches prosocial behaviours through modelling and role-playing
  • Anger Control Training develops self-control by having participants record anger-arousing experiences, identify “trigger” thoughts, and apply anger control techniques
  • Moral Education sets up discussions about moral dilemmas to develop moral reasoning
• Thinking for a Change consists of 22 sessions of group exercises and homework. It focuses on developing the understanding that thinking controls behaviour, understanding and responding to feelings of self and others, and problem-solving skills.

How much does it cost?

On average, the cost of CBT is likely to be high.

Estimates suggest the cost per participant is likely to be thousands of pounds. CBT is an intensive intervention and requires a trained therapist. The cost per participant will vary depending on the therapist works with individuals or a group.

Topic summary

• A large body of evidence from the UK and abroad suggests that CBT can have a relatively large desirable impact.
• The quality of implementation is associated with greater impacts. Programmes where fewer children dropped out, there was close monitoring of the quality of the therapy, and there was training for therapists were more effective. Are you able to invest in ensuring high-quality delivery?
• There are often long waiting lists to access psychological therapy. How can you ensure swift access to therapy for children who need it?

Take away messages

• Invest in clinically-led CBT provision and increase access for children at risk or already involved in violence. 
• Ensure referrals and assessments take place quickly.
• Ensure practitioners receive clinical supervision and have a clear referral pathway into specialist services.  
• Put strategies in place to reach children from racially minoritised communities, and to keep them engaged throughout the intervention.  
• Provide CBT interventions that offer more than one session per week. Put in place rigorous monitoring processes to check this.  

YEF projects and evaluations

YEF funded evaluations informed by Cognitive Behavioural Therapy. Therapists drew on the therapeutic approach to support children at risk of involvement in crime and violence.

The evaluations included:

• Feasibility and pilot evaluation of the Brandon Centres Systemic Integrative Treatment (SIT) programme, which provided 12-months of bespoke intervention to families.
• Feasibility evaluation of Pause 4 Thought, delivered by Blackburn and Darwen Council, which delivered 11 group and one individual session.
• Pilot study of Your Choice, which provided training for youth workers in Cognitive Behavioural Therapy (CBT) techniques, who then aimed to provide three meetings per-week, for 12 weeks.

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