NO 1667
Cognitive Behaviour Therapy
The mental health needs of children and adolescents have become an issue of grave concern worldwide. Recent evidence compiled by the World Health Organization indicates that by the year 2020 childhood neuropsychiatric disorders will increase by over 50% internationally, to become one of the five most common causes of morbidity, mortality, and disability among children (US Public Health Service, 2000).
In the school setting, children who exhibit moderate to severe emotional and behaviour disorders (EBD) are primarily served in special classes characterized by a high degree of structure (i.e., rules are clear and consistently reinforced) and teacher monitoring (Morgan & Ienson, 1988). Comprehensive behaviour management systems are in place to shape and encourage prosocial behaviours and to decrease inappropriate behaviours. However, for children with very severe EBD, more intensive therapy, individual attention, and close monitoring are required, typically beyond what an educational psychologist or counsellor could provide in the regular and special education settings. For this group of children with chronic and severe psychological disturbance, focused treatment in a more restrictive setting (e.g., hospital school or day treatment) is needed before they can function within the regular or special school system. Mental health professionals, therefore, need to determine interventions that are effective for troubled children who need more intensive support.
Cognitive-behavioural therapy (CBT) has shown good promise for children and adolescents with emotional and disruptive behaviour disorders. Anchored in behavioural and cognitive research and theory (Kendall, Panichelli-Mindell, & Gerow, 1995), it focuses on altering behaviour by changing thought processes and environmental reinforcement. CBT includes training in cognitive restructuring or positive self-talk (Meichenbaum, 1977), problem-solving skills (D’Zurilla & Goldfried, 1971; Spivack & Shure, 1976), and anxiety management (Suinn & Richardson, 1971). In addition to changing cognition, effort is made to shape the environment in ways that will reinforce desired behaviours. Hence, CBT is a skill-building therapeutic approach (Kendall et al., 1995) with the potential for promoting deep, internal change.
CBT has been used extensively with encouraging outcomes in the school setting for children with EBD. Self-instructional training significantly lowered impulsive responding on academic tasks (Meichenbaum & Goodman, 1971), increased on- task behaviour and locus of control (Manning, 1988), and reduced anger and aggression (Smith, Siegel, O’Connor, & Thomas, 1994) for school children who manifested hyperactivity/impulsivity or mild behaviour problems. A problem-solving approach to anger management led to significant improvement in self-control and reduction of physical aggression for children who were chronically disruptive, aggressive, and impulsive (Etscheidt, 1991; Lochman & Curry, 1986). Stress inoculation training raised self-esteem and reduced trait anxiety and anger in adolescent boys who needed help in stress management (Hains & Szyjakowski, 1990).
However, the literature on the effectiveness of CBT for treating severe EBD in a hospital and/or clinic setting is very limited albeit positive. In day treatment type settings, verbal mediation (i.e., self—talk) has been found to produce positive and durable outcomes for a group of impulsive and emotionally disturbed adolescents (Baum, Clark, McCarthy, Sandler, & Carpenter, 1986) and children with anxiety or . phobic disorders in a School Refusal Clinic (King et al., 1998). In inpatient hospitalization programmes where children were being treated for severe anti-social behaviours or Conduct Disorder, problem-solving skills training led to positive outcomes such as a significant increase in prosocial behaviours (Kazdin, Bass, Siegel, & Thomas. 1989) and reduction of depressive symptoms (Roberts, Schmitz, Pinto, & Cain, 1990).
Most studies involving EBD youths in mental health settings have focused on predominantly psychodynamic treatments (Grizenko, 1997; Grizenko, Papineau, & Savegh, 1993; Grizenko, Savegh, & Papineau, 1994; Kettlewell, Iones, & Iones, 1985; Kiser et al., 1996; Kotsopoulos, Walker, Beggs, & Iones, 1996). A consisistent finding that emerged is that a largely psychodynamic multimodal treatment is not effective for children with severe behaviour disorders or conduct disorders even when interventions are delivered in a hospital setting intensively over an extended length of time (Kazdin, 1985; Kettlewell et al., 1985; Kiser et al., 1996; Zoccolillo & Rogers, 1991).
In light of the limited CBT research involving emotionally disturbed children and adolescents, this study evaluated the outcome of a hospital-based CBT programme for a group of youths who were receiving intensive psychotherapy for very severe EBD. We examined the extent to which the youths irriproved in global psychological functioning and day-to-day adjustment. We also evaluated whether the benefits would be maintained over a three-month period.
Lay See Yeo, Margaret Wong, Kathryn Gerken & Timothy Ansley
Yeo, L.S., Wong, M., Gerken, K. and Ansley, T.
(2005) Cognitive-behavioural Therapy in a Hospital Setting for Children with
Severe Emotional and/or Behaviour Disorders. Child Care in Practice, 11
(1), pp.7-9
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