Cognitive Behavioral
Interventions in the School
Richard Van Acker, Ed. D.
University of Illinois at Chicago
College of Education (M/C 147)
1040 W. Harrison
Chicago, IL 60607
vanacker@uic.edu
A Case for Need…..
• Among children ages 9-17, almost
21% have a diagnosable mental
health or addictive disorder;
– of these 11% have a significant
impairment and
– 5% have an extreme functional
impairment. (Surgeon General’s Report)
• Less than 1 in 5 children or
adolescents with mental health
problems receives mental health
services in any given year.
(President’s New Freedom Commission).
• While only 16% of all children and
youth in need receive mental
health services, 70-80-receive that
care in the school setting (Rones &
Hoagwood, 2000).
• The public school has become the
de facto national mental health
system for children and youth.
The population of children and youth in
the public school is changing…
• Greater exposure to risk factors for the
development of emotional and mental health
disorders:
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Poverty
Minimal parental education
Marital discord or family dysfunction
Ineffective parenting
Coercive discipline
Child maltreatment (abuse and neglect)
Poor physical health of child or parent
Parental mental illness
School failure
Social rejection or isolation from peers
Lack of meaningful interaction with a significant adult
Maltreatment and Risk
Posttraumatic Stress Syndrome
Infancy
Attachment
Disorders
Early to
Middle
Childhood
Internalizing
Disorders
Externalizing
Disorders
SeparationAnxiety
Disorders
ADHD
Mild
Depression
Chronic PTSD
Major Depression
Adolescence
to Adulthood
Oppositional
Defiant
Disorder
Suicide
Attempts
Conduct Disorders
Cognitive and
Learning
Disorders
Pervasive
Developmental
Disorders
Poor School
Performance
Personality Disorders
Increased Risk to Maltreat One’s Children
The Prevalence of Common
Mental Health Disorders Affecting
Children and Youth
Disorder
Number of Children/Youth
Affected
Anxiety
8 to 10 out of 100
Conduct
7 out of 100
Depression
6 out of 100
Learning
5 out of 100
Attention
5 out of 100
Eating
1 out of 150
Substance Abuse
Not known
CMHS. Mental, emotional, and behavior disorders in children and adolescents. The Center for Mental
Health Services. Accessed at www.mentalhealth.org/publications/allpubs/CA-0006/default.asp
As a result of the growing number
of students with emotional and
mental health concerns…
• School personnel (school-based clinicians,
teachers and administrators) are being
called upon to have a greater
understanding of these disorders, and
• To employ prevention and intervention
strategies that have been empirically
validated to be effective.
Why should the school be involved in
addressing children’s mental health needs?
• Mental health significantly impacts both the
social/emotional and academic outcomes of students.
• Children spend over half of their waking hours in
school – this makes the educators front line agents in
recognizing and implementing treatments.
• The economic and racial segregation found in schools
enables the targeting of those populations with the
greatest need.
• Children and youth do not leave their emotional and
mental health needs at the gate when they enter the
school.
• The public school remains the only mandated ‘noreject’ service agency for all children.
Key Processes in Prevention and
Intervention
• Build relationships (student, family, school staff,
other)
• Reduce or build boundaries to stress and risk
• Build protective factors
• Educate in key cognitive behavioral skills
• Use evidence-based practices
• Emphasize strong outcome evaluation and
continuous program improvement.
• Advocate for program improvement and growth
Cognitive-Behavior Intervention
• Is not a singular approach, but rather a
body of methods and strategies used to
change behavior.
• Behavior change is accomplished through
the active engagement of the child’s
understanding and taking control of their
thoughts, beliefs, feelings, and behaviors.
Cognition
Behavior
Effective Treatment
Mental Health Disorders
• Multimodal approach
Medication
Behavioral
Interventions
CognitiveBehavioral
Interventions
Common Cognitive and Behavioral
Interventions for Children and Youth
Cognitive Interventions
• Examining and testing the
evidence
• Challenging cognitive
distortions
• Reattribution
• Decatastrophizing
• Self-Instruction or Self-Talk
• Self-regulation
• Problem solving training
• Desensitization imagery
• Thought stopping
• Refocusing
• Evaluating pros and cons
Behavioral Interventions
• Contingency management
– Reinforcement (DR_)
– Punishment
– Shaping
• Behavioral rehearsal (role
playing)
• Social skills training
• Token economy
• Modeling
• Self-monitoring
• Behavioral experiment
• Systematic desensitization
• Activity scheduling
In effective intervention – cognitive-behavioral and behavioral interventions
often play complementary roles.
Factors impacting the selection of
an intervention strategy
• Age
• Development
• Presenting
problem
CognitiveBehavioral
Interventions
Behavioral
Interventions
Age and Cognition
Some Common CBI Interventions
Self-Regulation/Self-Control
• Self-monitoring – the ability to collect data
or otherwise identify one’s own thoughts
and behavior.
• Self-evaluation – to be able to judge one’s
performance accurately against some
standard of performance.
• Self-reinforcement – the ability to deliver
self-praise or a reward contingently on the
display of a specified desired behavior.
Self-Instruction Training
(Meichenbaum & Goodman 1971)
• Cognitive Modeling – the teacher performs a task
•
•
•
•
while talking aloud; the student observes.
Overt External Guidance – The student and teacher
both perform the task while talking aloud together.
Overt Self-Guidance – The student performs the task
using the same verbalizations as the teacher (talk
together).
Faded Self-Guidance – The student whispers the
instructions (often in an abbreviated form) while going
through the task.
Covert Self-Guidance – The student performs the
task, guided by self-speech.
Attribution Retraining
• Needed when student displays dysfunctional
maladaptive or irrational explanations for why he or she
is performing well or poorly.
• These explanations have implications for behavioral
persistence, expectancies for future performance, and
emotional reactions to success and failure.
• For example, students who attribute their success to
external, unstable factors and their failures to internal
stable, or global factors.
• Two phases to the process:
– Student is set up to experience some degree of failure (care
must be taken here).
– Student is taught to make statements that attribute the contrived
failure to insufficient effort (student must have the skill required
to be successful)
Problem- Solving Training
• Problem Identification – component skills involve
problem sensitivity or the ability to “sense” the presence
of a problem by identifying “uncomfortable” feelings.
• Alternative Thinking – the ability to generate multiple
alternative solutions to a given interpersonal problem
situation.
• Consequential Thinking – the ability to foresee the
immediate and more long-range consequences of a
particular alternative and to use this information in the
decision-making process.
• Means-Ends Thinking – the ability to elaborate or
plan a series of specific actions ( a means) to attain a
given goal (ends), to recognize and devise ways around
potential obstacles, and to use a realistic time framework
in implementing steps towards the goal.
Cognitive Restructuring
• Goal: Target maladaptive thoughts
–Negative Schemas
• Ways of thinking that lead individuals to perceive
and interpret experiences in a negative manner
1. Automatic, often occur rapidly in certain
situations and may be outside of person’s
awareness
2. Involve discrete predictions or interpretations
of a given situation
3. Develop out of negative experiences
Bibliotherapy – provide examples of new schema
Cognitive Restructuring (Cont.)
Altering irrational, dysfunctional or maladaptive
patterns of thought.
•Process:
– Identify and understand the triggering events
causing the student difficulty.
– Identify and understand the student’s thoughts in
response, and
– Help the student alter the irrational, dysfunctional
or maladaptive thoughts.
Common Cognitive Distortions
Encountered in Children and Youth
• Dichotomous Thinking- The student views
situation in only two categories rather than on a
continuum.
• Overgeneralization – The student sees a current
event as being characteristic of life in general,
instead of one situation among many.
• Mind Reading – The student believes he or she
knows what others are thinking about him or her
without any evidence.
• Emotional Reasoning – The student assumes
that his or her feelings or emotional reactions
reflect the true situation.
Common Cognitive Distortions Encountered
in Children and Youth (Cont.)
• Disqualifying the Positive – The student
discounts positive experiences that conflict with
his or her negative views.
• Catastrophizing – The student predicts that
future situations will be negative and treats them
as intolerable catastrophes.
• Personalization – The student assumes that he
or she is the cause of negative circumstances.
• Should Statements – The student uses should or
must to describe how he/she or others are to
behave or act.
Common Cognitive Distortions Encountered
in Children and Youth (Cont.)
• Comparing – The student compares his or her
performance to others (often to higher
performing or older students) and focuses on the
discrepancy.
• Selective Abstraction – The student focuses
attention to one detail (usually negative) and
ignores other relevant aspects of the situation.
• Labeling – The student attaches a global label to
describe him- or herself rather than looking at
behaviors, attributes, and actions
CBI in the school can be
delivered…
• Individually
• In small groups,
and/or
• In large groups
• Making it an excellent
fit for RtI and PBIStype school-wide
efforts.
School-Wide Epidemiological
Approaches
Targeted Interventions
Individualized Plans
Selected Interventions
Coping Cats (Kendall) Anxiety
Friends (Bartlett) Social Problem Solving
CBT for Impulsive Children (Kendall & Braswell) ADHD
Universal Interventions
I Can Problem Solve (Shure , 2001)
Olweus Bullying Prevention (Olweus & Limber, 1999)
Goal of School-wide Programming
-Strengthen Protective Factors• Strengthening peer relationships
• Increasing self-monitoring and selfregulation skills
• Improving parent-child, and teacherstudent relationships
• Promoting positive school climate
• Increasing school success
Learn to “Double Dip”
Combine academic and social emotional
instruction when teaching
Bibliotherapy Index
• Identify critical needs and
select readings that have
this as the theme.
• Employ instructional
strategies that allow
students to learn and
practice social skills.
• Whenever possible use
instructional consequences
for behavioral infractions
Build Capacity Within Your
Community
• Approach the United Way for assistance in
securing community agency support.
– “How do you serve the students in our public
schools directly?”
– Social services within the school
• Identify business partners that can
provided needed person power (e.g., for
mentors, etc) or for tangible support
(funding, possible reinforcers).
Group Activity
Each group will select either Option 1 or 2 and discuss in some detail a plan to
address the situation using a combination of strategies including cognitive
behavioral strategies. Be prepared to have one group member who can report
out to the larger group.
• Option #1
– Read the vignette related to
the student with Oppositional
Defiant Disorder.
– An FBA determined that the
student engages in many of
these behaviors for power and
control and to earn peer
recognition.
– Obviously his family dynamics
play a role in this behavior as
well.
– Discuss how you would
address this behavior
employing both behavioral and
cognitive behavioral
intervention strategies.
• Option #2
– Your school has a problem
with bullying and children and
youth being disrespectful to
one another. You are part of a
team that has been given the
task of developing a schoolwide program to address the
problem.
– Identify universal and selected
strategies that you might
implement and discuss how
you will build practice and
feedback to both teachers and
students related to the display
of both desired and undesired
behaviors across the course of
each day.
For More Information
• The Center for Health and Health Care in Schools
www.healthinschools.org
• Center for Mental Health Services
http://www.mentalhealth.org/cmhs/
• Mental Health: The Surgeon General's Report
http://www.surgeongeneral.gov/library/mentalhealth/toc.html#chapter3
• National Institute of Mental Health
http://www.nimh.nih.gov
• University of Maryland Center for School Mental Health
Assistance
http://csmha.umaryland.edu/
• School Mental Health Project
http://smhp.psych.ucla.edu
1. Dream
2. Goal
3. Now
4. People to enroll
5. Ways to build strength
6. Charting ACTIONS
7. Next month’s work
8. Committing the first step
DREAM
NOW People Ways Commit- Next
ting to
Month’s Charting
to
1st
to
work
Actions
step
Build
enroll
GOAL
Strength
Situate yourself in a very positive
future -- picture it clearly, then think
backwards
(Falvey, Forrest, Pierpoint,
& Rosenberg. 1992)