Enhanced Thinking Skills Cbt Training
Haydee Cliche
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The most widely implemented offending behaviour programme in the United Kingdom was Enhanced Thinking Skills (ETS), a cognitive-behavioural group intervention that aimed to develop participant's general cognitive skills. A new offending behaviour programme has been developed to replace ETS: the Thinking Skills Programme (TSP). This study reports an evaluation of the effectiveness of TSP using psychometric assessments. Phasing of the two programmes created an opportunity to compare the two programmes consecutively. Forty participants, 20 from each programme, completed a range of psychometric measures to examine cognition, attitudes, and thinking styles. Analysis of pre- and post-programme psychometric results indicated that participants of TSP demonstrated improvements on 14 of the 15 scales, 9 of which were statistically significant. Effect sizes between pre-post results were generally greater for TSP than ETS, demonstrating that TSP had a more positive impact on the thinking styles and attitudes of participants than the ETS programme.
The study investigated the effect of enhanced thinking skills (ETS) and social skill training (SST) in fostering interpersonal behaviour among Nigerian adolescents. A pre- and post-test experimental-control group design with a 3x2 factorial matrix was employed for the study. Gender which was used as a moderator variable was considered at 2 levels along with two (2) experimental and one (1) control groups. The study participants were one hundred and twenty (120) Senior Secondary 2 and 3 students randomly selected from 3 chosen secondary schools in Sagamu LGA of Ogun State. One standardized instrument was used in collecting data while analysis of covariance and t-test statistical methods were used to analyze the generated data. Both the treatment programmes were effective in fostering interpersonal behaviour in the adolescents but Enhanced Thinking Skill was found to be more effective than Social Skill Training. The study also revealed that both ETS and SST did better with females compared to males. Based on the findings, it was recommended that all caregivers must continuously update their skills on the use of ETS and SST to help our youngsters live a meaningful and fulfilled live.
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The effectiveness of offending behaviour programs in forensic mental health settings is not well established. Thus this study aimed to evaluate the Reasoning and Rehabilitation Mental Health program (R&R2 MHP) among a mentally disordered offender (MDO) population.
A sample of 121 adult males drawn from 10 forensic mental health sites completed questionnaires at baseline and post-treatment to assess violent attitudes, locus of control, social problem-solving and anger. An informant measure of social and psychological functioning, including disruptive behaviour, was completed by unit staff at the same time. At three month follow-up patients completed again the violent attitudes and locus of control questionnaires. The data of 67 patients who participated in the group condition were compared with 54 waiting-list controls who received treatment as usual.
78% of group participants completed the program. In contrast to controls, significant treatment effects were found at outcome on self-reported measures of violent attitudes, rational problem-solving and anger cognitions. Improvements were endorsed by informant ratings of social and psychological functioning within the establishments. At follow-up significant treatment effects were found for both violent attitudes and locus of control.
This study aimed to evaluate the completion rate and effectiveness of R&R2 MHP using a waiting-list controlled design on a larger cohort of 121 MDOs detained in medium and low secure forensic facilities. Group attendees were compared with controls post-treatment on a primary outcome measure of violent attitudes and secondary outcome measures of locus of control, social problem-solving, reaction to provocation (anger), disruptive behaviour and social functioning. Measures of violent attitudes and locus of control were re-administered at three month follow up. It was hypothesized that group completion would be favorable compared with the 50% rate previously reported [17, 18] and that group participants would show greater improvement at outcome than waiting-list controls.
This quasi-experimental controlled study involved the participation of 121 male patients detained under the UK Mental Health Act at 10 secure forensic facilities in the south-east of England (six medium secure and four low secure, N = 89 and N = 32 respectively). In order to optimize recruitment, patients from both low and medium security settings were invited to participate in the study. These settings differ in their staffing arrangements and physical security measures. Patients in medium security are those who present a serious danger to others and have the potential to abscond. Patients in low security are considered to present a less serious danger to others and security measures are intended to impede rather than prevent absconding. Usually patients go through an integrated care and treatment pathway that spans one or more levels of care.
The treatment group consisted of 67 patients who participated in the group condition (R&R2 MHP) and their data were compared with that of 54 waiting-list controls who received treatment as usual (TAU).
R&R2 MHP [26] consists of 16 90-minute sessions. It is a manualized CBT intervention program developed for antisocial youths and adults with mental health problems. It is a revised edition of the 36-session Reasoning & Rehabilitation program [8] that was originally developed as a pro-social competence training program for use in correctional facilities. R&R2 MHP is a structured, manualized program that aims to reduce antisocial attitudes and behaviour and improve cognitive and problem-solving skills. It consists of five treatment modules (1) neurocognitive, e.g. learning strategies to improve attentional control, memory, impulse control and constructive planning, (2) problem solving, e.g. developing skilled thinking, problem identification, consequential thinking, managing conflict and making choices, (3) emotional control, e.g. managing feelings of anger and anxiety, (4) pro-social skills, e.g. recognition of the thoughts and feeling of others, empathy, negotiation skills and conflict resolution, and (5) critical reasoning, e.g. evaluating options and effective behavioral skills. The program integrates group and individual treatment, the latter being achieved by the incorporation of a mentoring paradigm whereby a member of staff meets with the patient between group sessions to assist the participant to transfer skills learned in the group into their daily lives. Importantly the mentoring role is not devised to be an additive individual session; but aims to provide a structure for meetings or sessions that are routinely held between the participant and the designated staff mentor (e.g. primary nurse, keyworker, social supervisor). As a structured manualized program for both group facilitators and mentors, R&R2 MHP facilitates consistency in delivery and maximizes program integrity. All R&R2 MHP facilitators were experienced CBT practitioners and had received training in delivering the program. Mentors received written guidance about how to approach each mentoring session (included with program materials) and received training and onsite supervision from program facilitators. A steering committee was established in order to maintain a consistent approach to research and treatment and onsite supervision was carried out at each site. Thus treatment fidelity was ensured by the highly structured style of this manualized program, together with supervision provided at regular steering meetings by SY, an experienced clinical and forensic psychologist and program author.
Participants were not asked to refrain from engaging in interventions considered to be part of their usual treatment with the exception that the control group were not permitted to attend R&R2 MHP sessions or other similar programd cognitive skills interventions such as R&R and ETS. Interventions that are commonly provided in medium and low secure settings include pharmacological treatments, individual and group occupational and psychological therapy, the latter including cognitive behavioral therapy for psychosis, anxiety, depression, substance misuse and relapse prevention.
The following measures were administered to assess the primary (violent attitudes) and secondary outcomes (locus of control, social problem-solving and reaction to provocation (anger), disruptive behaviour and social functioning). These measures are commonly used with mentally disordered offenders. All measures are self-rated with the exception of the Disruptive Behaviour and Social Problem Scale (DBSP) which is rated by an informant. All of the measures were administered at baseline (Time 1) and repeated post group (Time 2); measures relating to violent attitudes and locus of control were repeated at 3-month follow-up (Time 3).
In addition a post-hoc per protocol analysis was performed on the subgroup of participants for whom full data at Times 1, 2 and 3 were available. The analyses showed a similar pattern of results, thus only the ITT results are reported.
Sample size calculations were based on data obtained in our pilot study [27]. Calculations performed at 80% power with an alpha level of 0.05 suggested that 35 participants per group were needed to detect a difference in the primary outcome measure of violent attitudes using the Total MVQ score with an effect size of .42 [pre-treatment mean 15.95 (S.D. = 10.83); post-treatment mean 11.36 (S.D. = 10.53)].
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