Presentation on theme: "Treating Student Anger and Aggression: Skills-Based Cognitive-Behavioral Approaches Texas Association of School Psychologists 2014 Jim Larson, Ph.D. Professor."— Presentation transcript:
1Treating Student Anger and Aggression: Skills-Based Cognitive-Behavioral Approaches Texas Association of School Psychologists 2014Jim Larson, Ph.D.Professor EmeritusDepartment of PsychologyUniversity of Wisconsin-WhitewaterContact:
2Today’s Agenda Theoretical underpinnings of reactive aggression Screening, identification, and progress monitoring for anger treatmentCBT orientation and generalization issuesAnger management group program (8-12)Anger management group program (13-18)Treating individual students
3Learning ObjectivesAt the conclusion, workshop participants will be able to:describe the cognitive and behavioral characteristics of reactive aggressive children and adolescents;describe procedures for screening, identification, and progress monitoring;describe the essential elements for the group and individual treatment of children and adolescents experiencing behavior problems associated with reactive aggression
4Click “?” first and follow directions VideosAll therapy videos from this workshop may be downloaded at:Click “?” first and follow directions
6Proactive/Premeditated Aggression goal-oriented aggressive behaviors; want somethingcool-headed, bully-type; gang leadershipovervalued use of aggressionmanaged best with effective security measures
7Video https://www.youtube.com/watch?v=X9_WwuGF4dM What was the trigger?Event?Student response?Principal response?Teacher response?What might have changed the outcome?What if the principal sent him to your office the next day?Feelings?Thoughts? Behaviors? For all three-
8Reactive/Impulsive Aggression Unplanned, impulsiveHot tempered, easily riledShow less control over emotionsNumerous social-cognitive deficitsThe focus of today’s workshop
9Goals of School-Based Intervention Interrupt the downward spiral of academic and behavioral engagementTrain new cognitive-behavioral skill sets for addressing trigger eventsBegin the formation of adjusted school-based schemata to foster increased confidence and competenceIntroduce slide: This is not a fix all, it’s one intervention to address a specific need.Point 1. For many kids, this spiral began the first day they walked into Kindergarten. Many think ‘this is the best day of my life! It’s going to be so fun!’ but for some it ends up being the worst day. Everything they had been learning is WRONG and will get you into trouble. The rules have changed. The cultural environment is entirely new. These kids had NOT been learning letters, colors, shapes, and had NOT been listening to stories or watching Discovery channel, and had NOT been following rules. By the time we get them in 4th or 5th grade, they have already been turned off to education and the spiral toward negative behavior has sped up.Point 2. Want to train new skill sets. Most kids can comply; however, there are those that don’t like to be told what to do, esp. in front of their friends. We want to help them manage triggers that set them off (i.e. confrontation with teachers).Point 3. We want to get adults smiling at you (the student). Their already thinking…not going to happen today. Need to build a belief in themselves – “I CAN finish that worksheet.” Students are watching to see if their skill level has increased and they become excited to see it happen.We need to go into this with our eyes open. Think, “I’m going to change a big chunk of them… but not all”9
10Risk Factors for Child Disruptive Behavior Disorders 10
11What is the course of aggressive behavior in childhood? Frequency of physical aggression steadily decreases from age 2 to 12 (Tremblay & LeMarquand, 2001)With preschoolers, if someone takes a toy almost all kids react – hit, grab, or even bite. This is normative. This aggression decreases over time because verbal skills increase11
12Is Aggressive Behavior a Stable Pattern? Subgroup of chronic aggressive children are at risk of most physical violence during adolescence (Nagin & Tremblay, 1999)This subgroup tends to be the kids with lower verbal skills and those with ADHD. Because one needs to stop and think to make a non aggressive response, hyperactive kids particularly have a tough time making this transition.12
13The Interaction and Potentiation of… PovertyHigh risk pregnancyYoung, poor nutrition, low birth weightPossible substance abuse sequelaeDifficult temperamentCoercive parenting style (Patterson et al.)Limited discipline responsesPoor child monitoringAttack-Counterattack -Positive OutcomeEscalating counterattacksTobacco -- emotion regulation problems and Inter-Uterine Growth RetardationCocaine – aggressionDifficult Temperament – strong genetic predisposition; Chess and Thomas’s work ;Fussy, demanding, hard to warm up to
14Attack – Counterattack – Positive Outcome “All right! All Right! Take it easy! Just keep the noise down, okay?"“Stop hitting your sister!”“No! She started it!!”Mother’s escape behavior is reinforced & child’s antisocial behavior is reinforcedParent makes a compliance demandRepeat.…
15The Path Continues… Poor readiness and peer rejection in school Co-morbid ADHD, ODD, SLD, traumaAcademic difficulties, retention, and/or special educationPoor or missing interventionsMiddle -Exposure to high risk or deviant peersLack of prosocial models and supervised community activitiesAlcohol, drugs, and weapons
16These risk factors can produce… Students with pro-aggression schema and negative affiliation schemaStudents who lack an adequate sense of academic self-efficacy and possess accompanying counter-productive learning habitsStudents who possess problematic cognitive deficits and distortionsStudents who “think fast” far too much
17Automatic Processing Daniel Kahneman’s Thinking, Fast and Slow System 1 (fast) and System 2 (slow)\Automatic ProcessingQuick, no effort, suppresses ambiguity & doubtFocuses on existing evidence & ignores less salient evidenceConfirms existing beliefsAutomatic processing has value……but not when DELIBERATE processing is needed
18Effects of Automatic Processing on Problem Solving Response EnactmentMemory BinStimulusPerceived ThreatDirect ActionDirect ActionVerbal AssertionIF can wait 20 secs, then will possibly be able to pull up a more adaptive solution—get better at it.Help SeekingJ. Lochman18
19Effects of Deliberate Processing on Problem Solving Response EnactmentMemory BinStimulusPerceived ThreatDirect ActionVerbal AssertionVerbal AssertionOur goal is to get some of those ‘other strategies’ (like verbal assertion) in their memory bin to the top of the stack of choice so it becomes more automatic. This done through practice and repetition.Help Seeking19
20Effects of Automatic Processing on Problem Solving Memory BinResponse EnactmResponse EnactmentStimulusPerceived ThreatVerbal AssertionVerbal AssertionDirect ActionWith rehearsal, don’ t need the 20 seconds anymore. Get the appropriate response further up in the memory bin!! No longer need 20 secs to get them to rely on Verbal Assertion.Help Seeking20
21Effects of Deliberate vs Automatic Processing on Problem Solving Both aggressive and nonaggressive boys who use automatic processing produce 50 % fewer verbal assertion solutions and three times more direct action solutions than when they use deliberate processing (e.g. instructed to wait 20 seconds before responding)Lochman, Meyer et al. (1991)When we talk about solutions, many of us come up with an aggressive solution if we don’t stop and think first. Both verbal assertion and help seeking are in your memory, but if you don’t stop and think you cannot access them.EXAMPLE: DRIVING: When you were on the way here today, bad weather/running late. Someone cuts you off. What is your immediate response? Some of us may be aggressive-swear/throw the finger etc. Let’s try imagining that situation and then I am going to ask you to wait 20 seconds. Count to 20 slowly. What might you do now?? What did that feel like? 20 seconds is too long! Can’t wait 20 secs. Instead-need to think about how to move into the memory bin.21
22QUESTIONHow do we design an intervention that will increase the probability that the student will engage in deliberate processing and make wiser personal decisions?
23Social Information Processing (Dodge, 1991; Crick & Dodge, 1994) OCCURING IN A SPLIT SECOND… attend to available social cuesgive meaning to the cuesselect desired outcomesGenerate possible responsesIdentify potential consequences of a responseact out selected responsesHallway passing stimuli, brushed on shoulderScan memory; Prior hallway experiencesAvoid trouble; Get to class on timeCall him out; Keep moving to classPossible trouble; Get to class w/out incidentThink about something else and head for classTo the audience – “You are attending to my voice now. You’re going to learn something. You take notes to meet that goal.”The kids we are talking about have processing deficits. They don’t deal well with these 6 steps.Jim’s joke: “I know you do well with these steps, because you’re not in jail ”23
24attend to available social cues give meaning to the cues Social Information Processing Deficits in Reactive Aggressive Youth (Dodge, 1991; Crick & Dodge, 1994)attend to available social cuesgive meaning to the cuesselect desired outcomesGenerate possible responsesIdentify potential consequences of a responseact out selected responsesHypervigilant for aggressive cuesHostile attributional biasesHigher value on retaliation than affiliationNarrow solution generation abilitiesTendency to evaluate aggression positivelyDifficulty enacting prosocial skillsTo the audience – “You are attending to my voice now. You’re going to learn something. You take notes to meet that goal.”The kids we are talking about have processing deficits. They don’t deal well with these 6 steps.Jim’s joke: “I know you do well with these steps, because you’re not in jail ”24
25Reactive Aggressive Youth Implications for Treatment Interventions Social-Cognitive DeficitHypervigilant for aggressive cuesHostile attributional biasesHigher value on retaliation than affiliationNarrow solution generation abilitiesTendency to evaluate aggression positivelyDifficulty enacting prosocial skillsTraining FocusTrain verbal & nonverbal cue recognitionAttribution re-trainingConsequential thinkingSolution generation skillsPerspective-taking developmentBehavioral skills trainingPoint 1. Reactive kids look for someone rolling their eyes or that shoulder bump, -they are looking for hostile cues.Example – you’re walking down the hallway and you accidentally bump someone. You turn around and (trainer holds palms up and mouths the word ‘sorry’). Reactive kids do not pay attention to the cue of hands up, rather they are still focused on the shoulder bump.Point 2. This is the tendency to judge a neutral stimulus as hostilePoint 3. They have a great desire to get back and someone than to make friends. The teacher may say ‘make up and shake hands’ but these kids later will want to get even.Point 4. Example. Driving down the highway and someone ahead of you is driving 20 miles/hour below the speed limit. Many possible solutions: lay on the horn, flip them off, bump up behind them…. but I took a deep breathShow video – boy dribbling a soccer ball and another boy comes and kicks the ball into the street. What to do? I’ll beat the crap outta him! I’ll kick his head in! I’ll get my cousin to… Want to get kids to a point that they see value in assertive but non aggressive responses – “hey, go get my ball”What we do in these interventions is help kids look at and think about the consequencesWe usually tell kids to ignore, or take a deep breath. They SAY they can do it, but in action they cannot.Example – If our training today were about how to fly, I could get you to the point that you would pass the (written) test. You can learn all ABOUT flying an airplane but not how to actually DO it. We need to TEACH these kids through practice, practice practice…TRAINING FOCUS- You all know when you’re getting angry and then you regulate- You think about the situation – could it have been an accident (that so and so did that)? Maybe he confused me with someone else.(consequential thinking) If I do this then what would happen?(sol’n generating) What could I do?(Persp) What might she have been thinking? If you were that teacher what would you be thinking. (this is the first step in empathy development)(skills training) actually TEACH them things such as being assertive. These are skills they do not know25
26Knowing THAT vs. Knowing HOW Knowing about a new behavior is NOT the same as being able to enact that behavior under rapidly moving conditions of ambiguity and emotionFlight Instruction
31When Does Anger Occur?A threat to your (or loved one’s) physical well-beingA threat to your self-concept (“How dare he!”)Reaction to your unmet demands (“I told you not to do that!”)Reaction to being offended/dissedReaction to being denied
32What is the Purpose of Anger? It energizes behavior, increasing the level of respondingIt focuses attention on the threatIt communicates displeasure to prompt conflict resolutionIt signals information about personal stateIt dramatizes a social-role enactmentNovaco, 2007
33The 3 Components of Anger The FEELING partYour physical sensation of becoming or being angryThe COGNITIVE partWhat you choose to say to yourselfThe BEHAVIOR partHow you choose to express yourself
34The FEELING part Generally the first indicator Physiological arousal through rapid hormone releaseLimbic system functionHeartbeat, blood pressure, flushing, muscle tension
35The COGNITIVE part Your identification of the arousal Neocortex function – Label itYour choice of self-talkBased on incoming sensory data and firmly held beliefsThreat, fairness, offense, rights
36The BEHAVIOR part Communication function Aggression initiation functionThreat-stopping functionConflict resolution functionScript enactment function
37The 3 Components of Anger The FEELING partYour physical sensation of becoming or being angryThe COGNITIVE partWhat you choose to say to yourselfThe BEHAVIOR partHow you choose to express yourself
38Like you, except that…. …students with problem anger and aggression: Over-label emotional arousal as “anger”Fail to recognize internal anger cuesLack experience with mild angerLack effective anger regulatory skillsTend to read environmental cues inaccuratelyEngage in WYSIATI problem solvingLack useful alternatives to anger displaysAre more immersed in peer anger modeling
39When is Anger a Problem? In the context of location… Frequency IntensityDurationMode of expression
40Anger and Reactive Aggression Cognitive, affective, and behavioral aspectsAnger cognitions; demandingness; fairnessYou don’t get from anger to aggression without the cognitive attribution of intentionalityPhysiological sensation of angerTendency to over-label arousal as angerAggression - verbal, physical, otherwiseInterventions should focus on all three.”40
41Small Group Interventions Angry, Aggressive Girls withAngry, Aggressive Girls
42Rates of arrests for assault among girls have climbed steadily since the 1990’s 180,000 murders, rapes, armed robberies, and assaults on TV over typical childhood viewing period (Garbarino, 2006)
43Aggression in GirlsPhysically aggressive girls are at comparatively higher risk as a groupFavor aggressive boysBegin sexual relationships earlyHigh risk for physical abuseMost of their fighting is about boys or about perceived disrespectGirls who have been physically and/or sexually abused in the home are at increased risk to be physically aggressive in school
44Reactive Aggression in Girls Girls can exhibit reactive aggressive patterns similar to boysNature of other girl anger forms may be qualitatively different from many boysRelational aggressionGreater tendency to hold prolonged grudges
45Screening, Identification, and Managing Grudges Discuss their friendship and “enemy” relationships with the classroom teachers.Ask each individual girl who she “likes least” and “likes best” among the girls in the school. Make note of reciprocated nominations of mutual dislike.Examine office discipline recordsWithin the group, seek to establish a “peace zone”Consider of taking a survey and having them rate who they like the most and the least. Look for reciprocal nominations of least. Can also check school records of who’s fighting with whom.“peace zone” – see if they will agree to be “OK” with each other at least during group time.45
46Victimization IssuesHigh likelihood of previous or ongoing physical or sexual abuse; ASSESS!Some training activities (e.g., the taunting exercise) may be contraindicated for children with PTSD or anxiety concernsConsider providing physical self-defense trainingBe alert for co-occurring depression46
47Tier 2 Small Group Skills Training Screening, Assessment, and Identification
48Three Levels of Social and Emotional Support in School FEWSOMEALLINDICATEDSELECTEDUNIVERSALIndividual Clinical Support - PSDAnger Coping & Think FirstSEL & Discipline?At the SECONDARY level, we are concerned with those students who are showing signs or symptoms of mental health problems. What do these students need know and be able to do to stop or reverse the progression of the problem?At the TERTIARY level, we are concerned with the needs of those students with severe and pervasive mental health problems. These students are typically, but not always, is special education. We are concerned with assisting in the teaching of coping skills and facilitating transitions.48
49General Considerations Remember your tier…Energize/actualize Tier 1 supports if necessary, incl. point of performance interventions in classroom & elsewhereDetermine if aggression/anger regulation is “can’t do” or “won’t do”Watch for false positivesCorrect attendance problems firstScreen for trauma, depression, substance
53Multidimensional School Anger Inventory Mike Furlong and Doug Smith
54Progress Monitoring Baseline Need to establish a behavioral baselineHow will we know it’s “working?”What is he/she doing that is observable, measureable, and subject to change?Authentic data from home or schoolIncrease something or decrease somethingDisciplinary reports, home/school/unit point systemClassroom Progress Monitoring ReportUse of “Direct Behavioral Rating” (DBR)
55Psychometric Baseline Data Can also be report data from self, parent, or teacher instrumentE.g., Achenbach CBCL or BASC-2SeeNumerous instruments for downloadStrengths and Difficulties QuestionnaireChild, Teacher, and Parent forms w/scoring templates
56Strengths and Difficulties Questionnaire (SDQ) Also, the Classroom Progress Monitoring Report
58Monitoring Progress and Evaluating Outcomes Goal Attainment ScalingPercentage of Non-Overlapping Data (PND)
59Goal Attainment Scaling GAS Form for…Period covering…Behavior…+2 Much more than expected…+1 Somewhat more than expected…0 Expected level of Outcome-1 Somewhat less than expected-2 Much less than expected
60Sample PND Obtain at least 3 data points in baseline phase overlapping dataPND = 16/18 = 88.9%PND of 90 or greater is considered highly effective, moderately effective, questionably effective, and 50 or lower is ineffective (Jenson, Clark, Kircher, & Kristjansson, 2007)
62GeneralizationThe transfer of insights and behaviors from the therapy room to the natural environment so as to facilitate adaptive participation and positive growthThe maintenance of these skills over time and across environments and situationsSee Donald Meichenbaum -
63Facilitating Generalization Collaborate on behavioral goalsCare for your therapeutic relationship!Identify generalization agents (teachers, etc.)Create an expectation for changeDesign mini-experimentsProblem-solve barriers to changeNear the end, address relapse issues and mutually design supports
64Rapport: Readiness for Change Rapport: Readiness for Change Motivational Interviewing - Miller & Rollnick, 2002Most people resolve most of their own problems naturallyWant to make a change: How important is it?Able to make a change: Perceived abilityReady to make a change: Timing & prioritiesStages for therapeutic change mirror that of natural changeYour clients must be ready, willing, and able
65Building Rapport with Angry, Aggressive Young Clients Take a “collaborative stance”Together we can make life easier“What do YOU want to change?”“How can I be of help to you?”“Where’s the best place to start?”“Join” client’s angry concerns“Sounds like you have a pair of problem parents!”“I’d hate that school, too! What can we do about that?”Gently challenge irrational “have to’s” of treatment
66CBT OrientationUse of cognitive techniques (e.g., self-instruction) in combination with behavioral techniques (e.g., behavioral rehearsal)Preference for current reality over remote explanationsManualized delivery, but….“Flexibility within Fidelity”
67CBT Orientation What does the client need to know? E.g., Most behaviors are choicesWhat does the client need to be able to do and under what conditions?E.g., Regulate anger and respond non-violently when provoked by peers on the busHow do we facilitate the acquisition of that knowledge and those skills?
68CBT OrientationTherapist stance is that of a “supportive coach” -- teaching, conducting practice, and providing encouragementA “metacognitive prosthetic device” rather than a “surrogate frontal lobe!”Best book? Stress Inoculation Training by Donald Meichenbaum; Next? Child and Adolescent Therapy (4th Ed.) by Philip Kendall
69TREATING CHILDREN AGES 8-14 USING THE ANGER COPING PROGRAM
70Overview of Anger Coping Program Session 1: IntroductionSession 2: Goal SettingSessions 3-7: Anger Awareness and ManagementSessions 8-10: Social Problem SolvingSessions 11-18: Video Production
71Overview of Anger Coping Program Developed by John Lochman, Ph.D. (now at U. of Alabama) and colleagues. See citations in References section.Manual available from major online booksellers or publisher:Larson, J., & Lochman, J. E. (2010). Helping schoolchildren cope with anger: A cognitive-behavioral intervention (2nd ed.). New York: Guilford Press
72Group Treatment in School, Residential Facility, or Clinic Setting Identify generalization agents (e.g., teachers, residential unit staff, parents)Who has most contact in critical other environment?Involve agents in identification and selection to foster collaborative treatment relationshipAvoid simple “time keeper” rolesAssess possible levels of agent involvementSkill level, interest, time commitments
73Role of Classroom Teacher(s) Critical partners in Anger Coping ProgramAssist in screening and identificationProvide child background information, including favored reinforcersEvaluate weekly goal attainmentConsult weekly with skills trainer about child behaviorManage transfer of training of skills learned in small group
74Teacher Nomination Form P. 165Need at least 3 of 5 statements
76FOSTERING the Collaboration Foster sense of teacher ownership in the program by:Involving them in the selection of childrenObtaining their input about children's behavioral needsKeeping them informed about what the children are learning in groupProvide examples of how agents can facilitate generalization of skills in the classroom or residenceElicit suggestions for reinforcers (teacher’s helper, homework pass, dinner choice, TV choice)
77FOSTERING the Collaboration Frame the program as serving their needs by addressing disruptive behaviorRefer to “OUR” Anger Coping GroupWork with teacher on best times for group meetings, but be assertive regarding the value of what you are doingMany teachers will undervalue any activity that is willing to meet during lunch hour or recessSocio-emotional learning is at least as important as reading or math for these selected children
78Getting Started: Group Composition 6 to 8 childrenSimilar age range, with related presenting problems (i.e., disruptive behavior)Exclude children who areLikely to pose substantial challenges to group behavior management. Work with individually first.Substantially different from the proposed pool of group members (age, gender, developmental level)
79Getting Started: Prior to Each Session Review the session content in manual – allow enough time to review prior to session to ensure time to gather any required materialsReview fidelity monitoring forms for the specific session and previous sessionsDiscuss leader roles with co-leader, if nec.Prepare materials
80Getting Started: Preparing for the First Meeting Schedule group time (45-60 minutes)Identify group meeting spaceAssemble materials:Binders/folders for childrenGoal sheetsPostersPrize box/incentives (see manual for free reinforcer list)Activity materials
81Point System Individual Points Behavioral Goals Participation Group PointTeamworkOptional PointsGood transition to/from classroomAdditional points for quizzes, games, and homework assignments
82Group Incentives or “Teamwork Points” Common goal for all group members to work together to achieve; minimizes “scapegoating”Often associated with final session “graduation” but can utilize multiple group rewards if helpful for promoting group cohesion or addressing specific goalsAttendance (group or school)No discipline reports for group membersReturning Goal sheetsRationale: helps minimize “scapegoating” of one group member; promotes group cohesion and cooperation
83Strike System Response cost procedure Strikes given as warnings for rule violations3 strikes – Time-out or loss of day’s pointsEmphasize a strike is a warningIntentionally give strikes during first few sessions to shape group behavior
84Ongoing Behavior Problems Ongoing behavior problems may require more intensive intervention.Individualized behavior planInvolve home/school environmentMeet with very disruptive child individually; perhaps make return to group contingent on behavioral improvementDismiss if necessary to avoid iatrogenic effectsTry to avoid removing a child from group permanently whenever possible.
85ANGER COPING INTERVENTION Session 1 - Overview First meeting jitters resolved for everyone!Transition issues clarified and addressedProgram is introduced to childrenGroup rules are discussed and put in writingPoints and strikes are explainedChildren become acquainted with each otherThe story-telling task (perhaps accomplished at the interview) is completed
86ANGER COPING INTERVENTION Session 1 Explain purpose of group as a way to learn better anger/behavior controlEstablish group rules, times, and explain behavior management systemDo a “Get Acquainted” activityComplete the individual perceptual process activity – Card description differences
87pp. 199 and 200What is happening in this picture?
88Why is he sitting there and not playing ? DUSOWhy is he sitting there and not playing ?
89Session Closing Activities Positive FeedbackEach student says 1 positive thing about him/herself and also about person next to him/herLeader models appropriate compliments firstPrize BoxTally each student’s pointsAllow to “shop or save” (set time limit)Free Time (optional)Game/snack of choice for every child who earned 1 point
90ANGER COPING INTERVENTION Session 2: Overview Review previous meeting with groupDefine “goal”Explain “My Goal Sheet”Help children determine their own goalsHelp children complete goal sheetsClosing activitiesRemember to send home the first Parent Letter – English or Spanish – at the end of this session
91ANGER COPING INTERVENTION Session 2: Goal Setting Teach concept of both “goal” and “goal setting.”Members generate behavioral goals around problem issues in schoolTeacher input is important - “Classroom Goals Interview” form can be helpfulDiscuss, complete, and sign Anger Coping Agreement
92My Goals1. A goal is something that I want and something I am willing to work for.2. A goal is real and possible for meMy Goal for this week is: __________________________________ for ___ out of___ daysTo achieve this goal, I must:_____________________________________Day 1 Day 2 Day3 Day 4 Day 5 Day 6___ ___ ___ ___ ___ ___Signed,________________________________________ Date____________
93Short and Long Term Goals Make the basketball team
94Short Term and Long Term Goals Make the basketball teamReduce suspensions so eligible to playResolve problems without fightingGet in fewer fights this weekKeep hands and feet to myself in P.E.
95Session 3 & 4- Anger Management Anger is understood as both normal and dimensional in expressionObjective is to give the children a greater sense of personal control by helping them to understand and use the thoughts-feeling-behavior connectionSets the stage for self-instruction use throughout the program
96ANGER COPING INTERVENTION Session 3: Overview Review last session and Goals“Too Few Puppets” problemIntroduce self-talk, distraction, and self-calmingPuppet taunting activityFirst Generalization taskWe are trying to help the children learn to generate the time for a deliberativeproblem-solving style
97ANGER COPING INTERVENTION Session 3 Have the children practice distraction (“Imagine being at the most fun place in the world!) and long, slow breathingExplain the puppet taunting activityStay behind the lineNo obscene language, no racial or sexual slursDecide about “your mama” taunts
98Anger Management Training: Sample Self-Statements Stay calm. Just relax. Be cool. Chill.As long as I keep my cool, I’m in control.What she says doesn’t matter.I’ll grow up, not blow up.It’s too bad he has to act like this.I don’t need to prove myself to any one.
100ANGER COPING INTERVENTION Session 4: OVERVIEW Obtain cards and dominosGoals, then review insights from puppet taunting- Can they demonstrate and verbalize the concept?Do card recall and domino line taunting activitiesDo circle taunting activityAssign Generalization taskClosing procedures
101ANGER COPING INTERVENTION Session 4 OBJECTIVE 2 – Practice Self-Control10 card array with 15 second “pre-taunt”Same taunting rules as puppets5 second exposure while being tauntedTauntee writes numbers (not suits) on paperDebrief each: e.g., “How did you concentrate?”Repeat with domino towerRepeat with circle taunting ala’ puppets
102ANGER COPING INTERVENTION Session 4 Titrate the taunting as necessary (see next)Debriefing each child after participating is critical for you to gather level of learningPractice, practice, practice…Note modification suggestion for girlsLeave time for de-compression!Emphasize the Generalization task as an expectation not a suggestion!
103ANGER COPING INTERVENTION Session 5:OVERVIEW Goals, Review, and Generalization discussionUse a stimulus picture to gather group opinions about “what the problem is.”Do role plays from stimulus picturesClosing
104Session 5: Perspective Taking Rationale:Helps with problem solvingHelps children evaluate and modify their hostile attribution biasesHelps increase empathy and concern for victim sufferingSkill Deficit:Attending to verbal and nonverbal cues to try to identify other people’s motivationGenerating a range of possible attributions about other people’s motivations
105ANGER COPING INTERVENTION Session 5: Different Perspectives Goals, review, then use manual, DUSO, or Second Step card to elicit "what the problem is," with each member coming up with a different ideaComment on multiple perspectivesDo “roving reporter” activity with members in various picture rolesElicit “point of view” perspectives
108ANGER COPING INTERVENTION Session 6:Looking at Anger Overview Repeat roving reporter activity with a stronger focus on the issue of angerObjectives are to help group members get a better understanding of anger as a distinct feeling and understand others’ perspectives in anger situations“Anger” is definedHassle Log is introduced
109ANGER COPING INTERVENTION Session 6: What Does Anger Look Like? Goals, review, then members role play an incident involving angerDiscuss the features of anger in role-play(s) - facial features, body language, what they said or didGet a consensus definition of angerGenerate discussion of anger triggers among childrenIntroduce Hassle Log
110HASSLE LOGWHERE WAS I?__In class __In the gym __In the hall __In the lunchroom __In the restroom __ By my locker ___ (Where?)_____WHAT HAPPENED?__Someone hit or pushed me __Someone took something of mine __Someone provoked me __Someone showed me disrespect __Someone threatened me __(Other)WHO WAS THE PERSON?__Student __Teacher __Administrator __Aide __(Other)_____________WHAT DID I DO?__Hit or pushed them __Used anger control __Was verbally aggressive __Walked away, left __(Other)___HOW ANGRY WAS I? (Circle Number)Furious! Pretty Upset Irritated Annoyed, but okayHOW DID I HANDLE MYSELF? ___Great! I controlled my anger and kept out of unwanted trouble ___Pretty well. I tried to use what I have learned ___Not so well. I got in more trouble than I wanted
111ANGER COPING INTERVENTION Session 7: What Does Anger Feel Like Overview Help the group members to identify and begin an understanding of the value of physiological cues in anger controlExplore the role of cognition/self-statements and their effect on anger intensity
112ANGER COPING INTERVENTION Session 7: What Does Anger Feel Like? Goals, review, then discussion of the physiological aspect of angerFeelings as signals that they are getting angry and that there is a problem to be solvedGroup “go-round”Thoughts-feeling connection with visuals
113Session 7: What Does Anger Feel Like? Anger Warning CuesDraw parallels to nervous & embarrassedHeartbeat accelerationRapid breathingFlushingMuscle tension in neck or elsewhereHyperactivityPursing of lips, jaw clench
114Sessions 8 and 9: Problem Solving Rationale: Improve students’ ability to find non-aggressive alternatives to solve social problemsSkills Deficits:Narrow definition of the problem (my perspective is the only perspective)Limited ability to generate solutions (the first and often only solution that comes to mind is aggressive)Limited ability to stop and evaluate possible consequences of different potential solutions
115ANGER COPING INTERVENTION Session 8: Problems and Choices Goals, review, then visual of recent problems and choices madeExamine choices and decide which used anger control and what self-statements might have been usedDiscuss idea of "consequences" - positive and negativeApply to choices listed earlier
116Social Problem-Solving: Applying the Model Problem Identification:John pushes ahead of me in line at a kickball game.What is my goal? I want my place back in lineHow do I feel? I’m a little angryChoices Consequences
117Choices: Consequences 1. Call him names Problem Identification: John pushes ahead of me in line at a kickball game.Choices:1. Call him names2. Kick him3. Ask him to move back.4. Talk to the teacher.Consequences1. John might yell back and push. We will both get into trouble.2. John might kick back. I will be suspended.3. John might move.4. John might get into trouble and be mad at me.
118ANGER COPING INTERVENTION Session 9:Choices and Consequences ANGER COPING INTERVENTION Session 9:Choices and ConsequencesGoals, review, then train:What is the problem? (Problem Ident.)What is my feeling? (Affect recognition)What are my choices? (Response gen.)What might happen? (Consequential Th.)What will I do? (Decision Making)
119ANGER COPING INTERVENTION Session 10 through End: Problem Solving Objective 1: Identify Problems in School for video projectObjective 2: Desensitize the Group to Being on Camera:Objective 3: Tape the Problem Situation:Objective 4: Prepare for Taping of Alternatives and Consequences:
120ANGER COPING INTERVENTION Session 10 through End: Problem Solving Objective 5: Tape the Alternative Solutions:Objective 6: View the "finished products" with comments about strengths and weaknesses.
121Termination/Celebration Play review game to recall and discuss skills learnedHighlight positive behavior changes in each studentDiscuss how group members can use skills in future and address relapse concernsHave a “graduation” ceremonyDistribute personalized certificatesHold pizza party if earned group reward
122Maintenance and Relapse Prevention Schedule booster sessionsUse relapse prevention reminder tacticsroom/locker signs (”Stop and Think!”)hassle logs to GA’s or other responsible adultsself-talk to manage mistakesRe-invigorate generalization agent roles and provide them additional support as necessary
123TREATING ADOLESCENTS USING THE THINK FIRST PROGRAM
124Common “Big Ideas” of AC/TF Anger recognitionAnger cues in self and othersAnger regulationReducers and self-instructionSocial problem-solvingDefinition, choices, consequences, action
125Think FirstAdapted and modified from Feindler & Ecton’s original Art of Self ControlManual available from major booksellers or from the publisherLarson, J. (2005). Think First: Addressing aggressive behavior in secondary schools. New York: Guilford Press.
126Think First: Training Objectives Increase student’s capacity for personal self-control over own behaviorIncrease student’s capacity for regulating personal feelings of angerIncrease student’s capacity for understanding the perspective of othersIncrease student’s commitment to academic progressProvide student with a useful problem solving methodology
127Best Candidates Ninth grade or strong repeater Regular attender History of anger-associated behavior problemsSchool discipline structure ineffectiveConnected to school in some manner, such as sports or clubsNo serious mental health or AODA issuesPOTENTIAL for CHANGE
128Screening Aids Current Behavior Screening Form Intervention Record ReviewAdolescent InterviewBrief Problem Assessment Interview
129Think First Five Training Modules Knowledge LevelSkill LevelBuilt-in assessment strategies trigger advancement in training (Checking It Out)Treatment length mediated by observed knowledge and skill acquisition and progress monitoring data
130Similarities and Differences from Anger Coping Content is more alike than different, but therapeutic approach with adolescents is very different, of courseNeed for greater collaborative styleGenerally, less concern for behavior management issuesPotential for increased cognitive restructuring strategiesStakes are typically higherParental influence may be lessenedOutside influences – AODA, delinquency, social issues – different and often greater
131Think First Skill Areas Anger cue recognitionPalliative anger regulationSelf-instruction in anger regulationProblem definitionProblem response generationProblem response enactment
132Session Structure Reinforce attendance; Assign points for classroom self-monitoring/Teacher ReportsFill-out a hassle log on an event that occurred since the previous meeting;Through active role-play, address one or more of the most salient hassle log issues, practicing new knowledge and skills,Review knowledge and skills from previous meetings;Introduce new training;Assign homework or challenge tasks;Close with snack reinforcer and relaxation exercise
133Module Organization - 1 Preparation Outcomes. Each Module has desirable learning outcomes that may be used to guide decisions about movement through the training elements. The Outcomes are subdivided into Knowledge and Skills.Functional Vocabulary Examples include:Confidentiality Choice Consequence Irritated Annoyed Furious Anger Cue Trigger Intention Hostile
134Module Organization - 2Comment This section contains introductory observations about the content of the Module to come as well as any necessary review of research relevant to the training procedures.Trainers’ Hints This is the section that contains “wheels that have already been invented” and is designed to provide first-time trainers with ideas and proactive strategies to assist in effectiveness and efficiency.
135Think First Module IIntroductions, HousekeepingBehavioral Rules
136Module 1 Overview Introductions and housekeeping Rules and confidentiality issuesPersonal Choice BehaviorThe A-B-C’s of BehaviorTwo progress assessments
137Module 1-Trainers’ Hints Suggested responses to resistanceModel RulesBring snacksGet school grant to purchase suppliesGet prize donations from local merchants“Free pizza slice” from kitchen staffPlan a group activity for endLunch out, video, pizza delivered
138Think First Module I continued Model Behavioral RulesNo physical contact between group membersAllow everyone to express his or her opinion without interruptingWhat is said in here stays in here, except as explained by (Trainer)No racial or sexual slursNo group member put-downs, except in role-playsAttend all meetings or have a valid excuse signed by an adult
139Think First Module I continued Point SystemConfidentiality – Mandated Reporter IssuesTraining Goals and Think First AgreementAcademic Self-Monitoring
140Academic Self-Monitoring Name________________________________ Week of__________ to __________Class:___________________________ Check all that apply this week:o No unexcused absenceso All homework turned ino Asked questionso Positive comment to teachero _________________
141Think First Module I continued Personal Choice Behavior (PCB)Locus of control inwardChoice vs. Have to
142Think First Module I continued Teach Personal Choice Behavior (P. 111)Ask for list of “choose to’s” and list of “have to’s”Challenge the “have to’s”Is it POSSIBLE to NOT do this?I don’t care if it is smart, is it POSSIBLE?If it is possible, it is probably a CHOICEDying is NOT a choice, but how or when CAN beIf you are locked in or chained to, you HAVE to stay there. Otherwise…
143Personal Choice Behaviors Have to?Attend schoolDo homeworkObey parentsObey teachersObey copsObey lawsGet back when diss’dDefend family honorChoose to?Skip schoolNot do homeworkHang with friendsDrink/Use drugsBuy $$$ stuffUse social mediaSee girlfriend/boyfriendBreak the law
144Think First Module I Consequences A consequence is what happens after a choice behaviorTo the chooser and to othersConsequences can be good or bad for someone, and most are fairly predictablePeople choose behaviors based upon their prediction of consequences (It will be fun, satisfying, enriching, etc.)Think First tries to help students learn to make good choices, thus gain good consequences
145Think First Module I continued A – B – C MethodA - what triggered the problem? Led up to itB - what did you do? Response to "A“C - what were the consequences for everyone?Trainer Example:A –On my way to school, slow driverB – Got angry, sped around himC – Got a ticket
146Think First Module I concludes Comprehension Check Decision Point – See Manual, p. 114Questions and Concerns?
147Think First Module II Overview Learn Hassle LogProvide definition of angerUnderstand dimensional anger vocabularyUnderstand physiological anger cuesLearn palliative anger reducers
148Module 2-Trainers’ Hints Be sure to review and make connectionsRole-plays should be realistic, serious, and always non-aggressive, reflecting new trainingDimensional anger terminology can help with anger regulation“Anger thermometers” can be usefulDebunk “Just ignore them”Boys and feeling state recognition
149Think First Module II Explain Hassle Log (Handouts p.186) Alter and adapt it to your situationSelf-Monitoring, memory aid, and role play guideHave them fill one out now and discussAfterward, beginning of every group meetingProvide dean or administrator with a stack
150Think First Module II Understanding Anger Write “anger” on chalkboard or piece of paper“Think of a time when you were REALLY angry. What was happening?”Model first, then go around (feeling, not behavior)“What do these all seem to have in common?”Did not like what someone said or did
151Think First Module II Understanding Anger Seek agreement on what the purpose of anger is: Fear – Protect from harm. Anger??Scare, stop them from messing with you, send a message (recall Day 1 workshop)Ask: When is anger good and when is it bad? (see p. 120)
152Think First Module II Understanding Anger Teach anger continuum of intensitySolicit terms, but include “irritated” and “annoyed”Complete MSAI activity (P. 171)Model and ask for “irritating” events and events occasioning rage or furyCompare consequences following each
154Think First MODULE II continued Anger CuesPhysiological warning signs for the need to regulateDraw parallels to nervous & embarrassedHeartbeat accelerationRapid breathingFlushingMuscle tension in neck or elsewhereHyperactivityPursing of lips, jaw clenchAnger Reducers
155Think First Module II Anger Reducers “Purpose is to give you time to make the right choice when quickness is not critical”A choice in your best interestRole play one of the group members refusing to return to seat when asked and talk through anger cues (“I can feel…”)Train “Deep Breathing” and “Backward Counting” using role-plays on p. 123
156Incident + Cue + Anger Control I got pulled over but I was only 5 MPH over. I felt my face get warm and muscles tighten as I saw him sitting in his car behind me. I took some long, slow breaths.Person express lane had too many items and was demanding price checks. I felt my heart start to beat harder and faster. I began counting backwards.
157MODULE II concludesAllow students to role play provocation PLUS anger cue PLUS anger reducerComprehension Check Decision PointComplete Checking It Out II-1
158Think First Module III Overview Understand, describe, and identify own most problematic external anger provocations (Anger Triggers)Understand, describe, and identify own most common Thought TriggersDifferentiate the features of intentional hostility from other intentions
159Think First Module III Trainers’ Hints Start Progress Monitoring ReportUse hassle logs to stimulate role plays using skills learned to dateUse school-related anger triggers onlyAvoid too much depth with thought triggers but reference them laterE.g., “What were your thought triggers when ___________ happened?”
160Think First Module III Anger Triggers – Who, What, Where? Often A in A-B-CCommonalities?PCB and triggers – What can you do?Thought TriggersAwfulizing TriggersDemanding TriggersOvergeneralized TriggersName-Calling Triggers
161Module III continued Comprehension Check Decision Point – Complete Checking It Out III-1Attribution RetrainingHostile attributional biasUnderstand definition of “intention” and “hostile”
162Module III continuesDiscuss importance of understanding intent and how to judge itNonverbal cuesFacial expression, body postureHow does a hostile person look? Stand? Behave?ContextWhat’s been going on up until now? Loose or tense?Who else is there? Does the person need to save face?
163Module III concludes Comprehension Check Decision Point Complete Checking It Out III-2Questions and Concerns?
164MODULE IV Self-Instruction and Consequential Thinking - OVERVIEW Understand concept of self-instruction (“Reminders”) and their use in anger regulationIdentify times when reminders can be usedIntroduce consequential thinking as a way to avoid unwanted trouble
165MODULE IV Trainers’ Hints Anger control does not mean “fear of fighting.”“Code” issues in and out of schoolThe rare “spontaneous fight”More choices means more powerThinking Ahead – Watch for unrealistic and unlikely responses that provide the “right answer.” Challenge them.
166MODULE IV Self-Instruction Staple in CBT since Meichenbaum 1972 Externalizing vs. Internalizing differencesMakes use of a natural human behavior by focusing it productivelyAnalogies to anxiety/fear – Remember when you used it?“Remind” ourselves to stay calm in pressure or anxiety provoking situations
167MODULE IV continued Model anger reducer PLUS reminder “I take a long, slow deep breath and say to myself…”Before – When you can anticipate“You can do this…”During – To keep your cool“Chill, take it easy…”After – Self-reinforcing or self-coaching“Good job, man!” or “I need to practice more.”
168MODULE IV continued Complete taunting exercise a minimum of 5X’s Why practice?Write reminders on 3X5 cardTape lines 4 feet apart30 seconds of “before” reminders30 seconds of taunting within the rulesHandshakes and debriefingTrainers model first!
169MODULE IV continued Consequential Thinking Part of George Spivack’s interpersonal cognitive problem-solving (ICPS) skillsAbility to think of different things that might happen in a situationExplain “thinking ahead” and discuss as “If…then…” scenariosIf I (misbehave) now, then I will (negative consequences)
170MODULE IV continuedBrainstorm all the positives and all the negatives that come from fightingDifferentiate short- and long-term consequencesOn board, write reminder + thinking ahead + goal-directed behavior“What is my goal here?”Calm yourself, think first, then act
171MODULE IV concludes Clients complete “If I… then… So I will” exercise “Be cool. If I shove him, then he’s gonna come back at me. So I will tell him this ain’t worth a suspension and walk off.”Reminder + thinking ahead
172Module IV concludes Comprehension Check Decision Point – Complete Checking It Out IV-2Questions and Concerns?
173MODULE V Social Problem Solving - Overview Training the skill of breaking down interpersonal and other conflicts into solvable problems“Problems” are defined and the steps to problem-solving trainedGroup members address at least one major school problem
174MODULE V Social Problem Solving STOP AND THINK: WHAT IS THE PROBLEM?WHAT CAN I DO?WHAT WILL HAPPEN IF?WHICH SHOULD I CHOOSE?NOW DO IT!HOW DID I DO?
175MODULE V Trainers’ Hints Use authentic problems as much as possible for trainingRemember the need for behavioral skills training throughoutDon’t just tell us what you are going to do, show usConvey “challenges” as a motivating toolSee top p.147
176MODULE V continued STOP AND THINK: WHAT IS THE PROBLEM? Help them learn to own the problemNot another’s behavior, but my response to itGoal and obstacle construction“I WANT to stay out of trouble (goal) BUT my enemies keep hassling me (obstacle)
177MODULE V continued The Cousin Problem “Imagine you are about to go into school for first period when your cousin runs up and begs you to go help find some guys who were threatening him on the way to school. You have an important test first period that you studied for and know you can pass, but he’s your cousin and he could get hurt.”What is my problem?
178MODULE V continued Practice problem definition (“I want… BUT…”) Comprehension Check Decision Point –Complete Checking It Out V-1 (p. 121 in Handouts)
179MODULE V continued Step 2: WHAT CAN I DO? Problem generating alternative solutionsStart simple:I want to watch my TV show, but my sister is watching her show. What are all the things I could do?Play the “What Can I Do?” Game for two or more meetingsManual, pAlternatives must be possibleUse other locally relevant problems
180MODULE V continued What can I do? You are eating lunch and a student you don’t like walks by and whispers, “Punk.”A teacher accuses you wrongly of writing a gang symbol on the bathroom wall.A friend comes by school with a car he peeled and stole, and suggests you go for a ride with him.
181MODULE V continued Assist group to understand meaning of “anticipate” Encourage realistic consequencesComplete “Worst” and “Most Likely” exerciseIf I do (this):What is the worst that could probably happen?What is most likely to happen?
182Worst and Most LikelyAnother student makes an insulting remark about your mother while the two of you are getting dressed after gymYou bust him up goodWorst and Most LikelyYou ask him if he was playing or serious?
183MODULE V continuedPractice “What will I do?” using the first four problem-solving stepsDo they have the skill required at the “Now Do It!” step?Can you do that? What do you mean by…? Show me how you would do that.
184MODULE V completedHave students’ analyze own problems with Handout V.3Provide multiple opportunities for problem-solving in authentic contextSelf-evaluation and managing set-backs addressed
185When Formal Curriculum is Finished Two weeks prior, brainstorm a suitable conclusion ceremonyStudents may invite adult of choiceInvite administrator(s) and selected othersAsk each student to prepare a short written statement: “What I Learned and How I’ve Changed”Provide Certificates of Completion
186When Formal Curriculum is Finished Set dates for follow-up booster sessionsEmphasis is on authentic, ongoing issues in the school settingContinuing skill development through role-plays and behavioral rehearsalsWhat is the problem and how will you address it?Practice, Practice, Practice!
187Maintenance and Relapse Have students right down self-reminders to guide behavior, e.g.:“Avoid door 3 in the morning”“Think ahead before acting”“Use my reminders in gym class”Anticipate possible problems and help with managementHow will you think about it?What will you do to bounce back?
188Therapeutic Interviewing using Problem-Solving Discourse Strategies by Donald Meichenbaum for working with aggressive adolescents
189Three Levels of Social and Emotional Support in School FEWSOMEALLINDICATEDSELECTEDUNIVERSALIndividual Clinical Support - PSDAnger Coping & Think FirstSEL & Discipline?At the SECONDARY level, we are concerned with those students who are showing signs or symptoms of mental health problems. What do these students need know and be able to do to stop or reverse the progression of the problem?At the TERTIARY level, we are concerned with the needs of those students with severe and pervasive mental health problems. These students are typically, but not always, is special education. We are concerned with assisting in the teaching of coping skills and facilitating transitions.189
190Tier 3 SupportStudent is emotionally/behaviorally incapable of functioning in a small group…….ORStudent needs more intensive services than can be found in group work
191Working with Individual Adolescents General Considerations Establish collaborative relationshipHow can we work together?Respect the youth’s perspectiveGet student to convince you of its authenticityTake a solution-focused approachInstill hope, a way outFoster responsibilityEnact a plan
192Problem-Solving Discourse Meichenbaum, 2008 A “Phase-Oriented Problem-Solving” process to help angry youth become better problem-solvers;Follows a “discovery training” modelHelps teach a variety of coping skills and problem-solving vocabulary
193Problem-Solving Discourse PHASE I - PREPARATIONCollaborative alliance, defuse emotions, obtain timeline of aggressive eventPHASE II - PROBLEM-SOLVING PHASEConsider and develop more prosocial alternatives and assume more responsibilityPHASE III - IMPLEMENTATIONPractice and apply new skills
194PSD PHASE I - PREPARATION If necessary, defuse the situation and de-escalate the angerExplore the “what, when, where, who” of the present incident – “mental videotape”Conduct a behavioral chain analysis that connects feelings, thoughts and behaviorsHow did you feel when that happened to you?What went through your mind at that point
195PSD PHASE I - PREPARATION Emphasize choice behaviorsHow did you come to choose (decide) to do … ?What happened after you made the choice to …?Summarize student’s view of the eventCorrect me I’m wrong, but what I hear you saying is…Nurture hopefulness, a way outLet's see if we can make sense of what happened to you
196THIS VIDEO DEMONSTRATION… Highly compressed timeframeRemarkably cooperative client!Watch/listen for major objectivesThoughts and feelings connectionMoving locus of control inwardTaking perspective of otherConsidering alternativesTender Ears Advisory…
198PSD PHASE I - PREPARATION What did you observe? What more do you want to know about this youth?
199PSD PHASE II - PROBLEM SOLVING Help the client take the perspective of othersWhat was going through his head when he saw you?If you were thinking that, would you have done the same thing?Help the client generate causal explanationsWhy do you think he got so mad about that?What seemed to trigger the problem?Everything was going okay until what?
200PSD PHASE II - PROBLEM SOLVING Help the client generate alternative solutionsWhat other ways are there to try to solve the problem?Can you think of a different way so X wouldn’t happen?Help the client notice warning signsHow can you (or others) tell when you are first getting upset ?Foster responsibility (ownership)
202PSD PHASE II - PROBLEM SOLVING What did you observe? What direction would you take now?
203PSD PHASE III - IMPLEMENTATION Covey a “challenge” and bolster self-confidenceThis might be really difficult. Can you do it?I believe you are mature enough to face thisGenerate an action planWhat advice would you have for a friend who has this same problem?What has worked for you in the past?Help anticipate consequencesIf you do…what do you think will happen?
204PSD PHASE III - IMPLEMENTATION Help anticipate barriersLet’s suppose that…How can you remind yourself to…?Reinforce effortHelp youth see the connections between action and outcomes and how he/she will benefitWhy is it important for you to stay out of trouble?Do you think you can teach what you have learned to someone else?