Project C.A.R.E.

Conceptual Framework

Background
Cognitive-behavioural Therapy
Dispute Irrational Beliefs

Background

Dr. Annis Fung is the worldwide pioneer to adopt two-factor model in distinguishing the subtypes of aggressive behaviour, reactive and proactive aggression, for developing specific interventions for each subtype to tackle the problem of school bullying. Fung has filled up the research gap that there are distinctive features between reactive and proactive aggressors over three decades (Dodg & Coie, 1987), but without having particular intervention for each subtype of aggressors. Also, Fung has replaced the one-factor model which simply focuses on bullies and victims, but not subtype of aggression (reactive and proactive aggression) and victimisation (aggressive and pure victims) of school bullying. To remedy this, the Project C.A.R.E. developed a 10-session cognitive-behavioural therapy counselling group intervention for reactively aggressive (Fung, 2007; Fung, revised manuscript), proactively aggressive (Fung, 2008; Fung, Gerstein, Chan, & Hutchison, 2011), aggressive victimised (Fung, 2008; Fung, 2012), and passive victimised (Fung, 2007; Fung, 2012) children and adolescents. With the aim to verify the effectiveness of each intervention, the outcomes of each intervention had been scientifically evaluated by quantitative and qualitative measures with different sources of data (student self-reports, parent-reports, and teacher-reports) across multiple time-points in a two-year longitudinal study.

The encouraging results of the interventions are largely supported by previous studies. Glancy and Saini (2005) suggested that small-group therapy is more effective at reducing students’ aggressive behaviour than individual counselling and family therapy. The small-group approach not only encourages the participants to share their personal experiences but also helps to generate sympathetic responses from other group members. More specifically, the participants can learn from other group members’ experiences, absorb what is useful and self-reflect to achieve personal growth.

To prevent the labelling effect, our promotional materials for the schools emphasised leadership training and critical thinking. All group members were encouraged to participate in the activities in a positive manner. Prior to the commencement of the school term, teachers were required to attend workshops organised by the project team. All teachers were briefed on the project’s content and implementation process to ensure they would not label the participating students, and at the same time to take the initiative in encouraging students who joined the project. All selected aggressors and victims were carefully assessed to ensure they meet the clinical criteria. Each group consisted of eight members and was led by two social workers.

One child who did not meet the clinical criteria was purposely selected to become a group member. He or she must be a positive thinker and has social communication skills so that the labelling effect could be eliminated. The positive beliefs and interaction that he or she brought can improve the overall effectiveness of the therapy (Kazdin, 1995; Lochman & Larson, 2002).

Cognitive Behavioural Therapy (CBT)

Previous researches had found that using cognitive-behavioural therapy as the theoretical framework for aggressors and victims group interventions is far more effective than other types of therapy, such as psychodynamic theory, behaviourism and cognitive theory (Kazdin, 1987, 1995; Lochman, 1990; Lochman & Wells, 1996; McMahon & Wells, 1989; Southam-Gerow & Kendall, 2000). Further, the project's principal investigator previously used cognitive-behavioural therapy to design the content of group intervention and found it to be very effective at reducing children’s aggressive behaviour (Fung,2006, 2008, 2009, 2010, 2011, 2012; Fung, Gerstein, Chan, & Hutchison, 2011; Fung, Raine, & Gao, 2009; Fung & Tsang, 2006; Fung & Tsang, 2007; Fung & Wong, 2007; Fung, Wong & Chak, 2007; Fung, Wong, & Wong, 2004). For this reason, cognitive-behavioural therapy was used as the framework for the group intervention in this project.

In ancient Greece, the Stoic philosopher Epictetus said that ‘people are not disturbed by things, but by the view they take of them’. It was not until the mid-twentieth century that Western psychologists systematically transformed this philosophy into psychological therapy. Albert Ellis was one of the most influential founders of cognitive behavioural therapy (Ellis, 1962).

Ellis (1956) believed that humans have the ability to think and self-evaluate through reflection and self-talk. Hence, people that have rational beliefs live logical and happy lives. In contrast, people with irrational beliefs experience negative emotions and behaviours. Researchers had utilised this concept in therapy programmes addressing adolescent aggressive behaviour (Guerra, Huesmann, Tolan, Van Acker, & Eron, 1995; Huesmann & Guerra,1997; Lochman & Dodge, 1994; Quiggle, Garber, Panak, & Dodge, 1992; Rabiner, Lenhart, & Lochman, 1990). Di Giuseppe and Kelter (2006) reviewed outcome studies and articles related to the effectiveness of REBT and concluded that it is a well-suited treatment for aggressive children. Further, due to the psycho-educational nature of REBT, it is applicable to educational settings and can also be applied to the family system of aggressive children, particularly parents. For these reasons, REBT is adopted as our major theoretical framework.

Through the A-B-C model, we could understand the cognitive processes behind students’ aggressive behaviour.

When an event (A) happened, the belief of an individual (B) about the event will lead to different consequences (C), including behavioural and emotional responses (Ellis, 1977). Therefore, if an individual held an irrational belief, it probably will lead to negative consequences. The following links are examples and explanations of various types of aggressors’, victims’ irrational beliefs and their negative consequences. (To learn more about proactive aggressor and aggressive victim, please refer to Subtypes of Aggression－Proactive Aggressor and Subtypes of Victimisation－Aggressive Victim).

Event (A): I was knocked down by a classmate during recess.

A student with a rational belief:
Belief (B): “He was just being careless.”
Consequence (C): It’s not a big deal. Get up and return to the classroom as though nothing has happened.

A proactive aggressor with an irrational belief:
Belief (B): “I have to let others know that I’m not that weak and I have the power.”
Consequence (C): Threaten the classmate and ask for compensation.

An aggressive victim with an irrational belief:
Belief (B): “Why pick on me and not other classmates? It’s his fault, and I have to retaliate and let him know that he is wrong.”
Consequence (C): Stare at the classmate angrily, and curse him quietly.

From the above examples, we can see that the individuals’ beliefs directly affect their emotional and behavioural consequences. Because aggressors and victims have cognitive distortions, their irrational beliefs cause deviant behaviour and negative emotions.

Ellis (1977) discovered 12 types of irrational beliefs that cause deviations in people’s thinking, resulting in emotional distress and negative behaviour. The 12 irrational beliefs are introduced below, although interpretations of the irrational beliefs in group intervention vary in accordance with the characteristics of the two subtypes of aggressors and victims.

It is essential that people must be loved by significant others for almost everything they do.
Certain acts are awful or wicked, and people who perform such acts should be severely punished.
It is horrible when things are not the way we like them to be.
Human misery is invariably externally caused and is forced on us by outside people and events.
If something is or may be dangerous or frightening, it is natural to be terribly upset and endlessly obsess about it.
It is easier to avoid than to face life’s difficulties and self-responsibilities.
We need something fundamentally other or stronger or greater than ourselves on which to rely.
We should be thoroughly competent, intelligent, and successful in all possible respects.
Since something once strongly affected our lives, it will affect our lives indefinitely.
We must have certain and perfect control over things.
Human happiness can be achieved by inertia and inaction.
We have virtually no control over our emotions and we cannot help feeling disturbed about things.

These irrational beliefs reflect individuals’ personal values and views of life. If people’s lives do not match what they believe (i.e. their beliefs are irrational), they will doubt their own self-worth, become emotionally distressed and may do something to harm themselves or others. Workers will introduce the twelve irrational beliefs described by Ellis in the group intervention. Group members should gain a better understanding of the irrational beliefs underlying their behaviours and emotional distress.

Disputing Irrational Beliefs

The steps to help aggressors and victims dispute their irrational beliefs are as follows:

Help group members to understand irrational beliefs through the use of case studies;
Probe members about the causes of irrational beliefs and the various effects they have on health, emotional, and social domains;
Challenge the deviant thoughts underlying irrational beliefs – the process consists of Detect, Discriminate, and Debate;
Broaden group members’ thinking and encourage them to develop rational beliefs;
Encourage group members to apply their new rational beliefs and positive behaviour in daily life so that they experience different emotions and behavior.

This project assists aggressors and victims dispute irrational beliefs and reconstruct new beliefs through group intervention. Thereafter, aggressors can reduce their aggressive behaviour and victims can enhance their self-expression and emotional control.