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COGNITIVE GROUP THERAPY FOR AGGRESSIVE BOYS
LETTERS TO THE EDITOR
Treatment for Adolescents With Depression Study (TADS) Team (2005), The Treatment for Adolescents With Depression Study (TADS): demographic and clinical characteristics. J Am Acad Child Adolesc Psychiatry 44:28–40 DOI: 10.1097/01.chi.0000170555.00551.37
COGNITIVE GROUP THERAPY FOR AGGRESSIVE BOYS To the Editor: The article by van Manen et al. (2004) provides evidence of the effectiveness of two intervention programs provided in an in-group setting for aggressive boys aged 9–13 years. Both social cognitive intervention (SCI) and the social skills training (SST) programs were significantly superior to the notreatment control. Furthermore, the SCI was significantly more efficacious than SST. The contribution of this article to the literature goes beyond its stated specific aims, hypotheses, and findings. One of the issues not mentioned in this article involves its contribution to the debate regarding the repercussions of the influential article ‘‘When Interventions Harm: Peer Groups and Problem Behavior’’ by Dishion et al. (1999). This article and later publications by Dishion et al. suggest that ‘‘high-risk youth are particularly vulnerable to peer aggregation, compared with low-risk youth. Association with deviant peers in early adolescence, under some circumstances, inadvertently reinforces problem behavior’’ (Dishion et al., 1999). This assertion led many to conclude that group therapy for youths with aggressive or delinquent behavior or oppositional or conduct disorder may produce more harm than benefit and therefore should not be provided. Such a categorical approach that may unconditionally support the statement by Dishion et al. has been challenging sound empirical research findings supporting the utility and efficacy of various manual-based group interventions, even for diagnostically heterogeneous youths with substance use disorders (Dennis et al., 2004; Kaminer et al., 2002). It has become clear that the developmental literature and intervention literature converse here. This approach has impeded the progress made in researching group therapy for adolescent substance use disorders and has interfered with the dissemination of the benefits of efficacious treatment technology with service providers and the community. There is some evidence in the articles by Dishion et al. indicating potential harm for groups that include antisocial youths. Nevertheless, these data cannot be taken concretely and unequivocally as implying that every group intervention for any subpopulation of youths is harmful. It would be a grave error to disregard the benefits of group therapy and categorically mark it as a harmful approach. It is the ‘‘how’’ as much as the ‘‘what’’ that matters here and predicts the efficacy of the
intervention and the control of adverse effects; that is, it is how groups are formed and are managed that matters (Kaminer, in press). Indeed the article by van Manen et al. delivers that point ‘‘loud and clear’’ by simply conducting an innovative and high-quality study without even meddling with the politics of science as evidenced by the debate over the assertion by Dishion et al. It would be interesting, however, to have the authors address this issue of ‘‘potential harm’’ for groups that include antisocial youths in a response to my letter. Yifrah Kaminer, M.D. University of Connecticut Health Center Farmington Disclosure: The author has no financial relationships to disclose.
Dennis M, Godley SH, Diamond G et al. (2004), The Cannabis Youth Treatment Study: main findings from two randomized trials. J Subst Abuse Treat 27:197–213 Dishion T, McCord J, Poulin F (1999), When interventions harm: peer groups and problem behavior. Am Psychol 54:755–764 Kaminer Y (in press), Challenges and opportunities in adolescent substance abuse group therapy: a critical review. Addictive Behaviors Kaminer Y, Burleson J, Goldberger R (2002), Psychotherapies for adolescent substance abusers: short- and long-term outcomes. J Nerv Ment Dis 190:737–745 van Manen TG, Prins PJM, Emmelkamp PMG (2004), Reducing aggressive behavior in boys with a social cognitive group treatment: results of a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 43:1478– 1487 DOI: 10.1097/01.chi.0000170555.00551.37
Mr. van Manen et al. reply: The letter by Kaminer on the article by van Manen et al. (2004) addresses an important issue not dealt with in our article. First of all, there is much to agree and little to disagree with in the comments made by Kaminer. Indeed, we found in our study that two intervention programs provided an ingroup setting for aggressive boys aged 9–13 years were effective in aggressive boys. Unfortunately, we did not include an individual cognitive-behavioral therapy (CBT) condition because our primary interest was in studying the influence of cognitive components in a CBT program rather than evaluating the specific contribution of group versus individual treatment formats. For that same reason, we did not include measures for peer group interaction and did not monitor whether the youths met outside the therapeutic sessions. Our impression, however, is that this hardly occurred. The assertion by Dishion et al. (1999) that ‘‘association with deviant peers in early adolescence, under some circumstances, inadvertently reinforces problem behavior’’ was based on
J. AM. ACAD. CH ILD ADO LE SC. PSY CH IAT RY, 44:9, SE PT EM BE R 2005
843
Treatment for Adolescents With Depression Study (TADS) Team (2005), The Treatment for Adolescents With Depression Study (TADS): demographic and clinical characteristics. J Am Acad Child Adolesc Psychiatry 44:28–40 DOI: 10.1097/01.chi.0000170555.00551.37
COGNITIVE GROUP THERAPY FOR AGGRESSIVE BOYS To the Editor: The article by van Manen et al. (2004) provides evidence of the effectiveness of two intervention programs provided in an in-group setting for aggressive boys aged 9–13 years. Both social cognitive intervention (SCI) and the social skills training (SST) programs were significantly superior to the notreatment control. Furthermore, the SCI was significantly more efficacious than SST. The contribution of this article to the literature goes beyond its stated specific aims, hypotheses, and findings. One of the issues not mentioned in this article involves its contribution to the debate regarding the repercussions of the influential article ‘‘When Interventions Harm: Peer Groups and Problem Behavior’’ by Dishion et al. (1999). This article and later publications by Dishion et al. suggest that ‘‘high-risk youth are particularly vulnerable to peer aggregation, compared with low-risk youth. Association with deviant peers in early adolescence, under some circumstances, inadvertently reinforces problem behavior’’ (Dishion et al., 1999). This assertion led many to conclude that group therapy for youths with aggressive or delinquent behavior or oppositional or conduct disorder may produce more harm than benefit and therefore should not be provided. Such a categorical approach that may unconditionally support the statement by Dishion et al. has been challenging sound empirical research findings supporting the utility and efficacy of various manual-based group interventions, even for diagnostically heterogeneous youths with substance use disorders (Dennis et al., 2004; Kaminer et al., 2002). It has become clear that the developmental literature and intervention literature converse here. This approach has impeded the progress made in researching group therapy for adolescent substance use disorders and has interfered with the dissemination of the benefits of efficacious treatment technology with service providers and the community. There is some evidence in the articles by Dishion et al. indicating potential harm for groups that include antisocial youths. Nevertheless, these data cannot be taken concretely and unequivocally as implying that every group intervention for any subpopulation of youths is harmful. It would be a grave error to disregard the benefits of group therapy and categorically mark it as a harmful approach. It is the ‘‘how’’ as much as the ‘‘what’’ that matters here and predicts the efficacy of the
intervention and the control of adverse effects; that is, it is how groups are formed and are managed that matters (Kaminer, in press). Indeed the article by van Manen et al. delivers that point ‘‘loud and clear’’ by simply conducting an innovative and high-quality study without even meddling with the politics of science as evidenced by the debate over the assertion by Dishion et al. It would be interesting, however, to have the authors address this issue of ‘‘potential harm’’ for groups that include antisocial youths in a response to my letter. Yifrah Kaminer, M.D. University of Connecticut Health Center Farmington Disclosure: The author has no financial relationships to disclose.
Dennis M, Godley SH, Diamond G et al. (2004), The Cannabis Youth Treatment Study: main findings from two randomized trials. J Subst Abuse Treat 27:197–213 Dishion T, McCord J, Poulin F (1999), When interventions harm: peer groups and problem behavior. Am Psychol 54:755–764 Kaminer Y (in press), Challenges and opportunities in adolescent substance abuse group therapy: a critical review. Addictive Behaviors Kaminer Y, Burleson J, Goldberger R (2002), Psychotherapies for adolescent substance abusers: short- and long-term outcomes. J Nerv Ment Dis 190:737–745 van Manen TG, Prins PJM, Emmelkamp PMG (2004), Reducing aggressive behavior in boys with a social cognitive group treatment: results of a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 43:1478– 1487 DOI: 10.1097/01.chi.0000170555.00551.37
Mr. van Manen et al. reply: The letter by Kaminer on the article by van Manen et al. (2004) addresses an important issue not dealt with in our article. First of all, there is much to agree and little to disagree with in the comments made by Kaminer. Indeed, we found in our study that two intervention programs provided an ingroup setting for aggressive boys aged 9–13 years were effective in aggressive boys. Unfortunately, we did not include an individual cognitive-behavioral therapy (CBT) condition because our primary interest was in studying the influence of cognitive components in a CBT program rather than evaluating the specific contribution of group versus individual treatment formats. For that same reason, we did not include measures for peer group interaction and did not monitor whether the youths met outside the therapeutic sessions. Our impression, however, is that this hardly occurred. The assertion by Dishion et al. (1999) that ‘‘association with deviant peers in early adolescence, under some circumstances, inadvertently reinforces problem behavior’’ was based on
J. AM. ACAD. CH ILD ADO LE SC. PSY CH IAT RY, 44:9, SE PT EM BE R 2005
843