R E L AT I O N A L AG G R E S S I O N

A G UIDE TO CO G NI TIV E B E H AV IO R AL I NDIVIDUAL & GR O U P T HE R A P Y

BY K AT H Y GRANITE

Literary Reviews by: Tiffany Haswood & LeyLecia Henderson

Table of Contents
Table of Contents ............................................................................................................1 Cognitive Behavioral Therapy: Preventative Measures ...........................................2 Aggression Replacement Training ...............................................................................3 Training in Moral Reasoning ....................................................................................... 3 Social Skills Activities for Kids, Older Kids & Teenagers .........................................4 Four Strategies to Cope With Anger in a Healthy Way ............................................5 Second Step: A Curriculum for Violence Prevention ...............................................6 Literary Review ..............................................................................................................7 Resources .......................................................................................................................12 References ......................................................................................................................13

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G U I D E TO

C O G N I T I V E BE H AV I O R A L T H E R A P Y F O R

I N D I V I D UA L

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G RO U P

R E L AT I O N A L AG G R E S S I O N

Cognitive Behavioral Therapy: Preventative Measures

30% of school aged children have bullied or have been bullied by other children (NCSL, 2013). Bullying is the result of numerous types of aggressive behavior. CBT interventions are based on the theory that behaviorally aggressive children and adolescents have prevalent misperceptions of social stimuli and cognitive distortions amplified by a lack of social Aggression is defined as any form problem solving skills (Feindler & of behavior directed toward the goal Scalley, 1998). Therefore, CBT of harming another. This behavior focuses on cognitive restructuring can be displayed in various forms and development of problemsuch as physical, verbal, or indirect solving skills in order to reduce aggression (National Youth Violence aggressive behavior. Prevention Center, 2002). With the growing concern regarding bullying In this paper, several CBT and aggression have come many intervention methods for aggression different behavioral intervention will be explored. It is hypothesized strategies aimed to decrease that assisting students in adjusting aggressive behavior. Among the their thought processes and most widely used is Cognitive developing students pro-social Behavioral Therapy (CBT) skills will help them to display less intervention plans. aggressive behaviors. The subsequent three literary reviews attempt to address and support the hypothesis. You will find more information addressing the the literature review review on page page 7.

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Aggression Replacement Training (ART)

National Center for Mental Health Promotion and Youth Violence Prevention.!(2007).!
Aggression Replacement Training (ART) is a cognitive behavioral intervention program to help children and adolescents improve social skill competence and moral reasoning, better manage anger, and reduce aggressive behavior. The program specifically targets chronically aggressive children and adolescents. Developed by Arnold P. Goldstein and Barry Glick, ART has been implemented in schools and juvenile delinquency programs across the United States and throughout the world. The program consists of 10 weeks (30 sessions) of intervention training, and is divided into three componentssocial skills training, in schools and mental health settings and for adults. Special Populations/Available Adaptations:! ART can be taught to children and adolescents from all socioeconomic backgrounds in rural, urban, and suburban communities. In addition to being implemented in schools, ART has been used in juvenile delinquency programs and in mental health settings to reduce aggressive and antisocial behavior and promote anger management and social competence. Program Components:! The ART program is a multimodal intervention consisting of three components: social skills training, anger control training, and training in moral reasoning. Research has shown that students who develop skills in these areas are far less likely to engage in a wide range of aggressive and high-risk behaviors. Lessons in this program are intended to address the behavioral, affective, and cognitive components of aggressive and violent behavior. Detailed descriptions of the three components are provided below: Social Skills Training: Social skills training teaches youth what to do in threatening or stressful situations. ART Structured Learning is based upon a social learning process, and activities include modeling, roleplaying, and performance feedback. Program Components:! The ART program is a multimodal intervention consisting of

Training in Moral Reasoning: This component of ART aims to raise participants awareness of others points of view (perspective taking) and teaches youth to view their world in a more fair and equitable way. Moral reasoning example: Through moral reasoning, discuss examples of moral reasoning by using cognitive skills to: examine all facets of a dilemma evaluate this understanding of the situation against known experiences imagine, and deliberate upon possible avenues of action consider personal and societal effects and affects of actions, and then select the most appropriate behavior from within this considered range of choices.
Milvain, C.!(1996).!Moral Reasoning as Part of a Primary School Programme.!Analytic Teaching, 17(1), 1-28. Retrieved!from!http:// www.viterbo.edu/analytic/Vol. %2017%20no.1/ 3. moral1.20reasoning.pdf

RESEARCH HAS SHOWN THAT STUDENTS WHO DEVELOP SKILLS IN THESE AREAS ARE LESS LIKELY TO ENGAGE IN A WIDE RANGE OF AGGRESSIVE AND HIGH RISK BEHAVIORS.
anger-control training, and training in moral reasoning. Clients attend a one-hour session in each of these components each week. Incremental learning, reinforcement techniques, and guided discussions enhance skill acquisition and reinforce the lessons in the curriculum. Target Audience:! The program was first developed for aggressive and violent adolescents aged 12 to 17 who were incarcerated in juvenile institutions. ART has been adapted for children

three components: social skills training, anger control training, and training in moral reasoning. Research has shown that students who develop skills in these areas are far less likely to engage in a wide range of aggressive and high-risk behaviors. Lessons in this program are intended to address the behavioral, affective, and cognitive components of aggressive and violent behavior. Detailed descriptions of the three components are provided below: Social Skills Training: Social skills training teaches youth what to do in threatening or stressful situations. ART Structured Learning is based upon a social learning process, and activities include modeling, roleplaying, and performance feedback. Dewar, Ph.D., G.!(2013).!Social skills activities for children and teenagers: Ideas inspired by research.!Parenting Science.!Retrieved from http:// www.parentingscience.com/socialskills-activities.html

Social skills activities for kids, older kids & teenagers GAMES FOR THE V E RY YO U N G
The Name Game Researchers Sandra Sandy and Kathleen Cochran note that young children need to learn the importance of getting someones attention before you speak. Theyve invented this little game for teaching social skills: Have kids sit in a circle and give one kid a ball. Then ask him to name

another child in the circle and roll the ball to that child. The recipient then takes his turnnaming a child and rolling the ball--and so on.
Follow the Leader Have kids line up behind a leader and follow him through an obstacle course. Kids must stay in line, and take turns as they pass through each section of the course.

S O C I A L AC T I V I T I E S F O R O L D E R K I D S A N D TE E N AGE R S
Active listeners show speakers that they are paying attention. They do this through body language (offering appropriate eye contact, orienting the body in the direction of the speaker, remaining quiet) and verbal feedback (restating, in their own words, what the speaker is trying to communicate). One popular method of teaching active listening assigns people to one of three roles: A speaker, a listener, and an observer. The speaker is instructed to talk for a few minutes about something important to him. The listener attends quietly, providing cues to the speaker that she is paying attention. When the speaker is nished talking, the listener also repeats back, in her own words, the speakers points. The observers job is to evaluate the speaker and listener. Did the speaker stay on topic? How did the listener indicate that she was paying attention? After the observer shares his observations with the others, the players switch roles and try again.
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Four Strategies to Cope With Anger in a Healthy Way

Published on February 28, 2011 by Judith Orloff, M.D. in Emotional Freedom

1. WH E N YO U R E U PS E T , PAU S E , A N D S L OWLY COUNT TO TEN

To offset the adrenaline surge of anger, train yourself not to lash back impulsively. Wait before you speak. Take a few deep breaths and VERY slowly, silently, count to ten (or to fty if necessary). Use the lull of these moments to regroup before you decide what to do so you don't say something you regret

2. TAKE A CO O LI NG OF F PE RI O D
To further quiet your neurotransmitters, take an extended time-out, hours or even longer. When you're steaming retreat to a calm setting to lower your stress level. Reduce external stimulation. Dim the lights. Listen to soothing music. Meditate. Do some aerobic exercise or yoga to expel anger from your system.

3 . DON T ADDRES S AN GE R W HE N YOU R E RU SHE D

Make sure you have adequate time to identify what's made you angry. A Princeton study found that even after theology students heard a lecture on the Good Samaritan, they still didn't stop to help a distressed person on the street when they thought they'd be late for their next class. Thus, allotting unhurried time to resolve the conict lets you tap into your most compassionate response.

4. DONT TRY TO ADDRESS YOUR ANGER WHEN YOURE T I R E D O R B E F O R E YO U G O TO S L E E P

Since anger revs up your system, it can interfere with restful sleep and cause insomnia. The mind grinds. Better to examine your anger earlier in the day so your adrenaline can simmer down. Also being well-rested makes you less prone to reacting with irritation, allows you to stay balanced.
For more information on coping with anger, please log onto: http://www.psychologytoday.com/blog/emotional5. freedom/201102/four-strategies-cope-anger-in-healthy-way

Second Step: A Curriculum for Violence Prevention

(U.S. Department of Justice Office of Justice Programs ,!2013)

Second Step Program Specications

New Rating: Effective Re-reviewed Date: February 2012 Program Type: Bullying Classroom Curricula Conict Resolution / Interpersonal Skills School/Classroom Environment Ethnicity: Asian African American White Gender: Both Age: 5 - 12 Target Settings: Suburban Urban Problem Behaviors: Aggression/Violence
U.S. Department of Justice Ofce of Justice Programs .!(2013).!Second Step: A Violence Prevention Curriculum.!Retrieved from http://www.ojjdp.gov/mpg/ mpgProgramDetails.aspx? ID=422

Second Step: A Violence Prevention Curriculum is designed to reduce impulsive and aggressive behavior in children by increasing their social competency skills. The program is composed of three grade-specific curricula: preschool/kindergarten (Pre/K), elementary school (grades 15), and middle school (grades 68). The curricula are designed for teachers and other youth service providers to present in a classroom or other group setting. A parent education component, A Family Guide to Second Step for Pre/K through grade 5, is also available. Students are taught to reduce impulsive, high-risk, and aggressive behaviors and increase their socioemotional competence and other protective factors. Intended for use with a broad population of students, the program has proven effective in geographically diverse cities in the United States and Canada, in classrooms varying in ethnic/racial makeup (predominantly African-American, predominantly European-American, or highly racially mixed), and in schools with students of varied socioeconomic status. The Second Step elementary curriculum consists of 15 to 22 thirty-five-minute lessons per grade level taught once or twice a week. Group discussion, modeling, coaching, and practice are used to increase students social competence, risk assessment, decision-making ability, self-regulation, and positive goal setting. The programs lesson content varies by grade level and is organized into three skill-building units covering the following: Empathy Training (teaches young people to identify and understand their own emotions and those of others) Impulse control and problem solving (helps young people choose positive goals, reduce impulsiveness, and evaluate consequences of their behavior in terms of safety, fairness, and impact on others) Anger management (enables youths to manage emotional reactions and engage in decision-making when they are highly aroused) The Second Step curriculum for middle school students is composed of eight to fifteen 50-minute lessons per grade level organized into four units: Unit 1 is centered on knowledge and describes violence as a societal problem. Unit 2 trains students in empathy and encourages emotionality through learning to find common ground with others, avoid labeling and stereotyping, using I messages, and active listening. Unit 3 combines anger management training and interpersonal problemsolving for reducing impulsive and aggressive behavior in adolescents. Unit 4 applies the skills learned in previous units to five specific situations: making a complaint, dealing with peer pressure, resisting gang pressure, dealing with bullying, and diffusing a fight. Students learn modeling behaviors through role-plays and videotapes. For more Second Step information, visit: http://www.ojjdp.gov/mpg/ mpgProgramDetails.aspx?ID=422

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Literature Review According to an article written by Cole, Treadwell, Dosani, and Frederickson (2012), research was conducted to measure the effectiveness of a cognitive-behavioral group anger management program called Learning How to Deal with our Angry Feelings (Cole et al., p. 82, Southampton Psychology Service, 2003). The motivation for completing this research stemmed from the theory of hostile attribution bias prevalent in children with social, emotional, and behavioral difficulties ( Cole et al., p.83, De Castro, Veerman, Koops, Bosch, & Monshouwer, 2002). According to this theory, many children who display excessive aggressive behavior interpret ambivalent situations as threatening. Moreover, this misinterpretation often leads to aggressive reactions because of their limited problem solving abilities. Therefore, Cole and colleagues geared their research toward cognitive- behavioral therapy because it is highly focused on the development of pro-social skills and cognitive restructuring. The researchers randomly assigned thirteen groups of 7-11 year old students to two different cohorts. Students used in the study were identified by teachers as having aggression issues. The first cohort received the intervention lessons for a period of time then was assigned to a period with no intervention. The second cohort was assigned to a nointervention period followed by a period with intervention. Measures of behavioral competency and teacher ratings of students aggressive behavior were collected at 3 different times during the study. It was hypothesized that cohort IN (intervention, no-intervention) would show more improvement than cohort NI (no intervention, intervention) between measurements 1 and 2 (Cole et al., 2012). Considering the fact that measure 1 was taken before any cohort received the intervention, and measure 2 was taken after only cohort IN received the intervention. Likewise, it was also hypothesized that cohort NI would display
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significant improvement between measures 2 and 3 and no improvement between measures 1 and 2 (Cole et al., 2012). This was based on the fact that measure 2 was taken before cohort NI received the intervention lessons and measure 3 was taken after. Results did not support the first hypothesis regarding improvement in study measures for cohort IN relative to cohort NI (Cole et al., 2012). However, the second hypothesis was supported according to the results of the study. Cohort NI showed significant improvement in understanding of anger and behavior ratings between measures 2 and 3 (Cole et al, 2012). This indicated retention of curriculum material and development of pro-social behavior in the classroom environment. Overall, these results point to an increase in students ability to self regulate their expression of anger as a result of cognitive-behavioral therapy. Tools for Getting Along (TFGA) is another cognitive-behavioral social problem solving curriculum circulating the education circuit. TFGA is designed to help students develop positive solutions to anger-provoking situations. The curriculum guides student decision making through six problem solving steps. In 2006, Daunic and colleagues conducted a study to measure the effectiveness of cognitive-behavioral interventions on students at risk for aggressive and disruptive behavior in the classroom. The research was conducted in order to address two main questions. Whether TFGA curriculum would increase the knowledge of problem solving strategies for target students and whether it would improve student ratings of aggression and anger expression (Daunic, Smith, Brank, and Penfield, 2006). It was hypothesized that this cognitive behavioral intervention would strengthen pro-social behavior and decrease student aggression and disruption. A preliminary study was conducted prior to the investigation in order to determine target
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students of the study. This resulted in 76 students from 17 classrooms being selected by teachers for having or being at risk of developing aggressive/disruptive behavior patterns differing from typical peer behavior (Daunic et al., 2006). A treatment wait/list control design was used during the research to preserve the validity of the study. The effectiveness of TFGA was measured using a variety of tools. A problem solving questionnaire was used to measure students problem solving development as a result of TFGA curriculum. Secondly, the Pediatric Personality (PPS-1 and 2) and Anger Expression PAES-3) scales were used to determine students anger control, suppression and expression. Lastly, a Reactive-proactive aggression scale (R/P) allowed teachers to rate students behavior. Results indicated that changes in knowledge and behavior of target students after TFGA exposure were positive and therefore supported the research hypothesis (Daunic et al., 2006). Researchers found that the curriculum decreased teacher ratings of target students proactive and reactive aggression. In addition, TFGA resulted in an increase in problem solving conceptual knowledge for both target students and typical peers. However, target students self-reports of anger expression did not decrease as a result of the TFGA curriculum. This could reflection of study limitations. According to Daunic et al. (2006), there were a few methodology and design issues in the study. For example, experimental groups were self-selected according to teachers decision to teach TFGA curriculum during the Spring or Fall semester. In addition, the 15 lessons built into the curriculum were taught in only 5-8 weeks. Lastly, there were significant between group demographic differences that could have affected the validity of the results as well. Perhaps a more longitudinal experiment that encompasses a more experimentally sound design could yield even more positive results about this cognitive-behavioral intervention.
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The selected intervention for the manual is a cognitive-behavioral based group curriculum called Second Step. This curriculum was chosen because of its incorporation of all the aforementioned effective strategies for aggression in children. Second Step is evidence based and proven effective for children ages 5-12 for both males and females. The curriculum has been researched in both suburban and urban areas for a variety of ethnicities. According to an article written by Frey, Nolen, Schoiack-Edstrom, Hirschstein (2005), research was conducted to evaluate the effectiveness of this school-based social competency program Second Step. Second Step curriculum is a form of cognitive behavioral therapy because it involves developing students thought processes and competencies in order to decrease anti-social behaviors. Within this violence prevention curriculum various skills are covered such as anger management, reduction of aggressive and impulsive behavior, interpersonal problem solving etc. In this study, 15 elementary schools were included in the sample. Schools were randomly assigned to the intervention group or the control group. The intervention group included two-thirds of the entire sample while the remaining one-third was assigned to the control group. The students in both groups were followed for two years. The intervention students were exposed to the Second Step curriculum while the control group was not. There were no significant differences between groups in regards to race/ethnicity or socioeconomic background. It was hypothesized that the students in the intervention group would display a decrease in aggressive/anti-social behavior compared to their baseline rating. In order for researchers to measure results, teachers of both the control group and intervention group were administered the School Social Behavior Scale (SSBS). Within this scale, they were asked to report students behavior frequency in 32 antisocial and 33 socially competent behaviors. In addition, students were administered
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surveys that assessed the likelihood of hostile goals through hypothetical vignettes. Students were asked to rate intentions of vignette characters and how likely there were to react with verbal aggression, physical aggression, or socially competent behavior. The ratings were based on a 5-point scale. According to Frey and colleagues (2005), the results supported the experimental hypothesis. During the first year of the study, the students in the intervention group who had a high antisocial behavioral baseline rating displayed a greater reduction in aggressive behaviors compared to students in the control group with a high antisocial baseline rating (Frey et al., 2005). This decrease is anti-social ratings was significant and reflected an increase in overall social competency for students who were exposed to the Second Step curriculum. This outcome also supports the overall hypothesis that cognitive behavioral therapy is an effective intervention strategy to use for aggression in students.

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RESOURCES
The American School Counselors Association recognizes the need for a decrease in school violence. As a result, within the ASCA position statement it is outlined that school counseling programs should include antibullying/harassment and violenceprevention programs along with comprehensive conflict-resolution programs to foster a positive school climate (ACSA, p.36). Similarly, the National Association of School Psychologists recognizes that bullying and relational aggression threatens the wellbeing of students within the school system. Within their position statement are guidelines that promote school psychology programs with interventions that decrease student aggression (NASP, 2011). Cognitive-behavioral therapy interventions include a heavy emphasis on promoting pro-social skills and developing students conflict resolution abilities. In order to decrease in-school bullying and violence, it is imperative that individual student aggression is decreased. Implementation of such interventions can aid in accomplishing the overall goal for ASCA and NASP of having safe and peaceful school environments across the country. Listed below are some national resources available for aggression and conflict resolution information.
ASCA Position Statement on Anti-bullying and violence prevention. http://www.schoolcounselor.org/files/PS_Bullying.pdf ASCA Resource Center: ASCA journal & magazine articles, webinars, lesson plans, publications, and web sites regarding anger management and relational aggression/conflict resolution. http:// www.schoolcounselor.org/resources.asp NASP Position Statement on School Safety http://www.nasponline.org/about_nasp/positionpapers/ schoolviolence.pdf NASP Aggression resources in Spanish: Includes strategies for prevention http://www.nasponline.org/ resources/translations/aggression_spanish.aspx NASP Crisis Resource in Spanish: Includes violence prevention info http://www.nasponline.org/resources/ crisis_safety/resources_spanish.aspx National Association of School Psychologists Resources: Variety of resources on topics such as aggression, bullying prevention and conflict resolution. http://www.nasponline.org/resources/index.aspx NASP Relational Aggression in Schools Information: Information on relational aggression and its warning signs and guidelines for decreasing relational aggression. http://www.nasponline.org/resources/bullying/ Relational_Aggression.pdf Preventing School Violence: A Plan for Safe and Engaging Schools: Data collection, and effective interventions. http://www.nasponline.org/resources/principals/Student 12.

REFERENCES
References American Academy of Child and Adolescent Psychiatry (2011). Understanding Violent Behavior in Children and Adolescents. Retrieved from http://www.aacap.org/cs/ root/facts_for_families/ understanding_violent_behavior_in_children_and_adolescents American School Counselor Association. (2012). Resource Center. (membership required). Retrieved from http://www.schoolcounselor.org/resources.asp American School Counseling Association. (2011). The professional school counselor and the promotion of safe schools through conflict resolution and bullying/harassment prevention. Retrieved from http://www.schoolcounselor.org/files/PS_Bullying.pdf Barry, T.D., Lochman, J.E. La agresin en los nios pequeos: estrategias para padres y educadores. National Association of School Psychologists. Retrieved from http:// www.nasponline.org/resources/translations/aggression_spanish.aspx Cole, R.L., Treadwell, S., Dosani, S., Frederickson, N. (2003). Evaluation of short-term, cognitive-behavioral intervention for primary age children with anger-related difficulties. School Psychology International, 34(1) 82100. DOI: 10.1177/0143034312451062 Daunic, A.P., Smith, W.S., Brank, E.M., Penfield, R.D. (2006). Classroom-based cognitive behavioral intervention to prevent aggression: Efficacy and social validity. Journal of School Psychology, 44(2) 123- 139.
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Dewar, Ph.D., G.!(2013).!Social skills activities for children and teenagers: Ideas inspired by research.!Parenting Science.!Retrieved from http://www.parentingscience.com/ social-skills-activities.html Feindler, E. L., & Scalley, M. (1998). Adolescent anger-management groups for violence reduction. In K. C. Stoiber, & T. R. Kratochwill (Eds.), Handbook of group intervention for children and families (pp. 100119). Needham Heights, MA: Allyn and Bacon. Frey, Karin S., Susan B. Nolen, Leihua Van SchoiackEdstrom, and Miriam K. Hirschstein. 2005. Effects of a School-Based Social Competence Program: Linking Childrens Goals, Attributions, and Behavior. The Journal of Applied Developmental Psychology 26:171200. Furlong, M.J., Felix, E.D., Sharkey, J.D., Larson, J. (2005). Preventing school violence: A plan for safe and engaging schools. National Association of School Psychologists. Retrieved from http://www.nasponline.org/resources/principals/Student%20Counseling %20Violence%20Prevention.pdf Milvain, C.!(1996).!Moral Reasoning as Part of a Primary School Programme.!Analytic Teaching, 17(1), 1-28. Retrieved!from!http://www.viterbo.edu/analytic/Vol. %2017%20no.1/moral1.20reasoning.pdf National Association of School Psychologists. Crisis resources in Spanish. Retrieved from http://www.nasponline.org/resources/crisis_safety/resources_spanish.aspx

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National Association of School Psychologists. NASP resources. Bethesda, MD. Retrieved from http://www.nasponline.org/resources/index.aspx National Association of School Psychologists. (2006). School violence (Position Statement). Bethesda, MD: Author. Retrieved from http://www.nasponline.org/ about_nasp/positionpapers/schoolviolence.pdf National Conference of State Legislatures, 2013. School Bullying. Washington. National Conference of State Legislatures. Retrieved from http://www.ncsl.org/issuesresearch/educ/school-bullying-overview.aspx National Youth Violence Prevention Resource Center, 2002.Facts for Teens: Aggression. Rockville, MD. National Youth Violence Prevention Resource Center. Retrieved from http://herkimercounty.org/content/departments/View/ 11:field=services;/content/DepartmentServices/View/68:field=documents;/ content/Documents/File/123.PDF Office of Justice Programs. Program file of Aggression Replacement Training. Retrieved from http://www.crimesolutions.gov/ProgramDetails.aspx?ID=254 Oroloff, M.D., J.!(2011).!Psychology Today.!Psychology Today.!Retrieved from http:// www.psychologytoday.com/blog/emotional-freedom/201102/four-strategiescope-anger-in-healthy-way U.S. Department of Justice Office of Justice Programs.!(2013).!Second Step: A Violence Prevention Curriculum.!Retrieved from http://www.ojjdp.gov/mpg/ mpgProgramDetails.aspx?ID=422
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Washington State Institute for Public Policy. 2004. Outcome Evaluation of Washington States Research-Based Programs for Juvenile Offenders. Olympia, Wash.: Washington State Institute for Public Policy. Young, E.L., Nelson, D.A., Warburton, B., Young, B.K. (2010). Relational aggression in schools: Information for educators. National Association of School Psychologists. Retrieved from http://www.nasponline.org/resources/bullying/ Relational_Aggression.pdf

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