Cognitive Behavior Therapy is paving the path to becoming a leader in combating crime reduction and criminal offending, according to a report by the Manhattan Institute.
In light of the 40% rise in mental-health diagnoses in state and federal prisoners cases across the nation, CBT is an effective means of addressing criminal behavior in jails and prisons to reduce recidivism, the report said.
Timothy Fitzgerald, program director for Integrated Substance Use Disorder Treatment at San Quentin said CBT is necessary in prisons since most people will eventually go home and need the treatment to be successful post-release.
“Would you rather have everyone sitting in cell with no pro-social skills, or come to classes and learn these skills so the recidivism rate can drop significantly?” said Fitzgerald.
CBT is a psychotherapy that strives to combat distress and problematic behaviors by helping individuals “identify, challenge, and change maladaptive thought patterns in order to change their responses to difficult situations.” CBT is aimed at changing current behaviors by utilizing solution-oriented techniques and strategies that allow the individual to develop new emotional and behavioral responses.
“The biggest thing for me was I had distorted thinking that was altering my perception of reality,” said Stephen Greel, Peer Mentor at ISUDT. “I had a good guy stance which means I would always try to change the narration of the circumstances to make it look like I was a good guy, when in reality I wasn’t.”
According to a Campbell Systematic Review by Mark W. Lipsey, Nana A. Landenberger, and Sandra J. Wilson centered on 58 studies evaluating the effectiveness of CBT-based methods and its effect on recidivism, they found on average that CBT reduced recidivism by about a quarter, from 40% in the typical control group and 30% among those treated.
Despite the promising results and concept of CBT, it does not always prove to be the most effective form of criminal behavior treatment.
A meta-analysis in Lancet Psychiatry review showed that using randomized controlled trials, the gold standard research method for evaluation that keeps things fair and unbiased, showed in six CBT studies that it had no effect on recidivism.
The authors also noted the lack of high-quality research on CBT in correctional settings does not provide substantial evidence if this form of treatment can be consistently achieved under average conditions.
The use of reward/penalty scheme to modify behavior was associated with worse outcomes. Incentives such as good-behavior credits and sentence reductions can prove to be desirable incentives, but also can attract participants that are not committed to the work and thus prove to be ineffective for ulterior motives, cited the article.
The article argues that while CBT is a statistically proven program that reduces recidivism, it should not be the only form of treatment for incarcerated individuals and not the sole remedy for criminal offending.
Alongside with mentalhealth programs, other services such as housing and employment programs should be complemented with CBT as these factors can directly affect recidivism rates.
Greel said that CBT is not the only option for recidivism reduction because people are different and complex.
“CBT focuses on our thoughts and actions, and we need to identify those triggers to help us succeed; and if people don’t have those community resources, they will feel like they have fewer options, which could lead to reoffending or what led to their criminality in the first place,” Greel said.
The article noted that high-quality facilitators and healthcare workers were proven to enhance the treatment results and overall value of the process.
Fitzgerald said the most effective solution to addiction is connection. He said that the program works well due to the team of peer mentors and participants who share their lived experiences in safe spaces with OMCP mentors and staff counselors, with incarcerated mentors facilitating teach backs to other residents and staff members.
“Society, family, and the system has given up on addicts and alcoholics, but in come us to instill hope into them in prison systems to one day overcome these issues and never come back again; and that’s the payoff for us,” Fitzgerald said. “The pleasure we used to get from drugs and alcohol is replaced with the pleasure of helping others get over their addictions.”
San Quentin Rehabilitation Center proves to be a statewide leader in CBT programming as major programs such as Guiding Rage into Power, Victim Offender Education Group, and No More Tears have an almost zero percent recidivism rate.
Greel plans to achieve his certification as an ISUDT counselor and hopes to return to prisons in the future to continue his life work.
“I used to have severe mental illness issues, using all kinds of anti-psychotics and mood stabilizers,” Greel said. “Right now, I’ve been off medication for 6 years, sober for 5 years, in a Level Two prison, and not imposing the problem on others.”
