Last updated: September 2010 www.ojjdp.gov/mpg

Cognitive–Behavioral Treatment 

Cognitive–Behavioral Therapy/Treatment1 (CBT) is a problem-focused approach to helping people 

identify and change the dysfunctional beliefs, thoughts, and patterns of behavior that contribute to their 

problems. Its underlying principle is that thoughts affect emotions, which then influence behaviors. 

CBT combines two very effective kinds of psychotherapy: cognitive therapy and behavioral therapy. 

Cognitive therapy concentrates on thoughts, assumptions, and beliefs. With cognitive therapy, people 

are encouraged to recognize and to change faulty or maladaptive thinking patterns. Cognitive therapy 

is a way to gain control over inappropriate repetitive thoughts that often feed or trigger various 

presenting problems (Beck 1995). For instance, in a young person who is having trouble completing a 

math problem, a repetitive thought may be “I’m stupid, I am not a good student, I can’t do math.” 

Replacing such negative thoughts with more realistic thoughts, such as “This problem is difficult, I’ll 

ask for help,” is a well-tested strategy that has been found to help many young people face their 

academic problems. 

Behavioral therapy concentrates on specific actions and environments that either change or maintain 

behaviors (Skinner 1974; Bandura 1977). For instance, when someone is trying to stop smoking, the 

individual often is encouraged to change his or her daily habits. Instead of having a cup or coffee upon 

waking—which may trigger the urge to have a cigarette—the person is encouraged to take a morning 

walk. Replacing negative behaviors with positive behaviors is a well-known strategy to help change 

behaviors, particularly when the new behavior is reinforced. 

The combination of cognitive therapy and behavioral therapy has proven highly beneficial. For 

example, in the midst of a panic attack, it may feel impossible to gain control over thoughts and apply 

cognitive therapy techniques. In this case, a behavioral technique such as deep breathing may be easier 

to implement, which may help to calm and focus thinking. 

1This is also referred to as Cognitive–Behavior Therapy, which gives the behavioral components of CBT more emphasis. 

Another known term is Cognitive–Behavioral Treatment. Because of the proven success of CBT, many practitioners and 

theorists have drawn on its theoretical foundations and have extended them to be useful in many different situations. Such 

extensions include Rational Emotive Behavioral Therapy (Ellis and Harper 1975), Moral Reconation Therapy, and Dialectical 

Behavior Therapy (Trupin et al. 2002). For purposes of this review, programs are included that are theoretically based on, and 

use facilitative strategies drawn from, cognitive therapy and behavioral therapy. 

Suggested Reference: Development Services Group, Inc. 2010. “Cognitive Behavioral Treatment.” Literature review. 

Washington, D.C.: Office of Juvenile Justice and Delinquency Prevention. 

https://www.ojjdp.gov/mpg/litreviews/Cognitive_Behavioral_Treatment.pdf

Prepared by Development Services Group, Inc., under cooperative agreement number 2013–JF–FX–K002. Points of view or 

opinions expressed in this document are those of the author and do not necessarily represent the official position or policies of 

OJJDP or the U.S. Department of Justice.

 Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov 1 
The distinctive features of CBT are as follows: 

 It is the most evidence-based form of psychotherapy. 

 It is active, problem focused, and goal directed. In contrast to many “talk therapies,” CBT 

emphasizes the present, concentrating on what the problem is and what steps are needed to 

alleviate it. 

 It is easy to measure. Since the effects of the therapy are concrete (i.e., changing behaviors), the 

outcomes tend to be quite measurable. 

 It provides quick results. If the person is motivated to change, relief can occur rapidly. 

The studies reviewed provide consistent empirical evidence that CBT is associated with significant and 

clinically meaningful positive changes, particularly when therapy is provided by experienced 

practitioners (Waldron and Kaminer 2004). CBT has been successfully applied across settings (e.g., 

schools, support groups, prisons, treatment agencies, community-based organizations, churches) and 

across ages and roles (e.g., students, parents, teachers). It has been shown to be relevant for people with 

differing abilities and from a diverse range of backgrounds. Studies have found that parents perceive 

CBT favorably and prefer CBT to pharmacotherapy for treating both externalizing and internalizing 

disorders (Brown et al. 2007). 

The strategies of CBT have been used successfully to forestall the onset, ameliorate the severity, and 

divert the long-term consequences of problem behaviors among young people. Problem behaviors that 

have been particularly amenable to change using CBT have been 1) violence and criminality, 2) 

substance use and abuse, 3) teen pregnancy and risky sexual behaviors, and 4) school failure. Across 

the range of continuum-of-care, many model programs have successfully incorporated the strategies of 

CBT to effect positive change. 

The future of CBT may involve its integration with other types of approaches. For instance, integration 

of CBT with motivational interviewing may increase treatment effectiveness among less compliant 

individuals and populations (Zinbarg et al. 2010). Integrating CBT with strengths-based approaches 

may similarly yield improved outcomes (Zinbarg et al. 2010). This type of integration may be 

particularly important for achieving improved outcomes with delinquent youth. 

Delinquency, Criminality, and Violence Prevention 

The most widely used approaches to treatment in criminal justice today are variations of CBT (Little 

2005). Distorted cognition is one of the most notable characteristics of chronic offenders (Beck 1999). 

Faulty thought processes include self-justificatory thinking, misinterpretation of social cues, deficient 

moral reasoning, and schemas of dominance and entitlement (Lipsey, Chapman, and Landenberger 

2001). Cognitive–behavioral treatments for juvenile offenders are designed to correct dysfunctional 

thinking and behaviors associated with delinquency, crime, and violence. Moral Reconation Therapy 

is one CBT approach that has been implemented successfully in a host of correctional systems, such as 

residential juvenile facilities and boot camps, and in numerous other venues, such as schools and job 

training programs (Little 2001). 

Meta-analyses of programs designed for criminal offenders have shown cognitive–behavioral 

programs to be highly effective in reducing recidivism rates (Little 2005; Lipsey, Chapman, and 

Landenberger 2001; Pearson et al. 2002; Wilson, Bouffard, and MacKenzie 2005; Walker et al. 2004). A 

meta-analysis by Landenberger and Lipsey (2005) looked at whether certain components of CBT 

programs used with adult and juvenile offenders were associated with greater recidivism effect sizes. 

They concluded that programs with better implementation quality and fidelity, along with higher-risk 

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offender populations, were associated with greater effect sizes. Programs incorporating anger control 

and interpersonal problem-solving components enhanced effectiveness, while those incorporating 

victim impact and behavior modification components diminished effectiveness. Programs were equally 

effective for adult and juvenile populations. Programs with the most effective CBT implementation and 

components corresponded to a decrease in recidivism of 50 percent, compared with a control condition. 

Examples of successful programs that draw on CBT are Operation New Hope and SAFE–T. 

Many of the model programs that target young people who are at risk for delinquency often involve 

the family in applying the strategies of CBT. Some model programs that have proven successful in this 

area include Functional Family Therapy, Multisystemic Therapy, and the Michigan State Diversion 

Project. Multiple context approaches such as these that encourage CBT implementation in the home 

and in the school have demonstrated their effectiveness at positively changing the life course of some 

of these young people (Brosnan and Carr 2000). A good example of a multicontext program is FAST 

Track. Techniques used to promote change include modeling, reframing and reattribution, and 

behavioral training. 

Substance Use and Abuse 

Particularly for young people, the initial draw to smoking cigarettes, drinking alcohol, or doing drugs 

is the perception that everyone experiments or uses (Prokhorov et al. 1993). The primary prevention 

strategy used by many model programs is to alter these faulty beliefs and attitudes about the 

universality of alcohol, tobacco, and other drug use, and to teach young people the behaviors needed 

to refuse if, or when, presented with the opportunity (Botvin, Botvin, and Ruchlin 1998). Evidence 

suggests that resistance skills are essential protective factors for the reduction of substance use in 

adolescence (Dusenbury and Falco 1995). For some successful program examples, see LifeSkills® 

Training and the Midwestern Prevention Project. 

Other cognitive–behavioral based programs that target substance use and related problems view use 

as a learned behavior that is initiated and maintained in the context of environmental factors (Waldron 

and Kaminer 2004). Programs built on this premise concentrate on helping young people anticipate and 

avoid high-risk situations as a means to facilitate abstinence. Techniques used to facilitate change 

include identifying the circumstances surrounding use, learning strategies to manage urges and 

cravings, and remembering to engage in positive behaviors (Kaminer 2004). 

For more advanced use and abuse issues, successful programs such as Adolescent Portable Therapy 

have involved the family in the treatment. There are quite a few model programs that concentrate on 

the family in general and on parenting in particular. These well-evaluated, science-based programs 

often incorporate CBT in their facilitative strategies (Ferrer–Wreder et al. 2003; Taylor and Biglan 1998) 

(see Program Types Parent Training and Family Therapy for more details). 

Teen Pregnancy and Risky Sexual Behavior 

Programs designed to significantly reduce harm related to adolescent sexual behavior have also found 

that using CBT strategies contribute to the overall effectiveness. These programs are designed to 

forestall the initiation of sexual activity or address the health needs of adolescents who are currently 

sexually active. The emphasis of these latter programs is on reducing a range of behaviors that include 

unprotected intercourse, sexually transmitted diseases, and unintended pregnancy. Practical and 

Cultural Education (PACE) Center for Girls is one model program that includes sexual health in its 

curriculum. The program concentrates on helping at-risk adolescent girls make positive lifestyle 

choices. Many of these students had been the victims of physical, emotional, or sexual abuse, and a 

portion of them had prior pregnancies. The curriculum, which encourages girls to have healthy 

 Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov 3 
attitudes and make positive choices regarding their health, has shown to decrease subsequent 

pregnancies (Harrington 2001). For another promising program that uses CBT–based strategies to 

strengthen girls’ protective knowledge, attitudes, and behaviors about the origins and modes of 

transmitting HIV/AIDS, see Urban Women Against Substance Abuse. 

School Failure 

There are numerous programs designed to promote academic competence in children and teens by 

using strategies based on the foundations of CBT (McLaughlin and Vacha 1992; Wilson, Lipsey, and 

Derzon 2003; Wood and O’Malley 1996). Often one of the strongest pathways to school failure is selfdefeating, attributional biases (Ferrer–Wreder et al. 2003). These biases are negative, self-blaming 

thoughts about poor performance that are based on a history of failure and skill deficits. These 

attributions can influence students to behave in ways that reinforce these negative thoughts and 

increase their chances of actual failure (Nurmi 1993). 

Research provides support for the relations between these negative achievement strategies, a range of 

youth problem behaviors, and adult adjustment difficulties (Calabrese and Adams 1990; Costa, Jessor, 

and Turbin 1999; Durlak 1997; Eronen and Nurmi 1999; Schulenberg, Maggs, and Hurrelmann 1997). 

Many academic achievement programs directly target these negative thoughts and reinforce positive 

behavior by using CBT strategies delivered by teachers, mentors, tutors, peers, and school staff. Some 

of the strategies to be found most effective are those that draw on the behavioral strategies posited by 

Skinner’s Operant Conditioning Theory (e.g., positive reinforcement of positive behaviors and having 

well-defined rules and consequences) and Bandura’s Social Learning Theory (e.g., providing 

opportunities for positive peer role-modeling). 

These have been applied at many different levels: at the individual level (e.g., one-on-one mentoring 

programs, such as Across Ages), the classroom level (e.g., classroom management programs, such as 

The Incredible Years), the school level (e.g., schoolwide programs, such as the School Transitional 

Environment Program), and within the community (programs such as Movimiento Ascendencia). 

School-based behavior management strategies often fall into four categories: structured playground 

activities; behavioral consultation; behavioral monitoring and reinforcement of attendance, academic 

progress, and school behavior; and special educational placements for disruptive, disturbed, and 

learning-disabled students. 

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