Effectiveness of Cognitive-Behavioral Therapy in Reducing Classroom Disruptive Behaviors: A Meta-Analysis

NICHCY’s Structured Abstract 45 describes the following:

Title | Effectiveness of Cognitive-Behavioral Therapy in Reducing Classroom Disruptive Behaviors: A Meta-Analysis

Author | Ghafoori, B., & Tracz, S.M.

Source | ERIC Document Reproduction Service No. ED 457 182

Year Published | 2001

Abstract
A meta-analysis was conducted to evaluate the success of cognitive-behavioral therapy in reducing disruptive behaviors exhibited by school-age children in a school setting. Twenty-seven articles about studies using cognitive-behavioral therapy and a teacher measure of disruptive behavior were analyzed critically, and appropriate outcome measures were included in the analysis. Meta-analysis of these studies revealed that children who received cognitive-behavioral therapy displayed fewer disruptive behavior problems than did children who did not receive a cognitive-behavioral intervention. Cognitive-behavioral therapy used in conjunction with teacher-implemented contingencies was not found to be more effective in reducing disruptive behavior than cognitive-behavioral therapy alone. Also, no global difference in disruptive behavior was found relative to treatment administered in a school setting as compared to other settings. A difference in level of disruptive behavior was found with respect to the following factors: ethnicity, diagnosis, and socioeconomic status.

Background
Cognitive-behavioral therapy (CBT) has a strong research base as a form of psychotherapy used to treat disorders such as depression, anxiety, and phobias. This meta-analysis examined whether CBT is also an effective intervention for students with behavior disorders. There are many types of CBT, and they all share similar principles. Cognitive-behavioral therapy is often explained as a combination of two other forms of therapy—behavior therapy and cognitive therapy.   From behavioral therapy CBT borrows methods such as reinforcement to encourage positive responses to difficult situations. From cognitive therapy CBT borrows the concept that distorted thoughts about a situation can influence people’s attitudes and reactions in that situation. Within cognitive therapy, when people recognize their distorted thinking patterns, they can consciously change them.

Research Questions
This meta-analysis examined whether cognitive-behavioral therapy interventions are effective in reducing disruptive behavior in school. The studies were further analyzed to determine: (a) the effect of teacher-implemented contingencies; (b) the effect of the treatment setting; (c) the effect of socioeconomic status (SES); (d) the effect of ethnicity; and (e) the effect of a student’s diagnosis.

Research Design
Meta-Analysis*

  • Number of Studies Included | 27
  • Number of Subjects | N/A
  • Years Spanned | 1987-1997

Research Subjects
Students in elementary and middle schools with disruptive behavior problems.

Age/Grade of Subjects
Students in the studies ranged in age from 5 to 13 years old.

Specified Disability
Behavior Disorders

Intervention
All students in these studies participated in cognitive-behavioral therapy. In some studies students with behavior problems received both cognitive-behavioral therapy and teacher-implemented contingencies such as prompts and reinforcement.

Duration of Intervention
N/A

Findings

  1. This meta-analysis found that cognitive-behavioral therapy (CBT) was an effective form of treatment for school-age children with disruptive behavior.
  2. Teacher-implemented interventions (such as prompts and positive reinforcement) used in conjunction with CBT were found to be no more effective than interventions implemented by others.
  3. Treatments administered in school and nonschool settings were equally effective.
  4. Children classified as low socioeconomic status (SES) showed significantly greater changes in behavior than those children classified as low-middle SES.
  5. A test comparing children described as African American, Caucasian, mixed ethnicity, or other suggested that children classified as Caucasian showed significantly greater improvements in behavior than children classified as mixed ethnicity.
  6. Finally, differences between children described as having no diagnosis, ADD/ADHD, conduct disorder, or mixed diagnoses were calculated. The findings suggested that children classified as having a diagnosis of conduct disorder showed significantly greater improvements in behavior than did children classified with mixed diagnoses.

Combined Effects Size

  1. The overall mean effect size was 0.29.
  2. The effect size for teacher-implemented contingencies used in conjunction with CBT (ES = 0.27) was not significantly different than the effect size for CBT alone (ES = 0.30).
  3. The effect sizes were similar for both treatment settings: school setting (ES = 0.30) and nonschool setting (ES = 0.27).
  4. When children were compared by socioeconomic status, children classified as low socioeconomic status had a larger effect size than children classified as low-middle socioeconomic status (ES = 0.50 vs. ES = 0.21, respectively).
  5. By racial groups the effect sizes were: children described as predominantly African American (ES= .24), Caucasian (ES = .36), mixed ethnicity (ES = .10), or other (ES = .27).
  6. By diagnosis the effect sizes were: children described as predominantly having no diagnosis (ES =.29), ADD/ADHD (ES =.31), conduct disorder (ES =.43), or mixed diagnoses (ES =.11).

Conclusion/Recommendations
Cognitive-behavioral therapy (CBT) is an effective form of treatment for school-age children with disruptive behavior. This meta-analysis, however, did not find a difference between the effectiveness of teacher-implemented interventions in conjunction with CBT versus interventions utilizing CBT alone. The authors note that this finding is contrary to other literature in this area and suggest that the age of the students, the amount of teacher training in CBT, or use of CBT methods which were inappropriate for the classroom may explain this finding.

Students appear to benefit from CBT training regardless of the setting in which they learn it. The authors suggest that this may show that, once CBT is learned, it is easily generalized to new settings, but recommend further research.

Future Research
Further research is also recommended to determine why CBT appears to be the most beneficial to students who are Caucasian, have low SES, or have conduct disorders; and the least beneficial for students who are of mixed ethnicity, have low-middle SES, or have mixed diagnoses.

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* Meta-Analysis | A widely-used research method in which (1) a systematic and reproducible search strategy is used to find as many studies as possible that address a given topic; (2) clear criterion are presented for inclusion/exclusion of individual studies into a larger analysis; and (3) results of included studies are statistically combined to determine an overall effect (effect size) of one variable on another.

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