Does Cognitive Behavioral Therapy (CBT) for youth at risk for violence have a down side?

In last week’s New Yorker “Critic at Large”, Louis Menand, took on the cultural implications of various responses to depression, especially depression triggered by emotionally difficult but normal life events, like losing a job, or bereavement in the face of natural death. Yesterday, the head of JIPP, a gang prevention program in one of the most crime ridden neighborhoods in the country, published impacts on teen depression scores (along with more traditional markers of school achievement) for a program targeting youth at high risk of gang involvement in an LA school (www.jipp-la.org). What do these two things have to do with each other?
Menand’s article was triggered by Gary Greenberg’s book “Manufacturing Depression” that simultaneously argues: 1) difficult but normal emotions are not a sickness (depression); medicating them away is an economically driven policy propelled by the pharmaceuticals; 2) being upset is a healthy reaction to insane elements of a dysfunctional culture, cognitive behavior techniques for coping with that reaction are dangerous, because they promote acceptance of unacceptable life conditions.
The JIPP gang prevention program in LA has a psycho-social component, because many students in that program are depressed when they get there. Few could argue their wholesale depression is manufactured by repackaging normal life responses as abnormal. Most of these kids have direct experience of the murder of a friend or family member. Many have been physically or sexually abused. Most have no certainty that where they live today will be a home for them next month. These students are not good candidates for medication. Among other reasons, they don’t have the health care that would pay for it. What about CBT?
Ripple Effects self-directed training software is the heart of the psychosocial component of the JIPP intervention, which is why I got the notice of new findings yesterday. It teaches the cognitive behavioral techniques that Greenberg is convinced indoctrinates people with optimism at the expense of needed social-political change. The fact that students in the JIPP program reported feeling 127% more “normal” from pre to post intervention, despite their exposure to unmerciful life conditions can be read two ways. It seems positive on its face, but what of the social critique? Are we teaching them it is “normal” to function in gang ridden, poverty constrained conditions?
Hopefully not. We are teaching them that they are strong enough to survive even harsh life circumstance. Does that mean they should accept those circumstances as their lot? Unequivocally not. CBT and other internal strategies, such as mindfulness practice, do not intrinsically oppose either the talk therapy that Greenberg believes in, or the social action that unjust conditions most often require. This is why the JIPP program includes leadership training as well as CBT techniques. It is why Ripple Effects software not only provides young people with CBT to help survive what they should never have to endure, but also provides training in community organizing techniques to prepare them to change the systemic conditions of their lives. Tutorials include “confronting injustice” along with “controlling thoughts,” and (dealing with) “racism”, as well as “managing feelings” (link to Ripple Effects list of topics for teens). We congratulate the JIPP program on success so far, and believe that early CBT intervention for depression, paired with leadership training, will lead to more active, not more passive citizens on every level. To see the research report on Ripple Effects in the JIPP program: www.rippleeffects.com/ojjdp

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