This chapter presents a combined creative-corrective approach to working with the bereaved by emphasizing on cognitive assessment as a tool for social workers. It determines how best to facilitate an adaptive grief process with individuals who experience traumatic loss or complicated grief. Cognitive therapies (CT) and cognitive behavior therapies (CBTs) were found suitable with individuals suffering from posttraumatic stress disorder (PTSD), anxiety, and chronic or traumatic grief. Grief as a process of reorganizing one’s life and searching for a meaning following a loss through death is a painful experience. The Adversity Beliefs Consequences (ABC) model is based on a cognitive theoretical model to be applied in treatment of bereaved individuals. Like other cognitive models, rational emotive behavior therapy (REBT) emphasizes the centrality of cognitive processes in understanding emotional disturbance, distinguishing between two sets of cognitions that people construct, rational and irrational ones and their related emotional and behavioral consequences that differ qualitatively.
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This chapter reviews the basic tenets of evidence-based practice (EBP), and discusses the potential applications of this model of practice and training for the field of clinical social work. It also presents some actual illustrations of its use. The chapter describes the major forms of clinical outcome studies: Anecdotal Case Reports, Single-System Designs With Weak Internal Validity, Quasi-Experimental Group Outcome Studies, Single, Randomized Controlled Trial, Multisite Randomized Controlled Trials and Metaanalyses that comprise the priority sources of information underpinning EBP. As the human services increasingly develop robust evidence regarding the effectiveness of various psychosocial treatments for various clinical disorders and life problems, it becomes increasingly incumbent upon individual practitioners to become proficient in, and to provide, as first choice treatments, these various forms of evidence-based practice. It is also increasingly evident that cognitive behavior therapy (CBT) and practice represents a strongly supported approach to social work education and practice.
This chapter describes the relevance of critical thinking and the related process and philosophy of evidence-based practice (EBP) to cognitive behavior therapy and suggests choices that lie ahead in integrating these areas. Critical thinking in the helping professions involves the careful appraisal of beliefs and actions to arrive at well-reasoned ones that maximize the likelihood of helping clients and avoiding harm. Critical-thinking values, skills and knowledge, and evidence-based practice are suggested as guides to making ethical, professional decisions. Sources such as the Cochrane and Campbell Collaborations and other avenues for diffusion, together with helping practitioners and clients to acquire critical appraisal skills, will make it increasingly difficult to mislead people about “what we know”. Values, skills, and knowledge related to both critical thinking and EBP such as valuing honest brokering of knowledge, ignorance and uncertainty is and will be reflected in literature describing cognitive behavior methods to different degrees.
Over the past 25 years there has been a growing recognition of the importance of working with families of persons with severe mental illnesses such as schizophrenia, bipolar disorder, and treatment-refractory depression. Family intervention can be provided by a wide range of professionals, including social workers, psychologists, nurses, psychiatrists, and counselors. This chapter provides an overview of two empirically supported family intervention models for major mental illness: behavioral family therapy (BFT) and multifamily groups (MFGs), both of which employ a combination of education and cognitive behavior techniques such as problem solving training. Some families have excellent communication skills and need only a brief review, as provided in the psychoeductional stage in the handout “Keys to Good Communication”. One of the main goals of BFT is to teach families a systematic method of solving their own problems.
Over the years, cognitive behavior therapy (CBT) has been applied to a variety of client populations in a range of treatment settings and to the range of clinical problems. This chapter provides a general overview of the cognitive behavior history, model, and techniques and their application to clinical social work practice. It begins with a brief history and description, provides a basic conceptual framework for the approach, highlights the empirical base of the model, and then discusses the use of cognitive, behavior, and emotive/affective interventions. Cognitive behavior therapy is based on several principles namely cognitions affect behavior and emotion; certain experiences can evoke cognitions, explanation, and attributions about that situation; cognitions may be made aware, monitored, and altered; desired emotional and behavioral change can be achieved through cognitive change. CBT employs a number of distinct and unique therapeutic strategies in its practice.
Social work professionals are in key roles for providing effective education, treatment, training, and services for adult survivors. This chapter helps the social workers to equip with an evidence-based treatment framework to effectively enhance their work with this population of adult survivors. A community study of the long-term impact of the sexual, physical, and emotional abuse of children concluded that a history of any form of abuse was associated with increased rates of psychopathology, sexual difficulties, decreased self-esteem, and interpersonal problems. There is well-established and increasing empirical evidence that cognitive and cognitive behavior therapies are effective for the treatment of disorders that are typical among adult survivors of sexual and physical abuse. The chapter presents some basic cognitive behavior therapy (CBT) strategies that social workers can use in whatever roles they play in working with the multidisordered adult survivor. There are three types of schema avoidance: cognitive, emotional and behavioral.
Cognitive behavior theory attempts to deconstruct individual differences in vulnerability, adaptation, and development of psychopathology, through systematic assessment of a client’s thoughts and behaviors, and use of empirically validated interventions. This chapter presents an overview of depression, demonstrates empirical support for CBT and clarifies its potential usefulness in social work settings. Albert Ellis’s rational emotive behavior therapy (REBT) was developed in the 1950s. Albert Ellis’s REBT model uses cognitive restructuring to change irrational thoughts. Behavior therapy is founded on the premise that when environmental consequences are linked to particular behaviors, the consequence either increases or decreases the likelihood of a person responding in the same manner when confronted with similar stimuli in the future. Despite extensive research into variables that might contribute to suicidal behaviors, evaluating suicide risk continues to be both clinically difficult and scientifically imperfect for mental health providers.
This chapter offers a brief and focused review of human development, with specific emphasis on cognition and emotion. It is essential that the reader distinguishes between cognitive development, cognitive psychology, and cognitive therapy. Both short-term and long-term memory improve, partly as a result of other cognitive developments such as learning strategies. Adolescents have the cognitive ability to develop hypotheses, or guesses, about how to solve problems. The pattern of cognitive decline varies widely and the differences can be related to environmental factors, lifestyle factors, and heredity. Wisdom is a hypothesized cognitive characteristic of older adults that includes accumulated knowledge and the ability to apply that knowledge to practical problems of living. Cognitive style and format make the mysterious understandable for the individual. Equally, an understanding of an individual’s cognitive style and content help the clinician better understand the client and structure therapeutic experiences that have the greatest likelihood of success.
Clinical social workers have an opportunity to position themselves at the forefront of historic, philosophical change in 21st-century medicine. As is so often true for social work, the opportunity is associated with need. For social workers, in their role as advocates and clinicians, this unmet need would seem to create an obligation. This chapter argues that, if choosing to accept the obligation, social workers can become catalysts for vitally needed change within the medical field. While studies using the most advanced medical technology show the impact of emotional suffering on physical disease, other studies using the same technology are demonstrating Cognitive behavior therapy’s (CBT) effectiveness in relieving not just emotional suffering but physical suffering among medically ill patients. While this chapter discusses the clinical benefits and techniques of CBT, it also acknowledges the likelihood that social work will have to campaign for its implementation in many medical settings.
Social workers have a long history of working with abused children and adolescents. This chapter focuses on the clinical treatment of the abused child or adolescent using a cognitive behavior approach (CBT). It familiarizes the reader with the treatment of children and adolescents who are experiencing impairment as a result of post-traumatic stress associated with their history of abuse. The chapter focuses on the treatment of children who have been victims of physical and/or sexual abuse. Child abuse is a widespread problem that impacts society on a variety of levels having long lasting effects on the child, the family, and the community. The use of CBT in clinical social work with abused children and adolescents offers an opportunity to utilize treatment that has been shown to be effective in reducing posttraumatic stress disorder (PTSD) symptoms.
Most Behavioral Group Therapy (BGT) with children and adolescents include aspects of problem solving or social skills training or both. This chapter describes group workers can make an important contribution to children, families, and schools through preventive and remedial approaches. Social skills training grew out of the clinical observation and research that found a relationship between poor peer relationships and later psychological difficulties. The social skills program taught the following four skills: participation, cooperation, communication, and validation/support. The chapter focuses on the unique application of behavioral treatment using groups with an emphasis on assessment, principles of effective treatment, and guidelines for the practitioner. It also focuses on the use of the group in describing these aspects of BGT. The primary goal of using BGT with children is enhancing the socialization process of children, teaching social skills and problem solving, and promoting social competence.
This chapter discusses the treatment of comorbid chronic depression and personality disorders. It then discusses recent treatment advances in the cognitive behavior field relevant to this population. Recently, research has been done comparing schema therapy to Otto Kernberg’s latest model. Because of severe emotional distress, patient often experience suicidal and/or parasuicidal behaviors. The chapter explores the benefits of mode work with these particular difficulties while maintaining a therapeutic approach of connection and compassion; this alliance is crucial for the approach to be effective. It focuses on the five most common modes for those with chronic depression and personality disorders namely the abandoned/abused mode, the detached protector mode, the angry mode, the punitive mode and the healthy adult mode. The interventions described in schema mode therapy have cognitive, experiential, and behavioral components. Identification of the mode the patient is in when suicidal is essential when managing a crisis.
School social workers provide direct treatment for a multitude of problems that affect child and adolescent development and learning; these problems include mood disorders, attention deficit hyperactive disorder (ADHD), disruptive behavior disorders, and learning disorders, as well as child abuse and neglect, foster care, poverty, school drop out, substance abuse, and truancy, to name but a few. This chapter examines four constructs that are important when working with students. These constructs include: assessment and cognitive case conceptualization, the working alliance, self-regulated learning, and social problem solving. The chapter discusses the development of attainable and realistic goals is a critical component both of self-regulated learning and social problem solving. The chapter examines the problem of academic underachievement and four constructs that are critically important when working with children and adolescents in school settings. Academic underachievement is a serious problem affecting the lives of many children.
When Charles, a 46-year-old divorced male with an extensive psychiatric history of depression, substance abuse, and disordered eating resulting in a suicide attempt, erratic employment, and two failed marriages, began treatment with a clinical social worker trained in dialectical behavior therapy (DBT), he was an angry, dysphoric individual beginning yet another cycle of destructive behavior. This chapter provides the reader with an overview of the standard DBT model as developed by Linehan. Dialectical behavior therapy, which engages vulnerable individuals early in its treatment cycle by acknowledging suffering and the intensity of the biosocial forces to be overcome and then attending to resulting symptoms, appears to be the model most congruent with and responsive to the cumulative scientific and theoretical research indicating the need for the development of self-regulatory abilities prior to discussions of traumatic material or deeply held schema.
Social workers are committed to the protection and empowerment of weak populations, of those people who are least powerful. Gradually, social work started to rely more on problem-solving methods, client-focused therapy, family theories, and, more recently, cognitive behavior theories, constructivist theories, and positive psychology developments. Clinical social work today operates in a variety of settings in the statutory, voluntary, and private sectors. Clinical social workers have always been interested in helping clients change effectively. The importance of empirical study, valid information, and intervention effectiveness has always been accentuated by the social work field’s central objectives of increasing accountability, maintaining exemplary ethics and norms, and establishing clear definitions and goals. Cognitive behavior theory emphasizes several components. First and foremost, human learning involves cognitive mediational processes. Social workers need to look for effective methods for change, and CBT methods are very promising in this respect.
The emotional pain and concomitant psychological and behavioral consequences of couple relationship distress are rivaled by few other life crises and stresses. Negative reciprocity has been found to exist to a degree in both distressed and nondistressed couples. This chapter provides a view of the evolution of Cognitive Behavior Couple Therapy (CBCT) identifying the predominant influence of Behavioral Marital Therapy (BMT) along with the work of early cognitivists. The chapter also provides social workers with effective methods for the treatment of problems in intimate committed relationships. It presents conceptualization of couple functioning and treatment and clinical procedures that are highly relevant for same gendered couples. The chapter depicts the use of cognitive behavior methods to ameliorate problems in intimate relationships. Communication problems have been identified as the greatest area of limitation among unhappy couples. Cognitive behavioral couple therapy is comprised of approaches that are compatible with evidence-based practice.
Cognitive behavioral therapy (CBT) with children addresses four main aims: to decrease behavior, to increase behavior, to remove anxiety, and to facilitate development. Each of these aims targets one of the four main groups of children referred to treatment. This chapter suggests a route for applying effective interventions in the day-to-day work of social workers who are involved in direct interventions with children and their families. An effective intervention is one that links developmental components with evidence-based practice to help enable clients to live with, accept, cope with, resolve, and overcome their distress and to improve their subjective well-being. CBT offers a promising approach to address such needs for treatment efficacy, on the condition that social workers adapt basic CBT to the specific needs of children and design the intervention holistically to foster change in children. Adolescent therapy covers rehabilitative activities and reduces the disability arising from an established disorder.
The clinical social worker typically interfaces with older adult clients and their families in a variety of settings, providing diverse services ranging from assessment to clinical treatment to referral. This chapter discusses the ways in which cognitive behavior therapy (CBT) techniques can be used by social workers across different milieu to assist elderly clients who may be suffering from depression. These settings include the client’s home, an inpatient or outpatient mental health facility, a hospital or medical setting, a long-term care facility, or a hospice setting. The chapter provides an overview of how cognitive behavior techniques can be integrated throughout the range of services social workers may provide to elderly clients. Clinical examples demonstrate the use of CBT in a variety of settings. For many older adult clients, issues related to the need for increasing dependence on family, friends, and paid caretakers may become the central focus of counseling.
This chapter explores how and why mindfulness has emerged in recent years as an important intervention in cognitive behavior theory (CBT) both as a stand alone treatment and woven into more complex treatments. It introduces the core skills of mindfulness as described by Linehan and discussed how they are useful to clients and to social workers. The chapter provides an example of how mindfulness, combined with good social work and other treatments, succeeded with a depressed veteran with chronic pain and a history of heroin dependence. In cognitive behavior theory and research treatment development will continue. How mindfulness is incorporated into existing treatment will change according to the research and new treatments will emerge. The principles of mindfulness, however, will remain. They are ancient and changeless and will always be of use to those seeking shelter from the suffering of life.
The contents of social work interventions in the future will likely be highly determined by technological and medical advances. Modern society has discovered remarkable ways to extend people’s lives, helping them live longer, live with illnesses that caused death in the past, and cope with traumatic threats to their lives. Modern life has enabled a shift from a human preoccupation with basic survival needs to questions about the quality of life. Recognition of the role of emotions in behavioral change and in human functioning has opened a whole new world to social workers, legitimizing a focus on internal events, affects, and awareness rather than a concern with mainly environmental causes for human disorders. Growing consensus in the profession about the need to address subjective well-being and emotional disorders will necessitate new modes of intervention.
This chapter discusses some of the critical issues surrounding culture and cognitive behavioral methods in order to better inform the advancement of culturally responsive social work practice. It focuses on one such treatment modality, cognitive behavior therapy (CBT). The chapter reviews relevant theoretical frameworks, existent empirical studies on CBT with diverse cultural groups, strengths and limitations of this modality across cultures, and suggestions for culturally responsive CBT practice, in order to better inform social work practice. While cognitive behavior therapy was developed with universal assumptions and without consideration to the diversity of the cultural contexts of consumers, it is grounded in theory that is likely to have “some universal basis across populations”. Several studies have described the use of cognitive behavior methods with gay and lesbian clients, particularly the use of rational emotive therapy, cognitive restructuring, and behavior experiments.
Community-based epidemiological studies find that when grouped together, anxiety disorders are the most common mental health conditions in the United States apart from substance use disorders. Anxiety disorders are also associated with substantial impairments in overall health and well-being, family functioning, social functioning, and vocational outcomes. This chapter includes a brief description of the anxiety disorders followed by a more detailed review of the cognitive behavior interventions indicated for these conditions. Social phobia is the most common anxiety disorder in the United States. Panic attacks are sudden surges of intense anxiety that reach their peak with 10 minutes and involve at least 4 of a list of 13 symptoms. Another somewhat less common anxiety disorder is obsessive compulsive disorder. The chapter discusses the posttraumatic stress disorder (PTSD). Two anxiety management procedures, breathing retraining and deep muscle relaxation, have been subject to some level of empirical investigation for certain anxiety disorder.
The treatment of the suicidal individual is perhaps the most weighty and difficult of any of the problems confronted by the clinical social worker. Some frequent comorbid pathology with suicidal behavior includes alcoholism, panic attacks, drug abuse, chronic schizophrenia, conduct disorder in children and adolescents, impulse control deficits, schizophrenia, and problem-solving deficits. Suicidal harmful behavior appears in all ages and characterizes clients in a large spectrum of life. There are four types of suicidal behavior namely rational suicider, psychotic suicider, hopeless suicider and impulsive or histrionic suicider. This chapter presents some primarily cognitive techniques for challenging suicidal automatic thoughts. Recent reports suggest that individuals suffering from alcohol or substance abuse are at an increased risk both for attempting, and for successfully completing, a suicidal act. The therapist must develop an armamentarium of cognitive techniques, and the skills to use these effectively in ways that are appropriate for each individual client.
This chapter provides a general overview of substance-related disorders and the diagnostic criteria. It discusses cognitive behavior therapy (CBT) techniques for treating as well as a review of the neurophysiologic basis of addiction and reward pathways. The chapter examines the impact of substance use and misuse on the patient, the family, and social worker in the therapeutic process. The social worker should be familiar with general assessment guidelines for substance misuse spectrum disorders with and without confounding comorbid conditions such as medical and psychiatric problems. The chapter then discusses the biological-psychological-social components that must be in place for a substance disorder to be diagnosed. According to Freeman and Dolan the five-step stages of change (SOC) model widely accepted in substance misuse treatment settings lacks the specificity that is an essential part of the cognitive behavior treatment model, namely precontemplation, contemplation, preparation, action, and maintenance.
This chapter describes the Coping Skills Program, an innovative, school-based, universal curriculum for elementary-school aged children that is rooted in cognitive behavior theory. Rooted in cognitive behavior theory, the Coping Skills Program consists of carefully constructed metaphorical fables that are designed to teach children about their thinking; about the connections among their thoughts, feelings, and behavior; and about how to change what they are thinking, feeling, and doing when their behavior causes them problems. The chapter provides a thorough description of the Coping Skills Program and how it is implemented through a discussion of relevant research-based literature, and the theoretical underpinnings underlying this cognitive behavior approach with school-aged children. It also includes the results of preliminary testing of the Coping Skills Program. The research-based literature shows that cognitive behavior approaches are among the interventions commonly used by social workers to help young children in school settings.
This chapter presents the definitions, prevalence, prognosis, warning signs, and treatment for anorexia nervosa (AN), bulimia nervosa (BN), eating disorder not otherwise specified or atypical eating disorder (AED), and binge-eating disorder (BED). The distinctive core psychopathology for both anorexia nervosa (AN) and bulimia nervosa (BN) is a person’s constant concern and evaluation of his or her shape and weight. Psychological symptoms of AN include depression, anxiety disorder, irritability, mood swings, impaired concentration, loss of sexual desire, and obsessive thoughts. Some people who suffer with BN complain of stomach flu symptoms or complain that certain foods do not digest well. The distinguishing factor between BN and BED is the absence of compensatory purging in BED. BED shares the core eating disorder psychopathology, including preoccupation with shape and weight, the degree to which self-worth is influenced by weight, low self-esteem, poor social adjustment, and high rates of comorbid psychiatric disorders.
- Go to chapter: Using Neuroscience to Inform Social Work Practices in Schools for Children With Disabilities
Progress in neuroscience over the past several decades has led to a greater understanding of how the brain functions as a child or adult learns. This chapter focuses on disorders of the brain as applied to school settings. It explores learning disabilities (LD) as they pertain to practice in schools, as well as policy and research implications, and ethical and legal issues. Social workers must understand how the brain develops during various developmental ages and how this affects the learning of individuals. Research by the National Institutes of Mental Health (NIMH) have detected that the causes of LD are diverse and complex. New brain cells and neural networks continue to be produced for a year or so after the child is born. Electroencephalogram (EEG) can provide accurate timing information but provides little impression of where in the brain a particular activity is occurring.
- Go to chapter: Targeting Transdiagnostic Processes in Clinical Practice Through Mindfulness: Cognitive, Affective, and Neurobiological Perspectives
Targeting Transdiagnostic Processes in Clinical Practice Through Mindfulness: Cognitive, Affective, and Neurobiological Perspectives
This chapter focuses on six maladaptive processes that underlie a wide range of emotional and behavioral problems commonly addressed by social work practitioners in the mental health field. First, it explicates how a focus on transdiagnostic processes differs from traditional views of psychopathology and accords more closely with neuroscientific evidence. Next, the chapter reviews current research in the fields of experimental psychopathology and neuroscience to detail the cognitive, emotional, and neurobiological features of these six core transdiagnostic processes: automaticity, attentional bias, memory bias, interpretation bias, suppression, and stress reactivity. Then it discusses how these processes may be assessed by clinical social workers in the field, and offer six case vignettes that depict how they manifest in human suffering and impaired psychosocial functioning. Finally, the chapter discusses mindfulness-based interventions as a means of targeting transdiagnostic processes in clinical practice.
This chapter explains maltreatment as any form of physical, sexual, or emotional abuse and/or neglect, is associated with many negative outcomes, especially poor mental health. By understanding the impact of maltreatment on the developing brain, social workers can identify some of the underlying mechanisms of the psychiatric problems common in this population, and provide more effective treatment. Externalizing disorders, such as attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder, are the most common diagnoses given to children in the child welfare system but internalizing disorders, such as anxiety, depression, and posttraumatic stress disorder (PTSD), are frequently diagnosed as well. Hypothalamic-pituitary-adrenal (HPA) axis is one of the major pathways through which the effects of stress can shape brain development. The chapter illustrates how social workers can incorporate findings from neurobiological research into their clinical practice with maltreated children through the use of a case study.
- Go to chapter: How Neuroscience Can Inform Educational Practices for Youth Involved in the Child Welfare System
Mogro-Wilson and Smith-Osborne both discuss how neuroscience can inform social work practices in educational settings. This chapter attempts to build a bridge between the child welfare and educational settings by discussing the educational achievement gap for youth in foster care. It explores the effects of maltreatment on the brain functions and structures related to learning. The chapter identifies promising educational and child welfare policies and practices for youth in foster care to optimize educational success. Federal education policy has responded to the pervasive trends in educational achievement for children of poverty. No Child Left Behind Act (NCLB) was intended to ensure that students in every public school achieve important learning goals while being educated in safe classrooms by well-prepared teachers. National Child Traumatic Stress Network (NCTSN) offers a ‘Child Trauma Toolkit for Educators’ that provides facts and resources for teachers of high-risk children ranging from preschool to high school.
This chapter provides a summary of the social-cognitive neuroscience conceptualization of empathy. It discusses the application of neuroscience research to social work education, practice, and research. Empathy activates neural networks, groups of nerve cells that are connected by synaptic junctions. These three cognitive abilities, self-other awareness, perspective-taking, and emotion regulation, are critical components in the inductive process that results in the experience of affective empathy. Without these three cognitive abilities, people are more likely to be overwhelmed by the effects of the Shared representation System (SRS) and experience emotional contagion rather than affective empathy. Underlying the cognitive empathy appraisal process is the concept known as theory of mind (ToM). The affective empathy induction process relies heavily on a part of the brain known as the limbic system, which is near the center of the brain and evolved first in early mammals.
This chapter focuses on mirror neurons, which were discovered in the 1990s in Italy. It describes the relevance of mirror neurons for social work practice and addresses some research implications of this topic. The chapter explains the functions of the mirror neuron system (MNS), which includes a discussion of imitation, action understanding, intention understanding, theory of mind (ToM), and empathy. It includes sections on the neuroscience contributions to attachment theory, the concept of the social brain, micro-practice and policy implications, and research implications. Mirror neurons are a specialized kind of brain cells that form a network located in the temporal, occipital, and parietal visual areas, and two additional brain regions that are mainly involved with motor actions. The auditory motor neurons found in the high vocal center (HVC) of swamp sparrows are considered to be very similar to the visual motor mirror neurons that have been discovered in primates.
The case for major depression being an inflammatory condition has been advanced in the literature on neuroscience as well as in the literature on psychiatry. The correlational data suggested that depressed persons exhibit signs of systemic inflammation. One way to induce inflammation in the blood is to place a piece of the wall of a bacterium in the paw of an animal. There are other ways to induce systemic inflammation besides introducing fragments of a bacterial cell wall. Consistent with the view that behavioral depression involves inflammation, particular alleles for genes involved in the immune system have been identified as risk factors for depression. Mediterranean diets are associated with lower levels of inflammatory factors and lower levels of depression. Parasympathetic nervous system (PNS) releases factors that will inhibit the release of inflammatory factors from white blood cells and from the liver.
The current common combat era casualties have been posttraumatic stress disorder (PTSD), head injuries, hearing loss or impairment, and polytrauma. Common causes of military traumatic brain injuries (TBI) are blasts, falls, vehicular accidents, and penetrating fragments or bullets. Mild TBIs (mTBIs) usually are not detectable by lab tests or scans, which typically show normal results. The most common assessment instrument used for TBI is the Glasgow Coma Scale, which scores eye opening responses, motor responses, and verbal responses. Findings of effectiveness of psychosocial rehabilitation models for civilians with TBI and their families suggest that developing models of supported education and employment for injured veterans may be similarly helpful. Stigma, military stoicism, mTBI-related executive function compromise, and PTSD-related avoidance symptoms are barriers to care for neurological disorders, but disclosure of care is still perceived as possibly leading to loss of career or current employment, both among active duty and veterans.
- Go to chapter: F.I.T. Camp: A Biopsychosocial Model of Positive Youth Development for At-Risk Adolescents
Adolescence is a particularly intense stage of development. During the time of life between prepubescence and young adulthood, youth are challenged by accelerated mental, emotional, cognitive, and physical changes. The ordinary biopsycho-social stressors of adolescence, in conjunction with extraordinary environmental conditions, harmful external stimuli, and the dearth of resources that are associated with lower class and ethnic social status, tend to disrupt homeostasis and thwart positive youth development (PYD). Poor, ethnic minority youth are at disproportionate risk of negative social outcomes. The majority of these disparities involve externalizing factors, such as teen pregnancy, academic underachievement, and antisocial peer-group affiliation, as well as violent victimization and offending. The basic mission of F.I.T. an acronym for Focus, Initiative, and Tenacity Camp is to empower disadvantaged, ethnic minority youth by means of fostering positive social and emotional development.
Substance addiction is a biopsychosocial challenge in living characterized by impairment in three primary areas of brain-behavior functioning: motivation/reward system; learning and memory processing; and impulsivity and behavioral control. The neuroscience literature has begun to identify the disrupted neural pathways and functional impairments that may lead to reduced emotional competence and diminished decision-making ability. High cortisol levels are associated with greater risk for substance use disorders in depressed adolescents, specifically when experiencing other significant stressors, suggesting that substances may be used to modify hypothalamic-pituitary-adrenal (HPA) activity level. The neuroscience literature has dramatically influenced innovations in addiction treatment. Three of these innovation areas are highlighted: community engagement models of addiction and recovery; dual processing practice models; and an integrated neurosystems approach. The World Health Organization calls for government policies that support not only neurobiological research on addictions, but that also “link” neuroscience and social science research within the field of addictions.
One of the emerging approaches to explaining the normative spike in adolescent risk-taking, with delinquent/antisocial behavior as one expression, is based on recent advances in developmental neuroscience. Brain imaging studies have identified two main processes for which co-occurrence in the healthy adolescent brain directly impacts delinquent behavior. The first neuropsychosocial process implicated in heightened risk-taking involves sudden and dramatic changes in activity in the limbic system that coincides with puberty. The second process is associated with a developing ability to self-regulate behavior that continues to mature into the early 20s. Mindfulness meditation may be an effective method for reducing delinquency in juvenile justice involved youth because of its association with increases in self-regulation. The juvenile justice system was built on the argument that children and youth are less culpable for criminal and delinquent behavior than adults, making adolescence a mitigating circumstance in determining the state’s response to youth criminality.
This chapter describes the toxic stress often experienced by young homeless children and the effect that this type of stress can have on brain development, behavior, and lifelong health. Mental health and cognitive challenges are abundant among homeless families. Stress can affect maternal cardiovascular function and restrict blood supply to the placenta, potentially reducing fetal nutritional intake or oxygen supply, and lead to reduced fetal growth, increased risk of placental insufficiency, preeclampsia, and preterm delivery. Trauma in early childhood has clear neurological and developmental consequences, especially with regard to brain development and executive functioning. The chronic release of two stress hormones glucocorticoids and cortisol can have damaging effects on neurological functioning and lifelong health. Similarly, exposure to high levels of cortisol inhibit neurogenesis in the hippocampus, further impacting executive functioning and the ability to distinguish safety from danger, a symptom of posttraumatic stress disorder (PTSD).
- Go to chapter: Neurodevelopmental Approaches to Understanding and Working With Adolescents in the Juvenile Justice System
Neurodevelopmental Approaches to Understanding and Working With Adolescents in the Juvenile Justice System
This chapter briefly reviews the extant literature on the social neuroscience of risk-taking, and the developmental pathways to antisocial behavior among youth, including sexually abusive youth in the juvenile justice system. It explores neurodevelopmental impact of victimization, as well as the relationship between traumatic experiences, posttraumatic stress disorder (PTSD), and dissociation and sexual and nonsexual offending. The chapter discusses neuroethical and policy issues concerning the applicability of neuroscience in making decisions about criminal intent and culpability, along with considerations for implementing a trauma-informed approach in social work practice. Many juvenile offenders are vulnerable to exploitation themselves and have experienced multiple types of victimization, including complex trauma, which concomitantly impacts brain development. One commonality among various types of youthful offenders, especially habitual offenders, is a history of life course trauma, victimization, and mental health issues, such as attention deficit hyperactivity disorder (ADHD).
- Go to chapter: Use of Meditative Dialogue to Cultivate Compassion and Empathy With Survivors of Complex Childhood Trauma
Use of Meditative Dialogue to Cultivate Compassion and Empathy With Survivors of Complex Childhood Trauma
This chapter offers a review of selective literature on complex childhood trauma. It explains a case study demonstrating the use of meditative dialogue, a collaborative practice through which client and therapist are able to work together to develop empathy and compassion toward self and others during psychotherapy sessions. Thompson and Waltz described an inverse relationship between exposure to trauma and subsequent posttraumatic stress disorder symptom severity, and self-compassion. Recent neuroscience research has begun examining the effects of meditation practices on specific areas of the brain through neuroimaging studies. Clinical trials on the use of meditative dialogue in psychotherapy with survivors of complex childhood trauma, looking at the brains of the clients, and using magnetic resonance imaging (MRI) to measure changes, would help to demonstrate its efficacy and move it into the realm of evidence-based practices.
This chapter discusses the impact of trauma and its treatment through discussion of posttraumatic stress disorder (PTSD) and its neurological components-especially those affecting memory, evidence-based therapies (EBTs) for the treatment of PTSD, and the implications for practice, policy, and research. Two primary predictors exist for a person developing PTSD. The first one is experiencing dissociation during the trauma. The second predictor is the person developing acute stress disorder. Specifically, neuroimaging shows how PTSD affects neurological functioning in the brain. The primary regions of the brain affected by PTSD are the medial prefrontal cortex, the left anterior cingulate cortex, the thalamus, the medial temporal and hippocampal region, and the amygdala. The different regions of the brain associated with memory encoding are: left prefrontal cortex, left temporal/fusiform, anterior cingulate, and hipocampal formation. Cognitive-behavioral therapy (CBT) has been used extensively to treat PTSD.
This chapter explores the utility of applying the unified theory of crime with theory of developmental trajectories of childhood aggression to predict possible neuroscience-informed policy and practice strategies for improved outcomes in the management of violence and aggression in schools. Contributions of neurobiological factors to violence and aggression have received less attention in the social work literature than psychosocial factors, as is true of many behaviors that are a focus of social work practice. Specific research into violence in the schools has focused less on neurological contributors to youth aggression in the school setting, and more on hypothesized trigger behaviors or events such as bullying, and social rejection. When examining neurological underpinnings to violence in schools, the role of health disparities and related educational status disproportionalities emerge in the policy context. Enacting schoolwide screening policies for behavioral risk factors has shown promise as a violence prevention step for some time.
This introduction presents an overview of key concepts discussed in the subsequent chapters of this book. The book serves as a practice resource for social workers by making accessible the vast territory covered by the social, cognitive, and affective neurosciences over the past 20 years, helping the reader actively apply scientific findings to practice settings, populations, and cases. It helps readers gain a deeper understanding of how neuroscience should and can help the design, development, and expansion of therapeutic interventions, social programs, and policies for working with our most vulnerable populations. The book considers the neuroscientific implications for social work practice in child welfare and educational settings across system levels. It highlights the neuroscientific literature that can inform social work practice in health and mental health. The book concludes by discussing the neuroscientific implication of social work practice in the criminal justice system.
- Go to chapter: The Role of Neurobiology in Social Work Practice With Youth Transitioning From Foster Care
This chapter presents advances in the understanding of adolescent brain development that can inform and improve social work practice with youth leaving foster care. Foster care populations have a high rate of mental health disorders, and the association of types of child maltreatment with elevated risk for such disorders is well known; discussion of specific mental health problems and their treatment can be found elsewhere. Conventional mental health approaches have often targeted the innervated cortical or limbic neural systems, rather than the innervating source of the dysregulation. Psychotherapy, whether psychodynamic or cognitive, acts on and has measurable effects on the brain, its functions, and metabolism in specific brain areas. The ethical response is a sharing of the dilemma, and of information about the neurobiology of the client’s struggle, to enable the client to make as informed a decision as possible. In addition, neuroimaging techniques themselves lead to other ethical dilemmas.
Qualitative methods help researchers examine the nuances and complexities in relationship processes. In developing grounded theory, researchers are able to explore the systemic interactions between partners and identify and explain variations in the ways in which couples respond to each other and to the larger society. Grounded theory researchers begin with sensitivity to the research topic, but start with no predetermined hypotheses. Using gender equality as a sensitizing lens provides a framework through which to address this question, helps explain the meaning and nuance underneath the surface of couple interaction, and helps us explore the link between what couples do in their lives together and the larger social context. The lens of gender equality that we bring to our studies of couple life involves the four interrelated aspects of relationships such as relative status, attention to the other, accommodation patterns, and well-being.
Research on brain structure and function in white-collar criminals is a notable gap in the neurolaw literature, a gap that was addressed for the first time in one recent research report. Neuroscience is suggesting a link between brain abnormalities and some types of criminal behavior, but it is not yet clear exactly what those abnormalities are. Research on brain function and criminality focuses primarily on levels of hormones and neurotransmitters involved in neuronal communication. The findings regarding connections between the brain and adult criminal behavior, preliminary as they are, have implications for social work practice, including prevention of criminal behavior as well as intervention with offenders. The consistent finding that the likelihood of antisocial behavior is greatest when genetically based brain abnormalities encounter harsh environments has implications for social policy beyond the criminal justice system.
- Go to chapter: Carrying Equal Weight: Relational Responsibility and Attunement Among Same-Sex Couples
Comparison studies have long found that same-sex partners maintain more equal relationships than their heterosexual counterparts, largely because they do not divide roles and responsibilities based on gender. Thus the study of samesex couples offers the ability to examine the processes that create and maintain equality when gender differences do not organize couple relationships. However, same-sex partners emphasize the satisfaction of intimacy needs, rather than moral obligation or societal expectations, as their reason for maintaining the relationship. This primary focus on the relationship itself, which is also becoming more common among heterosexual couples, tends to be associated with egalitarian ideals that are not necessarily easy to translate into practice. A distinguishing characteristic of couples who were classified as demonstrating attuned inequality is the indebtedness that the benefiting partner feels to the other. Attuned couples describe conscious strategies for managing their relationships.
Fatherhood is a socially constructed notion that arises within the gender, economic, and political structures that underlie families. Historically the meaning of fatherhood in the United States has shifted from “moral leader” during the Colonial period to “breadwinner” as industrialization took fathers out of the home. Recent decades have given rise to a new ideal, the nurturing father. This chapter focuses on the partner-relational processes that support the development of this new model of fathering. Workplace norms and governmental policy have also been slow to recognize that fathers’ responsibilities for children extend beyond bread-winning and exist independently of their relationships with mothers. The chapter presents the results that distinguish father responsivity as the key relational process through which changing societal notions of gender, work, and family play out within the emotional world of families and help to clarify the conditions that support its development.
This chapter explores how 15 contemporary heterosexual middle and professional-class African American couples with young children define and expresses gender equality in their relationships. It considers how the social context of individualized racism shapes these processes at the level of couple interaction. Most early research on African American families focused on their deficits, using the standards of the dominant culture to suggest that these families were disorganized, deprived, and deficient. Many African American couples are adept at sharing the load and accessing individual, interpersonal, and social resources to address these challenges. Racial inequalities in the larger society are an important reason that couples pull together. Several African American wives expressed a sense of relational anxiety, fear that their husbands would just walk out on them. Religion plays a central role in many African American families and has historically been an important source of strength and resilience.
This chapter explores how gender equality is related to the relationship processes that construct two different models of motherhood. It examines how the experiences and meanings of motherhood are created and maintained within the context of ongoing interactions among mothers, fathers, and children. The idea of “mother” was frequently raised by both women and men in interviews in the Contemporary Couples Study (CCS), even though interview questions did not specifically ask about motherhood. Mothering is inextricably linked with ideas of femininity and gender which vary across history and cultures. Our goal was to accurately understand how our interviewees viewed mothering and to identify the interpersonal processes that account for variations in meanings as they relate to gender equality in couple relationships. Traditional couples consciously believe that mothering young children is a gendered talent and deliberately divide family responsibilities following the model of separate-sphere parenting.