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Towards a Better Understanding of theIndividual, Dynamic, Criminogenic Factors

Underlying Successful Outcomes ofCognitive Behavioural Programs like EQUIP

Farewell lecture

April 11, 2012

Daniel Brugman

Developmental Psychology

Utrecht University

The Netherlands

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Towards a Better Understanding of the Individual, Dynamic, Criminogenic Factors

Underlying Successful Outcomes of Cognitive Behavioural Programs like EQUIP

The interest in the relationship between morality and behaviour is often determined by the

interest in antisocial behaviour, particularly in the prevention of that behaviour or the decrease

in the prevalence or seriousness of it. Antisocial behaviour is observable behaviour that

directly or indirectly harms others by the transgression of important social or moral norms and

includes aggressive and delinquent behaviour (Barriga, Gibbs, Potter & Liau, 2001). The

prevention and reduction of antisocial behaviour is an important societal task and morality

can be viewed as one of the many possible contributing factors.

This perspective is shared by my many colleagues at our department. They are interested in

the dynamic and static factors, individual and environmental factors related to antisocial

behaviour or, more specifically, that causally contribute to its prevalence. Individual’s

morality and moral reasoning in particular, is considered to be one of the many individual

dynamic criminogenic factors underlying antisocial behaviour and, in general, seems to be

considered as relatively unimportant. Seldom morality is explicitly operationalized as one of

the variables in their research on antisocial behaviour. Depending on the individual quality,

morality can be viewed as a protective or risk factor: mature moral reasoning is conceived as

a protective factor, while immature moral reasoning is conceived as a risk factor. This view

implies an instrumental perspective on morality. Stimulating moral reasoning development

towards maturity can be made part of the toolbox of educators to prevent or reduce antisocial

behaviour.

One can also be interested in the relationship between morality and behaviour because one

has an interest in the meaning of morality for human functioning. To question the relationship

between morality and behaviour springs from an interest in the consequences of morality for

behaviour. This perspective is characterized by an awareness of the tension between what a

person thinks s/he should do and why and what s/he actually does. In many cases there is a

gap between moral reasoning and behaviour. Because of this gap, some people have drawn

the conclusion that the morals people put verbally forward are superfluous or merely some

sort of rationalization. Others have tried to fill the gap, to understand the processes,

competencies, skills and circumstances that affect the relationship between moral reasoning to

behaviour.

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This latter perspective is my scientific background for studying the relationship between

morality and antisocial behaviour. Our goal is an empirically established theory on the

development of moral functioning, including disfunctioning. Characteristics, skills,

competencies or processes that are of importance for understanding the relationship between

moral reasoning and (antisocial) behaviour are included.

With my colleagues and students I have been working on two research questions:

(1) What moral processes, competencies and skills are related to antisocial behaviour in

children and adolescents? What is the nature of the relationship? What factors do

affect this relationship? Technically speaking: what are the mediating and moderating

factors?

(2) Is it possible by using educational programs to improve these moral processes,

competencies or skills to such a degree that antisocial behaviour in children is

prevented or reduced? Moderators can also be found when one tries to improve certain

processes, skills or competencies.

To answer these questions we have carried out cross-sectional and longitudinal survey and

intervention research using standardized measures in children and adolescents, in clinical as

well as non-clinical groups.

This interest in the relationship between morality and behaviour can also be found in the

works of several distinguished colleagues, notably of Lawrence Kohlberg, Augusto Blasi,

Larry Nucci and John Gibbs. The concept of morality as used in their research is limited to

interpersonal relationships; issues concerning the rights and well-being of other persons, and

issues of fairness and justice. Moral behaviour is viewed as involving a kind of conscious,

deliberate behaviour (Blasi, 1999, Nucci, 2004). Moreover it focuses on the individuals’

moral judgment and reasoning, in which developmental progress is observed.

To elicit individuals’ moral reasoning moral dilemmas were constructed in which different

values are pitted against one another. For example in the classical Heinz dilemma the value of

life conflicts with the value of property.

“In the US a woman was near death from a special kind of cancer. There was one drug that

the doctors thought might save her. It was a form of radium that a druggist in the same town

had recently discovered. The same drug was expensive to make, but the druggist wanted

people to pay ten times what the drug cost him to make. The sick women’s husband, Heinz,

went to everyone he knew to borrow the money, but he could only get together about half of

what the druggist wanted. Heinz told the druggist that his wife was dying, and asked him to

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sell it cheaper or to let him pay later. The druggist said, “No, I discovered the drug and I’m

going to make money from it.” So the only way Heinz could get the drug would be to break

into the druggist’s store and steal the drug. Heinz has a problem. He should help his wife and

save her life. But on the other hand, the only way he could get the drug she needs would be to

break the law by stealing the drug.”

In general a weak to moderate relationship has been found between moral reasoning and

antisocial behaviour. In case of serious delinquency the delay in moral reasoning stage might

be larger (Stams et al., 2006). Individuals at a lower stage are balancing their own interest

against the chances of being caught. They do not take into account the material and non-

material damage of their behaviour for their victims.

Given the weak to moderate relationship between moral reasoning and antisocial behaviour, it

has been concluded that other factors are involved that affect this relationship. Kohlberg

himself already realized the necessity of a multifactor theory of moral action and included

concepts like moral atmosphere and responsibility in his model (Kohlberg & Candee, 1984),

as did Rest (1986). Krebs, Denton and Wark (1997) have given an overview of these factors.

This resulted in a completely other list than one usually receives from the first perspective in

which the focus is on the reduction of antisocial behaviour. Three of these factors have played

a major role in my research: perception of the moral atmosphere, self-serving cognitive

distortions (SSCD) and moral identity. Our current research has made clear that the list

presented by Krebs et al. is not exhaustive and needs expansion.

Furthermore, we have looked more closely at the activities in the cognitive behavioural

intervention program EQUIP (Gibbs, Potter & Goldstein, 1995) on the one hand and the

conceptual representation of the program on the other. We believe that the conceptual

representation of the activities in the program is incomplete or that in theory as well as in

research more attention needs to be paid to these characteristics: moral value evaluation, just

world belief, empathy, self-esteem, self-debasing cognitive distortions, and attitude towards

delinquency. We also believe that by including these characteristics explicitly in the rationale

of the program and in the study of its effectiveness, the performance and effectiveness of the

program can be improved.

Today I will present three conclusions based on the findings of research on the two questions

I just mentioned:

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Discrepancies exist between the contents practiced during the EQUIP program

(Gibbs et al., 1995) and the theoretical model upon which it is based;

The reduction of self-serving cognitive distortions (SSCD) should receive priority

in preventing or reducing antisocial behaviour;

SSCD are not exclusively cognitive. They refer to attitudes, beliefs and personal

worldview.

I will present evidence upon which these three conclusions are based and finally answer the

question what the impact is for the relationship between morality and antisocial behaviour.

With these conclusions I aim to contribute to a better understanding of the successful

outcomes of the EQUIP program and to improve these effects as well.

Before discussing some of these newly introduced concepts, we discuss two important

concepts from the list of Krebs and colleagues that mediate the relationship between moral

reasoning and antisocial behaviour: moral atmosphere and SSCD. It is important to stress that

in general they do not moderate the relationship as one perhaps would expect, showing for

example that under the condition of a high moral atmosphere the relationship between moral

reasoning and behaviour is strong, and under the condition of a low moral atmosphere the

relationship is weak. Moral atmosphere and self-serving cognitive distortions (partially or

completely) mediate the relationship, making the weak to moderate relationship between

moral reasoning and behaviour even weaker.

Moral atmosphere as mediator in the relationship between moral reasoning and antisocial

behaviour

Lawrence Kohlberg (1970) introduced the contextual moral atmosphere, climate or culture as

a mediator in the relationship between moral reasoning and antisocial behaviour. His research

had shown that the moral reasoning stage of adolescents could be moved upward by having

students discuss moral dilemmas. Nevertheless, no effects were found on adolescents’

behaviour (Kohlberg, 1985). Students’ behaviour seemed to be influenced not so much by

their abstract moral reasoning competence, but by the implicit norms and values students

share with each other in the particular context of the behaviour i.e. the moral atmosphere.

Making these norms and values explicit and discuss them with the students resulted in a

change in the moral atmosphere in school and in the behavioural change of students Kohlberg

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was looking for (Power, Kohlberg & Higgins, 1989). Several schools with a high moral

atmosphere, ‘just communities’, were realized in schools-within-a-school, which means that

the students were volunteers, that is, a selected group of students participated in a just

community project. When the concept was introduced in regular schools and applied in

several schools in Europe, i.e. Germany, it was not very successful and most experiments to

create just community schools were stopped after a while. Participatory democracy as a

means to create just communities seemed to be just too complex and cumbersome in normal

high schools with large student populations. Selection of volunteers and small schools seemed

to be preconditions for success.

Based on Kohlberg’s ideas and extensive open interviews with students a questionnaire was

constructed to measure students’ perception of the moral atmosphere in school (Høst,

Brugman, Tavecchio, & Beem, 1998). In the questionnaire students are asked their

perceptions concerning the experiences and behaviours of the majority of the students in their

class or school. Instead of developing just communities, we were interested in testing

Kohlberg’s ideas in normal secondary schools. In the Netherlands and elsewhere schools

differ in their educational policies and in their student sample characteristics, and it seemed

reasonable to expect differences between schools in how students perceive the moral

atmosphere in their school. This indeed seemed to be the case.

At the school level we found a rather strong relationship between school moral atmosphere

and student’s moral reasoning stage. Nevertheless, we found secondary schools with a

relatively high moral atmosphere with adolescents having on average a low to medium moral

reasoning stage, but also schools with a relatively low moral atmosphere but with students

having on average a relatively high moral reasoning stage. From the perspective of behaviour

students are better off when they are at a school with a relatively high moral atmosphere than

having a relatively high moral competence. We found that students’ perception of the school

moral atmosphere was a much better predictor of antisocial behaviour, than students’

individual moral reasoning stage (Høst al., 1998). This finding has now been replicated in

several studies in the Netherlands, Russia, and Italy and might be regarded as an established

empirical fact (Brugman, 2010; Brugman et al., 2003; Foà, Brugman & Mancini, 2012).

Interestingly, in a generalizability study it was found that while perception of the school

moral atmosphere reflects as one would expect more strongly an environmental characteristic

than individual’s moral reasoning stage, the individual component (together with the error) in

the perception was still very high. This finding suggests that two individuals in the same class

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could perceive a highly different moral atmosphere in their school (Beem, Brugman, Høst, &

Tavecchio, 2004; Høst et al., 1998). The students may participate in different groups within

class or school, each group characterized by a different perception of school moral

atmosphere, but it seems more likely that their schemas for perceiving and interpreting social

situations differ; schemas that are not completely represented in their moral reasoning stage.

At the individual level the relationship between moral reasoning and perception of moral

atmosphere was low (Brugman et al., 2003; Høst al., 1998).

We found evidence that at the individual level the perception of school moral atmosphere

mediates the relationship between moral reasoning stage and antisocial behaviour in a normal

population (Boom & Brugman, 2005). However, no evidence was found that moral reasoning

stage was a moderator in the relationship between perception of school moral atmosphere and

behaviour. A similar finding was found for moral atmosphere at home (De Wolff & Brugman,

2010). In other words, if a person is being a part of a social group which is characterized by a

low moral atmosphere, then a high moral reasoning stage is not sufficient to withstand the

negative influence it exercises on behaviour (Boom & Brugman, 2005)1. These are crucial

findings for understanding the relationships between moral reasoning, perception of moral

atmosphere and behaviour in a population of normal adolescents.

When I got the opportunity to include juvenile delinquents in the research, these relationships

between moral reasoning, moral atmosphere and antisocial behaviour could be investigated in

the context of a high-security juvenile correctional facility (Brugman & Aleva, 2004).

According to Kohlberg the low moral atmosphere as was found in prisons in the US, had a

depressing effect on delinquents’ moral reasoning level. This sheds a different light on the

difference found in moral reasoning between delinquents and non-delinquents. The difference

is in general interpreted as developmental delay in delinquent youth, but it could be also at

least in part be attributed to the pitiful circumstances in many youth prisons (Emler &

Reicher, 1995). To our surprise the perception of moral atmosphere in the juvenile

correctional facility was not lower than in a secondary school of a similar educational level as

the juvenile delinquents received (Brugman & Aleva, 2004). We found no evidence for a

depressing effect which might also be of help to explain the fact that in the Netherlands the

discrepancy between the moral reasoning stage of juvenile delinquents was only slightly

1 A more promising alternative as a moderator is moral type (Colby & Kohlberg, 1987; Gibbs, Basinger &Fuller, 1992; Kohlberg, 1984).

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lower than of their non-delinquent peers (Brugman & Aleva, 2004). Within the juvenile

delinquent population evidence was also found for a stronger relationship between the

perception of moral atmosphere in the institution and antisocial behaviour as compared to

their level of moral reasoning and this behaviour (Brugman & Aleva, 2004).

A second and even more important mediator in the relationship between moral reasoning and

antisocial behaviour turned out to be self-serving cognitive distortions.

Self-serving cognitive distortions (SSCD) as mediator in the relationship between moral

reasoning and antisocial behaviour

According to social-cognitive theories, people act upon their interpretation of social events

and antisocial behaviour is based on deficiencies in interpreting these events, i.e. cognitive

distortions. Cognitive distortions are “inaccurate or biased ways of attending to or conferring

meaning upon experiences” (Barriga, Gibbs et al., 2001, p. 1). Barriga, Gibbs et al. (2001)

focus on self-serving cognitive distortions that, at a high level of prevalence, facilitate

aggression and other types of antisocial behaviour. Primary SSCD are self-centred attitudes

and beliefs: one’s own views, expectations, needs, rights, immediate feelings, and desires are

considered so important that the legitimate views, expectations, etc. of others (or even one’s

own long-term best interests) are not taken fully into account or are completely disregarded

(Barriga, Gibbs et al., 2001, p. 4). Secondary SSCD are pre- or post-transgression

rationalizations driven by emotions evoked by antisocial behaviour. These distortions serve to

neutralize conscience, potential empathy and guilt, and thereby prevent damage to the self-

image when an individual engages in antisocial behaviour. The secondary distortions consist

of blaming others, minimizing/mislabelling, and assuming the worst. These secondary SSCD

have been labelled by Bandura (2002) as processes of moral disengagement.

The How-I-Think Questionnaire is an instrument to measure SSCD. The instrument can be

used for normal adolescents, adolescents at risk and juvenile delinquents. The measure has

been proven to be reliable and valid (Nas, Brugman & Koops, 2008) and strongly predicts

self-reported antisocial behaviour (Van der Velden et al., 2010a), but is also related to teacher

reported antisocial behaviour (Van der Velden et al., 2010a). In a longitudinal study by Van

der Velden et al. (2010a) a bidirectional relationship was found between SSCD and antisocial

behaviour in females, but in males antisocial behaviour predicted SSCD instead of the other

way around. Furthermore, the HIT discriminates between juvenile delinquents and their non-

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delinquent peers of the same gender, age, educational level and ethnic background (Brugman

et al., 2011).

Intervention research using the EQUIP program showed that a decrease in SSCD predicted a

decrease in recidivism in the EQUIP treatment group in the USA (Devlin & Gibbs, 2010),

while the level of (primary) SSCD at time of release from prison predicted the speed of

recidivism in the experimental EQUIP group in The Netherlands (Brugman & Bink, 2011). In

sum, there is a strong relationship between SSCD and antisocial behaviour, but the nature of

the relationship is unclear at the moment, although the findings on the effects of the EQUIP

program seem to indicate that behavioural change is possible after cognitive change (i.e. the

reduction of SSCD precedes the reduction of recidivism).

Self serving cognitive distortions and the attachment to moral values

It is important to realize that secondary SSCD or moral disengagement is needed because

individuals with antisocial behaviour share the same moral values as we do. The secondary

SSCD aim to neutralize potential feelings of empathy and guilt, and to protect self-esteem.

However, although antisocial individuals might subscribe to the same moral values, it does

not necessarily follow that they attach the same importance to these moral values as non-

antisocial individuals do (Beerthuizen & Brugman, 2012).2 Moral value evaluation or the

attachment to moral values is part of the measures John Gibbs and colleagues have

constructed to measure moral reasoning (Basinger & Gibbs, 1987; Basinger, Brugman, &

Gibbs, 2007; Gibbs, Basinger, & Fuller, 1992). It is an affect oriented stimulus to elicit moral

reasoning. No attention has been paid to this construct until Tarry and Emler (2007) showed

in their research that moral value evaluation was negatively related to antisocial behaviour in

a normal adolescent population. Beerthuizen (2012) reanalyzed several studies that had been

carried out using one of the moral reasoning measures constructed by Gibbs and colleagues

and found that moral value evaluation was consistently related to antisocial behaviour and

that juvenile delinquents attach les importance to moral values than their non-delinquent

peers.

2 The alternative holds that delinquents have different values than non-delinquents. From that

perspective self-serving cognitive distortions are no defense mechanisms (Beerthuizen, 2012).

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Furthermore, while the moral component lessons of the EQUIP program focuses on moral

reasoning, the implicit and explicit message of those lessons is that moral values are of

importance. In a recent study, Helmond, Overbeek and Brugman (2012) found that in a

control group of juvenile delinquents the importance that juveniles attach to moral values

decreased, while it stayed at the same level in the EQUIP group of juveniles.

Beerthuizen and Brugman (2012) constructed a path analytic model in which moral value

evaluation precedes the other morality related characteristics (moral reasoning, moral identity

and SSCD). In this model, moral value evaluation is only indirectly related to antisocial

behaviour. However, it has a higher indirect relationship than moral reasoning or moral

identity. Actually in the model all direct paths to antisocial behaviour except for SSCD are

non-significant. The bivariate correlations with antisocial behaviour were significant, but once

SSCD were introduced the direct relationships disappeared. This mediating effect of SSCD

has been repeatedly found in several cross-sectional studies (cf. also Oosterlaken, Brugman,

& Oskam, 2012). It is hard to find moral engagement processes that affect moral

disengagement processes. Moral reasoning and also moral identity, constructs that have been

studied a lot in relationship to antisocial behaviour, do not have such an effect. They do not

buffer the relationship between SSCD and antisocial behaviour.

One of the issues in studying the relationship between moral reasoning and antisocial

behaviour is whether the moral reasoning of individuals with externalizing problem behaviour

is lower in all values domains or whether there are specific delays on certain value areas

(Brugman & Aleva, 2004; Gregg, Gibbs, & Basinger, 1994). Research has found specific

delays on the value areas “property and law” in regular delinquents, but also on “sex and

erotic love” in sexually abusive youths (Beerthuizen & Brugman, 2010). We now have data

that a similar effect is found in high school students (Beerthuizen & Brugman, submitted).

When a distinction was made between moral values that were supported by legislation and

moral values not supported by legislation a clear differentiation was found in the relationship

with antisocial and more specifically delinquent behaviour. Only the evaluation score on

moral values supported by legislation were related to antisocial behaviour and delinquency.

Just World belief as a moderator in the relationship between SSCD and antisocial behaviour

While the potential effects of moral value evaluation, moral reasoning or moral identity and

also empathy disappear when SSCD come into play, we found one variable that actually

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buffers the effect of SSCD: the belief in a just world. The Just World Belief is a concept

introduced by Lerner many years ago. Humans are motivated to believe in a just world in

which they get what they deserve. Just World Belief functions as a protective factor against

antisocial behaviour; it is negatively related to antisocial behaviour in adolescents (Van

Brussel, Cameron, Van Dijken, & Van Osch, 2012). In contrast to moral value evaluation,

moral reasoning, or moral identity the Just World Belief buffers the relationship between

SSCD and antisocial behaviour (Van Brussel et al., 2012). Although the effect is not strong it

might play a meaningful role in interventions.

The intervention programme EQUIP contains an important lesson ‘Planet A/Planet B’ that

tries to model the helping relationships that are expected of participants (Gibbs et al., 1995).

The lesson is used as a reference point for social relationships during the course (positive peer

culture); a trainer might remind the participants about the planet A/planet B distinction during

other lessons. This lesson may strengthen participants’ Just World Belief. I think it would be

helpful for participants when they recognize their ‘Bad (or Rotten) World Belief’ and could

learn to accept or develop a Just World belief. It is an important construct for trainers too,

because they know better what kind ‘belief’ or worldview they try to foster in their

participants, which could make their actions more effective.

Self-serving cognitive distortions and self-esteem

Another important construct in the literature on antisocial behaviour is self-esteem. This

concept is lacking in the theoretical underpinnings of the EQUIP program and in the research

on its effectiveness, but is nevertheless important during the lessons and meetings of this

program.

From a theoretical point of view secondary SSCD are needed to protect self-esteem (Gibbs,

2010). However, the empirical literature on the relationship between secondary SSCD and

self-esteem is scarce. For many years it has been a popular topic of research for our bachelor

students. In one study they selected two matched groups of students that reported antisocial

behaviour: one group with a relatively low self-esteem and one group with a relatively high

self-esteem. Between these two groups a difference was found in the prevalence of some

secondary SSCD. Adolescents with antisocial behaviour and a low self-esteem report higher

scores on ‘assuming the worst’. Clearly, if assuming the worst aims to protect self-esteem it

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functions differently in adolescents committing antisocial behaviour and having a high self-

esteem than in adolescents having a low self-esteem (Ter Haar, Van Kessel, & Meijer, 2012).

The concept of self-esteem is also of importance because externalizing problem behaviour is

positively related to internalizing problem behaviour (co-morbidity). When we start from a

social-cognitive framework we should not pay attention only to cognitions that promote

externalizing behaviour, but also to cognitions that promote internalizing behaviour. Against

the self-serving cognitive distortions we find the self-debasing cognitive distortions. The

dynamics of these different types of distortions need further study. Gender effects may play a

role here too: for girls SSCD may contribute to internalizing problem behaviour. For boys on

the other hand, self-debasing cognitive distortions may inhibit externalizing problem

behaviour (Ter Haar et al., 2012).

Now that I have identified several constructs that are related to antisocial behaviour and that

should be paid attention to in theory and research incorporating moral development, I come to

the second part of my presentation: findings based on research on the EQUIP program.

Studies on the effects of the EQUIP program

In the Netherlands four studies have been published on the effects of the EQUIP program,

including one on the preventive version of EQUIP (Brugman & Bink, 2011; Helmond et al.,

2012; Nas, Brugman & Koops, 2005; Van der Velden, Brugman, Boom, & Koops, 2010b). In

the US three published studies are available, an early study by Leeman, Gibbs and Fuller

(1993), a study by Liau et al. (2004), and a recent study by Devlin and Gibbs (2010).

Furthermore two studies are available on the preventive version of EQUIP, one carried out in

Canada (DiBiase, 2010) and one in Spain (Van der Meulen et al., 2010). In addition several

studies have been carried out that are reported in dissertations or reports. To compare the

effects of the studies carried out in the Netherlands and the US is a bit like comparing apples

and pears; as we will see, there are many differences between types of institution, target

groups and conditions. All studies in the Netherlands were carried out in normal facilities for

juvenile offenders or high schools by regular trainers, group leaders or teachers working at

these facilities. I will not present a detailed overview of the findings today but point only to

some general impressions:

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In the Netherlands several effects have been found on intermediate variables:

SSCD, aspects of social information processing, attitude towards delinquency,

moral value evaluation and empathy (Brugman & Bink, 2011; Helmond et al.,

2012; Nas et al., 2005). Although these variables were found to be of importance,

not all are included in the theoretical framework of the program.

In the Netherlands the effects of the EQUIP program in incarcerated youths seem

to decrease over the years instead of increase (Brugman & Bink, 2011; Helmond et

al., 2012; Nas et al., 2005). One would expect an increase because of an increasing

experience.

In contrast to the US in the Netherlands no effects were found on recidivism

(Brugman & Bink, 2011).

The most consistently found effect of EQUIP is on SSCD (Brugman & Bink,

2011; Devlin & Gibbs, 2010; Nas et al., 2005; Van der Velden et al., 2010b).

In the US nor the Netherlands effects have been reported on moral reasoning. One

sleeper effect of moral reasoning is mentioned in the Leeman et al. (1993) study

and one effect on moral value evaluation by Helmond et al. (2012).

The difference in effects of EQUIP found at the behavioural level needs to be studied further

as this is the most important variable that would make all educational efforts worthwhile.

These differences in effects can be attributed to:

Target Group: Adults (Devlin & Gibbs, 2010; Liau et al., 2004) versus adolescents

in the Netherlands;

Selection effects as one of the institutions in the US that uses the EQUIP program

in the context of the Responsible Adult Culture does not accept violent offenders

(https://www.fccbcf.org/);

Type of facility (treatment in the USA versus care in The Netherlands);

Conditions of the control group (treatment as usual is at a higher standard in The

Netherlands than in USA);

Program integrity (Helmond et al., 2012);

Etc.

Helmond (forthcoming) carried out a study on program integrity as a next step in the research.

She made systematic observations on 13 EQUIP groups of 2 facilities in the US and of 21

groups of 5 facilities in the Netherlands and Belgium. She indeed found striking differences in

program integrity between the institutions in the US and in the Netherlands. In the

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Netherlands the program integrity was often found below the critical minimum level of 60%.

However, not on all aspects of program integrity differences were found. Differences were

found on Exposure (an organizational quality) and on Achievement of goals during mutual

help meetings, Anger (cognitive distortions) and Social skills lessons (teacher qualities). No

differences were found on Achievement of goals during the moral component lessons,

Participation of the youngsters during the lessons/meetings, and Teaching techniques. This

information results in important feedback to facilities and the trainers and might be of help to

improve the program integrity. However, it is not entirely clear how these differences do

affect the behavioural outcomes.

One clue could be the difference found in program integrity of the anger management lessons.

Devlin and Gibbs (2010) found that a decrease in SSCD in the EQUIP group predicted

recidivism. Individuals that showed a relatively large decrease in SSCD recidivated less than

individuals that showed a relatively minor decrease. In the Netherlands we found a

relationship between the post-test score on SSCD (self-centeredness) and speed of recidivism.

Moreover the program integrity of the anger management lessons – which focuses on the

decrease of SSCD – was higher in the USA than in the Netherlands (Helmond, 2012).

When we compare the improvements reported on SSCD in the Netherlands (Brugman &

Bink, 2011) with those reported in the United States (Devlin & Gibbs, 2010), we found to our

surprise that the reduction of SSCD was actually higher in the Netherlands than in the US!

We had to use the change score because in the US no control group was available for the

SSCD measure. The change effect size of Cohen’s d was .42 in the Netherlands (Brugman &

Bink, 2011), but only .31 in the US (Devlin & Gibbs, 2010).

1

1,5

2

2,5

3

3,5

PRETEST POSTTEST

CONTROL-NL

EQUIP-NL

EQUIP-US

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Figure 1: Changes in cognitive distortions (HIT total score) for males in the Netherlands in

the EQUIP group and the control group and in the United States for the EQUIP group.

Notwithstanding the difference in the length of treatment (3 months in the Netherlands, 5

months in the US), the presumably lower treatment integrity in the Netherlands, the possible

selection effect, etc., the gains in decreasing SSCD were larger in the Netherlands than in the

United States.

The comparison of the results also showed that the mean score on SSCD in the US facility at

the pre-test was much lower than in the Netherlands. The mean SSCD scores in the

Netherlands at pre-test are in the borderline or clinical range; in the US in the normal range.

The difference between the groups at pretest is statistically significant (t(127) = 2.53, p = .01)

and presumably indicates that the seriousness of the behavioural disorders of the delinquents

is much higher in these individuals in the Netherlands than in the USA. The mean post-test

score on SSCD found in the EQUIP group in the Netherlands which is about the same as the

pretest score in individuals in the US facility is quite normal for regular youth of the same

relatively low educational level as the delinquent youth (Van der Velden et al., 2010a). The

relatively high level on SSCD found in a large group of normal, non-incarcerated adolescents

was an important reason to implement the preventive version of EQUIP as an universal

prevention program in such schools (Van der Velden et al., 2010b).

The decrease in the Netherlands in the EQUIP group found on self-centeredness resulted in a

post-test score with a large range and this score predicted speed of recidivism (Brugman &

Bink, 2011). Individuals with a high self-centeredness score all recidivated within one year

(M = 313 days). A group with a medium score stayed outside prison for at least one year (M =

370 days), while the low self-centred group succeeded not to recidivate within two years. This

last group has a mean score on SSCD that is on average comparable to the US group at the

post treatment test (even a bit lower: 1.95), the other two groups had much higher scores

(respectively within the clinical range and close to the borderline range). In sum, this makes

clear that two of the three groups distinguished by Brugman and Bink (2011) did not make

sufficient progress in the reduction of SSCD. One might say from an educational viewpoint:

they were not well prepared to be released already.

However, the reduction in SSCD did not lead to better recidivism data than the control group

that received the treatment as usual (Brugman & Bink, 2011). Presumably the ‘treatment as

16

usual’ condition is of a much better quality in the Netherlands than in the USA. Nevertheless

the percentage of recidivism in the experimental as well as in the control group in the

Netherlands was extremely high. EQUIP as it was implemented does not succeed to

‘resocialize’ these youths within a period of three months. Although I admire the work carried

out in institutions as CBCCF and Red Wing, they would probably neither succeed in such a

short period and given the conditions of institutions in the Netherlands.

These findings help us to rephrase our question about the differences in effectiveness in the

US and the Netherlands: “Why do differences in effect exist between the US and the

Netherlands at the behavioural level, while the effect at the intermediate level (e.g., SSCD)

are about the same?” Or even more specifically: “Why does a decrease in cognitive

distortions result in a behavioural change in the US, but not in the Netherlands?”

The most obvious answer seems to me that in the Netherlands one is working with youths that

have more serious behavioural problems than in the US and need to be treated or schooled

over a longer period of time than currently is possible. The teaching has to be continued until

their prevalence of SSCD is at the same level that is realized by the subgroup of youths with

the low primary cognitive distortions mentioned above, and that can be compared with the

mean score for the whole group in the Devlin and Gibbs (2010) study.

Because of these results, the consistent findings of the EQUIP program on cognitive

distortions, and because in normal youth the cognitive distortions nullify all positive effects of

morality related characteristics on antisocial behaviour, I would like to make a plea for

focusing the treatment on the reduction of cognitive distortions and making this reduction the

cornerstone of the EQUIP program. This plea is supported, I think, by the lack of effects in

general found on moral reasoning, the relatively low relationship between moral reasoning

and antisocial behaviour, the absence of evidence that an improvement in moral reasoning

would result in behavioural change, and the many variables that have an impact on the

relationship between moral reasoning and antisocial behaviour in particular SSCD. The

improvement in social skills has been demonstrated in one study but no evidence is available

that it had an effect on the reduction of recidivism.

I expect that the effects of the program will become stronger when the lessons for reducing

cognitive distortions are doubled and a lesson in anger management is alternately followed by

a moral component lesson or a social skills lesson.

For a more central focus on reducing SSCD it would be of help to have a closer look at the

meaning of the construct. I would like to stress that cognitive distortions are not only

17

cognitive distortions. We are dealing with a distorted worldview with its accompanying

distortions in beliefs and attitudes that penetrate social relationships and behaviours. Actually,

this is all in the definition of cognitive distortions, but probably seldom realized, at least in the

Netherlands. The label cognitive distortions is ironically an example of a (real) cognitive

distortion, i.e. minimizing/mislabelling.

There are several reasons that indicate that SSCD are closer to a distorted attitude and

worldview than to a cold-blooded cognition. SSCD are measured on a 6-point Likert scale,

they are sensitive to social desirability effects and are more strongly related to all kinds of

affective factors than to cognitive factors. Furthermore they are sensitive to in- and outgroup

effects, and their relationship with antisocial behaviour is moderated by a Just World Belief.

In my opinion the reduction of cognitive distortions needs a multimodal effort. In the US the

context of the EQUIP program is a positive peer group or a just community. In a group with

such an atmosphere participants engage in social relationships based on mutual respect and

cooperation. According to Piaget (1932) it is the engagement in reciprocal relationships that

creates a morality based on reciprocity. Not the other way around, as Kohlberg hypothesized.

In his discussion programs Kohlberg found only effects at the cognitive level, not on the

behavioural level. It needed a just community with reciprocal relationships to realize

behavioural changes. In sum: In the US a decrease in cognitive distortions is accompanied by

a change in relationships and behaviours during the intervention, in the Netherlands it

probably is more an individual achievement. Visitors of institutions in the US and in the

Netherlands where the EQUIP program is carried out will agree.

I want to finish with a summary of some recommendations in order to improve the effects of

the EQUIP program, particularly in the Netherlands:

Improve and maintain a high program integrity (Helmond, 2012);

Double the number of lessons in reducing cognitive distortions as compared to

moral and social skills components lessons;

Stress the importance of moral values during the moral component lessons;

Pay more attention to empathy, the affective aspect in role-taking;

Invest in guidance and supervision after treatment;

Stimulate a Just World Belief - although that might be a cognitive distortion too.

18

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