Police arrest a man on the sidelines of protests against the worsening economic crisis, in Monrovia, Liberia, January 6, 2020.
©Carielle Doe / AFP
Cognitive-behavioral therapy (CBT) can help reduce delinquent behavior in at-risk youth and in men with a history of wrongdoing. This method has been effective in tackling violence in Liberia, according to a new study by professors and researchers from the University of Chicago, the University of Exeter and the University of North Carolina.
Atlantico: With your three co-authors, Sebastian Chaskel, Julian C. Jamison and Margaret Sheridan, you have studied how cognitive behavioral therapy – which aims to questioning and changing cognitive distortions and associated behaviors in order to improve emotional regulation and develop personal coping strategies – could reduce insecurity and crime in Liberia. What has been put in place?
Christopher Blattman : A small organization has for more than 15 years tried different approaches to see what would work to help the most difficult and violent young men on the streets of the capital. The people running the program are mostly former criminals and rebels who wanted to help younger versions of themselves. Much of the solutions they have found effective come from cognitive behavioral therapy. What is it exactly ? It’s a way to become aware of the problematic things we do, our automatic reactions, like anger, etc. and train on these reactions. You breathe, you concentrate on something to avoid being angry. And finally you fail to escape the situation the first time, but you try again and with practice you can improve. This makes these violent young people realize that they can easily become normal people. If you act a certain way, wear certain clothes, shave, cut your hair, etc. it will be easier and easier to be a normal person. Our study also included donating money. This money was given to people who had completed CBT to help them start a small business, like shining shoes for example.
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The method has been in action for ten years, what concrete results have you observed?
CBT is decades old, and there is plenty of evidence of its effectiveness. It is one of the greatest discoveries of the 20th century. The interest of CBT here is that it is an experience in a new domain. No one has ever tested it with a robust protocol like we did. What we see, after a month, a year, ten years, is the fact that men who received both therapy and money saw a fifty percent reduction in crime and violence (sale of drugs, theft, etc.). This does not mean that people have become 50% better, but rather the fact that about half of men have changed their lives.
Are there differences in outcomes between therapy alone and therapy plus financial incentives?
We tested money alone, therapy alone, and both together. The therapy alone gave similar, but not as significant, results. The results were statistically noisier. Cash alone is normally very effective, but in this case it was not because it was lost or stolen within six months. It is therefore curious to know why TCC + cash gives better results, ten years later. We think the answer is that the money to start a business is also a good way to practice therapy, which explains the success.
The result is also very profitable, how?
We did it on purpose. Many NGOs have a lot of extras in their program. They want to do everything. It’s admirable, but at the end of the day, when you help someone more on a topic, you’re probably not helping someone else. So we thought about what could be the most urgent need and how it could be profitable. We managed to get something functional for around $500. This means it’s easier to do, even in low-income countries.
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This example is promising, but can it be replicated? Is it possible to replicate it in other countries besides Liberia, including diametrically opposed countries like France, USA, etc.
The experience in Liberia stems from the CBT developed in the United States. The results can therefore travel. Just adapt them to the local situation. We are actively trying to expand and test it in other African countries. I’m pretty confident that if we go to Ivory Coast, Nigeria or Kenya, we can get similar good results.
I participated in a large study in Chicago. We are starting to see some very interesting results, more mixed than in Liberia, but including much more dangerous men. But we are seeing a reduction in violence, including homicides. The important thing is to have the right population to work with. If you put people who are not violent in an anti-violence program, you will not help them and it may even make their situation worse. Almost all good anti-violence programs are about finding the 500 to 1,000 young people, often men, in the city, and figuring out how to help them. All the other strategies you can think of: employment, economic development, police reform, etc. are good things for society but do not constitute an anti-violence policy. Because even in Chicago, the perpetrators of violence represent only a very limited part of the population. It is more effective to reach them with this CBT method than to develop an entire neighborhood. They have the means to find a thousand people and help them change the course of their lives.
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In your book, Why we fight, you have studied how society tries to build more peaceful norms. In our current situation, is CBT a promising solution to violence?
Each of us can use CBT in our daily lives, and many of us do. Most people probably learned to control their temper as children. This was done with the practices and guidance of parents, teachers, etc. Likewise, a lawyer must find a way to resolve a dispute in court without giving in to anger. CBT is just teaching those lessons to people who haven’t learned them.
The biggest political mistake we make, in any country, is to react to violence by thinking that we need more police or more jobs. It’s a good thing, but countries are investing almost nothing in this type of TCC program, when there is so much potential. And it’s a lot cheaper than jobs and a lot less violent than the police. I think every policy maker should try it. Fortunately, the message is heard, Joe Biden is starting to talk about this kind of program as a solution to gun violence in the United States. I feel more optimistic than I have in a long time.
Christopher Blattman, Professor at the Harris School of Public Policy at the University of Chicago, published “Why We Fight” with Viking UK publishing.