Prevention “action, action, action…”

Wherever it is implemented - Japan being no exception – cognitive behavioral therapy and social skills training owe much to the ABC theory developed during the 1950s by the US psychologist Albert Ellis.

Ellis (1913-2007) was an anti-Freudian who was credited by The New York Times at his death with the invention of “a pragmatic, stop-complaining-and-get-on-with-your-life form of guidance”.

“The trouble with most therapy is that it helps you to feel better,” he said in a 2004 article in same newspaper. “But you don’t get better. You have to back it up with action, action, action.”

The A in his therapeutic alphabet refers to an “activating” experience, generally negative, such as falling out with a classmate at school. The B is an irrational belief attached to the experience, such as linking the falling out to all kinds of other problems in the student’s life. C is the emotional consequence of the belief, for example depression or anxiety.

Rightly, ABC should be called “A to E” since securing the solution to a problem takes up two more letters of the alphabet. D is the disputing of the irrational belief or helping the student to take a more objective view of the situation.

Finally there is the E of the new emotional response, along the lines of “I can see why my friend has fallen out with me, and I am going to take care that if the same things happen again I will not let it take over my emotions”.

In a series of quasi experimental trials the approach has been applied to depression, loneliness and other aspects of emotional well-being. Some programs deal with basic social skills, such as knowing how to greet strangers and deal with other aspects of social interaction.

A typical program involves a school lesson every three weeks over a six month period. Lessons show students how to initiate relationships, how to give positive messages and how to encourage a group to work together. Being respectful, dealing with unreasonable demands and understanding emotions are also covered.

Teaching will be familiar to all exponents of social skills training, with an orderly pattern of instruction, modelling behavior, getting the children to rehearse effective strategies followed by feedback and reinforcement.

Trials have extended from pre-schoolers to high schools students. The benefits are modest but wide ranging, going from simple interaction skills to improved likability of students to lower levels of depression.

As with many aspects of prevention in Japan, the results indicate a need for more research and greater sophistication in evaluation techniques and methods to take the programs to scale. That said, there may be much to learn from these simple easy to run school-based programs.

See: Kanayama M and colleagues, “Effects of classroom-based social skills training for pre-school children: the application of coaching in natural settings and generalizability of training” Japanese Journal of Counseling Science, 2000, 33, pp 196-204 and Emura R and Okayusu T, “Classroom-based social skills education: junior high students” Japanese Journal of Educational Psychology, 2003, 51, pp 339-350.