I can recall many times where I witnessed a very interesting interplay between the processes of cognition and affect. I was working as a residential counselor at a lockdown facility where children were sent by the judge to live until a proper foster care placement was found. The group of boys I was working with were between the ages 5-17, mostly around the age of 12-13. The program I worked for used a behavioral point system to measure the children’s progress while in treatment. If they completed certain tasks as expected (i.e. following daily routine and schedule as instructed, completing tasks on time), they could earn points that would put them on a higher level. Each level came with more privileges. Some of the boys would be very good at following the rules and staying on task while others were very defiant and found it very difficult to do what was expected of them. A simple instruction as, “Have a seat at the table for breakfast,” would often trigger negative emotions in the boys, causing them to act out in disruptive and oftentimes, aggressive ways. They would refuse to do what was asked or expected, which sometimes appeared to be purposefully done with a conscious intent to break the rules.
My experience in working with those group of kids taught me that all behavior isn’t a matter of choice; some behavior is a matter of chance. If any of us were given the same circumstance, put in the same environment, we would react in the same way as well. Essentially, it boils down to the way in which the human body and brain work. When we are in a situation where our mind perceives danger or fear, it causes the rest of the body to act accordingly. Many of the boys on the unit where I worked were diagnosed with PTSD and had a very low trigger threshold. Almost any stimulus from the environment, whether it was a direct instruction from a staff member or the smell of eggs and bacon cooking in the kitchen, was a trigger for those boys and would set them off. During the time when they were presenting with PTSD symptoms, they would become angry and violent, wanting to assert their power in the situation, and attempt to gain some sense of control. They had difficulty regulating their emotions, so a perceptual cognitive trigger that is first conceived in the mind sends a signal to the rest of the body, putting it in a state of flight or fight. In the staff’s mind, they saw the child as being rude and disobedient; but if we were to take a look at this scenario through a cognitive-affective lens, we could see that it was the children’s inherent perceptions that were influenced by their emotional state, which in turn reinforced their cognitive state. They would perceive staff’s attempt to get them to stay on task and follow directions as a threat to their ability to exert free will and make their own decisions. When you have a history of rape and abandonment where your power is constantly snatched away from you, being told what to do, when to do it, and how to do it, becomes a trigger and even more of a bigger threat to one’s safety and security. Feeling a lack of control creates a sense of insecurity and danger which feeds into feelings of fear and endangerment, thus causing a repetitive self-sabotaging cycle.
Looking back, it appears that offering the children rewards and punishments wasn’t enough to warrant on task behavior. The program was lacking a very important component – well-trained staff in the areas of cognitive and clinical psychology. Many of my coworkers had no formal education or training in psychology, therefore they lacked a basic understanding of the child’s behavior and how their own behavior contributed to the dynamic of the problem. The idea that the children’s behavior could be explained by an inability to regulate their emotions and perceptions never crossed their minds or was a topic of discussion. It was all about punishing the child when they disobeyed because seemingly, they knew what the rules were and would purposely attempt to break them. In reality, the issue was much deeper than that and the staff lacked the necessary and proper experience and training to effectively assess what was happening inside the kid to efficiently intervene to treat them. The end result of the child’s acting out behavior often would result in a physical restraint followed by a shot of Ativan injected into the child’s buttox by the nurse. So the instances of problematic behaviors quadrupled over time because it was a repetitious cycle that fed into itself. My hypothesis is that proper staff training on being able to recognize the signs and symptoms of various disorders and effectively treat them, would drastically reduce the number of physical restraints, which often feed into the problem.
Proper training in symptom identification and regulation on a cognitive-affective level is necessary. In past years, many child-serving treatment centers have only focused on the behavioral aspect, not taking into account the cognitive and affective processes that underpin problematic behavior. There’s very little talk about external/internal triggers that ignite these kinds of emotionally exaggerated responses in kids who are diagnosed with conduct and oppositional defiant disorder. For many clinicians, the child’s behavior is rooted in individual choice and should be controlled with strict behavioral consequences if the child lacks the ability to control it himself. Because our emotions are closely tied to our cognitions, attitudes, and perceptions, it’s very difficult to teach someone to regulate his/her emotions without teaching them a certain degree of mindfulness and cognition regulation. Even for many adults, regulating our thoughts and feelings can be a challenge; so imagine the difficulty a child who wasn’t afforded a normal development could be experiencing in having to somehow develop those skills at a later time in life with no proper guidance or emotional support. The way in which they react to situations they perceive as a threat has served an adaptive function in their life as a means to keep them alive and protected from potential sexual predators and life-threatening situations.