Youth, Violence, and Therapy

This post is coauthored with Ricardo Morel (IPA) and Florence Dzame (IPA)

There is often a disproportionate concentration of violence and crime among young people in low-income urban areas compared to their high-income counterparts. This is largely driven by structural violence, which includes systemic inequalities, limited opportunities, and inadequate social support systems.

Over the past few years, we have engaged with policymakers and practitioners who already understand the severe detrimental effects of youth involvement in criminal and violent activities. They are actively seeking effective cost-effective ways to reduce or deter such engagement.

Cognitive Behavioral Therapy (CBT) as an Intervention

While initially developed to treat depression, Cognitive Behavioral Therapy (CBT) offers a practical approach to mitigating violence and crime. CBT works by identifying and challenging negative thought patterns, reframing them, and modifying behaviors. It is based on the principle that thoughts, feelings, and behaviors are interconnected. The therapy typically involves mental health counseling over several weeks and helps develop crucial interpersonal skills, such as assertiveness, perseverance, and emotional regulation. CBT also addresses stress management, self-control, and problem-solving.

Evidence of impact

Experimental evidence from high-crime contexts highlights the effectiveness of CBT-inspired interventions in reducing criminal, violent, and antisocial behaviors. Here, we share relevant evidence from low- and middle-income countries and marginalized communities.

One randomized evaluation tested the impacts of a CBT-inspired therapy combined with cash transfers, as well as each intervention separately, in Monrovia, Liberia. The therapy was led by reformed street youth and young ex-combatants from the civil war. The combination of CBT plus a cash transfer showed the most significant and lasting positive impacts on reducing criminal, violent, and antisocial behaviors, with stable results even after 10 years. The effects were slightly smaller and less precise when therapy was delivered alone, without cash. Those who received the cash transfer invested it in small businesses, but this did not lead to sustained changes in economic performance or antisocial behaviors. The results suggest that the program was more effective among youth who reported the highest initial levels of crime and violence, implying that targeting the highest-risk young men yields the greatest returns.

The program was also cost-effective when delivering CBT alone or with cash transfers. The cost of delivering both therapy and cash together was approximately $530 per participant. Considering the impacts on theft and robbery, researchers estimated that the therapy resulted in at least 200 fewer crimes per participant, translating to $2.50 per crime averted. This calculation does not account for reductions in drug dealing and other forms of violence, suggesting that the cost-effectiveness estimate is conservative.

These findings from Liberia inspired the design of the Rapid Employment and Development Initiative (READI) program in Chicago, USA. READI offered subsidized jobs, professional development, and group therapy to high-risk young men in Chicago for 18 months. While it did not reduce severe violence—based on an index combining shooting and homicide victimizations, shooting and homicide arrests, and other serious violent crime arrests—the results still suggest positive effects of the CBT intervention. Specifically, it lowered arrests for shootings and homicides.

In El Salvador, an after-school program inspired by CBT for vulnerable public school students reduced teachers’ reports of misbehavior, students’ reports of delinquent and violent behaviors, and absenteeism, while also improving academic performance. The program also had positive spillover effects, improving behavior and academic performance for students who did not directly participate but were exposed to those who did.

The Road Ahead: Integration into Governance Processes and Further Evidence Generation

In sum, the existing evidence suggests that, by improving interpersonal skills, stress management, and problem-solving abilities, CBT not only helps reduce criminal and violent behavior among youth but can also enable their active participation in economic and social life, contributing to their communities.

In this sense, governments and policymakers can leverage CBT to increase youth engagement by integrating it into violence prevention and youth development programs. In addition, youth should be involved in the governance of CBT programs through advisory roles and feedback mechanisms. Engaging youth in this way promotes peer influence, inspires future generations of trainers, and extends the benefits through social networks.

However, some questions remain unanswered, and further evidence is needed. First, while targeting the most violent or vulnerable individuals might seem like a good strategy to maximize the intervention’s impact, recent evidence suggests that mixing participants with different levels of violence can improve the effects for the most violent individuals, compared to treating only the most violent. Second, we know that combining therapy with economic incentives like cash transfers has proven effective in reducing violence and fostering economic inclusion in both the short and long term. However, we need to explore other less costly complementary services to bundle with CBT that can increase the cost-effectiveness and scalability of such interventions. Lastly, it is important to generate evidence on how to reduce the delivery costs (and thus increase the scalability) of CBT interventions, such as by incorporating digital platforms or training non-professional staff to deliver the therapy.

For funding opportunities aimed at generating new evidence on CBT-related programming, consider exploring the Peace & Recovery Initiative and the Crime & Violence Initiative. These two competitive research funds support impact evaluations focused on preventing, mitigating, and responding to crime, violence, and conflict. New Calls for Proposals will be announced in 2025.