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Cognitive Behavioral Therapy Techniques Reducing Youth Anxiety & Trauma

Part of the Hiding in Plain Sight blog series

Written by Hansa Bhargava, Senior Medical Director at WebMD and Medscape, Author and Pediatrician

November 30, 2021

Can persistence and science change a traumatized young person’s life? Kurt Palermo from Roca believes that it can. Roca is an organization dedicated to disrupting incarceration, poverty, and racism by engaging young adults, police, and systems at the center of urban violence in relationships to address trauma, find hope and drive change.

Kurt works at Roca in the deep inner city of Baltimore, where numerous young men and women are incarcerated for crimes every day. When you look deeper, these youth have been caught up in a punishing cycle of violence, and often come from impoverished families that live in areas of low income, suboptimal schools with chaos as an everyday fact. Kurt, alongside Roca, believes that the cycle can be broken, and it has been proven to be true with 25 years of data. He has seen many of these pessimistic, hardened young men and women, not only get their lives together but become happy, successful, contributing members of society. Roca, meaning Rock in Spanish, has helped thousands of young men and women. It initially began in Massachusetts and expanded into several cities there, and now has expanded to Maryland.

Kurt talks about three ingredients that have had an impact in this program, where other programs have failed – persistence, meeting people where they are, and Cognitive Based Theory (CBT), a scientific method that is used to modify behavior. He believes true impact is connected to ‘relentless outreach’ and trains his staff to embrace this key action. The average young person, who has a history of incarceration, violence, or trauma will open the door to Roca staff an average of 12-14 times after the first attempt.

“This is something that we do that is different from other programs …. meeting a person where they are. You have to go where the young people are,” said Kurt. The human connection is key and so is the introduction to CBT. Based on brain science, the neuroplasticity capacity of the brain to change is significant, especially in young adulthood. CBT training for youth is “laser-focused on what works” and is based on research in the cognitive stages of change. Although it takes time for the behavioral change to occur, approximately 2 years, it is working with the program “graduating” over 220 people every 4 years. Since its start, several centers have seen and helped hundreds of young men- in 2021, 745 men enrolled and more than 82% have stayed and practiced the CBT techniques, making an impact on their lives.

An example that Kurt points to is a previously traumatized young man who came for his 8:00 A.M. workday to the organization. He felt sick that day and told his supervisor. When the supervisor said he should go home and rest, the man mistook this as rejection and became triggered and started yelling that he wasn’t going to go home and that no one could make him. The staff quickly realized that this situation had put him back into a “fight or flight” response and it had invoked what Kurt calls the “bottom brain survival” part of his brain. The harm reduction and CBT model targets this behavior allowing, over time, for people to build in 8-10 seconds of pause before going into an automatic stress response. Talking and using the CBT methods, the staff were able to calm the young person down and get him back on track. With continuing practice, he was able to master this behavior change over time, an important mental-emotional tool, that can impact his entire life.

Molly Baldwin, the founder, CEO, and relentless leader of this organization is located in Massachusetts where 5 centers serve young men.  They have opened additional arms at two of these centers to serve young mothers as well. The aim is to teach behavioral learnings and get them back to productive lives. With over 254 young moms in the program, the hope is that stabilizing the mother will lead to better outcomes for the children. And it has. 52% of child welfare cases have been closed, and over 88% of the children had improved developmental outcomes. After 2 years in the program, ¾ of the young moms were successfully placed in employment. Many young moms have been helped and are now working as well as raising young children, breaking out of the cycle of incarceration.

“People can change,” Kurt passionately says. “It’s not magic and may be painful and frightening, but it is critical.”


About the Author

Hansa Bhargava is Senior Medical Director at WebMD and Medscape, Author and Pediatrician

The “Hiding in Plain Sight” blog is a series leading to the upcoming 2022 documentary Hiding in Plain Sight: Youth Mental Illnessproduced and directed by Ewers Brothers Productions, executive produced by Ken Burns, and presented by WETA, the PBS flagship station in our nation’s capital. 


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    WellBeings.org is a mental health resource, not a crisis or suicide response website. If you are in crisis, or experiencing thoughts of suicide, please text the Crisis Text Line (text HELLO to 741741), or call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). Both services are free and available 24 hours a day, seven days a week.