Bullying: A School Mental Health Perspective

  • Susan M. SwearerEmail author
  • Cixin Wang
  • Adam Collins
  • Jenna Strawhun
  • Scott Fluke
Part of the Issues in Clinical Child Psychology book series (ICCP)


This chapter focuses on the issue of bullying, which has grown as a significant concern among school personnel, students, and parents in the past few decades. The literature on school disciplinary procedures, social-emotional learning approaches, positive behavioral interventions and supports, and cognitive-behavioral treatment for aggressive behavior are reviewed and form the foundation for an individualized mental health assessment and treatment approach for working with students who bully others. This chapter provides a framework for bullying as a mental health issue and emphasizes the importance of schools, communities, and families working together in order to create a culture where bullying is not rewarded, supported, nor accepted. We describe the Target Bullying Intervention Program (T-BIP), which was designed to evaluate and address the mental health issues that may be underlying bullying behaviors.


Oppositional Defiance Disorder Cognitive Distortion Bully Behavior Aggressive Youth Scholastic Competence 
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The current zeitgeist surrounding the phenomenon of bullying has reached an unprecedented crescendo. Most states have passed some type of anti-bullying law, school personnel are struggling with how to effectively reduce bullying among school-aged youth, and websites and program addressing the issue have increased exponentially. This chapter provides a framework for bullying as a mental health issue and will argue that in order to prevent bullying behaviors, schools, communities, and families will need to work together in order to create a culture where bullying is not rewarded, supported, or accepted. We review standard disciplinary practices and social-emotional learning approaches and describe the Target Bullying Intervention Program (T-BIP) designed to evaluate and address the mental health issues that may be underlying the bullying behaviors. Finally, a call to understand bullying as a mental health problem that, by definition, requires effective mental health promotion and treatment is asserted.

Disciplinary Procedures in Schools

Unfortunately, many school personnel use generic approaches to school discipline and behavior management, such as zero-tolerance procedures, which do not address the individual needs and deficits of particular students. Moreover, zero-tolerance approaches provide inconsistent consequences for bullying behaviors and do not include components that aim to increase students’ social and emotional competence. Zero tolerance sends a message to students that the preservation of order, control, and vague notions of school safety is more important than individual rights, building students’ social competencies, and facilitating healthy relationships (Skiba & Peterson, 1999). This is not to say that there should be no consequences for misbehavior; however, consequences need to be developmentally appropriate for students, and their misbehaviors and coordinated prevention and intervention efforts should be established.

Social and Emotional Learning (SEL)

Programs that emphasize prevention, early identification of students with behavioral concerns, and social skills instruction should be implemented in schools in order to create positive school climates and reduce aggressive behavior (Peterson & Skiba, 2001). Although schools are often faced with limited training, resources, and budgets, students spend an extensive time in a school building each day, making schools an ideal setting to teach pro-social behaviors (Durlak & Weissberg, 2010). Schools need to identify and implement worthwhile, evidence-based approaches that demonstrate clear learning and behavioral objectives for increasing students’ social and emotional development. These social and emotional learning (SEL) competencies include understanding and monitoring emotions, identifying and attaining goals, forming positive relationships with peers and adults, responsible decision-making, and demonstrating the ability to deal with interpersonal difficulties in an effective way. Other skills related to the enhancement of SEL are problem-solving, conflict resolution, self-control, leadership, and competencies related to increased self-efficacy or self-esteem (Durlak, Weissberg, & Pachan, 2010). Individual student behavior plans and functional behavior assessments that teach replacement behaviors can also aid in the fostering of SEL (Elinoff, Chafouleas, & Sassu, 2004).

The Collaborative for Academic, Social, and Emotional Learning (CASEL) has emphasized that the programs that are most successful in forming students’ SEL skills are focused on modeling, practicing, and reinforcing desirable social behaviors (Durlak & Weissberg, 2010). Specifically, SEL programs that offer a sequential and integrated skills curriculum, use active forms of learning, devote ample attention to skill development, and create clear learning goals are particularly effective in promoting SEL skills. SEL programs that are continuously monitored and evaluated also produce the largest and most meaningful gains in skill development (Durlak et al., 2010; Durlak & Weissberg, 2010). SEL programs then instruct students to apply these skills to a larger framework, such as violence prevention and community service.

Research has shown that participation in SEL programs is related to gains in academic performance and reductions in problem behaviors. Compared to control students who did not participate in an SEL program, students involved in an SEL program displayed higher levels of pro-social behavior and decreased levels of conduct problems and emotional distress. Compared to controls, students in the SEL group showed an 11% gain in academic achievement following their participation in the SEL program. SEL programs that are implemented consistently and thoroughly have been proven effective for students belonging to various ethnic groups and who have been deemed at risk for emotional and behavioral problems (Durlak & Weissberg, 2010). These gains are in stark contrast to the research on zero tolerance, which shows that suspensions occur at increased rates for African-American students and students verified with emotional and behavior disorders (Skiba, Peterson, & Williams, 1997).

SEL as an Approach to Understanding Bullying Prevention and Intervention

Schools that create positive, supportive, and safe school climates by teaching students the necessary skills for social interactions reduce rates of bullying behaviors (Skiba et al., 2006). Instead of using suspension as the first response to aggressive and bullying behaviors, comprehensive threat assessments and interviews should be implemented in order to evaluate the seriousness and extent of aggressive threats and obtain an account of the incident from relevant individuals involved (Skiba et al.). Suspension or expulsion should only be applied in the most serious of aggressive and violent offenses.

Successful bullying prevention and intervention programs have demonstrated reduced rates of not only fighting but also vandalism and truancy, while increasing students’ positive attitudes toward their school (Ttofi & Farrington, 2011). Additionally, effective bullying prevention programs, whether they are universal, secondary, or tertiary approaches, always include awareness and adult involvement. In contrast to interventions that rely solely on punishment, bullying programs usually aim to provide students with knowledge about the causes and consequences of bullying behavior, the feelings of the students involved in bullying, and alternative solutions to aggression and violence (Peterson & Skiba, 2001).

Addressing Bullying Through Positive Behavioral Interventions and Supports

Positive Behavioral Interventions and Supports (PBIS; Horner, Sugai, Todd, & Lewis-Palmer, 2005) is a research-based framework school personnel can use to guide the selection and implementation of evidence-based academic and behavioral practices. PBIS has been developed around the three-level model of prevention and intervention. All students receive Tier 1, or primary support, while students who are at risk for problem behaviors receive Tier 2 (secondary) support. Students who need intensive intervention receive Tier 3 (tertiary) support (Walker et al., 1996). As students receive support through the three levels, the intensity (and therefore the resource requirement) of the interventions increases, while the number of students served decreases. In this way, all students receive some level of support, while resources are still allocated in greater proportion to students who exhibit the greatest behavioral difficulties.

PBIS is a school-wide model for preventing and reducing problem behaviors while increasing positive behaviors (Sugai et al., 2000). PBIS has been implemented in thousands of schools across the United States and has been shown to decrease problem behaviors, resulting in fewer office referrals and suspensions (Bradshaw, Mitchell, & Leaf, 2010; Bradshaw, Waasdorp, & Leaf, in press; Horner et al., 2009; Waasdorp, Bradshaw, & Leaf, 2012).

Bullying behaviors may be particularly suited to this model of prevention and intervention (Espelage & Swearer, 2008). While bullying is a serious problem for many students, it is likely the case that the majority of students are not frequent perpetrators or targets of bullying (Nansel et al., 2001). Thus, intensive interventions for every student are unnecessary. However, students who are consistently involved in bullying are at risk for serious negative mental health and behavioral outcomes, such as depression, anxiety, suicidal ideation, drug and alcohol use, and incarceration (Swearer, Song, Cary, Eagle, & Mickelson, 2001; Ttofi, Farrington, Losel, & Loeber, 2011). These students need the increased focus and intensity of secondary and tertiary interventions. Additionally, as proposed by the social ecological model of bullying, the multitude of factors surrounding bullying means that individualized interventions are often necessary, suggesting that no single intervention will work for all students. Tertiary interventions, because they are used only for students who need them most, are well suited to this sort of flexibility. For these reasons, schools should consider adapting the PBIS framework for their bullying prevention and intervention strategies and conceptualize a fluid model starting from a prevention focus and moving to evidence-based interventions as needed. Therefore, in terms of a model to address bullying behaviors, we will present an integrated prevention-to-intervention framework.

Primary Prevention and Intervention

The primary level of prevention, often called “school-wide interventions,” is designed to target every student in the building. It is generally predicted that approximately 80% of students can be served through Tier 1 strategies alone. The goal of these interventions is to provide a predictable, structured environment in which students know what behaviors are expected of them and what consequences will occur if they behave in undesirable ways. As such, Tier 1 interventions are often preventative in nature. Some examples of interventions at this level that are applicable to most behavioral issues include the development of consistent rules that are taught to students and staff, explicit teaching of desired behaviors, and reinforcement of desired behaviors (e.g., through praise). The promotion of collecting data and using data to inform intervention is a particularly important component of Tier 1 and is a critical part of PBIS.

A variety of bullying intervention strategies can serve as Tier 1 interventions. At the district or state level, anti-bullying policies can be drawn up that outline expected responses to bullying. Many schools hold regular staff meetings to train staff on how to handle bullying reports. Schools may also hold anti-bullying assemblies or have students create posters to hang throughout the building in an effort to raise awareness of the issue. To support data-based decision-making, schools can benefit from distributing bullying surveys to every student to determine where, when, and how bullying occurs (Sherer & Nickerson, 2010). A combination of these strategies may lead to better outcomes than any particular strategy in isolation.

Increasingly, schools are turning to packaged bullying prevention and intervention programs to serve their Tier 1 needs. However, a meta-analytic review of these interventions found that the programs collectively led to only modest decreases in bullying (Ferguson, Miguel, Kilburn, & Sanchez, 2007). Moreover, caution should be taken in selecting one of these programs, as there are a large number of programs available on the market, and only a few are considered evidence-based. Therefore, schools should not rely on any single intervention package to eliminate bullying behaviors. Instead, schools interested in these interventions should (1) ensure they select a program with strong research support and (2) consider the program to be a Tier 1 intervention and support it with a variety of Tier 2 and 3 interventions. Administrators should anticipate that approximately 20% of students will still require services above and beyond those provided by any Tier 1 strategy and plan their policies and procedures accordingly.

Secondary Prevention and Intervention

In order to prevent more serious behaviors in the future, the secondary level of intervention is designed to address the needs of students who are at-risk for developing significant problem behaviors. Approximately 15% of students are expected to be served at this level. Secondary interventions are more intensive and resource intensive than primary prevention and intervention, often taking the form of small groups or regular meetings with a counselor or psychologist. To qualify a student for secondary interventions, schools often require documentation that primary interventions were tried first but that they were unsuccessful or not potent enough. Importantly, students at this level receive Tier 2 services in addition to the Tier 1 services provided to the whole study body (Ross & Horner, 2009).

Students in need of Tier 2 bullying interventions may be those who have been involved in bullying, yet the involvement has not decreased following primary intervention. A common Tier 2 intervention may be placing victims of bullying into a small groups designed to build social skills like appropriate assertiveness skills. Another intervention may be role-playing with bullies and/or victims on how to handle confrontations. Increasing parental involvement through calls or homeschool notes may also assist students at this level.

Ross and Horner (2009) developed and tested a behavioral bullying intervention designed to be used as a Tier 2 intervention in PBIS. They hypothesized that a large portion of bullying behaviors are maintained by social attention. Thus, they taught bystanders and victims to ask the bully to stop, then walk away, and, if necessary, tell an adult. This decreased the amount of social attention available to bullies. Their results showed the expected decrease in both bullying behaviors and unwanted bystander behaviors (e.g., cheering the bully on, laughing). The researchers noted that bullying behaviors that are not maintained by peer attention will likely be unaffected by this intervention; this suggests a need for even more focused interventions for students whose negative behaviors remain even after secondary supports are put into place.

Individual Versus Group Interventions

Group interventions for students with physical or relational aggression problems appear on the surface to be the most efficient manner with which to address concerns. Unfortunately, these types of interventions are marred by several factors which result in reduced effectiveness. Although the literature is limited due to researchers choosing not to publish neutral or negative effects, several studies have shown how group interventions may negatively impact intervention efforts. These iatrogenic responses to interventions have been suggested to derive from deviant talk which influences participation in multiple antisocial behaviors (Dishion & Owen, 2002; Piehler & Dishion, 2007). Deviant talk refers to peers sharing negative ideas or actions such as aggressive exploits or rule-breaking behaviors. This type of talk is more likely to occur between youth with antisocial tendencies who develop friendships or relationships. Furthermore, when these interactions are reinforced, the antisocial behaviors which originally lead youth to be referred for services may increase (Newman-Carlson, Horne, & Bartolomucci, 2000).

Dishion, McCord, and Poulin (1999) conducted one of the few studies which specifically examined the negative effects of group interventions with aggressive youth. Their longitudinal analyses revealed several key findings. Youth who had relationships marked by deviancy training (i.e., receiving peer reinforcement during deviant talk) were more likely to display increases in delinquency, substance use, and violence. Additionally, those youth with moderate baseline rates of delinquency were more likely to show increases in future antisocial behavior than other groups. The authors of the study suggested that those deviant behaviors which were met with responses of laughter and social attention by peers served as a strong form of reinforcement. Thus, the likelihood of the deviant behaviors being repeated in the future increased. Dishion et al. concluded that repeated contact with similarly deviant peers within a group could contribute to the iatrogenic effects commonly observed in these settings.

The youth whom Dishion, McCord, and Poulin (1999) studied have similar characteristics to those students who engage in bullying, and the iatrogenic effects discussed in their research can be applied to bullying as well. Intervention programs designed to reduce bullying which are administered within a peer-group format have been shown to produce similar results. In the preface to their intervention manual, Newman-Carlson et al. (2000) describe the iterations and revisions conducted before its publication. One method of intervention delivery the authors attempted was group counseling. Students who were involved in bullying were placed in one of the three groups: (a) bully only, (b) victim only, and (c) bully victims. Newman-Carlson and colleagues wrote that “The ‘bullies only’ approach proved unsatisfactory because the bullies offered one another support in maintaining their aggressive behaviors. They identified the problem not as their own; but as the victims, who ‘deserved what they got’” (p. vii). Deviant talk was clearly a contributing factor in the iatrogenic effects. What is also interesting is the cognitive distortion of blaming the victims expressed by the bullies. Individual interventions may help prevent potential iatrogenic effects of deviant talk and cognitive distortions.

Tertiary Prevention and Intervention

When it has been documented that a student has not responded to secondary interventions, he or she may qualify for Tier 3 intervention. Tertiary interventions are designed for the most challenging students in the school building and also attempt to prevent more serious behaviors that might result in expulsion. Accordingly, they are the most intensive and resource dependent of the three tiers. Approximately 5% of students are expected to require this type of services. As in Tier 2, students being served at this level should still receive primary and secondary interventions in addition to tertiary services. Some examples of Tier 3 interventions include special education services, individualized behavior plans, counseling services, and functional behavior assessments (FBA).

The Target Bullying Intervention Program (T-BIP; Swearer & Givens, 2006) is an example of a tertiary intervention designed using evidence-based cognitive and behavioral assessment and intervention strategies for aggressive youth. The T-BIP is designed as a one-on-one cognitive-behavioral intervention for students who have displayed a history of bullying behaviors. The T-BIP is an individual cognitive-behavior therapy program administered by a trained therapist. In schools that use the T-BIP, parents of students who are referred for repeated bullying behaviors are given a choice: suspension (typical consequence) or participation in the intervention. Parents of these students are also involved in the intervention through a follow-up meeting with the therapist, school personnel, and student which provides specific and concrete recommendations to ameliorate the bullying behaviors.

The T-BIP intervention takes place in a 3-hour session consisting of assessment, psychoeducation, cognitive restructuring, and followed by a solution-focused feedback session approximately 2 weeks after the individual intervention. Students first complete several questionnaires designed to assess the bullying they have perpetrated, witnessed, and experienced; internalizing symptoms (i.e., anxiety, depression); self-perceptions of academic and athletic competence; cognitive distortions; and perceptions of school climate. Next, the therapist shows the student an age-appropriate PowerPoint presentation that is used to spark discussion and teach about bullying behaviors and why they occur. The student then completes a quiz over the presentation to check for understanding, several worksheets from the Bully Busters program chosen to address the specific type of bullying behavior perpetrated by the student (Newman-Carlson et al., 2000), and watches a video that illustrates different types of bullying behaviors. Throughout, cognitive restructuring strategies are used to help the student understand some of the underlying cognitive distortions that he or she is verbalizing. Following the session, the therapist creates a written report summarizing the assessment results and the insights gained from the session and makes recommendations designed to create supports in home and school that will reduce the likelihood of engaging in bullying behaviors in the future.

Bullying prevention programs that emphasize parental involvement have also been shown to decrease bullying behaviors in school. Parents who are involved and aware of their child’s academic and behavioral progress at school can create similar home environments that promote desirable behaviors, furthering the consistency of behavioral expectations (Peterson & Skiba, 2001). It has been proposed that parents of students who are at risk for expulsion due to bullying attend regular meetings with school personnel to problem-solve solutions for their child’s behavior (Peterson & Skiba, 2001). In this manner, parents can become more aware of their child’s misbehavior in school and target similar areas in the home setting. Furthermore, parent meetings build relationships between parents and staff, encouraging the reporting of future aggressive behaviors between the two parties. Therefore, the T-BIP also has a parent component designed to help facilitate home-school communication.

Cognitive-Behavioral Techniques to Reduce Aggression

Research on the effectiveness of using cognitive-behavioral techniques in an effort to reduce aggression has produced promising results. In their meta-analysis, Sukhodolsky, Kassinove, and Gorman (2004) examined the outcomes of cognitive-behavioral therapy (CBT) for aggressive children and adolescents. Analysis of 40 studies suggested CBT was effective in reducing aggressive symptoms with a medium mean effect size (Cohen’s d = 0.67). The authors of the meta-analysis divided the studies into four groups according to therapeutic technique and calculated the mean effect size for each group. Results indicated three of the four cognitive-behavioral techniques were effective: skills development (d = 0.79), eclectic treatments (d = 0.74), and problem-solving treatments (d = 0.67). Eclectic treatments referred to treatments which used several cognitive-behavioral procedures and addressed two or more aspects of anger. The fourth technique, affective education (i.e., teaching about emotions), was significantly less effective (d = 0.36) than the skills development and eclectic treatments groups. Further analysis revealed that skills training and multimodal techniques were the most effective in reducing experiences of anger in children and adolescents. Findings from this meta-analysis suggest that CBT techniques may provide youth with strategies which enable them to reduce their aggressive behaviors.

Cognitive-behavioral techniques may also help reduce aggression through the altering of cognitions (Lochman, Powell, Whidby, & Fitzgerald, 2006). Research over the past 30 years has repeatedly shown that aggressive youth have a hostile attributional bias toward neutral or nonhostile events (Dodge et al., 2003; Kupersmidt, Stelter, & Dodge, 2011); that is, these youth tend to assume that people are acting aggressively toward them, when they are not. This is true for the physically aggressive as well as relationally aggressive behaviors which frequently occur in bullying. A study by Lochman and Wells (2002) found mediating effects of altered cognitions for aggressive youth. Specifically, path analyses showed that the outcome effects of their CBT-based intervention program were partially mediated by the changed social-cognitive processes, schemas, and parenting processes. The T-BIP makes use of these findings by systematically measuring cognitive distortions which then inform intervention efforts. Thought distortions of participants in the T-BIP are assessed using the How I Think Questionnaire (HIT; Barriga, Gibbs, Potter, & Liau, 2001) during the assessment phase. Students who are overly aggressive, for example, may respond in a manner that suggests they minimize the damaging nature of their aggression and blame others for “causing” them to become angry. The therapist is then able to address students’ thinking patterns in the specific situations which prompted the T-BIP referral. The T-BIP used data-based decision-making to understand, educate, and provide a solution-oriented plan to alter the student’s bullying behavior.

CBT techniques have also been effective with students who suffer from more severe forms of aggression. In their review, Johnson and Waller (2006) examined several interventions designed to reduce aggression in youth who met the criteria for conduct disorder (CD) or oppositional defiance disorder (ODD). Several techniques were examined including interpersonal skills training (e.g., problem-solving, social, anger control), intrapersonal skills training (e.g., desensitization, imagery), multimodal treatment, and parent training. Results suggested that several interventions utilizing cognitive-behavioral techniques were efficacious. Interventions such as the T-BIP which utilize cognitive-behavioral techniques in one-on-one sessions with youth avoid this contagion effect from other aggressive youth. Johnson and Waller (2006) concluded that based on their findings, the best treatment for youth with CD or ODD is a multimodal approach that includes aspects of CBT in addition to parental involvement. The importance of parental involvement in combination with cognitive-behavioral interventions to reduce aggression has been supported by other studies in the field of aggression as well (Northey, Wells, Silverman, & Bailey, 2003; Southam-Gerow & Kendall, 2000).

The T-BIP is a promising tertiary intervention because its intensive, one-on-one nature allows for the therapist and student to identify and address the ecological factors that maintain the bullying behaviors. Furthermore, although the T-BIP is a time intensive program, by replacing suspension or reducing the length of the suspension, it allows students to spend more time in the classroom. Ideally, schools choosing to implement the T-BIP will do so in conjunction with effective primary and secondary behavioral supports. Following the PBIS model, a school may, for example, choose to implement the “Steps to Respect” curriculum as a Tier 1 support, run small social skills groups as Tier 2 support, and implement the T-BIP as Tier 3 support. In the next section we will present a de-identified sample T-BIP client, and we will present some preliminary data on the effectiveness of the T-BIP.

Sample Target Bullying Intervention Client

Kellen is a Caucasian 13-year-old female who lives with her mother, stepfather, four older brothers, three younger brothers, and younger sister. She was in the 7th grade at the time of the Target Bullying Intervention Program and was referred by her school counselor. This referral was precipitated due to concerns with Kellen’s behavior at school. Specifically, she was reported to physically bully other students, and her bullying behaviors had resulted in disciplinary actions, including two suspensions.

Assessment Results

Kellen completed the Children’s Depression Inventory (CDI). Total raw scores of 19 (T-Score = 60) or greater indicate the potential for depression. Her total CDI score (T-Score = 39) fell into the nonclinical range, as did her scores on the Negative Mood (T-Score = 48), Negative Self-esteem (T-Score = 39), Interpersonal Problems (T-Score = 43), Ineffectiveness (T-Score = 38), and Anhedonia (T-Score = 41). These scores indicated that Kellen was not self-reporting experiencing clinically significant symptoms of depression.

She also completed the Multidimensional Anxiety Scale for Children (MASC), which is a self-report measure consisting of 39 items, which are designed to assess dimensions of anxiety in children ages 8 to 19. These items provide measures on four factors, including Physical Symptoms, Harm Avoidance, Social Anxiety, and Separation/Panic. These four factors are combined to provide a Total Anxiety score. T-Scores greater than 65 indicate levels of clinical anxiety. Her total anxiety score (T-Score = 45) fell into the nonclinical range, as did her scores on Physical Symptoms (T-Score = 34), Harm Avoidance (T-Score = 51), and Separation Anxiety (T-Score = 49). Kellen’s score on Social Anxiety (T-Score = 57) fell into slightly above average range but was still within the nonclinical range. This indicated that social anxiety may be an area of relative difficulty for her. Overall, however, these scores indicated that Kellen was not self-reporting experiencing clinically significant symptoms of anxiety.

Kellen also completed the How I Think Questionnaire (HIT), which is a 54-item self-report measure that asks students to report how they think about things in their lives. Her total HIT score fell in the nonclinical range (<50%). Her scores on the Self-Centered (<50), Minimizing/Mislabeling (<50%), Assuming the Worst (<50%), Physical Aggression (<50%), Oppositional Defiance (<50%), Blaming Others (<50%), Lying (56%), and Stealing (<50%) subscales all fell into the nonclinical range. Notable items with which Kellen indicated that she agreed include “If I made a mistake, it’s because I got mixed up with the wrong crowd,” “Everybody lies, it’s no big deal,” “In the past, I have lied to get myself out of trouble,” “I have done bad things I haven’t told people about,” and “I have taken things without asking.” Her scores indicated that she was not experiencing any cognitive errors.

The Thoughts About School (TAS) questionnaire is a 34-item scale that measures aspects of school climate hypothesized to be related to bullying behaviors. For the items “There is a lot of graffiti written on school property (e.g., bathroom, outside walls),” “Lots of kids are afraid of bullies,” “Many students get bullied,” and “Bullying is a problem at my school,” she indicated that she believed these were true at her school. Thus, Kellen believed that bullying was a problem at her middle school. Kellen also completed the Self-Perception Profile for Children, which assesses domain-specific judgments of competence and self-adequacy, as well as a global perception of worth or self-esteem. There are a total of 36 items on which she was asked to score each item on a scale from 1 to 4, where a score of 1 indicates low perceived competence, a score of 2.5 indicates medium perceived competence, and a score of 4 reflects high perceived competence. Kellen’s scores on Global Self-Worth (M = 3.67), Scholastic Competence (M = 3.67), Athletic Competence (M = 3.67), Behavioral Conduct (M = 3.50), and Physical Appearance (M = 3.33) indicated high perceived competence. Her score on Social Acceptance (M = 3.00) indicated medium to high perceived competence. These scores suggested that Kellen exhibited high self-esteem overall while feeling slightly worse about her social acceptance. Her score on Scholastic Competence is consistent with school reports of her grades (i.e., mostly Bs). Given school reports of Kellen’s behaviors at school, her score on Behavioral Conduct was somewhat higher than might be expected. However, given her lower score on Social Acceptance, it appeared as though she recognized that she had problems with peer relationships.

Kellen also completed The Bully Survey-Student Version (BYS-S), which is a four-part survey that queries students regarding their experiences with bullying, perception of bullying, and attitudes toward bullying. In part A, students answer questions about when they were victims of bullying during the past year. Part B of the survey asks questions about the participants’ observations of bullying behavior among their peers during the past year (bystander). Part C requests information from the participants about when they have bullied other students. Finally, Part D requires students to provide their general perceptions of bullying. Kellen self-identified as having been bullied, witnessed bullying, and bullying others. She indicated that she had bullied girls in the same grade in the gym one or more times per week. Kellen reported that she bullied by calling others names and by pushing/shoving, which made her and the students she bullied feel bad or sad. She indicated that she bullied others in order to “get revenge.” When asked about her perceptions of bullying, Kellen reported that the items “Bullies make kids feel bad,” “I feel sorry for kids who are bullied,” and “Bullies hurt kids” were totally true.

Therapy Component

Kellen participated willingly throughout the session and acknowledged that she had bullied other students. She completed self-report measures, watched a video on bullying called Stories of Us (, and participated in a PowerPoint presentation on bullying. She was also asked to complete the Draw a Bully activity and to complete a worksheet activity (i.e., Knowing My Anger) from the Bully Busters curriculum workbook designed to equip students with skills to handle future bullying situations. She shared her experiences, feelings, and beliefs about bullying incidents, attempted to recognize and understand various bullying behaviors and the reasons behind those bullying behaviors, and role-played positive alternatives for bullying behaviors. She had been suspended two times for bullying (slapping) other students. When speaking with the student therapist, Kellen shared examples of verbal bullying she had perpetrated but was more reluctant to discuss the physical bullying she had done. When discussing the reasons behind bullying, she acknowledged that the main reason behind her bullying was the desire for revenge. She expressed a great deal of empathy toward victims of bullying and appeared to be ashamed of and distressed by the bullying she had perpetrated. She knew many positive alternatives to bullying behaviors; however, she indicated that she often felt so angry toward other students that she would bully them even when she did not want to and knew she should not act this way. She was able to articulate the connection between her own experiences with bullying and what she learned from the PowerPoint presentation about bully victims and the cycle of aggression. Her involvement in bullying appeared to be caused by a desire for revenge and difficulty controlling her negative emotions, particularly anger.

Follow-up Report and Solution-Focused Meeting

Two weeks after the T-BIP, Kellen’s mother, the school principal, her school counselor, and the T-BIP therapist met to complete the parent and teacher measures, review the report, and plan for ways Kellen can change her behavior. Interventions that can help Kellen to manage her negative emotions and to resolve conflicts using nonaggressive problem-solving strategies are likely to help her get out of the bullying dynamic. The T-BIP report ends with a list of data-based recommendations. The following recommendations were made based on her self-report measures and her interactions with the therapist during the bullying intervention session:
  1. 1.
    Monthly individual cognitive-behavior therapy (CBT) to help Kellen better understand the connection between her thoughts, feelings, and behaviors, particularly with regard to the connection between her interpretation of the bullying she experiences, her feelings of anger, and her behaviors (i.e., seeking revenge by engaging in bullying behaviors).
    1. (a)

      Kellen would benefit from anger management therapy and techniques that assist her in recognizing her anger and the signs/symptoms that accompany it as well as ways to calm herself down. Relaxation strategies, such as deep breathing and muscle tensing/relaxation, may also help her to calm herself down when she becomes angry. By managing her anger better, Kellen may be better able to problem-solve when being bullied by her peers and to take more socially appropriate steps to ending the bullying.

    2. (b)

      Although the session focused on Kellen’s relationships with peers at school, she mentioned that she has difficulty getting along with her siblings at home. If this is deemed to be an area of difficulty for Kellen and other members of the family, family therapy or filial therapy should be considered.

  2. 2.

    Kellen may benefit from checking in with her counselor or a trusted teacher at the end of every day to allow her to report on how her day was and to share information regarding bullying situations and personal successes. This would also provide an opportunity for her to anonymously report any bullying she experienced. Although these contacts may be brief, Kellen would further benefit from meetings with a counselor or trusted teacher to discuss specific events and to practice techniques she may be learning to help her deal with difficult peer interactions. Specifically, Kellen may benefit from practicing responding to other students who are bullying her or making her angry.

  3. 3.
    The adults in Kellen’s life should help her to generate and utilize nonaggressive/nonthreatening problem-solving strategies. It is especially important that the adults in her life model using appropriate problem-solving strategies and methods of managing anger and other negative emotions.
    1. (a)

      It is recommended that a positive reinforcement system be used at school and in the home to reward Kellen for positive behaviors and the use of alternative strategies for problem-solving during times of conflict. This can be developed with Kellen, her parents, support teacher(s), and/or counselor.

    2. (b)

      A homeschool note would be a helpful way to link behaviors at school with behaviors at home in order to help find patterns in Kellen’s behaviors. A homeschool note can also help adults at home and school to stay on the same page regarding consequences for Kellen and ways to support her.

  4. 4.
    Kellen reported that she bullied others in the gym. Thus, she may benefit from increased supervision when she is in the gym. Since competitive environments may make it more difficult for Kellen to control her emotions, she would benefit from a permanent pass that allows her to take a time-out from the activity in order to calm down before returning to the situation.
    1. (a)

      Kellen’s gym teacher is encouraged to triage with her before and after gym class in order to gauge her emotions and remind her to use her pass if she feels that she needs time and space to regain control over her emotions.

  5. 5.
    Kellen reported lower self-competence in the area of social acceptance. Therefore, strategies to help her to build more positive relationships with her peers (e.g., encouraging Kellen to become involved in school clubs/activities) are warranted.
    1. (a)

      Given Kellen’s high athletic competence, she may benefit from involvement in a school sports team. In addition to encouraging positive relationships between Kellen and her peers, sports often provide a healthy outlet for negative emotions, particularly anger.

    2. (b)

      Given Kellen’s report that she is the middle child of nine children, she may benefit from additional contact with an adult with whom she can build a trusting relationship and discuss problems she may be less comfortable sharing with parents and/or school staff members. Thus, participation in a mentoring program may be beneficial for her.

  6. 6.
    Kellen reported that she is most frequently bullied via Facebook and that she is also bullied via texting from going online/texting during school and outside of school. Therefore, Kellen would benefit from increased supervision when she is online and/or texting.
    1. (a)

      Kellen would also benefit from psychoeducation surrounding the dangers of cyberbullying and ways to keep herself safe while online, particularly on social media sites.


Preliminary Analysis of the Target Bullying Intervention

In order to examine the overall impact of the T-BIP, data have been collected on 78 students who participated in the T-BIP in elementary through middle school (4th through 8th grades). Of the 78 students, 52 were male and 26 were female and their ages ranged from 9 to 14 years old (M = 11.81; SD = 1.08). The racial distribution across the students was 65.4% Caucasian, 6.4% African-American, 14.1% biracial or multiracial, 6.4% Latino, 6.4% Native American, and 1.3% other races. These demographics are consistent with the overall school district population. Among the 78 students, 50 (64.1%) reported that they had been bullied during the school year, ranging from one or more times a day (n = 17), one or more times a week (n = 14), to one or more times a month (n = 15) (four missing values). Sixty students reported that they had seen a student who was bullied this school year, ranging from one or more times a day (n = 22), one or more times a week (n = 23), to one or more times a month (n = 13) (two missing values). Fifty-eight students reported that they had bullied other students this school year, ranging from one or more times a day (n = 20), one or more times a week (n = 17), to one or more times a month (n = 16) (five missing values).

Based on students’ self- report on the three “Yes/No” questions (“Have you been bullied this school year?” “Did you ever bully anyone this school year?” and “Did you ever see a student who was bullied this school year?”), students were grouped according to status: (1) bully, (2) bully victim, (3) victim, (4) bystander, and (5) not involved. In the current study, based on students’ self-report, 20 students self-identified as bullies, 12 as victims, 38 as bully/victims, three as bystanders, four as not involved, and one student answered “No” to both bullying and victimization question, but did not answer the question about seeing other students being bullied.

The number of office referrals for the students decreased significantly after the T-BIP intervention, t(60) = 2.50, p = 0.02. Specifically, the office referral mean decreased from 3.67 (S.D. = 3.90) to 2.30 (S.D. = 3.28). For pretreatment office referrals, boys (M = 3.95, SD = 4.34) received more office referrals than girls (M = 3.14, SD = 2.89), but the difference was not significant, t(59) = −.77, p = .45. Older students tended to receive more office referrals; specifically, 14-year-olds on average received 8 office referrals, 13-year-olds received 4.82 office referrals, 12-year-olds received 4.24 office referrals, 11-year-olds received 2.21 office referrals, 10-year-olds received 1.60 office referrals, and 9-year-olds received 0.67 office referrals. However, the difference was also not significant, F(5, 55) = 2.29, p = .058.

Most parents found the T-BIP as an acceptable treatment. Specifically, 47.1% of the parents who completed the survey rated the T-BIP as “very acceptable” for their general reaction to this intervention (M = 5.78, SD = 1.50, with 7 being “very acceptable”), and 37.1% of the parents rated the T-BIP as “very acceptable” for the students’ problem behavior (M = 5.80, SD = 1.18, with 7 being “very acceptable”). Teachers also generally found the T-BIP as an acceptable treatment. Specifically, 47.8% of the teachers rated the T-BIP as “very acceptable” for their general reaction to this intervention (M = 5.80, SD = 1.18, with 7 being “very acceptable”), and 44.7% of the teachers rated the T-BIP as “very acceptable” for the students’ problem behavior (M = 5.21, SD = 1.96, with 7 being “very acceptable”).

Conclusions Regarding Preliminary Impact T-BIP

Preliminary results from the T-BIP suggest that it is an acceptable treatment from the perspective of parents and teachers and the intervention significantly reduced the number of office referrals received by students who completed the intervention. Results also support the assertion that bullying is a mental health problem; students involved in bullying experience internalizing and externalizing problems and errors in thinking. Further research should continue to examine whether or not the T-BIP reduces these problems and errors in thinking over time. While there were no significant differences between the groups (i.e., bully, bully victim, victim) in terms of depressive symptoms, students who self-identified as bully victims had higher levels of social anxiety and overall anxiety. Bully victims and victims also had higher scores on harm avoidance, which assesses anxious coping symptoms. It stands to reason that students who are being bullied worry about this and strive to avoid upsetting behaviors. The students in the T-BIP endorsed higher levels of cognitive distortions, suggesting that cognitive distortions may be an important factor to consider when working with students who bully others. Students who self-identified as bully perpetrators had significantly higher scores than victims and bully victims on all the HIT subscales. Students who self-identified as bullies also endorsed high levels of social self-perception. Interestingly, these students are confident about their social behavior and may view bullying as a means to achieve social status (Rodkin, Farmer, Pearl, & Van Acker, 2006). This is also an important focus for intervention in that these bully perpetrators need help in channeling their social status in positive ways, not negative. Both bullies and bully victims reported understanding that their behavior was problematic. Indeed, they were referred to the T-BIP because of their bullying behaviors. The first step to changing behavior is the awareness that the behavior is a problem. In this regard, the T-BIP helps students, teachers, and parents understand the underlying dynamics of the bullying behaviors, and using a data-based decision-making model helps provide a roadmap for cognitive and behavioral changes.

It is important to keep in mind some limitations when reviewing the preliminary results from the T-BIP. The program was originally designed as an alternative to suspension with the plan that parents and students who did not choose the T-BIP could be used as a comparison group (i.e., suspension compared to T-BIP). However, in the 5 years that this intervention has been implemented, no parent has declined the T-BIP and opted for suspension in order to deal with bullying behaviors. Future plans for the T-BIP are to apply for grant funding so that students can be randomly assigned to suspension or to the intervention. Additionally, in the earlier years of the study, the total number of office referrals was collected before and after the date of the intervention. The dates of the office referrals were not recorded, limiting the ability to control for length of time before and after the date of the intervention.


In order to effectively prevent and intervene in bullying behaviors, a comprehensive PBIS framework should be implemented. A coordinated, structured set of strategies to create a positive school climate will be the foundation to preventing bullying; however, when bullying behaviors occur, helping those students change their behaviors will ultimately reduce levels of bullying among school-aged youth. Involvement in bullying is clearly linked to cognitive and psychological distortions and deficits. Teaching students the skills they need in order to successfully interact with others without having to use bullying behaviors will help create socially competent youth who will shape the next generation.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Susan M. Swearer
    • 1
    Email author
  • Cixin Wang
    • 2
  • Adam Collins
    • 1
  • Jenna Strawhun
    • 1
  • Scott Fluke
    • 1
  1. 1.Department of Educational PsychologyUniversity of Nebraska – LincolnLincolnUSA
  2. 2.Kennedy Krieger InstituteBaltimoreUSA

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