This meta-analysis of treatment-outcome studies of cognitive-behavioral therapy (CBT) for anger-related problems in children and adolescents included 21 published and 19 unpublished reports.
In this meta-analysis, the construct of anger was used as one of the selection criteria for the outcome studies. Anger was defined as "a subjective, negatively felt state associated with cognitive deficits and distortions and maladaptive behaviors." The phenomenology of anger includes emotional experiences that vary from annoyance to rage, behavioral patterns that vary from social withdrawal to physical aggression, and cognitive phenomena such as attributions of blame and mental rumination. Studies of CBT for anger-related problems in children and adolescents were considered for inclusion in this analysis. For the purposes of this study, CBT was defined as a class of child-focused treatments that target covert and overt behaviors to achieve improvements in symptoms and functioning. The objectives of the meta-analysis were to evaluate the overall effect size of CBT for anger-related problems in children and adolescents; to compare the effect sizes of skills development, affective education, problem-solving, and multimodal interventions; and to explore the effects of CBT across the domains of outcome measures and the categories of informants. In addition, the relationships between the magnitude of treatment effects and the mediating and moderating variables were explored. Meta-analysis was used to merge and analyze empirical results from individual studies for the purpose of integrating the findings. The four types of CBT grouped according to the target of therapy and predominant therapeutic techniques (skills development, affective education, problem-solving, and eclectic treatments) differed in their overall effects. Skills development and eclectic treatments were significantly more effective than affective education. Further, results suggest that the effectiveness of treatment increases as the amount of modeling and feedback increases. The use of homework was significantly and positively related to treatment outcomes. No significant relationship was found between the duration of treatment and the magnitude of treatment effect size. Although the positive effects of CBT for anger and aggression have been well documented, little is known about its mechanisms of change, moderators of outcomes, and the exporting of findings from clinical research to clinical practice. A review of research on factors in existing care systems that may influence the implementation of empirically supported interventions in clinical practice would be useful. 4 tables, 55 references, and appended studies included in the meta-analysis