Does action planning reduce anger and aggression in at-risk adolescents? A randomised controlled trial

Abstract

Background: Interventions that include action planning are more effective than others to reduce aggression among at-risk adolescents. However, they often include other behaviour change techniques. The efficiency of interventions could be improved if action planning on its own could reduce aggression. The current study investigates the effect of a volitional help sheet (VHS) that prompts the creation of action plans to manage anger in response to specific or generic anger triggers. It was hypothesised that participants completing the VHS would have lower levels of aggression and anger at follow-up. The moderation effects of violent intentions, callous-unemotional traits and negative urgency were also tested.Methods: One hundred adolescents (10-17 years old) with behavioural problems were recruited and randomised to three conditions: specific anger triggers, generic anger trigger or active control. An active control group was used to blind participants and teachers to group allocation. Self-reported data on anger and aggression was collected at baseline, one month and six months after intervention at the participants’ schools. This trial was registered at www.clinicaltrials.gov (identification number NCT03693209).Results: Eighty-one participants completed at least one follow-up and were included in the analysis. Neither VHS had a significant effect on anger or aggression overall, but moderator effects were found; both VHS were effective for participants with high callous-unemotional traits and low negative urgency. There were no differences between specific and generic triggers.Conclusions: Adolescents with high callous-unemotional traits have traditionally been seen as a difficult population to treat. The VHS is a cost-effective technique to reduce aggression in this population which is easy to implement. Future studies are needed to identify which behaviour change techniques are needed for other groups.