Using Implementation Intentions to Reduce Anger and Aggression in Adolescence
Condition: Aggression; Anger
MeSH terms: Aggression
Study type: Interventional

Summary: 
      This study will test whether making plans of action for situations that trigger anger is
      effective in reducing anger and aggression in adolescents with behavioural problems.

      Participants will be assigned to three groups: a control group and two experimental groups.
      Participants assigned to the experimental groups will receive either one general anger
      trigger or a list of specific anger triggers in addition to a list of strategies that can be
      used to manage anger. Participants will be instructed to link the triggers with the
      strategies, thus creating action plans with an if-then structure. Participants assigned to
      the control group will receive the same lists. However, they will receive different
      instructions which will ask them to select separately the most encountered triggers and the
      most useful strategies.

      It is expected that making plans will reduce the anger and aggression of participants. It is
      also expected that the reduction will be larger for participants with low violent intentions,
      low callous-unemotional traits and low impulsivity.
    

Detailed description: 
      This study aims to test whether aggression in adolescents can be reduced using implementation
      intentions. This technique involves identifying critical situations that might trigger the
      unwanted behaviour and making a plan to engage in an alternative course of action when those
      triggers are present. Implementation intentions formation has been found to be effective in
      reducing smoking uptake and consultations for emergency contraception in this age group.

      A randomised controlled trial will be conducted. Students from 11 to 17 years old attending
      special schools for children with behavioural problems or referred for anger issues will be
      randomised to three conditions: attention control, specific triggers and general trigger.
      Participants in the attention control and specific triggers conditions will receive the same
      Volitional Help Sheet (VHS), composed of a list of 10 anger triggers (if statements) and a
      list of 10 anger management strategies (then statements). However, the instructions will be
      different. Participants in the attention control condition will be instructed to select the
      triggers that they encounter more often and the strategies that they consider more useful. In
      contrast, participants in the specific triggers condition will have to link each specific
      trigger that they encounter often with a specific strategy, thus creating action plans with
      an if-then structure. Participants assigned to the general trigger condition will also be
      instructed to make plans linking the trigger with a strategy, but the VHS they will receive
      will contain only one general trigger: "If I am getting angry".

      Measures of anger and reactive physical aggression, reactive relational aggression, proactive
      physical aggression and proactive relation aggression will be collected at baseline, one
      month and six months after intervention. In addition, measures of negative urgency, violent
      intentions and callous-unemotional traits will be collected once.

      Both intervention groups are hypothesised to reduce anger and reactive aggression in
      comparison to the control group. It is hypothesised that the reduction in anger acts as a
      mediator for the reduction of reactive aggression. It is also hypothesised that violent
      intentions, callous-unemotional traits and negative urgency act as moderators of
      effectiveness.

      The effects of the intervention will be analysed on anger, on the aggression total score and
      on the four types of aggression separately using Multivariate Analysis of Covariance. In
      order to test whether the effect of the interventions on reactive aggression at follow-up is
      mediated by anger, a mediation analysis will be conducted using the PROCESS macro (Hayes,
      2013). In the analysis, the intervention conditions (dummy coded) will be entered as the
      independent variable, anger as the mediator variable, reactive aggression at follow-up as the
      dependent variable, and reactive aggression at baseline as the covariate. The analysis will
      asses the strength of the direct and indirect effects of the interventions on reactive
      aggression via anger. In order to test whether the effect of the interventions on aggression
      at follow-up is moderated by violent intentions, callous-unemotional traits and negative
      urgency, a moderated regression analysis will be conducted using the PROCESS macro (Hayes,
      2013). In the analysis, the intervention conditions (dummy coded) will be entered as the
      independent variable, violent intentions, callous-unemotional traits and negative urgency as
      the moderator variables, aggression at follow-up as the dependent variable, and aggression at
      baseline as covariates.
    

Intervention name(s): Volitional Help Sheet (VHS); Volitional Help Sheet (VHS)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): VHS with a general anger trigger and 10 anger management strategies; VHS with 10 specific anger triggers and 10 anger management strategies
Other intervention name(s): implementation intentions, action-planning; implementation intentions, action-planning
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: There will be one control group and two intervention groups. Each group will be independently be compared with the others, and not in combination.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Prevention
Keywords: Implementation intentions; Volitional Help Sheet; Adolescent