A meta-analytic review of anger management activities that increase or decrease arousal: What fuels or douses rage?

Anger is an unpleasant emotion that most people want to get rid of. Some anger management activities focus on decreasing arousal (e.g., deep breathing, mindfulness, meditation), whereas others focus on increasing arousal (e.g., hitting a bag, jogging, cycling). This meta-analytic review, based on 154 studies including 184 independent samples involving 10,189 participants, tested the effectiveness of both types of activities. The results indicated that arousal-decreasing activities decreased anger and aggression (g = -0.63, [-0.82, -0.43]), and the results were robust. Effects were stable over time for participants of different genders, races, ages, and cultures. Arousal-decreasing activities were effective in students and non-students, in criminal offenders and non-offenders, and in individuals with and without intellectual disabilities. Arousal-decreasing activities were effective regardless of how they were delivered (e.g., digital platforms, researchers, therapists), in both group and individual sessions, and in both field and laboratory settings. In contrast, arousal-increasing activities were ineffective overall (g = -0.02, [-0.13, 0.09]) and were heterogenous and complex. These findings do not support the ideas that venting anger or going for a run are effective anger management activities. A more effective approach for managing anger is "turning down the heat" or calming down by engaging in activities that decrease arousal.

Effectiveness of anger-focused emotional management training in reducing aggression among nurses.

AIM: The aim of this study was to conduct a 5-h training programme on anger-focused emotional management for nurses and verify its effectiveness. DESIGN: The study used a one-group pretest-posttest design. METHODS: Participants (N = 283) attended a programme comprising lectures and exercises. The Japanese version of the Buss-Perry Aggression Questionnaire was administered pre-, post- and 3-month posttraining. Regression analyses were used to assess the effects of the programme by gender. RESULTS: For the total aggression score, the difference between the pre- and posttraining scores was -2.827 points and remained at -1.602 points 3-month posttraining. Physical aggression scores decreased posttraining, but the scores increased after 3 months. There were statistically significant gender differences in hostility scores; pre-training scores were slightly higher for men than for women and lower for men after 3 months. Total and physical aggression scores were higher for men than for women. The training programme decreased aggression, and the effect persisted after 3 months.

The effect of solution-focused approach on anger management and violent behavior in adolescents: A randomized controlled trial.

BACKGROUND: This study was carried out to evaluate the effect of a solution-focused approach on anger management and violent behavior in adolescents. METHOD: The study was an experimental and randomized controlled trial including pre-test and post-test measurements and control group. The sample of experimental (n = 24) and control groups (n = 24) of the study consisted of 48 students. A 7-session program of anger management and prevention of violent behavior based on a solution focused approach was applied to the experimental group. RESULTS: There were no statistically significant differences between trait anger, anger in, anger out, anger control sub-dimensions and VTS scores of the experimental and control groups before the intervention (p > 0.05). In post-test and follow-up test, trait anger (23.32 ± 2.83) (21.10 ± 3.51), anger-out (14.95 ± 4.16) (15.50 ± 3.49) and the mean scores of VTS (30.77 ± 4.01) (32.80 ± 4.53) of the individuals in the experimental group were significantly lower, whereas their mean score of anger control (24.86 ± 3.62) (23.65 ± 4.44) were significantly higher than the control group. CONCLUSION: Solution-oriented approach programs should be used by psychiatric nurses to provide anger management and reduce violence tendencies in adolescents.

Effects of a nonviolent communication-based anger management program on psychiatric inpatients.

This quasi-experimental study aimed to determine the effects of a nonviolent communication-based anger management program on self-esteem, anger expression, and aggression in 44 psychiatric inpatients (experimental group: n = 21; control group: n = 24). The program consisted of six sessions of 60 min each, using a non-equivalent control group pretest-posttest design, and thereafter analyzing the intervention effects. Results showed statistically significant differences between the experimental and control groups in anger expression and anger suppression. There were positive, though not statistically significant, changes in self-esteem and aggression. The findings indicated a decreasing effect of anger expression and anger suppression.

Técnicas para Manejo da Emoção de Raiva: Uma Revisão Sistemática / Anger Management Techniques: A Systematic Review / Técnicas para el Manejo de la Emoción de Rabia: Una Revisión Sistemática

Introdução: Dentre as inúmeras possibilidades que um indivíduo possui de experienciar e expressar a raiva ou a ira, não é raro que o sentimento fuja do controle e termine em hostilidade e agressões, podendo gerar consequências importantes na vida de uma pessoa e de outros ao seu redor. Diante disso, torna-se fundamental a aplicação de técnicas comprovadamente eficazes, objetivando uma maior qualidade de vida ao indivíduo e às pessoas que com ele convivem. Objetivos: Identificar as principais técnicas no manejo da raiva em adultos. Método: Revisão sistemática de artigos científicos de estudos clínicos. Resultados: Nove estudos clínicos randomizados com utilização de técnicas psicológicas para o manejo da ira foram utilizados na análise. A Terapia Cognitivo-Comportamental mostrou-se predominante nas intervenções analisadas e provou-se eficaz para o controle da ira. Conclusão: Técnicas cognitivo-comportamentais, em especial a psicoeducação e a reestruturação cognitiva, são as ferramentas mais frequentemente usadas para o manejo da raiva em distintos grupos clínicos de pacientes, com resultados positivos na regulação emocional.

Introduction: Among the innumerable possibilities that an individual has to experience and express anger, it is not rare that the feeling gets out of control and ends up in hostility and aggressions, which can lead to important consequences in a person's life and others around. Given this, it is fundamental to apply techniques which are proven effective, aiming at a higher quality of life for the individual and for people who live with them. Objectives: To identify the main techniques for anger management in adults. Method: Systematic review of scientific papers from clinical trials. Results: Nine randomized clinical trials using psychological techniques for anger management were used in the present analysis. Cognitive-Behavioral Therapy was shown to be predominant in the analyzed interventions and proved to be effective in controlling anger. Conclusion: Cognitive Behavioral Therapy, especially psychoeducation and cognitive restructuring, are the most frequently used techniques for anger management in several clinical groups of patients, with positive results in emotional regulation.

Introducción: Entre las innumerables posibilidades que un individuo tiene de experimentar y expresar rabia o ira, no es raro que el sentimiento huya del control y termine en hostilidad y agresiones, pudiendo generar consecuencias graves en la vida de una persona y de otros a su alrededor. Por eso, es fundamental la aplicación de técnicas comprobadamente eficaces, objetivando una mayor calidad de vida al individuo y a las personas que con él conviven. Objetivos: Identificar las principales técnicas para el manejo de la rabia en adultos. Método: Revisión Sistemática de artículos científicos de estudios clínicos. Resultados: Se utilizaron nueve estudios clínicos aleatorizados con utilización de técnicas psicológicas para el manejo de la ira en el análisis. Terapia Cognitivo-Conductual demostró ser predominante en las intervenciones analizadas y eficaz para controlar la ira. Conclusión: La Terapia Cognitivo-Conductual, en especial la psicoeducación y la reestructuración cognitiva, son las técnicas más frecuentemente usadas para el manejo de la rabia en varios grupos clínicos de pacientes, con resultados positivos en regulación emocional.

The Influence of Cognitive Behavioral Intervention for Anger Management on Endothelial Function in Patients With Recent Myocardial Infarction: A Randomized Clinical Trial.

OBJECTIVE: Anger may cause adverse cardiovascular responses, but the effects of anger management on clinical cardiovascular outcomes are insufficiently understood. We sought to assess the influence of anger management through a cognitive behavioral intervention on endothelial function in patients with a recent myocardial infarction (MI). METHODS: Patients with ST-elevation MI and a low anger control score were enrolled during hospitalization in a randomized, parallel, controlled clinical trial. Intervention was anger management with cognitive behavioral techniques implemented by a psychologist in two individual monthly sessions. The primary end point was the between-group difference in the variation of flow-mediated dilation (FMD) in the brachial artery from baseline to the 3-month follow-up. The second end point comprised major cardiovascular events at 24-month follow-up. RESULTS: A total of 43 patients (age = 56 [9] years; 23.3% women) were randomized to the intervention group and 47 patients (age = 58 [10] years; 19.1% women) to the control group. Baseline clinical characteristics were not statistically different between groups. Both groups showed a significant improvement in anger control from baseline to end point; however, the difference in intergroup variation was not statistically significant. The difference in FMD variation from baseline to the 3-month follow-up was significantly higher in the intervention group. The partial η2 was 0.057 (p = .024), indicating a medium effect size. There was no difference between groups regarding major cardiovascular events. CONCLUSIONS: Anger management by cognitive behavioral techniques may improve endothelial function in post-MI patients with low anger control, but it remains unclear via which mechanism these effects occurred. Further studies with larger numbers of patients, assessments of changes in anger, improved comparability of preintervention FMD, and longer follow-up are warranted.Trial Registration:ClinicalTrials.gov identifier: NCT02868216.

Progression of anaemia during antenatal period among South African pregnant women

Background: Anaemia in pregnancy is a known public health problem in South Africa. Maternal, perinatal morbidity and mortality are known to be associated with anaemia in pregnancy. Very little is known from literature with regards to the progression of anaemia during the antenatal period of pregnancy. Objectives: To estimate haemoglobin levels, the prevalence and determinants of anaemia at different gestational ages and to show the trend. Method: A retrospective cohort (follow-up) study was conducted using the antenatal clinic register. Prevalence rates of anaemia (haemoglobin < 11 g/dl) at different gestational ages were measured. Factors associated with anaemia were assessed using chisquare test and stepwise multivariate logistic regression analysis. Results: A total of 801 pregnant women were enrolled at the booking visit and followed-up during their antenatal period. The prevalence of anaemia at the booking visit was 37%. The prevalence of anaemia at 20, 26, 32 and 36 weeks of gestation were 36.6%, 39.6%, 39.8% and 29.2% respectively. Binary logistic regression at the booking visit showed that teenage women were 2.5 times more likely to have anaemia (OR=2.5, p=0.005) than older women. Women who booked during the first trimester were 60% less likely to have anaemia (OR= 0.40, P=0.005) at the booking visit and 62% less likely to be anaemic at 36 weeks of gestation (OR=0.38, p=0.013) compared to those who booked late for antenatal care. Conclusion: Prevalence of anaemia during pregnancy was high. Early booking for antenatal care was a predictor for lower rate of anaemia. Thus, health education strategy should be encouraged for early antenatal booking

Facteurs de risque et prise en charge de la rupture utérine dans une structure de 1ere référence du Mali: cas du district sanitaire de Bougouni / Risk factors and management of uterine rupture in a 1st reference structure in Mali: case of the Bougouni health district

L'objectif était d'évaluer les facteurs de risque de la RU et de proposer les aspects thérapeutiques. Matériels et méthodes : Nous avons réalisé une étude cas-témoins au centre de santé de Référence de Bougouni en 2019. Résultats : De janvier au 31 décembre 2019; sur 1161 accouchements 43 RU ont été enregistrées soit 3,7% correspondant à une RU pour 27 accouchements. Les patientes de 35 ans et plus ont été plus touchée par la RU (44,2%) avec ORaIC95%= 6,3 [1,5 - 26,3]. Les évacuations obstétricales avaient un ORaIC95%=25,6 [7,8- 83,7]. La totalité des patientes étaient des femmes au foyer (97,7%) des cas versus (82,3%) des témoins avec ORaIC95%= 8,9 (1,1-69). Les Paucipares et multipares avaient respectivement un ORaIC95%= 6,2 [1,8 - 20,3] et 4,1[1,3 - 12,9]. La cicatrice utérine (20,9%) des cas contre 8,1 % les témoins avait un ORaIC95%= 2,9 [1,1 - 8,7]. En effet l'absence de CPN étaient un facteur de risque, ORaIC95%= 3,0 [1,3 ­ 6,9]. Le délai de la RU était ˂ 6 heures chez 95%. En effet 34 RU complètes (79,1%) et 9 RU incomplètes (20,9%) ont été notées. Seulement 2,3 % des cas avaient accouché par voie basse. Le traitement de la RU reposait sur la chirurgie (100%) complétée par celui du choc (51,2%) des cas et de l'infection (100%) des cas. Conclusion: La RU est fréquente dans nos pays sous médicalisés. Sa prévention efficace passe par des stratégies visant à agir sur les facteurs de risque

The objective was to assess the risk factors for and to suggest therapeutic aspects. Materials and methods: We carried out a case-control study at the Bougouni Reference health center in 2019. Results: From January to December 31, 2019; out of 1161 deliveries, 43 uterine rupture were recorded, 3.7% corresponding to one uterine rupture for 27 deliveries. Patients 35 years and older were more affected by uterine rupture (44.2%) with ORaIC95% = 6.3 [1.5 - 26.3]. Obstetric evacuations had an ORaIC95% = 25.6 [7.8-83.7]. All of the patients were housewives (97.7%) versus (82.3%) controls with ORaIC95% = 8.9 (1.1-69). Pauciparous and multiparous had an ORaIC95% = 6.2 [1.8 - 20.3] and 4.1 [1.3 - 12.9], respectively. The uterine scar (20.9%) of cases versus 8.1% of controls had a 95% ORaIC95% = 2.9 [1.1 - 8.7]. Indeed the absence of ANC was a risk factor, ORaIC95% = 3.0 [1.3 - 6.9]. The time to uterine rupture was ˂ 6 hours in 95%. In fact 34 complete uterine rupture (79.1%) and 9 incomplete uterine rupture (20.9) were noted. Only 2.3% of cases gave birth vaginally. Treatment of uterine rupture was based on surgery (100%) supplemented by shock (51.2%) of cases and infection (100%) of cases. Conclusion: Uterine rupture is common in our countries under medical care. Its effective prevention involves strategies aimed at acting on risk factors.

Descriptive and Quasi-Experimental Studies about Moral Emotions, Online Empathy, Anger Management, and Their Relations with Key Competencies in Primary Education.

BACKGROUND: Antisocial behaviours make social interactions difficult among students. Moral emotions, online empathy, and anger management are social and emotional variables related to prosocial and antisocial behaviours and health problems. This research aims to assess the impact of Cooperative Project-Based Learning intervention on these three variables for Primary Education students. Additionally, the relations of these variables with key competencies, such as social and emotional competencies and literacy competence, were studied. METHOD: This research is made up of two studies, descriptive and quasi-experimental, during regular school hours. The descriptive study was carried out with a sample of 516 primary school students and aimed to assess the development of the three variables, taking into account personal and ethnic-cultural factors. The quasi-experimental study, with pre-test and post-test data, had the participation of 145 students to study the incidence of these variables after Cooperative Project-Based Learning intervention in Primary Education. RESULTS: The results show the relation among the cited variables and the positive impact of the intervention on moral emotions and anger management in the experimental group compared to the control group. Experimental group girls presented higher scores in moral emotions than control group girls. CONCLUSION: These results open new research lines in relation to the intervention as a programme to prevent the appearance of antisocial behaviours and health problems at school.

A Comparison of Group Anger Management Treatments for Combat Veterans With PTSD: Results From a Quasi-Experimental Trial.

Difficulty controlling anger is a significant concern among combat veterans with posttraumatic stress disorder (PTSD), yet few controlled studies have examined the efficacy of anger treatments for this population. This study examined the effects of a group cognitive behavioral therapy (CBT) intervention compared with a group present-centered therapy (PCT) control condition in male and female combat veterans with PTSD. Thirty-six combat veterans with PTSD and anger difficulties began group treatment (CBT, n = 19; PCT, n = 17). Separate multilevel models of self-rated anger, PTSD symptoms, and disability were conducted using data from baseline, each of 12 treatment sessions, posttreatment, and 3- and 6-month follow-up time points. Significant decreases in anger and PTSD symptoms were observed over time, but no significant differences between CBT and PCT were observed on these outcomes. A significant interaction of therapy by time favoring the PCT condition was observed on disability scores. Gender differences were observed in dropout rates (i.e., 100% of female participants dropped out of CBT). Findings suggest that both CBT and PCT group therapy may be effective in reducing anger in combat veterans with PTSD. Results also highlight potential gender differences in response to group anger treatment.

Development and validation of Yoga Module for Anger Management in adolescents.

BACKGROUND: Development of anger management programs and in particular, yoga module for anger management has not been well researched. Being a complex emotion, anger poses serious challenges in developing a comprehensive anger management program. While various theories of anger are dealt in modern psychology, several anger management techniques are set forth in Indian traditional texts. Yoga, which is considered as a holistic and integrated approach is explored in this study to develop and validate a school-based yoga program for anger management in adolescence. MATERIALS AND METHODS: Integrated Approach to Yoga Therapy (IAYT) principles and literary review formed the basis for deriving the concepts of anger management. The methodology includes construction of the yoga module, validation of the module by 22 experts followed by a pilot non-randomised control study (n-50) to assess feasibility and initial effectiveness. Content Validity Ratio (CVR) and paired t-test were employed to analyse the experts' rating and pilot-study data respectively. RESULTS: Emergence of IAYT based yoga program for anger management. Based on CVR ratio, 16 out of 18 yogic techniques qualified for the final module. The pilot study revealed viability of the module and its recognition as an anger management program. Significant reduction of anger scores in yoga group substantiates initial effectiveness of the module. CONCLUSION: The developed and validated yoga module for anger management is recognised as a well-accepted and effective yoga program for anger management in adolescents.

Effects of the Anger Management Program for Nurses.

PURPOSE: The purpose of this study was to examine the effects of an anger management program on anger, job stress, psychological well-being, and heart rate variability in clinical nurses. METHODS: A quasi-experimental study was conducted using a nonequivalent control group, pre-post test design with repeated measures. The participants included 43 nurses assigned to the experimental and control groups. Anger, job stress, psychological well-being, and heart rate variability were evaluated before the intervention, immediately after the completion of the intervention, and four weeks after the end of the intervention. Chi-square test, t-test, Fisher's exact test, and GEE (Generalized Estimating Equations) were used to analyze the data. RESULTS: There were significant differences in the level of anger, state anger, job stress, and psychological well-being between the two groups. The rate of change in the total power (TP) and the high-frequency band (HF) of the experimental group increased immediately after the intervention completion, but that of the control group decreased at the same time. CONCLUSION: The above results demonstrate that an anger management program for nurses effectively attenuated anger and job stress, improved psychological well-being, and regulated heart rate variability.

Effects of an Extracurricular Anger Self-Control Program for Nursing Students.

Nursing students often experience anger in response to stress and suppress their anger instead of actively controlling it. Therefore, the anger self-control programs that can manage nursing students' anger level and dysfunctional anger expression are needed. The aim of this study is to investigate the effects of an anger self-control program on trait anger, anger expression style, grateful disposition, and depression among nursing students. The study used a quasi-experimental study with a nonequivalent control group and a non-synchronized design. Participants were 29 nursing students who were assigned to intervention and control groups. Compared to the control group, the intervention group showed significantly decreased mean scores for the trait anger, anger-in, and anger-out anger expression styles, and increased mean scores for the anger-control anger expression style and grateful disposition. Anger self-control programs might be usefully applied as extracurricular anger-management programs for nursing students.

The Effectiveness of Cognitive-behavioral Therapy on Anger in Female Students with Misophonia: A Single-Case Study.

Background: Misophonia is an unpleasant condition, in which the feeling of excessive anger is triggered by specific sounds. The main objective of the present study was to investigate the effectiveness of cognitive-behavioral therapy (CBT) on anger in female students with misophonia. Methods: A study based on a non-concurrent multiple baseline design was conducted in 2018 at the School of Education and Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran. Three female students aged 20-22 years were recruited using the multi-stage random sampling method. The study was conducted in three stages, namely baseline, intervention, and follow-up sessions. The Novaco anger questionnaire was used during the baseline sessions, intervention sessions (sessions three, six, and eight), and six weeks follow-up (two, four, and six weeks after the last intervention session). Data were analyzed using visual analysis, reliability change index (RCI), and recovery percentage formula. Results: CBT reduced the feeling of anger after the intervention and follow-up sessions. The recovery percentage at the end of the intervention sessions were 43.82, 42.28, and 9.09 for the first, second, and third participants, respectively. Conclusion: The findings of the present study confirm the effectiveness of CBT in reducing the feeling of anger in female students with misophonia.

The effect of acceptance and commitment therapy orientated anger management training on anger ruminations and impulsivity levels in forensic psychiatric patients: A randomized controlled trial.

PURPOSE: This study aimed at determining the effect of acceptance and commitment therapy (ACT) orientated anger management training on levels of anger rumination and impulsivity in people receiving forensic mental healthcare. DESIGN AND METHODS: This was a randomized controlled study. The research data were collected between July 2018 and February 2019. The personal information form, Anger Rumination Scale, and Barratt Impulsiveness Scale were used for data collection. FINDINGS: Total scores on the Barratt Impulsiveness and Anger Rumination Scales were significantly lower in the experimental group than in the control group (p < 0.001). PRACTICE IMPLICATIONS: This study adds to existing evidence on the provision of anger management training, offering an evidence-based solution along with necessary knowledge and skills for use by forensic psychiatric nurses.

An investigation of the effects of an anger management psychoeducation programme on psychological resilience and affect of intensive care nurses.

BACKGROUND: It is known that intensive care nurses experience stressful events more frequently than nurses working in other units. Experiencing stressful events frequently may reduce the psychological resilience of intensive care nurses and cause them to express their tension and negative emotions as anger. However, nurses' failure to manage their anger may also lead to medical errors and adversely affect the quality of healthcare services. PURPOSE: This study aims to investigate the effects of an anger management psychoeducation programme on psychological resilience and affect of intensive care nurses. METHODS: Using a self-controlled design, this study was conducted with nurses working in a tertiary intensive care unit of a private hospital in Turkey. The participants were randomly and equally distributed to the study group (n = 16) and the control group (n = 16). The participants in the study group attended an eight-week anger management psychoeducation programme, while those in the control group did not. The Psychological Resilience Scale for Adults (RSA) and Positive and Negative Affect Scale (PANAS) were applied to both groups as pre-test and post-test. In addition, one month after the post-test, RSA and PANAS were administered again to determine the stability of the impact of the psychoeducation program on the participants. RESULTS: No significant change over time was observed in the scores of the control group from the overall scale (all intra-group comparison p-values > 0.05), while a significant change over time was observed in the scores of the study group from the overall scale (all intra-group comparison p-values < 0.001). Although it was observed that both groups' positive affect scores changed over time (both intra-group comparison p-values < 0.05), the paired comparison revealed that the scores of the control group were similar. On the other hand, it was observed that the study group's positive effect scores increased significantly after the psychoeducation programme but remained similar in the follow-up period. Furthermore, only the study group's negative affect scores decreased over time, this decrease continued in the follow-up period. CONCLUSIONS: The study concludes that the anger management psychoeducation programme affected the psychological resilience and emotional state of intensive care nurses.

Development of a brief online intervention to address aggression in the context of emotion-related impulsivity: Evidence from a wait-list controlled trial.

Trait-like tendencies to respond impulsively to emotion, labelled emotion-related impulsivity, are robustly related to aggression. We developed and tested an online intervention to address emotion-related impulsivity and aggression. The 6-session intervention focused on behavioral techniques shown to decrease arousal and aggression, supplemented with implementation intentions and smartphone prompts to facilitate skills transfer into daily life. First, we piloted the intervention in-person with 4 people. Then, 235 participants were randomly assigned to take the online intervention immediately or after a wait-list period; those in the waitlist were then invited to take part in the intervention. Participants completed the self-rated Feelings Trigger Action Scale to assess emotion-related impulsivity, the interview-based Modified Overt Aggression Scale and the self-rated Buss Perry Aggression Questionnaire. Participants who took part in the treatment completed daily anger logs. Attrition, as with other online programs, was high; however, treatment completers reported high satisfaction, and outcomes changed more rapidly during treatment than waitlist across all key outcome indices. In analyses including all participants who took part in the treatment (immediate or delayed), we observed moderate-to-large treatment gains, which were maintained as of the 3-month follow-up assessment. This work supports the usefulness of an intervention for addressing emotion-related impulsivity and aggression.

Multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour (START): 5-year follow-up of a pragmatic, randomised, controlled, superiority trial.

BACKGROUND: Multisystemic therapy is a manualised treatment programme for young people aged 11-17 years who exhibit antisocial behaviour. To our knowledge, the Systemic Therapy for At Risk Teens (START) trial is the first large-scale randomised controlled trial of multisystemic therapy in the UK. Previous findings reported to 18 months after baseline (START-I study) did not indicate superiority of multisystemic therapy compared with management as usual. Here, we report outcomes of the trial to 60 months (START-II study). METHODS: In this pragmatic, randomised, controlled, superiority trial, young people (aged 11-17 years) with moderate-to-severe antisocial behaviour were recruited from social services, youth offending teams, schools, child and adolescent mental health services, and voluntary services across England, UK. Participants were eligible if they had at least three severity criteria indicating past difficulties across several settings and one of five general inclusion criteria for antisocial behaviour. Eligible families were randomly assigned (1:1), using stochastic minimisation and stratifying for treatment centre, sex, age at enrolment, and age at onset of antisocial behaviour, to management as usual or 3-5 months of multisystemic therapy followed by management as usual. Research assistants and investigators were masked to treatment allocation; the participants could not be masked. For this extension study, the primary outcome was the proportion of participants with offences with convictions in each group at 60 months after randomisation. This study is registered with ISRCTN, ISRCTN77132214, and is closed to accrual. FINDINGS: Between Feb 4, 2010, and Sept 1, 2012, 1076 young people and families were assessed for eligibility and 684 were randomly assigned to management as usual (n=342) or multisystemic therapy (n=342). By 60 months' of follow-up, 188 (55%) of 342 people in the multisystemic therapy group had at least one offence with a criminal conviction, compared with 180 (53%) of 341 in the management-as-usual group (odds ratio 1·13, 95% CI 0·82-1·56; p=0·44). INTERPRETATION: The results of the 5-year follow-up show no evidence of longer-term superiority for multisystemic therapy compared with management as usual. FUNDING: National Institute for Health Research Health Services and Delivery Research programme.