The role of self-serving cognitive distortions in reactive and proactive aggression.

BACKGROUND: Aggression is often divided into reactive and proactive forms. Reactive aggression is typically thought to encompass 'blaming others' and 'assuming the worst', while proactive aggression relates to 'self-centeredness' and 'minimising/mislabelling'. AIM: Our aim was to evaluate relationships between reactive and proactive aggression and cognitive distortions and to test whether changes in these cognitions relate to changes in aggression. METHODS: A total of 151 adolescents (60% boys; mean age 15.05 years, standard deviation 1.28) were enrolled in an evidence-based intervention to reduce aggression. Due to attrition and anomalous responses, the post-intervention sample involved 80 adolescents. Correlation and linear regression analyses were used to investigate the relationship between cognitive distortions and aggression. RESULTS: Blaming others was related to reactive aggression before the intervention, while all cognitive distortions were related to proactive aggression both pre- and post-intervention. Changes in reactive aggression were uniquely predicted by blaming others, while changes in proactive aggression were predicted by changes in cognitive distortions overall. CONCLUSION: To our knowledge, this study is the first to show a relationship between changes in cognitive distortions and changes in aggression. Treatment of reactive aggression may benefit from focusing primarily on reducing cognitive distortions involving misattribution of blame to others. Copyright © 2017 John Wiley & Sons, Ltd.

Treatment moderators of cognitive behavior therapy to reduce aggressive behavior: a meta-analysis.

Maladaptive aggression in adolescents is an increasing public health concern. Cognitive Behavior Therapy (CBT) is one of the most common and promising treatments of aggression. However, there is a lack of information on predictors of treatment response regarding CBT. Therefore, a meta-analysis was performed examining the role of predictors on treatment response of CBT. Twenty-five studies were evaluated (including 2,302 participants; 1,580 boys and 722 girls), and retrieved through searches on PubMed, PsycINFO and EMBASE. Effect sizes were calculated for studies that met inclusion criteria. Study population differences and specific CBT characteristics were examined for their explanatory power. There was substantial variation across studies in design and outcome variables. The meta-analysis showed a medium treatment effect for CBT to reduce aggression (Cohen'd = 0.50). No predictors of treatment response were found in the meta-analysis. Only two studies did examine whether proactive versus reactive aggression could be a moderator of treatment outcome, and no effect was found of this subtyping of aggression. These study results suggest that CBT is effective in reducing maladaptive aggression. Furthermore, treatment setting and duration did not seem to influence treatment effect, which shows the need for development of more cost-effective and less-invasive interventions. More research is needed on moderators of outcome of CBT, including proactive versus reactive aggression. This requires better standardization of design, predictors, and outcome measures across studies.

Conduct disorders.

Conduct disorder (CD) is a frequently occurring psychiatric disorder characterized by a persistent pattern of aggressive and non-aggressive rule breaking antisocial behaviours that lead to considerable burden for the patients themselves, their family and society. This review paper updates diagnostic and therapeutic approaches to CD in the light of the forthcoming DSM-5 definition. The diagnostic criteria for CD will remain unchanged in DSM-5, but the introduction of a specifier of CD with a callous-unemotional (CU) presentation is new. Linked to this, we discuss the pros and cons of various other ways to subtype aggression/CD symptoms. Existing guidelines for CD are, with few exceptions, already of a relatively older date and emphasize that clinical assessment should be systematic and comprehensive and based on a multi-informant approach. Non-medical psychosocial interventions are recommended as the first option for the treatment of CD. There is a role for medication in the treatment of comorbid syndromes and/or in case of insufficient response to psychosocial interventions and severe and dangerous aggressive and violent behaviours.