A Pilot Study Comparing the Efficacy of Group Versus Individual Anger Management in Subjects With IED

Intermittent Explosive Disorder (IED) is increasingly acknowledged as a common, potentially disabling psychiatric condition. Despite this, there are currently no empirically supported behavioral treatments for patients with IED. The purpose of the proposed study is to assess the short-term and long-term efficacy of a cognitive-behavioral treatment (CBT), previously found to be successful in treating dysfunctional anger, for treating IED. Secondary goals of the project are to:

• explore mechanisms involved in the successful treatment of IED, and
• examine individual differences associated with treatment response.

Seventy-two subjects meeting for both research and DSM IED criteria will be randomly assigned to either 12 weeks of individual CBT, 12 weeks of group CBT or 12 weeks of a wait-list control condition. Subjects will be assessed before and after therapy/wait-list as well as at 3 month and 6 month follow-up. Primary outcome measures will assess aggressive behavior, anger, and the presence of an IED diagnosis at post-treatment, 6-month follow-up and 12-month follow-up. Social and emotional information processing will be evaluated as potential mechanism of change. Trait aggression will be assessed as a potential moderating variable.

Inclusion criteria

• The subject meets research criteria for a lifetime diagnosis of intermittent explosive disorder (IED).
• The subject has a Trait Anger Score > 21 on the STAXI (see above).
• Subject is willing to be randomized to any one of the four conditions.
• The subject is willing and able to cooperate with study protocol (i.e., keep appointments, complete rating forms, etc.)
• Subject gives informed consent to participate in study.

Exclusion criteria

• The subject has any history of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I bipolar mood disorder, schizophrenia, delusional disorder, organic brain disorder, mental retardation.
• The subject meets DSM-IV criteria for alcohol or drug dependence within 30 days prior to the start of any of the study conditions.
• The subject has a Beck Depression Inventory, 2nd Edition (BDI-II) score > 32.
• The subject has aggressive obsessions in the context of Obsessive Compulsive Disorder (OCD).
• Current suicidal behavior or homicidal ideation.
• The subject is not willing to be randomized to any one of the four conditions.
• The subject is not willing to cooperate with study protocol (i.e., keep appointments, complete rating forms, etc.).
• The subject, in the opinion of the principal investigator (PI), is not able or likely to cooperate with study protocol (i.e., keep appointments, complete rating forms, etc.)
• The subject is already engaged in an anger management program elsewhere.
• The subject does not give informed consent to participate in study