The Impact of Interpretation Bias Modification Training on Anger and Reactive Aggression

• ClinicalTrials.gov Identifier: NCT03683979
• Recruitment Status: Completed
• First Posted: September 25, 2018
• Last Update Posted: March 24, 2020
• Sponsor: Ryerson University
• Information provided by (Responsible Party): Monique Tremblay, Ryerson University

Study Description

Brief Summary:

Difficulties with anger control are reported in a number of psychological conditions and are associated with social problems, such as dating violence and workplace violence. High trait anger is a personality construct characterized by elevations in the frequency, duration, and intensity of anger episodes. However, the cognitive processes contributing to high trait anger are still poorly understood. This study will examine the effectiveness of a computer-based cognitive bias modification (CBM) program designed to target hostile interpretations associated with high trait anger.

Condition or disease	Intervention/treatment	Phase
Anger	Behavioral: Interpretation Bias Modification; Behavioral: Control Training Program	Not Applicable

Detailed Description:

High trait anger is a personality construct characterized by elevations in the frequency, duration, and intensity of anger episodes. According to the Integrative Cognitive Model (ICM) of anger, three cognitive processes jointly contribute to an individual's level of trait anger and reactive aggression: hostile attributions, ruminative attention, and effortful control processes. Specifically, individuals high in trait anger are more prone to interpret ambiguous situations as hostile; are more likely to ruminate about anger-related events; and have a more limited capacity to employ control processes when they become angry.

One means of evaluating unconscious biases that has become increasingly popular is cognitive bias modification (CBM). CBM programs are computerized training paradigms, which aim to train more adaptive cognitive biases by repeatedly exposing participants to an experimental contingency between an emotional stimulus and a response.Previous researchers have begun to investigate the impact of CBMs targeting cognitive control and hostile attribution bias in relation to anger. However, these studies have been conducted exclusively in samples reporting low trait anger.

This study will examine the effectiveness of a short-term interpretation bias modification program (CBM-I) on hostile attribution biases and reactive aggression in a sample of undergraduate students eporting high trait anger.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 47 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Single (Participant)
• Primary Purpose: Treatment
• Official Title: An Investigation of the Short-term Impact of Interpretation Bias Modification Training on Anger Symptoms, Reactive Aggression, and Attentional Biases Toward Anger-related Stimuli
• Actual Study Start Date: September 12, 2019
• Actual Primary Completion Date: March 13, 2020
• Actual Study Completion Date: March 13, 2020

Arms and Interventions

Arm	Intervention/treatment
Experimental: Interpretation bias modification program; Participants in this arm will complete a computer-based training program two times in the lab. Participants will complete the first training session in the lab during their initial visit and they will return to the lab one week later to complete the second session.	Behavioral: Interpretation Bias Modification; A computer based interpretation bias modification program that aims to reinforce neutral interpretations of ambiguous social situations.
Sham Comparator: Control training program; Participants in this arm will complete a sham training program two times in the lab. The program will look similar in length and design to the experimental training program, but the content of the program will remain affectively neutral. As in the experimental condition, participants will complete the first training session in the lab during their initial visit and they will return to the lab one week later to complete the second session.	Behavioral: Control Training Program; A sham training program that is similar in design and delivery to the experimental training condition.

Outcome Measures

Primary Outcome Measures :

1. State-Trait Anger Expression Inventory 2nd Edition [ Time Frame: Administered two times over the course of one week. Changes will be examined from visit 1 (before CBM training program) to visit 2 (after CBM training program). ]
   A self-report measure of the experience of anger.
2. Interpretation Bias Assessment [ Time Frame: Administered two times over the course of one week. Changes will be examined from visit 1 (before CBM training program) to visit 2 (after CBM training program). ]
   A computer-based measure of hostile interpretation bias involving ambiguous social scenarios.

Secondary Outcome Measures :

1. Anger Rumination Scale [ Time Frame: Administered two times over the course of one week. Changes will be examined from visit 1 (before CBM training program) to visit 2 (after CBM training program). ]
   A self-report measure of the degree to individuals focus on experiences with anger. The scale is comprised of four subscales, angry after thoughts (e.g., "Whenever I experience anger, I keep thinking about it for a while"), angry memories (e.g., "I re-enact the anger episode in my mind after it has happened"), understanding causes (e.g., "When someone provokes me, I keep wondering why this should have happened to me"), and thoughts of revenge (e.g. "I have difficulty forgiving people who have hurt me."). Participants will be asked to read each item and rate it in terms of how well it reflects their experience on a 4-point scale from 1 ("almost never") to 4 ("almost always"). Totals for each sub scale will be summed to produce a total score (range: 19-76), with higher scores indicating a greater propensity for rumination.
2. Social Information Processing-Attribution and Emotional Response Questionnaire [ Time Frame: Administered two times over the course of one week. Changes will be examined from visit 1 (before CBM training program) to visit 2 (after CBM training program). ]
   A self-report measure of evaluate social information processing biases associated with hostile attribution bias.
3. Word Sentence Association Paradigm-Hostility [ Time Frame: Administered two times over the course of one week. Changes will be examined from visit 1 (before CBM training program) to visit 2 (after CBM training program). ]
   A behavioural measure of hostile attribution biases involving hostile and non-hostile words.
4. Depression and Anxiety Stress Scale-21 [ Time Frame: Administered two times over the course of one week. Changes will be examined from visit 1 (before CBM training program) to visit 2 (after CBM training program). ]
   A self-report measure of depression, anxiety, and stress symptoms. A self-report measure of depression, anxiety, and stress symptoms.Items are summed for each subscale to create subscale totals (i.e., depression, anxiety, and stress), with higher scores reflecting more severe emotional distress. Symptom score ranges include: normal (0-4), mild (5-6), moderate (7-10), severe (11-13), and extremely severe (14+).
5. Dot Probe [ Time Frame: Administered two times over the course of one week. Changes will be examined from visit 1 (before CBM training program) to visit 2 (after CBM training program). ]
   A behavioural measure of attentional bias towards angry faces.
6. Reactive-Proactive Aggression Questionnaire [ Time Frame: Administered two times over the course of one week. Changes will be examined from visit 1 (before CBM training program) to visit 2 (after CBM training program). ]
   A self-report measure of an individual's propensity for reactive aggression.
7. Taylor Aggression Paradigm [ Time Frame: Administered one time over the course of one week. Participants will be exposed to the paradigm following the second training session. ]
   A behavioural measure of reactive aggression.

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 65 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Students scoring 22 or higher on the Trait Anger Scale.

Exclusion Criteria:

1. Reports currently receiving psychological treatment or counseling for anger.
2. Reports changes in psychiatric medication within the last month.
3. Endorsement of current psychosis or bipolar disorder symptoms.
4. Indicates poor English language proficiency.

Contacts and Locations

Locations

Canada, Ontario

Ryerson University

Toronto, Ontario, Canada, M5B 2K3

Sponsors and Collaborators

Ryerson University

More Information

Publications:

Hawkins KA, Cougle JR. Effects of interpretation training on hostile attribution bias and reactivity to interpersonal insult. Behav Ther. 2013 Sep;44(3):479-88. doi: 10.1016/j.beth.2013.04.005. Epub 2013 Apr 19.

Wilkowski BM, Robinson MD. The cognitive basis of trait anger and reactive aggression: an integrative analysis. Pers Soc Psychol Rev. 2008 Feb;12(1):3-21. doi: 10.1177/1088868307309874. Epub 2007 Dec 18. Review.

• Responsible Party: Monique Tremblay, Monique D Tremblay, M.A Ryerson University, Ryerson University
• ClinicalTrials.gov Identifier: NCT03683979
• Other Study ID Numbers: Anger Study 1
• First Posted: September 25, 2018
• Last Update Posted: March 24, 2020
• Last Verified: March 2020

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No
• Plan Description: The results of this study will be disseminated through conference presentations and journal publications. Anonymized aggregate participant data may be made available upon request to a publishing journal or individual research group. However, research groups interested in accessing anonymized data will be required to submit a proposal detailing their intended use of the data. Their qualifications will be reviewed based on their proposal and CVs. Individual research groups approved for access will be required to agree to not attempt to re-identify participants, not further distribute data, and not use the data for purposes other than specified in their original proposal. No individual data will be shared.

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Monique Tremblay, Ryerson University:

Reactive aggression; High trait anger; Cognitive bias modification; Interpretation bias modification

Additional relevant MeSH terms:

Aggression; Behavioral Symptoms