Anger Control Training

Anger Control Training (Lochman, Barry, & Pardini, 2003) is intended for school-age children and can be delivered in an individual or group-based setting. It is based on social information processing theory (SIP), noting that children assess their environment, interpret their surroundings, and generate goals. As children generate these goals, they are thought to evaluate the consequence of each action and decide on the best response. SIP would indicate that, for children with disruptive behaviors, there are mistakes occurring in this stepwise progression of responses, with actions and goals not being accurately assessed.

During Anger Control Training, children are taught to use problem-solving strategies across hypothetical situations as well as personal, real-life scenarios that they may encounter at school or at home. Behavioral rehearsal of these strategies is relied on earlier in treatment, but in vivo practice is later used to arouse the children’s feelings of anger, providing them with the opportunity to practice their new skills within sessions.

Since the inception of Anger Control Training, Anger Coping and Coping Power have been developed as more targeted programs, utilizing and refining the basic tenets of Anger Control Training. Coping Power is the most comprehensive program, including 34 child sessions (Lochman, Wells, & Lenhart, 2008) and a 16-session parent component (Wells, Lochman, & Lenhart, 2008). Several randomized controlled trials of Coping Power have demonstrated its effectiveness in reducing delinquent behaviors and improving teacher reports of behavior, with effects maintained after 1 year (Lochman & Wells, 2003, 2004; Powell et al., 2011).

Problem-Solving Skills Training and Parent-Management Training

Problem-Solving Skills Training and Parent-Management Training (PSST and PMT) are manual-based treatments designed for children between 7 and 12 years of age (Kazdin, 2010). The treatment approaches are based on cognitive behavioral and behavioral concepts. PSST focuses primarily on the child’s cognitive experience and how the child is interpreting the environment. In contrast, PMT focuses on parent–child interactions and how parental behavior may modify or alter the child’s behavioral patterns (Kazdin, 2010).

Standard administration of PSST involves 12 sessions that focus specifically on problem-solving strategies. An example of this strategy involves four key questions or directives that may be repeated multiple times for a given problem:

1. What am I supposed to do?
   
2. I need to figure out what to do.
   
3. What happens when I do this?
   
4. Make a choice.

Standard administration of PMT also involves 12 sessions. Topics covered during these sessions include positive reinforcement strategies, time-out procedures, and other behavior-shaping strategies (i.e., ignoring, compromising, consequences, etc.) (Kazdin, 2010).

Both PSST and PMT have been assessed as reliable and efficacious across multiple studies either in isolation or together, with the combination of the two improving overall treatment outcomes (Bushman & Peacock, 2010; Eyberg et al., 2008; Kazdin, 2010). Studies examining the effectiveness of PSST have concluded that it produces improvement in both home and school behavior (Kazdin, Bass, Siegel, & Thomas, 1989).

Incredible Years

The Incredible Years (IY) (Webster-Stratton & Reid, 2010) curriculum is primarily designed for children 3 to 10 years of age who present with clinically significant externalizing problems. It is based heavily on cognitive social learning theory and focuses on social/emotional deficits observed in children with conduct-related disorders (Dodge & Price, 1994). The curriculum has modules for parents, teachers, and children that use a variety of methods including video modeling, discussion opportunities, and rehearsal techniques.

Parent modules are based on a 12-week program targeting interactive play, reinforcement strategies, and limit setting, with an optional supplemental program to address specific family problems (i.e., depression, marital discord, etc.). The teacher modules target classroom management skills, including reinforcement strategies and problem-solving strategies. Finally, the child module provides lessons on home and school behaviors, covering topics that include social skills, problem solving, and appropriate classroom behavior.

Published effects for the treatment model are strong, demonstrating reductions in behavioral difficulties at both home and school (Webster-Stratton, Reid, & Hammond, 2004). A randomized trial reported preventive functions of the model across 153 teachers and 1,768 students, indicating that use of the model produced fewer behavior problems across intervention classrooms when compared to control classrooms (Webster-Stratton, Reid, & Stoolmiller, 2008). Similar to other treatments, the combined effect of implementing both parent and child modules remains stronger than treatment effects of either in isolation (Webster-Stratton & Hammond, 1997). Regarding lasting effects of the treatment, a 2011 study reported that at a 10-year follow-up, children receiving IY were less likely to display conduct problems than was predicted by their early-onset conduct problems (Webster-Stratton, Rinaldi, & Jamilia, 2011).

Helping the Noncompliant Child and Parent–Child Interaction Therapy

Helping the Noncompliant Child (HNC) (Forehand & McMahon, 1981; McMahon & Forehand, 2003) and Parent–Child Interaction Therapy (PCIT) (Brinkmeyer & Eyberg, 2003) are manual-based treatments designed for 2- to 7-year-old children to address issues related specifically to parent–child interactions. Both are based on the Hanf model (Hanf & Kling, 1973) of parent training and may be described as having two phases: (1) the parent learns to apply positive attention skills (i.e., labeling and praise); (2) the parent learns discipline strategies to address unwanted behaviors.

Both models have routinely been cited as being highly effective for use with conduct-related disorders. HNC has been evaluated in over 40 studies that have documented short-term and long-term (up to 14 years posttreatment) effects on child behavior (for a review, see McMahon & Forehand, 2003). Two randomized controlled trials of PCIT have demonstrated positive effects on child disruptive behaviors and parent–child interactions (Bagner & Eyberg, 2007; Schuhmann, Foote, Eyberg, Boggs, & Algina, 1998), and gains have been found to persist up to 6 years posttreatment (Hood & Eyberg, 2003).

Parent-Management Training Oregon Model

Parent-Management Training Oregon Model (PMTO) (Patterson, Reid, Jones, & Conger, 1975) is a treatment approach that teaches parents how to implement specific behavior modification plans that are seated in six key areas:

1. Skill encouragement
   
2. Positive reinforcement
   
3. Discipline
   
4. Monitoring
   
5. Problem solving
   
6. Positive involvement

The model is based on social interaction learning, which posits that negative environmental/relationship factors may adversely affect child interaction styles (Reid, Patterson, & Snyder, 2002).

Numerous studies have documented affective change in parents after being taught the model, with these outcomes being directly related to reductions in child behavior problems (e.g., DeGarmo, Patterson, & Forgatch, 2004; Forgatch, Patterson, & DeGarmo, 2005; Kazdin, 1997). Additionally, long-term follow-up studies have indicated that PMTO may be effective at reducing later adolescent delinquency (Forgatch, Patterson, DeGarmo, & Beldavs, 2009).

Positive Parenting Program

The Positive Parenting Program (Triple P) (Sanders, 1999) is a systemically modified treatment plan that allows for five different levels of treatment intensity/focus, ranging from universal prevention to enhanced formats. Standard Individual and Enhanced Triple P are the most extensively studied and, as such, are the levels referenced when Triple P is considered an evidence-based approach. The skills targeted within Triple P include common parenting skills (i.e., positive attention, reinforcement, and limits) as well as problem-solving and coping strategies for parents and children. A detailed meta-analysis documented lasting effects of Triple P on reducing disruptive behaviors over a 12-month period. Results also indicated few moderators, revealing the potential validity of the model across diverse families and children (de Graaf, Speetjens, Smit, de Wolff, & Tavecchio, 2008). A randomized-controlled study showed significant intervention effects on parent–child relationships and disruptive behavior, suggesting that Triple P may have lasting, long-term effects (Wiggins, Sofronoff, & Sanders, 2009).

Group Assertiveness Training

In 1976, Winship and Kelley developed a three-part verbal response model of assertiveness, comprising an empathy statement, a conflict statement, and an action statement. Assertiveness training for conduct problems is based on the premise that adolescents exhibiting frequent aggression lack the appropriate skills to deal with interpersonal frustrations. Therefore, assertiveness teaches them more adaptive and socially acceptable ways to express their feelings, from which follows increased self-control.

Huey and Rank (1984) conducted a randomized trial comparing Counselor-Led and Peer-Led Group Assertiveness Training to counselor- and peer-led discussion groups and to a no-treatment control group. Participants were eighth- and ninth-grade African American boys referred for chronic classroom disruption. Compared to the other conditions, boys who received Group Assertiveness Training demonstrated significantly less aggression posttreatment, and analyses revealed that professional and peer counselors were equally effective (Huey & Rank, 1984).

Rational Emotive Mental Health Program

Similar to Group Assertive Training, the Rational Emotive Mental Health Program is based on the idea that adolescents who lack the skills needed to achieve in school can improve their performance by learning self-realization strategies. Block (1978) conducted a randomized trial with minority 10th and 11th graders referred for poor school performance (e.g., low grades, absences, disruptive behavior). Students were assigned to a rational emotive group, a human relations group (i.e., discussion of psychodynamic topics), or a no-treatment control group. The rational emotive sessions included dramatic-emotive exercises, honest expression of feelings, direct confrontation, and risk-taking experiences. Emphasis was placed on cognitive restructuring and self-questioning through these exercises, role-plays, group discussions, and homework assignments. Compared to the other groups, students who received the rational emotive program demonstrated fewer disruptive behaviors and absences and improved grades posttreatment and at a 4-month follow-up (Block, 1978).

Multisystemic Therapy

Multisystemic Therapy (MST) is a family- and community-based intervention for adolescents with antisocial behavior (Henggeler & Lee, 2003; Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998). MST assumes that adolescents with serious behavioral issues have problems in various settings and that the most effective treatment should intervene within and across these systems. MST combines several evidence-based approaches (i.e., cognitive behavioral, behavioral, parent training, family therapy, school consultation, peer intervention) as needed for each individual. Therapists adapt the approach for each case, and a core focus involves working with the family and addressing the adolescent’s role within the system and interrelationships among contexts. Treatment planning is guided by nine core principles (e.g., “Focus on systemic strengths,” “Promote responsible behavior and decrease irresponsible behavior among family members,” “Interventions should be developmentally appropriate”). Intervention occurs within the adolescent’s environment (e.g., home, school); therapists are available whenever needed and are in contact with the family at least weekly.

Extensive research has examined the effects of MST with adolescents demonstrating juvenile offenses, substance abuse, and psychiatric crises (i.e., homicidal, suicidal, psychotic), as well as with maltreating families (Henggeler & Lee, 2003). A randomized trial compared MST to usual community services for adolescents at risk for incarceration and found that, 1-year posttreatment, those who received MST reported fewer conduct problems and were less likely to have been arrested or incarcerated (Henggeler, Melton, & Smith, 1992). Another study randomized seriously delinquent adolescents to MST and alternative community treatments and found that the MST group demonstrated fewer conduct problems, decreased parent psychopathology, and improved parent–youth interaction (Borduin et al., 1995).

Multidimensional Treatment Foster Care

Multidimensional Treatment Foster Care (MTFC) also is a comprehensive and systemic intervention targeting chronic delinquent behavior in adolescents, with the goal of preventing more restrictive placements (e.g., residential treatment) and ultimately returning to the biological family, if possible (Chamberlain & Smith, 2003). For 6 to 9 months, adolescents are placed with foster parents who have been trained to enforce clear, consistent rules and to implement a behavioral point system. Foster parents receive ongoing support, and adolescents meet with therapists for individual issues (e.g., problem-solving training, anger management, social skills building) and with behavioral support specialists who reinforce prosocial behaviors in the community. The biological family or after-care personnel also receive parent training to support the adolescent’s transition back into the community following treatment.

Two randomized trials have demonstrated that MTFC is more effective than usual care for adolescents with histories of chronic delinquency. Chamberlain and Reid (1998) compared MTFC to group care placements that involved individual, group, and family therapy. Boys who received MTFC had shorter placements, fewer runaways and arrests, and decreased incarceration and delinquency at 1 year postintervention. At a long-term follow-up, MTFC boys had lower arrest rates than comparison peers (Chamberlain, Fisher, & Moore, 2002). Additionally, Leve, Chamberlain, and Reid (2005) randomized adolescent girls to either MTFC or care as usual (e.g., group homes, hospital, inpatient substance abuse facilities) and found that MTFC girls demonstrated a greater decrease in arrests and fewer hospital days at 1 year postintervention.