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Practice Profile

Cognitive Behavioral Therapy Based Anger Management for Adult Male Offenders

Evidence Ratings for Outcomes:

Promising - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types
Promising - One Meta-Analysis Crime & Delinquency - Violent offenses

Practice Description

Practice Goals/Target Population
Cognitive behavioral therapy (CBT) based anger management interventions that target adult male offenders aim to increase their ability to control their anger with the overall goal of reducing recidivism. Research suggests that anger that is longer, more intense, and more frequent may cause individuals to justify their aggression, reduce their inhibition to commit violence, and hinder their ability to think before they act (Novaco 2011; Henswood, Chou, and Browne 2015). Given this link between dysfunctional anger and violent offending, these interventions target dysfunctional anger to reduce reoffending. The target population is usually adult male offenders sentenced to probation or incarceration.

Program Theory
CBT is a behavioral approach designed to identify and change an individual’s maladaptive thoughts and behaviors. The approach teaches individuals to monitor their negative cognitions, recognize how these negative cognitions impact behavior, examine why these negative thoughts occur, substitute the negative thoughts with more prosocial thoughts, and identify and eventually alter these dysfunctional beliefs that in turn cause them to distort situations and behave in maladaptive ways (Beck et al. 1979). As these interventions use CBT as their foundation, they provide anger management training by helping individuals recognize and modify their maladaptive thoughts and behaviors. These programs also include violence prevention components, such as victim empathy and combating offense supportive thinking (Henswood, et al., 2015).

Practice Components
CBT-based anger management programs are typically brief interventions that aim to replace dysfunctional cognitions with cognitions that are likely to inhibit anger, including 1) finding alternative explanations for the precursor event; 2) addressing  and modifying aggression related structures, such as schemas and behavioral scripts; 3) teaching individuals arousal reduction techniques, such as breathing and visualization exercises; and 4) teaching behaviors that are the nonviolent, and prosocial equivalents to their dysfunctional behaviors (Henswood et al. 2015).

Meta-Analysis Outcomes

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Promising - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types
Aggregating the results across six studies, Henwood, Chou, and Browne (2015) found that cognitive behavioral therapy based anger management interventions had a statistically significant impact on general recidivism. Specifically, the overall mean effect size was 0.58, which represents a 42 percent reduced risk of general reconviction for adult male offenders who participated and completed treatment, compared with those who did not participate in treatment.
Promising - One Meta-Analysis Crime & Delinquency - Violent offenses
Examining the results from six studies, Henwood, Chou, and Browne (2015) found that cognitive behavioral therapy based anger management interventions had a statistically significant impact on violent recidivism. Specifically, the overall mean effect size was 0.44, indicating that adult male offenders who participated and completed treatment had a 56 percent reduction in risk of reconviction for violent offenses, compared with those who did not participate in treatment.
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Meta-Analysis Methodology

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Meta-Analysis Snapshot
 Literature Coverage DatesNumber of StudiesNumber of Study Participants
Meta-Analysis 11993 - 2010143226

Meta-Analysis 1
Henwood, Chou, and Browne (2015) analyzed the impact of cognitive behavioral therapy (CBT)–based anger management on adult male offenders sentenced to probation or incarceration. To be eligible for inclusion, the studies had to use random assignment or quasi-random assignment to the CBT program. Studies that did not use random assignment had to use a matched control, wait-list control, intent-to-treat group, or a comparison to attrition group. Eligible studies must have had a sample that comprised at least 50 percent adult offenders with a history of violence, or those who had been screened for, and found to have, dysfunctional anger. Studies had to test the effectiveness of CBT-based treatment for anger or violence delivered in prison or the community and include an outcome of general reoffending and/or violent reoffending. It is important to note that studies that focused solely on domestic violent offenders or offenders with a mental health diagnosis were excluded from the review.

To identify studies, keywords were used to search the following databases: the Cochrane Library, the Campbell Collaboration, Medline, PsychInfo, ASSIA, SCOPUS, and Web of Science. Additionally, reference lists of relevant systematic reviews were hand-searched, as well as governmental portals such as the Canadian Correctional Service, Australian Institute of Criminology, and the UK Ministry of Justice. The search yielded 3,362 references; however, after removing duplicates, book chapters, meta-analyses, opinion papers, or other irrelevant studies, 104 references remained. Of these 104 references, 14 studies met the eligibility criteria. These studies were derived from 13 articles (in other words, one article contained two studies using different samples, measures, and results, thus making it eligible for inclusion).

The included studies were published between 1993 and 2010 and were conducted in the United States (N=1), Canada (N=9), United Kingdom (N=1), and New Zealand (N=3). All included studies used quasi-experimental designs, and a mean age of participants that ranged from 23.5 to 35.6 years old. The offense history and demographics of participants varied widely; however, participants in all studies were male. Three of the 14 studies screened offenders for dysfunctional anger prior to treatment; however, all but one study focused on violent offenders. The one study that did not focus on violent offenders had a sample that was 40 percent nonviolent offenders (i.e., individuals who had no violent history). The risk level of the included participants also varied: some studies included only high-risk offenders and others measured both high- and low-risk offenders. Eleven of the studies took place in prison, and the other three were community-based programs. Although all the included studies used CBT components, the studies varied in their specific focus. For example, some programs combined anger management components with substance abuse treatment, while some also targeted other criminogenic needs (such as victim empathy). Furthermore, while the studies varied in duration, the mean length of the intervention across all studies was 190 hours. Finally, all included studies reported results on general and/or violent recidivism.

Given the level of diversity in programs included in the meta-analysis, an inverse-variance random effects model was used to account for the heterogeneity across studies. Effect sizes were calculated for each outcome and then averaged to create a mean effect size for each outcome, also known as a standardized mean difference.
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Cost

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There is no cost information available for this practice.
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Implementation Information

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All cognitive behavioral therapy based anger management interventions included in the Henwood, Chou, and Browne (2015) meta-analysis were manualized programs and provided training for program facilitators.
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Evidence-Base (Meta-Analyses Reviewed)

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These sources were used in the development of the practice profile:

Meta-Analysis 1
Henwood, Kevin S., Shihning Chou, and Kevin Browne. 2015. “A Systematic Review and Meta-Analysis on the Effectiveness of CBT Informed Anger Management.” Aggression and Violent Behavior 25: 280–92.
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Additional References

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These sources were used in the development of the practice profile:

Beck, A.T., A.J. Rush, B.F. Shaw, and G. Emery. 1979. Cognitive Therapy of Depression. New York: Guilford.

Novaco, Raymond W. 2011. “Anger Dysregulation: Driver of Violent Offending.” The Journal of Forensic Psychiatry and Psychology 22(5):650–68.
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Practice Snapshot

Age: 23 - 35

Gender: Male

Targeted Population: Prisoners, Serious/Violent Offender

Settings: Correctional, Other Community Setting

Practice Type: Cognitive Behavioral Treatment, Group Home, Individual Therapy, Violence Prevention

Unit of Analysis: Persons