Practice Profile: Cognitive Behavioral Therapy (CBT) for Anger-Related Problems in Children and Adolescents

Cognitive behavioral therapy (CBT) is a problem-focused, therapeutic approach that attempts to help people identify and change dysfunctional beliefs, thoughts, and patterns that contribute to their problem behaviors. This variant of CBT focuses specifically on children and adolescents who have anger-related problems. The practice is rated Effective for reducing aggression and anger expression, and improving self-control, problem-solving, and social competencies.

Practice Goals/Target Population

Cognitive behavioral therapy (CBT) is a problem-focused, therapeutic approach designed to help individuals identify and change dysfunctional beliefs, thoughts, and patterns that contribute to maladaptive behavior. In general, CBT has been used to address a wide range of problems, including anger-related problems. (Beck and Fernandez 1998; Lipsey 2009). This variant of CBT focuses specifically on children and adolescents who have anger-related problems.

Anger-related problems in children and adolescents include aggression, self-control, problem-solving, social competencies, and anger experience. Aggression is often associated with violence and antisocial behavior, and youth who have severe aggression problems typically have other behavioral problems, such as conduct disorder (Hoogsteder et al. 2010). Aggressive youth are also more likely to have been arrested or convicted of a crime, compared with their non-aggressive peers (Andrews and Bonta 2010). For youth with anger problems, CBT is designed to 1) change how anger is experienced (e.g., how quickly a child becomes angry, the intensity of the anger, and the amount of time spent feeling angry), 2) reduce aggressive behavior, and 3) improve social functioning.

Practice Components

CBT may be provided through individual or group formats in a variety of settings, including at school, inpatient or outpatient centers, and juvenile correctional facilities. Length of treatment varies from 2 hours to 1 year. It utilizes a variety of therapeutic techniques to change the clients’ cognitive processes and behavior including modeling appropriate behaviors, recognizing cognitive distortions and problematic biases, building cognitive-coping skills, using rewards to modify behavior, rehearsing appropriate behaviors, and training in affective education (Kendall 1993). Further, these specific therapeutic techniques can be incorporated and delivered via a variety of treatment methods, including

• Skills development, which targets overt anger expression and uses modeling and behavioral rehearsal to develop appropriate social behaviors
• Affective education, which focuses on overt anger experience and includes techniques of emotion identification, self-monitoring of anger arousal, and relaxation
• Problem-solving, which targets cognitive deficits and distortions and uses techniques such as attributional training, self-instruction, and consequential thinking
• Eclectic or multimodal, which incorporates multiple procedures and targets two or more components of anger (Sukhodolsky, Kassinove, and Gorman 2004).
• Mode deactivation therapy (MDT), which addresses the relationships among trauma, personality factors, and belief systems that contribute to anger and aggression (Apsche and Ward Bailey 2004).
• Stress-inoculation therapy, which specifically focuses on anger related to stress, stress management, and coping skills (Schlichter and Horan 1981).
• Cell phone therapy, which uses phone calls to monitor behavior and remind individuals of their goals during a cognitive training period (Burraston, Cherrington and Bahr 2010).

In addition, some CBT approaches include mindfulness exercises, which are aimed at reducing stress, while enhancing an individual’s consciousness in improving behavior.

Practice Theory

CBT is a behavioral approach designed to identify and change an individual’s maladaptive thoughts and behaviors. It is based on the cognitive model that describes how people’s distorted perceptions of situations influence their emotional, behavioral (and often physiological) reactions, which can lead to negative cognitions and maladaptive behavior (Sukhodolsky, Kassinove, and Gorman 2004). Dodge (1980) outlined a five-step sequential model of cognitive processes that consisted of 1) encoding of social cues, 2) interpretation or reception of cues, 3) response search, 4) response decision, and 5) enactment of behavior. Disruptions at any stage but particularly in the early stages, may lead to anger and aggressive behavior. Thus, CBT addresses problem behaviors by helping individuals to recognize and correct the flawed perceptions that may precede maladaptive thoughts and actions (Sukhodolsky, Kassinove, and Gorman 2004).

Sukodolsky, Kassinove, and Gorman (2004) conducted subgroup analyses on age, gender, and severity of presenting problems. No relationship was found between the age of participants and the magnitude of the overall effect size. Gender was significantly related to effect size only in regard to the outcome of anger experience: as the number of boys per group increased, there were fewer improvements with regard to quickness of anger, intensity of anger, and the amount of time spent angry. No significant differences were found between mild, moderate, or severe problems and overall effect sizes. The researchers also examined differences across four types of CBT treatment: skills development, affective education, problem solving, and eclectic or multimodal treatment. They found that problem-solving treatments had the largest positive effect on anger experience. This statistically significant between-group difference showed that youth who participated in problem-solving treatments experienced greater improvements in anger experience, compared with youth who participated in the other three treatment types. Conversely, affective education had the smallest effect, or resulted in the least amount of improvement in anger experience, compared with the other three treatment types.

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

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

Following are CrimeSolutions-rated programs that are related to this practice:

Equipping Youth to Help One Another (EQUIP)

Aggression Replacement Training (ART) for Adolescents in a Runaway Shelter

Power Source

Juvenile Justice Anger Management (JJAM) Treatment for Girls

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?