Neural Mechanisms of Cognitive-Behavioral Therapy for Aggression in Children and Adolescents: Design of a Randomized Controlled Trial Within the National Institute for Mental Health Research Domain Criteria Construct of Frustrative Non-Reward

Abstract

Objective: We present the rationale and design of a randomized controlled trial of cognitive-behavioral therapy (CBT) for aggression in children and adolescents, which is conducted in response to the National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) approach initiative. Specifically, the study is focused on the brain-behavior associations within the RDoC construct of frustrative non-reward. On the behavioral level, this construct is defined by reactions elicited in response to withdrawal or prevention of reward, most notably reactive aggression. This study is designed to test the functional magnetic resonance (fMRI) and electrophysiological (EEG) correlates of aggression and its reduction after CBT. Methods: Eighty children and adolescents with high levels of aggression across multiple traditional diagnostic categories, ages 8-16, will be randomly assigned to receive 12 sessions of CBT or 12 sessions of supportive psychotherapy. Clinical outcomes will be measured by the ratings of aggressive behavior collected at baseline, midpoint, and endpoint evaluations, and by the Improvement Score of the Clinical Global Impressions Scale assigned by an independent evaluator (blinded rater). Subjects will also perform a frustration-induction Go-NoGo task and a task of emotional face perception during fMRI scanning and EEG recording at baseline and endpoint. Results: Consistent with the NIMH strategic research priorities, if functional neuroimaging and EEG variables can identify subjects who respond to CBT for aggression, this can provide a neuroscience-based classification scheme that will improve treatment outcomes for children and adolescents with aggressive behavior. Conclusions: Demonstrating that a change in the key nodes of the emotion regulation circuitry is associated with a reduction of reactive aggression will provide evidence to support the validity of the frustrative non-reward construct.

Effectiveness of Cognitive-Behavioral Anger Management Training on Aggression and Job Satisfaction on Nurses Working in Psychiatric Hospital

“…The present study showed that nurses working in psychiatric hospital express less aggression after angermanagement training. Previous findings including [34][35][36][37][38][39] confirmed similarly that cognitive -behavioral angermanagement interventions decline aggression.…”

“…Other findings have also shown that cognitive -behavioral intervention improves attitude, increases anger -management knowledge and skill in different groups including students, tennis players and nurses [34][35][36][37][38] and the most impressive interventions are cognitive restructuring along with relaxation and regular unconditioning. These studies emphasize the necessity of existing cognitive -behavioral interventions among angermanagement interventions [39].…”

Distinct neural bases of disruptive behavior and autism symptom severity in boys with autism spectrum disorder

“…While our biological motion task provides a window into DMN deactivation, it awaits to be tested how disruptive behavior in ASD may be related to other self-regulatory neural systems, such as the meta-cognitive system [89], the orbitofrontal-amygdala circuit [90], the executive functioning circuit [91]. Similarly, while our task may be more cognitive, an important future direction is to use a task that may more actively induce frustration and requires mood regulation (e.g., a Go/No-Go task with high difficulty [92]), which may require proper functioning of the paralimbic system that regulates motivation and affect [93]. Future works may consider these directions.…”

“…Furthermore, it is primarily about DMN deactivation and it remains unclear how the results may generalize to DMN connectivity. Further research is needed to increase the length of fixation periods, for example, by adding jittered fixation periods between BIO and SCR blocks, use a more cognitively demanding task, and should also test whether the link between disruptive behavior and DMN atypicality in ASD can be observed in other fMRI tasks (e.g., [92]) or resting-state connectivity analyses (e.g., [96–99]).…”

Psychopathological and neuropsychological endophenotypes of children with disruptive behaviour

“…Additionally, many of these types of interventions target EF related life-skills such as impulsivity, emotion regulation, and perspective taking (Epstein, Fonnesbeck, Potter, Rizzone, & McPheeters, 2015;Sukhodolsky et al, 2016), including the Incredible Years…”