(PS12-5) Proof-of-concept Trial of Cognitive Behavioral Therapy for Oppositional Defiant Disorder in Children and Adolescents: Possibility of Cognitive Changes Characterized by Anger

Introduction: Oppositional Defiant Disorder (ODD) is a mental disorder associated with feelings of anger and oppositional behaviors (APA, 2022). The purposes of this study were to develop a Cognitive Behavioral Therapy Program for Anger in Children and Adolescents (CBT-Anger) and to evaluate its feasibility and effectiveness for ODD in children and adolescents using a Proof-of-Concept (POC) trial. Additionally, we aimed to examine the possibility of cognitive changes characterized by anger.

Method: Seven children and adolescents with ODD participated in this trial (5 boys and 2 girls; aged 11.14 ± 1.25 years). Based on previous studies on child anger (Kishida and Ishikawa, 2019; Kishida et al., 2022), we developed the CBT-Anger. The program consisted of 10 sessions (each lasting 60 minutes) and included psychoeducation, cognitive restructuring, and problem-solving. Several outcome and process measures were used before, immediately after, and three months after the intervention to evaluate the effectiveness of the CBT-Anger. Outcome measures included clinician-rated diagnosis of ODD, parent/self-rated irritability, and parent-rated ODD symptoms. Process measures included hostility attribution bias, blaming others, and anger emotion measured via self-rated questionnaires.

Results: The POC trial showed a low dropout rate (0%), indicating high feasibility of the CBT-Anger. Regarding the outcome measures, a satisfactory remission rate of ODD (42.86%) was demonstrated at the three-month follow-up. Additionally, parent-rated irritability and ODD symptoms improved at the follow-up (g = -1.10; g = -1.06). For the process measures, blaming others and anger emotion also showed improvements at the follow-up (g = -0.40; g = -0.66).

Discussion: A meta-analysis of psychotherapy for children and adolescents with externalizing problems (Riise et al., 2021) reported a remission rate of 32.4% for ODD and conduct disorder immediately after intervention. Although some differences exist in measurement timing and target disorders, the result of the meta-analysis is generally comparable to that of the present study. Furthermore, the POC trial showed that the CBT-Anger was more effective for blaming others than hostile attribution bias. A previous cross-sectional study (Kishida et al., 2022) indicated that anger emotion is associated with blaming others rather than hostile attribution bias. Hence, it also can be inferred that improvements in blaming others and anger emotion occurred simultaneously and accordingly.