(PS8-78) Cognitive Bias Modification Interventions for Aggression and Anger: A Meta-analysis

Aggression and its most common emotional antecedent, anger, pose substantial costs to public health and society. Aggression is a leading cause of death and non-fatal injury in the United States and globally (CDC, 2021; FBI, 2022; WHO, 2022). Beyond risk of death, violence has other notable short- and long-term impacts on victims (e.g., posttraumatic stress disorder; Krug et al., 2002) and aggressors (e.g., moral injury; Griffin et al., 2019), including the intergenerational transmission of aggression (Conger et al., 2003). Relatedly, chronic and/or high levels of anger are associated with a range of physical health problems including heart disease (Smith et al., 2004) and early mortality (Trudel-Fitzgerald et al., 2021). Thus, efficacious interventions for both aggressive behavior and dysregulated anger hold substantial public health importance. Aggression and anger are also associated with interpretation (Klein Tuente et al., 2019) and attention (Chan et al., 2010) biases in social information processing; thus, these cognitive biases may be important treatment targets among individuals who experience such clinically relevant behavioral and emotional dysregulation. Accordingly, cognitive bias modification (CBM), which was initially developed to treat attention (Amir et al., 2008) and interpretation (Beard & Amir, 2008) biases in anxiety disorders, has begun to be evaluated for the treatment of populations experiencing clinically-relevant aggression and anger. However, the overall effects of CBM on aggression and anger are inconsistent, with some studies showing significant effects (e.g., Hawkins & Cougle, 2013) and others showing weak to no effects (e.g., Ren et al., 2021). To address this, we conducted a meta-analysis of 11 studies (N = 746), published in EBSCOhost and PubMed between March 2013 and June 2022, assessing the efficacy of CBM in treating high levels of aggression and/or anger. Included studies were original empirical research (published or unpublished), assessed the delivery of CBM using a randomized controlled trial design, reported at least one quantitative outcome measure of anger or aggressive behavior at both pre- and post-treatment, and were conducted in a population exhibiting high levels of aggression and/or anger at baseline. Meta-regression analyses probed potential moderating effects of demographic (gender, age), treatment (duration, number of treatment sessions, interpretation vs. attention bias modification), and study-related (risk of bias) variables. Results demonstrated that CBM significantly outperformed control conditions in the reduction of both aggression (Hedge’s G = -0.21, 95% CI [-0.41, -0.03]) and anger (Hedge’s G = -0.20, 95% CI [-0.35, -0.03]), independent of all demographic, treatment, and study-related variables. These findings suggest that while effects were small, CBM is efficacious in treating the core symptoms in populations exhibiting clinically relevant aggression and anger.