Clinical and benefit--cost outcomes of teaching a mindfulness-based procedure to adult offenders with intellectual disabilities

The effects of a mindfulness-based procedure, called Meditation on the Soles of the Feet, were evaluated as a cognitive-behavioral intervention for physical aggression in 6 offenders with mild intellectual disabilities. They were taught a simple meditation technique that required them to shift their attention and awareness from the precursors of aggression to the soles of their feet, a neutral point on their body. Results showed that physical and verbal aggression decreased substantially, no Stat medication or physical restraint was required, and there were no staff or peer injuries. Benefit-cost analysis of lost days of work and cost of medical and rehabilitation because of injury caused by these individuals in both the 12 months prior to and following mindfulness-based training showed a 95.7% reduction in costs. This study suggests that this procedure may be a clinically effective and cost-effective method of enabling adult offenders with intellectual disabilities to control their aggression.     

Individuals with mental illness can control their aggressive behavior through mindfulness training

Verbal and physical aggression are risk factors for community placement of individuals with serious and persistent mental illness. Depending on the motivations involved, treatment typically consists of psychotropic medications and psychosocial interventions, including contingency management procedures and anger management training. Effects of a mindfulness procedure, Meditation on the Soles of the Feet , were tested as a cognitive behavioral intervention for verbal and physical aggression in 3 individuals who had frequently been readmitted to an inpatient psychiatric hospital owing to their anger management problems. In a multiple baseline across subjects design, they were taught a simple meditation technique, requiring them to shift their attention and awareness from the anger-producing situation to the soles of their feet, a neutral point on their body. Their verbal and physical aggression decreased with mindfulness training; no physical aggression and very low rates of verbal aggression occurred during 4 years of follow-up in the community.     

Adolescents with Asperger syndrome can use a mindfulness-based strategy to control their aggressive behavior

Children and adolescents with Asperger syndrome occasionally exhibit aggressive behavior against peers and parents. In a multiple baseline design across subjects, three adolescents with Asperger syndrome were taught to use a mindfulness-based procedure called Meditation on the Soles of the Feet to control their physical aggression in the family home and during outings in the community. They were taught to shift the focus of their attention from the negative emotions that triggered their aggressive behavior to a neutral stimulus, the soles of their feet.Prior to training in the mindfulness-based procedure the adolescents had moderate rates of aggression. During mindfulness practice, which lasted between 17 and 24 weeks, their mean rates of aggression per week decreased from 2.7, 2.5 and 3.2 to 0.9, 1.1, and 0.9, respectively, with no instances observed during the last 3 weeks of mindfulness practice. No episodes of physical aggression occurred during a 4-year follow-up. This study suggests that adolescents with Asperger syndrome may successfully use a mindfulness-based procedure to control their aggressive behavior.     

Peer with intellectual disabilities as a mindfulness-based anger and aggression management therapist

A young man with intellectual disabilities (ID) and mental illness, who had previously been taught to successfully manage his aggressive behavior by using Meditation on the Soles of the Feet, reported that he shared his mindfulness practice with his peers with ID. When requested by his peers, and without any training as a therapist, he began to teach this procedure to his peers for controlling their anger and aggressive behavior. We tracked the anger and aggressive behavior of three of the individuals he taught and the fidelity of his teaching of the procedure. According to self and staff reports, anger and aggressive behavior of the three individuals decreased to very low levels within five months of initiating training and remained at very low levels for the two years during which informal data were collected. The fidelity of his teaching the procedure was high, if one allows for his idiosyncratic teaching methods. These findings suggest that individuals with mild ID, who have mastered an effective mindfulness-based strategy to control their aggressive behavior, may be able to teach their peers the same strategy to successfully control their anger and aggressive behavior to a level that is acceptable for community living.     

A mindfulness-based intervention for self-management of verbal and physical aggression by adolescents with Prader–Willi syndrome

Purpose: There is a dearth of clinical and research literature on the treatment of maladaptive behaviors in adolescents with Prader–Willi syndrome (PWS). The purpose of this study was to evaluate the effectiveness of a mindfulness-based intervention, Meditation on the Soles of the Feet (SoF), to facilitate self-management of verbal and physical aggression. Method: We utilized a multiple-baseline design across participants to test the intervention with three adolescents diagnosed with PWS. Results: Relative to baseline, verbal aggression decreased to minimal levels following mindfulness-based practice and physical aggression was nearly eliminated. Intervention effects were maintained at 12-month follow-up. Quantitative analytics confirmed statistically significant outcomes. Conclusions: The SoF mindfulness intervention was effective in reducing verbal and physical aggression in three adolescents with PWS. Future research should test the SoF intervention with this clinical population in a larger clinical trial, and the SoF intervention may be applicable to other pediatric populations.     

Androgen levels and anger and impulsivity measures as predictors of physical, verbal and indirect aggression in boys and girls

Previous studies indicate that androgen levels and certain psychological characteristics such as anger and impulsivity are related to the development and maintenance of aggression. Further studies are required to analyze the potential predictor role of the interaction of said factors on aggressive behavior. 90 nine-year-old children (44 boys and 46 girls) were assessed in relation to their levels of physical, verbal and indirect aggression, using a peer-rating technique. Testosterone and androstenedione levels were analyzed using an enzymoimmunoassay technique in saliva samples. Anger (state and trait) and anger control were measured using the STAXI-NA, and impulsivity was measured through the MFF-20. A General Linear Model revealed that sex was the best predictor for aggression measures, with boys scoring higher than girls in physical, verbal and indirect aggression; after sex, testosterone was found to be the best predictor (in a positive sense) of all three types of aggressive behavior studied. In addition to observing a main effect of androstenedione on physical and verbal aggression, a 'state anger*androstenedione' interaction was found to predict these types of aggression, with androstenedione acting as a moderator (inhibitor) of the effects of anger on these behaviors; also, a 'state anger*testosterone' interaction was found to predict verbal aggression. The results support the idea that, after sex, androgens constitute a biological marker to be taken into consideration in relation to individual differences in aggressive behavior. It is possible that at the age of 9, testosterone tends to increase aggression, while androstenedione tends to moderate (inhibit) the effects of anger on aggression.     

A mindfulness-based strategy for self-management of aggressive behavior in adolescents with autism

Some individuals with autism engage in physical aggression to an extent that interferes with not only their quality of life, but also that of their parents and siblings. Behavioral and psychopharmacological treatments have been the mainstay of treatments for aggression in children and adolescents with autism. We evaluated the effectiveness of a mindfulness-based procedure, Meditation on the Soles of the Feet, in helping three adolescents to manage their physical aggression. This procedure required the adolescents to rapidly shift the focus of their attention from the aggression-triggering event to a neutral place on their body, the soles of their feet. Incidents of aggression across the three adolescents ranged from a mean of 14–20 per week during baseline, 4–6 per week during mindfulness training, including zero rates during the last 4 weeks of intervention. Aggression occurred a rate of about 1 per year during a 3-year follow-up. Our results suggest adolescents with autism can learn, and effectively use, a mindfulness-based procedure to self-manage their physical aggression over several years.     

The role of anxiety sensitivity in anger symptomatology: Results from a randomized controlled trial

Anger is often overlooked in the assessment and treatment of pathological anxiety, despite there being evidence that anger is elevated across all anxiety disorders. Anxiety sensitivity (AS), a major risk factor of anxiety disorders, has been shown to modulate anger in response to threat induced hyperarousal. The current study therefore examined if reductions in anxiety sensitivity (AS) mediate reductions in anger symptoms. Outcomes from a randomized control trial evaluating the efficacy of a brief AS mitigation intervention were analyzed. Patients with anxiety and comorbid conditions were randomly assigned to AS reduction (n = 58) or a repeated contact control condition (n = 60) and followed up with for three months. Analyses evaluated whether treatment related change in AS mediated later reductions in anger, hostility, verbal aggression, and physical aggression. Results revealed that reductions in AS temporally mediated the effects of treatment on later reductions in anger, hostility, verbal aggression, and physical aggression. Specificity analyses provided further support for the direction and specific variables examined in these models. Results suggest that AS may be a promising treatment target for anger symptoms among those with elevated anxiety symptoms.     

Adolescents with Childhood ADHD and Comorbid Disruptive Behavior Disorders: Aggression, Anger, and Hostility

This study examined the self-reported expression of overt aggressive behaviors and covert emotional and cognitive processes in adolescents diagnosed with ADHD and comorbid disruptive behavior disorders (DBDs) during childhood. Methods: Participants were a clinically referred sample of 85 individuals diagnosed with ADHD, initially recruited in the early to mid 1990s when they were 7–11 years of age. At that time, 44 (52%) met criteria for a comorbid diagnosis of ODD and an additional 22 (26%) met criteria for a comorbid diagnosis of CD. Approximately 10 years later, these youth, along with an age-matched comparison sample (n = 83), were re-evaluated to assess a wide array of outcomes including physical and verbal aggression, anger, and hostility. Results: Individuals diagnosed with ADHD + CD in childhood reported elevated levels of physical aggression when compared to Controls and the ADHD-only group. Individuals diagnosed with ADHD + ODD had elevated levels of verbal aggression compared to Controls. Additionally, both comorbid groups experienced significantly greater amounts of anger, but not hostility, as compared to Controls. Importantly, the persistence of ADHD symptoms into adolescence accounted for most group differences in verbal aggression and anger at follow-up, but not physical aggression, which was accounted for by childhood CD. Conclusion: Adolescents diagnosed with ADHD and comorbid disruptive behavior disorders during childhood report high levels of aggression associated with increased emotionality in the form of anger, but not hostile cognitions. These findings suggest that in addition to inattention and hyperactivity/impulsivity, emotional dysregulation may be an important component of ADHD, particularly as it presents in adolescence.     

The relation of aggression,hostility, and anger to lipopolysaccharide-stimulated tumor necrosis factor (TNF)-alpha by blood monocytes from normal men

Aggression, hostility, and anger significantly predict morbidity and mortality from atherosclerotic cardiovascular disease (ACVD). ACVD is believed to be an inflammatory disease characterized by increased expression of a number of proinflammatory cytokines, such as tumor necrosis factor (TNF)-alpha. This study examined the relation of aggression, hostility, and anger to monocyte-associated TNF-alpha expression following lipopolysaccharide (LPS) stimulation. Participants were 62 healthy, non-smoking men (aged 18-45 years). Hostility, anger, verbal, and physical aggression were assessed using the Buss-Perry aggression questionnaire (BPAQ). LPS-stimulated TNF-alpha expression was determined using dual-color flow cytometry gating for CD14(+) cells. After controlling for age, race, education, and alcohol use, scores on the hostility (p=.013), physical aggression (p=.010), and verbal aggression (p=.034) subscales, and the total score (p=.007) on the BPAQ were positively associated with LPS-stimulated TNF-alpha expression. The results suggest that hostility and aggression are associated with an increased expression of TNF-alpha, a cytokine implicated in ACVD.     

The relation of aggression, hostility, and anger to lipopolysaccharide-stimulated tumor necrosis factor (TNF)-α by blood monocytes from normal men

Aggression, hostility, and anger significantly predict morbidity and mortality from atherosclerotic cardiovascular disease (ACVD). ACVD is believed to be an inflammatory disease characterized by increased expression of a number of proinflammatory cytokines, such as tumor necrosis factor (TNF)-alpha. This study examined the relation of aggression, hostility, and anger to monocyte-associated TNF-alpha expression following lipopolysaccharide (LPS) stimulation. Participants were 62 healthy, non-smoking men (aged 18-45 years). Hostility, anger, verbal, and physical aggression were assessed using the Buss-Perry aggression questionnaire (BPAQ). LPS-stimulated TNF-alpha expression was determined using dual-color flow cytometry gating for CD14(+) cells. After controlling for age, race, education, and alcohol use, scores on the hostility (p=.013), physical aggression (p=.010), and verbal aggression (p=.034) subscales, and the total score (p=.007) on the BPAQ were positively associated with LPS-stimulated TNF-alpha expression. The results suggest that hostility and aggression are associated with an increased expression of TNF-alpha, a cytokine implicated in ACVD.     

Anger and parent-to-child aggression in mood and anxiety disorders

The relationship between anger and parent-to-child aggression (PTCA) was examined in mothers presenting for treatment of mood and anxiety disorders, because parental anger may have adverse effects on children and anger may decrease with treatment. Anger's role as mediator and moderator of the effects of the following predictors on PTCA was assessed: depression, anxiety, and ecologic variables that can induce or buffer against stress (partner verbal aggression, satisfaction with and perceived availability of social support, socioeconomic status, and number of children). Anger was found to mediate the effects of depression, partner verbal aggression, satisfaction with social support, and number of children on PTCA. Anger also had significant effects on PTCA after controlling for these variables. The other predictors did not have effects on PTCA, and anger did not moderate their effects. If replicated, these findings suggest the importance of examining whether treatment to reduce parental anger will reduce PTCA.     

Aggression in the general Swedish population, measured with a new self-rating inventory: The Aggression Questionnaire--revised Swedish version (AQ-RSV)

The aim of the present study was to develop a Swedish self-rating instrument for clinical aggression research based on the American Aggression Questionnaire (AQ), which measures physical aggression, verbal aggression, anger, and hostility. To test this adapted Aggression Questionnaire--revised Swedish version (AQ-RSV), it was mailed to 781 randomly selected individuals, aged 20-40 year. A total of 497 (64%) evaluable AQ-RSV inventories were obtained and analyzed statistically. Drop-out analysis showed that non-responders were most often male and significantly older than responders. Among the responders, AQ-RSV showed significant sex differences in all aggression subscales except Hostility. Aggression was found to vary with age, geographical region, and size of home community. The AQ and the AQ-RSV were comparable in correlations between the four aggression subscales and in alpha coefficients, which indicated considerable internal consistency. Development of the aggression-measuring instrument for Swedish conditions is important not only to study subtraits of aggression but to enable analyses of their relationships to neurobiological and psychiatric variables.     

Aggression in the general Swedish population,measured with a new self-rating inventory: The Aggression Questionnaire - revised Swedish version (AQ-RSV)

The aim of the present study was to develop a Swedish self-rating instrument for clinical aggression research based on the American Aggression Questionnaire (AQ), which measures physical aggression, verbal aggression, anger, and hostility. To test this adapted Aggression Questionnaire - revised Swedish version (AQ-RSV), it was mailed to 781 randomly selected individuals, aged 20-40 year. A total of 497 (64%) evaluable AQ-RSV inventories were obtained and analyzed statistically. Drop-out analysis showed that non-responders were most often male and significantly older than responders. Among the responders, AQ-RSV showed significant sex differences in all aggression subscales except Hostility. Aggression was found to vary with age, geographical region, and size of home community. The AQ and the AQ-RSV were comparable in correlations between the four aggression subscales and in alpha coefficients, which indicated considerable internal consistency. Development of the aggression-measuring instrument for Swedish conditions is important not only to study subtraits of aggression but to enable analyses of their relationships to neurobiological and psychiatric variables.     

The Influence of Aggressiveness on Rape-Myth Acceptance among University Students

The detrimental effects of rape are well established. In order to support victims of rape in reporting sexual assault, the factors which predict rape myths need to be investigated. Aggression has been linked to sexual violence, but little is known about the role of aggressive behaviour in rape-myth acceptance. The present study aimed to investigate whether rape myths could be predicted by verbal aggression, physical aggression, hostility, anger or sex in a sample of 121 participants. A regression analysis found that an individual's sex and self-reported physical aggression significantly predicted rape-myth acceptance.     

Mindfulness-based psychotherapies: a review of conceptual foundations, empirical evidence and practical considerations

OBJECTIVE: This paper, composed by an interest group of clinicians and researchers based in Melbourne, presents some background to the practice of mindfulness-based therapies as relevant to the general professional reader. We address the empirical evidence for these therapies, the principles through which they might operate, some practical questions facing those wishing to commence practice in this area or to refer patients into mindfulness-based therapies, and some considerations relevant to the conduct and interpretation of research into the therapeutic application of mindfulness. METHOD: Databases (e.g. PsycINFO, MEDLINE) were searched for literature on the impact of mindfulness interventions, and the psychological and biological mechanisms that underpin the effects of mindfulness practice. This paper also draws upon the clinical experience of the author group. RESULTS: Mindfulness practice and principles have their origins in many contemplative and philosophical traditions but individuals can effectively adopt the training and practice of mindfulness in the absence of such traditions or vocabulary. A recent surge of interest regarding mindfulness in therapeutic techniques can be attributed to the publication of some well-designed empirical evaluations of mindfulness-based cognitive therapy. Arising from this as well as a broader history of clinical integration of mindfulness and Western psychotherapies, a growing number of clinicians have interest and enthusiasm to learn the techniques of mindfulness and to integrate them into their therapeutic work. This review highlights the importance of accurate professional awareness and understanding of mindfulness and its therapeutic applications. CONCLUSIONS: The theoretical and empirical literatures on therapeutic applications of mindfulness are in states of significant growth and development. This group suggests, based on this review, that the combination of some well-developed conceptual models for the therapeutic action of mindfulness and a developing empirical base, justifies a degree of optimism that mindfulness-based approaches will become helpful strategies to offer in the care of patients with a wide range of mental and physical health problems.     

Soles of the Feet: a mindfulness-based self-control intervention for aggression by an individual with mild mental retardation and mental illness

Uncontrolled low frequency, high intensity aggressive behavior is often a barrier to community living for individuals with developmental disabilities. Aggressive behaviors are typically treated with psychotropic medication, behavioral interventions or their combination; but often the behaviors persist at a level that is problematic for the individual as well as care providers. We developed a mindfulness-based, self-control strategy for an adult with mental retardation and mental illness whose aggression had precluded successful community placement. He was taught a simple meditation technique that required him to shift his attention and awareness from the anger-producing situation to a neutral point on his body, the soles of his feet. After practice he applied this technique fairly consistently in situations that would normally have elicited an aggressive response from him. The data show that he increased self-control over his aggressive behaviors, met the community provider's requirement for 6 months of aggression-free behavior in the inpatient facility before being transitioned to the community, and then successfully lived in the community without readmission to a facility. No aggressive behavior was seen during the 1-year follow-up after his community placement. Mindfulness-based intervention may offer a viable alternative to traditional interventions currently being used to treat behavioral challenges in children and adults with mild mental retardation.     

Profiles of aggression among psychiatric patients. II. Covariates and predictors

An Aggression Risk Profile was developed as an objective multidimensional scale for characterizing aggressive psychiatric patients and predicting verbal, physical, and general manifestations of aggression. Based on earlier studies, the 39-item Aggression Risk Profile incorporated demographic, diagnostic, historical, and clinical parameters. Its reliability, discriminative validity, and predictive validity were supported in its application to a total of 208 inpatients. Aggressive patients were more often found to be men, to be diagnosed with organic mental syndrome or substance abuse disorder, and to be notable in history of aggression. They tended to be angry and excitable but not more floridly ill than control subjects. The contemporaneous covariates of aggression, however, were not the same as the predictors, as determined by 3-month prospective follow-up. Twelve significant predictors were identified, and multiple regression analysis revealed different sets of measures that explain 45.0% to 52.5% of the variance for verbal, physical, and total aggression. The most reliable predictors were younger age, shorter length of illness, hostility, depression, anger, and difficulty in delaying gratification. We concluded that prediction is augmented by the combination of clinical and nonclinical predictors, and we discussed likely sources of disparity in previous research.     

Anger experience and expression across the anxiety disorders

The purpose of this study was to explore possible differences in the experience and expression of anger across four anxiety disorder groups and non-clinical controls. Anger was assessed by two measures, the Reaction Inventory and the Aggression Questionnaire, in 112 individuals who met DSM-IV criteria for panic disorder (PD) with or without agoraphobia (n=40), obsessive-compulsive disorder (OCD; n=30), social phobia, (SOC; n=28), and specific phobia (SPC; n=14) as well as non-clinical controls (n=49). Patients with PD, OCD, and SOC reported a significantly greater propensity to experience anger than controls, whereas patients with SPC exhibited no differences in anger experience in comparison to controls. In addition, patients with PD reported significantly greater levels of anger aggression compared to both controls and patients with OCD, and patients with SOC reported significantly lower levels of verbal aggression than controls. Most, but not all, of these differences disappeared when symptoms of depression were controlled in the analyses. The implications of these findings and future directions for research are discussed.     

Posttraumatic stress and aggression among veterans in long-term care

Because stresses associated with long-term care settings may exacerbate distress and aggression related to past trauma, we investigated self-report and staff reports of posttraumatic stress disorder symptoms and staff observations of verbal and physical aggression in 32 elderly males who were patients in a long-term care unit for veterans. Feelings of anger and irritability were reported by 47% of patients; levels of anger and irritability were significantly correlated with observed aggressive behaviors (r = 0.43, P < .02); and observed aggressive behaviors were significantly more frequent among those reporting past traumatic stressors (t = 2.84, P < .008). Patient-reported posttraumatic stress disorder symptoms were significantly correlated with the frequency of past traumatic stressors (r = 0.48, P < .006). Observer-reported posttraumatic stress disorder symptoms and patient reports of anger were strongly correlated (r = 0.73, P < .001). No patient or staff reports were related to level of cognitive function. These findings are consistent with the hypothesis that posttraumatic symptoms can contribute to aggressive behaviors in elderly, medically ill, and cognitively impaired patients.