Enhancing Emotion Regulation in Adolescents with Externalizing Problem Behavior.

If left untreated, externalizing problem behavior is a serious risk factor for
the development of adverse outcomes later in live, such as rejection by peers,
school failure, crime involvement and psychopathology. Furthermore, it is
demonstrated that costs to society are 10 times higher for youth with elevated
levels of externalizing behavior. Over the past years, knowledge regarding the
effectiveness of interventions for externalizing problem behavior has
increased. Interventions are however generally found to be only moderately
effective and treatment responsiveness is variable. Emotion regulation training
is incorporated in many effective interventions for aggressive behavior
problems, but it is not clear which techniques (e.g. cognitive or behavioral)
are most effective. By examining this we hope to enhance the effectiveness of
treatment for aggressive behavior problems in youth.

The goal of the study is to examine the effectiveness of emotion-regulation
training for adolescents with externalizing problem behaviors and an (above)
average intelligence (target group A) or mild to borderline intellectual
disability (target group B). It will be examined which module (cognitive
emotion regulation training vs behavioral emotion regulation training vs both)
most effectively increases emotion regulation capacities.

We will use a randomized parallel-group design. For target group A, we will use
three conditions (two intervention conditions and one control condition). For
target group B, we will use two conditions (two intervention conditions(
Participants in the intervention conditions (target group A and target group B)
will receive both the cognitive and the behavioral module, but in a different
sequence. In this, way we can examine whether the second module has any effect
on top of the effect of the first module. Participants in the control condition
receive care-as-usual.

Participants in the experimental conditions will receive the Think and Act Cool
training, which consists of a behavioral and cognitive module. Both modules
consist of 5 sessions of 45 minutes. The behavioral modules incorporates
techniques such as physical relaxation, time-out, and the use of specific
social skills. The cognitive module incorporates techniques such as cognitive
relaxation, cognitive restructuring and problem-solving.

Adolescents with mild to borderline intellectual disabilities (target group B)
will receive the Think and Act Cool Plus training, which is adapted to their
specific needs.

The burden placed on the participants is small. Participants fill in the weekly
questionnaire for 19 weeks, this will take up only 2 minutes every week.
Moreover, additional data collection will take place on four occasions, which
will take up 30-45 minutes at each occasion. Participants will fill out the
5-day Daily Diary on three occasions. Participants in the intervention
conditions will receive ten 45-minute training sessions. In total, all
participants invest 4 hours and participants in the intervention conditions
invest an additional 7,5 hours.

Moreover, there is no risk of harm to the participants as a result of
participating in the study.The potential value of the study results is however
profound. Based on the results, it might be possible to enhance the
effectiveness of interventions for aggressive behavior problems in youth. This
is specifically important for the target group, because emotion regulation
capacities are developing during (early) adolescence and at a later age,
interventions are less effective.