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Manualised anger management intervention for people with mild to moderate learning disabilities
ISRCTN ISRCTN37509773
DOI 10.1186/ISRCTN37509773
ClinicalTrials.gov identifier
EudraCT number
Public title Manualised anger management intervention for people with mild to moderate learning disabilities
Scientific title A multi-centre phase III cluster randomised controlled trial of a manualised anger management intervention for people with mild to moderate learning disabilities
Acronym N/A
Serial number at source HTA 08/53/34
Study hypothesis To evaluate the effectiveness, compared to normal care, of a manualised anger management intervention, delivered to people with mild to moderate learning disabilities in a service setting, in reducing levels of reported anger.
Lay summary Not provided at time of registration
Ethics approval South East Wales REC - Panel C, 19/06/2009, ref: 09/SWE03/41
Study design Multicentre phase III cluster-randomised controlled trial
Countries of recruitment United Kingdom
Disease/condition/study domain Mild to moderate learning disabilities, anger management
Participants - inclusion criteria Services:
1. Reported anger control problems among at least four service users who meet individual inclusion criteria and want to participate
2. Availability of at least two staff members willing to be trained as group leaders
3. Service manager provides written agreement to participate

Service Users:
1. An adult attending a service for people with mild to moderate learning disabilities
2. Identified by service staff as having problems in managing their anger
3. Wishing to learn to improve their anger management
4. Able to provide informed consent
5. Able to complete the assessments
6. Aged 18 to 65 years, either sex
Participants - exclusion criteria Services:
1. The service is already running an anger management programme similar to this one
2. There are no suitable facilities for group work

Service Users:
1. Attending the service for a reason other than a diagnosed learning disability
2. Currently receiving psychological treatment for anger or aggression
3. Urgently requiring referral to a Clinical Psychologist for individual treatment of anger or aggression
4. Experiencing circumstances which indicate that a Protection of Vulnerable Adults (POVA) procedure should be initiated
5. If for any other reason the supervising Clinical Psychologist makes a clinical judgement that participation in the group would be counter-indicated
Anticipated start date 01/07/2009
Anticipated end date 31/12/2011
Status of trial Completed
Patient information material Not available in web format, please use the contact details below to request a patient information sheet
Target number of participants 180
Interventions Day care centres will be randomised to receive either a manualised cognitive behaviour therapy (CBT) intervention consisting of 12 weekly psycho-educational group sessions supplemented by, 'homework' or usual care. Participants in both groups will be followed up for 6 months post-intervention.
Primary outcome measure(s) Provocation Index (PI) as completed by the service-user, at follow-up. The PI is a direct measure of felt response to defined situations that may provoke anger and has frequently been used with this service-user group for the current purpose.

Outcome measures will be taken at baseline, immediately after the support as usual (SAU) or intervention in both groups in parallel and 6 months after the completion of the intervention or SAU.
Secondary outcome measure(s) Validated questionnaires will be completed to assess the following domians:
1. Anger (assessed by the PI) as completed by a key-worker and a home carer
2. Aggression will be assessed by key-worker report using the Irritability domain items of the Aberrant Behaviour Checklist (ABC) and the Modified Overt Aggression Scale (MOAS)
3. The Profile of Anger Coping Skills (PACS) will be completed by both service-user, home carer and key-worker to assess the development of alternative, more functional coping skills
4. Mental health will be assessed by using the Glasgow Depression and Anxiety Scales and an adaptation of the Rosenberg Self-Esteem Scale for people with a learning disability
5. Self-reported quality of life will be assessed by using the Comprehensive Quality of Life Scale - Intellectual Disability (ComQoL-ID)
6. Key-workers' attributions in respect of challenging behaviour will be measured by the Controllability Beliefs Scale (CBS)

Additionally, interview data for qualitative analysis will be collected from participants, therapists and service managers, and a health economic evaluation will be undertaken of the costs and consequences of the invervention.

Outcome measures will be taken at baseline, immediately after the support as usual (SAU) or intervention in both groups in parallel and 6 months after the completion of the intervention or SAU.
Sources of funding NIHR Health Technology Assessment Programme - HTA (UK)
Trial website
Publications 2011 protocol in http://www.ncbi.nlm.nih.gov/pubmed/21306624
2013 results in http://www.ncbi.nlm.nih.gov/pubmed/23701738
2013 results in http://www.ncbi.nlm.nih.gov/pubmed/23520220
Contact name Prof  Paul  Willner
  Address Consultant Clinical Psychologist
Directorate of Learning Disability Services
Abertawe Bro Morgannwg University NHS Trust
Community Support Team
The Laurels, 87 Lewis Road
  City/town Neath
  Zip/Postcode SA11 1DJ
  Country United Kingdom
Sponsor Cardiff University (UK)
  Address 30 - 36 Newport Road
  City/town Cardiff
  Zip/Postcode CF24 0DE
  Country United Kingdom
  Sponsor website: http://www.cf.ac.uk/
Date applied 07/07/2009
Last edited 19/03/2014
Date ISRCTN assigned 14/07/2009
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