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Effectiveness of group interpersonal psychotherapy for decreasing aggression and increasing social support among Chinese university students: A randomized controlled study
Accepted Manuscript
Effectiveness of group interpersonal psychotherapy for decreasing aggression and increasing social support among Chinese university students: A randomized controlled study Yutong Li , Nor Aniza binti Ahmad , Zoharah binti Omar , Linyu Zhang , Samsilah bt Roslan PII: DOI: Reference:
S0165-0327(18)31245-X https://doi.org/10.1016/j.jad.2018.12.051 JAD 10371
To appear in:
Journal of Affective Disorders
Received date: Revised date: Accepted date:
7 June 2018 25 October 2018 16 December 2018
Please cite this article as: Yutong Li , Nor Aniza binti Ahmad , Zoharah binti Omar , Linyu Zhang , Samsilah bt Roslan , Effectiveness of group interpersonal psychotherapy for decreasing aggression and increasing social support among Chinese university students: A randomized controlled study, Journal of Affective Disorders (2018), doi: https://doi.org/10.1016/j.jad.2018.12.051
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Highlights
Aggressive behavior in childhood and adolescence is a risk factor for violent and antisocial behavior in adults.
Reducing aggression level may be effective in preventing violent crime.
G-IPT was effective in treating aggression and improving social support level,
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and the effect was stable.
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Effectiveness of group interpersonal psychotherapy for decreasing aggression and increasing social support among Chinese university students: A randomized controlled study.
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Running title: Psychotherapy for university students Abstract Yutong Li1 , Nor Aniza binti Ahmad2 , Zoharah binti Omar2 , Linyu Zhang3 Samsilah bt Roslan2*
Department of Psychology, Chengde Medical University, Hebei, China
2
Faculty of Educational Studies, Universiti Putra Malaysia, Selangor, Malaysia
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Department of Psychology, Chengde Medical University, Hebei, China
*
Corresponding Author:
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Samsilah bt Roslan
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1
Faculty of Educational Studies, Universiti Putra Malaysia, Jalan Upm, 43400 Serdang,
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elangor, Malaysia
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Tel: +60 0192785705
Fax: +86-21-57643271
E-mail: [email protected]
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Abstract
Background: The objective of this randomized controlled experimental study was to determine the intervention effect of group interpersonal psychotherapy (G-IPT) for
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aggression and social support among Chinese first-grade university students.
Methods: Through stratified random sampling, 1469 students, aged 18–19 years, were enrolled. Participants whose score achieved the aggressive evaluation standard were selected and then 60 participants were randomly divided into 2 groups: G-IPT
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and control. The participants in the G-IPT group received 16 sessions of treatment, whereas the participants in the control group did not receive any intervention. All
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participants completed the assessment three times: before, after, and tracking.
Results: The results showed that the total score and the scores of all subscales of
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aggression dropped significantly (P < 0.01). Also, the total score and the scores of
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0.05).
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objective support and utilization degree of social support increased significantly (P <
Conclusion: G-IPT was effective in treating aggression and improving social support
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level, and the effect was stable.
Keywords:
Aggression;
Chinese
university
psychotherapy; social support
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students;
group
interpersonal
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INTRODUCTION
Aggression is best described as any form of action aimed at hurting or damaging another living being who intends to avoid such action. (Bushman and Anderson, 2001) It is a destructive behavioral expression that can result in pain and discomfort to
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others or oneself. Aggression is extensive (Dodge et al., 2006) and develops from childhood to adolescence. (Farrell et al., 2005; Karriker-Jaffe et al., 2008) Health outcomes associated with damage across countries are similar. (Simpson et al., 2005)
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Aggressive behavior affects the youth, their family, and society. Both aggression perpetration and victimization increase the risks of externalizing and internalizing problems, such as emotional symptoms and conduct problems, in adolescents. (Cluver
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et al., 2010; Jansen et al., 2012; Yen et al., 2010) Highly aggressive youths usually
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face more internalization, such as withdrawal, anxiety and depression, and externalization, such as hyperactivity, obstacles compared with their less aggressive
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peers. (Walters et al., 2010) Aggressive behavior in childhood and adolescence is a
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risk factor for violent and antisocial behavior in adults.(Huesmann, 2007; Olino et al., 2010)
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A recent series of vicious incidents occurred in campuses of China which caused
an irreparable loss for school, family, and society. Nearly 18% of college students reported experiencing campus violence in the previous year. (Wang et al., 2005) In Beijing, criminal detention of college students increased 3.8 times in 2005 than in 2000, and the number of crimes among college students increased by 28.2%.(Ding, 4
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2009) Since 1999, crime related to aggression among Chinese college students has increased every year. (Sun, 2008; Zhong, 2011)
Reducing aggression level may be effective in preventing violent crime (Feindler and Engel, 2011; Hellwege, 1998; Loebert and Stouthamer-Loebert, 1987; Magnusson
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et al., 1983; Mytton et al., 2002; Pulkkinen, 1983) But, an imbalance exists between theory and practice.(Dobson and Beshai, 2013) In mainland China, most studies involve preliminary discussion from the theoretical perspective.(Chen and Qu, 2013;
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Zhang et al., 2011) Therefore, studies into interventions on aggression should be conducted.
Traditional psychotherapies are available for treating aggression including therapy,
behavioral
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psychodynamic
therapy,
and
cognitive
therapy.
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(Bowman-Edmondson and Cohen-Conger, 1996; Deffenbacher et al., 2000; Martin, 2002; Saini, 2009; Tafrate, 1995) However, traditional psychotherapy has some
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weaknesses such as separation on the time dimension of past–present–future continuum,
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one-sided view of cognition, behavior, and emotions, as well as rigid processing of the relationship between person, family, and society. Interpersonal psychotherapy (IPT) is
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one successful integration model that is mainly rooted in interpersonal theory that emphasizes an interpersonal relationship is a basic human need, and a healthy and positive interpersonal relationship is closely related to mental health; and attachment theory that indicates attachment anxiety or attachment avoidance is associated with negative self-image or image of others, negative affect, and interpersonal hostility. 5
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(Mikulincer et al., 2003) IPT is a focused intervention different from traditional and supportive psychotherapies. (Tantleff-Dunn et al., 2004) The characteristic of IPT is to completely review significant life events, fluctuations in mood and self-esteem, and the interpersonal process to determine aspects of social functioning associated with the
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development and maintenance of psychological symptoms.(Wilfley et al., 2000; Wilfley et al., 2003) IPT helps clients modify their specific relationships or their expectations of these relationships. The mechanism of IPT involves four changes: reducing
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interpersonal stress; increasing social support; enhancing interpersonal skills, and improving emotional processing .(Lipsitz and Markowitz, 2013)
G-IPT adopts the same basic structure and focus of IPT, though modified to
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employ the group format. This has some advantages. Groups, by definition, are
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interpersonal and therefore provide a natural delivery platform on which to apply the strategies of IPT. As the social interaction can occur in the context of groups,
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interpersonal skills developed in group therapy may be more easily transferred to
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clients‟ real life than one-on-one individual treatment. In addition, groups in which the membership is based on the similarity of disorder offer a fundamental altered social
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environment for clients who have become isolated from others. Group participation, therefore, may help clients break patterns of social isolation that contribute to the maintenance of the disorder. Moreover, the group context may help normalize clients‟ symptoms and alleviate concerns that they are alone in their psychiatric disorder .(Wilfley et al., 2000) 6
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The social network of children or adolescents is a major factor in predicting whether they will become aggressive. (Bandura et al., 2001) The adolescent, who has positive company and fine social network, is able to generate a sociable trend instead of antisocial action. Pressure and distress are the most common causes of aggression.
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(Krahe, 2001; Tremblay and Nagin, 2005). Therefore, social support is a major environmental resource for young people. Studies in students and teenagers suggest a significant negative correlation between aggression and social support.(Kashani and
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Shepperd, 1990; Rajesh et al., 2014);(Kase et al., 2014) These results suggest that improving life skills and increasing perceived social support could reduce aggression and promote mental health.
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Studies using IPT or G-IPT to treat aggression are not available in the literature.
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Based on the research on the relationship between social support and aggression, we believed that participants could use G-IPT to identify problems in their interpersonal
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relationships and through training, they could decrease the external stressors leading
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to aggressive behavior. Thus, reducing interpersonal pressure, facilitating processing of emotion, and enhancing interpersonal techniques to improve their social support
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and reduce their aggression.
Hence, the purpose of this study was to examine two hypotheses: (1) G-IPT is
effective in treating aggression, and the effect is stable; and (2) G-IPT is effective in improving social support, and the effect is stable.
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METHODS
Design and participants
This study investigated the short-term and long-term effects of G-IPT on
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aggression and social support. It was a randomized control group design. A series of arrangements were made in the experimental design to eliminate or control the influence of extraneous variables as much as possible.
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The target population of this study was the first-grade students of three universities in Hebei Province of China, comprising a comprehensive university, a university of medical sciences, and a normal university, and participants aged 18 and
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19 years. The participants who took part in the intervention met the following criteria: (1) a score in the aggression questionnaire that was higher than the mean+ standard
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deviation (SD) of the general student population and (2) agreed to participate in the
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study with willingness to enhance their own mental health. All participants signed
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informed consent.
A total of 8853 university students met the requirement of this study. After
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random sampling stratified to gender and majority, 1469 students were enrolled. The participants were selected through assessment using the Chinese College Students‟ Version of Buss–Perry Aggression Questionnaire (CC-BPAQ).(Lv et al., 2013) The 199 participants were assigned a number and then 60 participants (32 males and 28 females) were selected, considering the gender and majority by random number 8
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selection using a computer and divided into 2 groups: G-IPT and control.
Intervention
The researcher undertook professional training in G-IPT and obtained the
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corresponding qualification.
The G-IPT program involved 16 weekly sessions. Each group included 10 participants, and each session lasted for 60 min. The participants in the control group
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did not receive any intervention. They just participated in the assessments.
There were four phases in the G-IPT: (1) pretreatment assessment; (2) initial sessions; (3) intermediate sessions; and (4) termination. The pretreatment assessment
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was undertaken on an individual basis rather than in a group. This allowed the researcher to establish a preliminary therapeutic alliance with the participants,
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complete an assessment, and evaluate the participants‟ suitability for G-IPT. The
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nature of the IPT groups was homogeneous, structured, developmental, and closed.
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In the initial sessions (sessions 1–3), first, the researcher (leader) encouraged the group members to know and understand each other, clarified the goal and nature of
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the group, and formed the expectation as well as the aim of the group through a series of group activities such as „Snowball‟ where participants took turns to share personal information, but each time they first stated the information of everyone who had already participated. So, the second person repeated the information from the first participant, but the last person repeated the information from the whole group. Second, 9
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the leader used the means of interpretation, discussion, and role playing to further enhance the mutual understanding between the group members, helped them understand the features of aggression and anger, explored the causes of aggression and anger from the interpersonal perspective, and allowed them to master preliminary
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methods of reasonable emotional expression.
In the intermediate sessions (sessions 4–14), first, the leader helped the group members understand the usual interpersonal, emotional, and behavioral problems
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easily caused by interpersonal problems and the relationship between interpersonal crisis and maladaptive behaviors such as aggression. Second, the leader introduced and helped the group members understand the four categories of interpersonal
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problems (grief, role transition, role conflict, and interpersonal deficits) through group
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activities, discussions, and so on. Then, the leader clearly illustrated to the group members that the maladaptive behaviors, such as aggression, could be understood as a
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response to the current difficulties in relationships. In turn, aggression could also
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affect the quality of their relationships. Third, the leader helped the group members understand that interpersonal conflict was an important cause leading to aggressive
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behavior and high aggression would also lead to the deterioration of interpersonal relationships. Effective intervention goals and strategies were provided to solve grief, role transition, role conflict, and interpersonal deficit; and learn techniques for building new relationships, change negative view of interpersonal conflict, and construct basic skills to solve the interpersonal conflict. Finally, the leader learned and 10
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used the core techniques of IPT, such as role playing, communication analysis, and exploration to help the group members understand that identifying, handling, expressing emotions, as well as two-way communication, were the tasks of this intervention; he/she also improved the group members‟ interpersonal skills within the
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framework of the focal interpersonal problem areas.
In the termination sessions (sessions 15 and 16), the group members reviewed and consolidated the knowledge and skills learned in the previous sessions, accepted
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the feedback from the leader and the other group members, understood their own performance in the group as well as progress and improvement after the group process, and obtained suggestions for further improvement. The leader ended the group
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intervention.
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Measures
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All participants were asked to complete assessments three times: pre-treatment (1 week prior to the intervention), post-treatment 1 (1 week after the intervention), and
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post-treatment 2 (tracking), which was 4 months after the intervention.
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Aggression
The CC-BPAQ included 22 self-reporting items scored on a 5-point Likert scale
from extremely uncharacteristic to extremely characteristic. It is the Chinese revision of the Buss–Perry Aggression Questionnaire with good validity and internal consistency.(Lv et al., 2013) 11
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Social support
The Social Support Scale for University Students was used to measure the social support of the participants. This is a rating scale suitable for Chinese college students.(Ye and Dai, 2008) It contains 17 items belonging to 3 factors: subjective
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support, objective support, and utilization degree. The confirmatory factor analysis showed that the values of normal fit index (NFI), non-normal fit index (NNFI), and compared fitted indices (CFI) were more than 0.9 (approximate error root mean
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square [RMSEA] = 0.03). The test accorded with the requirement of psychometrics and the internal consistency was good. For the full scale, α was 0.906. The test–retest reliability was good.
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Data analysis
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The methods of statistical analysis used in this study mainly included analysis of
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variance (ANOVA) for repeated measures and t test with a Bonferroni method for post-hoc comparison. The All data analyses were performed using the SPSS 22.0
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(SPSS Inc., Chicago, IL, USA)
RESULTS
Participants Table 1 shows the baseline data for the two groups. All participants were 18 or 12
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19 years old. No significant differences in the basic demographic characteristics, such as age, gender, university course, or family background were found between the two groups (P > 0.05). The total score of CC-BPAQ was the screening index and the foundation of the follow-up work. We also checked the consistency of total score of
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social support between the treatment and control groups.
The t test showed that no significant differences in the total aggression and social support scores were found between the control and G-IPT groups (aggression: T
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=.585, P > 0.05; social support: T =.161, P > 0.05) at baseline; so, the participants were homogeneous. Therefore, the intervention effect could be examined through comparing the data of the measurements of the control and G-IPT groups.
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Table 2 displays the means and standard deviations of the total score of
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aggression and social support with time. The spherical test results were not significant
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(Table 2, P > 0.05), and single-factor variance analysis could be used.
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Changes in aggression
For the total aggression scores, in the G-IPT group, post-treatment 1 and
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post-treatment 2 scores were significantly lower than the pre-treatment score (P < 0.001 Figure 1).
Total aggression scores in the two groups were compared at different times, and this showed that the post-treatment 1 and post-treatment 2 scores were significantly lower in the G-IPT group than in the control group (P<0.001). 13
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Analysis of effect size was undertaken to establish whether the intervention had a greater effect than no intervention over time. The results showed the total aggression and all of the aggression sub-scores, except hostility, were significantly changed at both post-treatment 1 and post-treatment 2 compared to pre-treatment and the effect
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was more significant in the G-IPT group compared to the control group. Table 2 also shows the detailed analysis of P time which shows if the scores change over time, P interaction which shows if there was an interaction between time and treatment, and P
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treatment which shows the main effect of treatment. The results show that all three were significant for total aggression, impulsivity, physical aggression, and anger proneness. But while P time and P treatment were significant for hostility P
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Changes in social support
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interaction was not (P>0.05).
In the control group the total social support score did not change significantly. In
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contrast, the total social support score increased significantly in the G-IPT group
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(P<0.01, Figure 2).
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Total social support scores in the two groups were compared at different times, and this showed that the post-treatment 1 score was significantly lower in the G-IPT group than in the control group (P=0.045) but the difference was not significant at post-treatment 2 (P=0.311).
Analysis of effect size for social support scores showed that neither the total score or 14
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most of the sub-scale scores changed significantly at post-treatment 1 or post-treatment 2 from pre-treatment after intervention compared to the control. However, there was an effect of the treatment on the sub-scale of utilization degree at post-treatment 1. Overall, P time, P interaction, and P treatment were not significant
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for total social support score and for many of the sub-scores. P time was significant for objective support score and P treatment was significant for subjective support and
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utilization degree.
DISCUSSION
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The objective of this randomized controlled experimental study was to determine whether G-IPT intervention reduced aggression and increased social support among
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Chinese first-grade university students. The results showed that the total score and the
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scores of all subscales of aggression dropped significantly in the G-IPT group compared to the control group. Also, the total score and the scores of objective
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support and utilization degree of social support increased significantly in the G-IPT
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group compared to the control group. However, while the effect size of G-IPT for aggression was seen only utilization degree in the social support scales showed a difference.
In the present study, the choice of participants, the therapist's attitude, and the structure of group activities for G-IPT might disrupt or even destroy group therapy 15
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without careful planning and reasonable arrangement. After considering these factors, the researcher ensured the homogeneity of the groups of participants through implementing a series of methods. The therapist ensured that he/she was objective, warm, and unconditionally positive during the intervention, and informed the team
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that their problems could be solved. The therapist used group activities to help the group members learn how to solve interpersonal problems, providing minimal direct assurance and advice. This helped the team members cultivate the feeling of
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competence. The researcher attached great importance to the emotional expression of the team members. In the strategy of developing new relationships, expressing the emotions associated with others helped participants decide the priority of things. The
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researcher also paid attention to communication analysis. The goal of communication analysis was to help the group members learn more effective techniques of
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communication. Besides, the therapist consciously used a preset problem or situation
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to guide the team members to learn and master more effective ways to communicate
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through discussion, role playing, and sharing of feelings.
It was slightly surprising that the total aggression score dropped in the control
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group, compared with pre-treatment and in the subscales scores the hostility score decreased in the post-treatment 1 and post-treatment 2 tests. The reason for this mainly involved the internal validity of the design of the experiment.(Judd et al., 1991) In this study, all participants had just entered the universities. Their environment had changed compared with high school. In addition, the survey found that all three 16
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universities offered a College Students‟ Mental Health course in the first year. This might have affected the results of the study to some extent. As this study adopted a randomized control group design, the general history events that might have influenced the control group also produced similar effects on the G-IPT group after
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randomization. On the premise of participants with homogeneity and through a series of control measures, the researcher believed that the differences between groups were caused by the independent variables.
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IPT is an interpersonally focused and time-limited psychotherapy aimed at promoting interpersonal skills and relieving symptoms. In fact, much of the effects of IPT may come from its optimization and re-association of the common factors of
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different therapies.(Markowitz and Milrod, 2011) IPT was initially developed to treat
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depression, and soon afterward, adapted for curing bipolar disorder,(Frank et al., 2005) social anxiety disorder, (Lipsitz et al., 1999) binge eating disorder, (Wilfley et al.,
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2002) panic disorder, (Lipsitz et al., 2006) and posttraumatic stress disorder.(Bleiberg
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and Markowitz, 2005) The group format of IPT is developed on the basis of individual treatment and is better for work on interpersonal problems and improving
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interpersonal techniques with other individuals struggling with similar dilemmas. G-IPT provides many unique therapeutic benefits, and some of them are quite different from the individual format. For example, the interpersonal techniques learned in groups may be more easily transferred to the participants‟ real lives
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compared with those learned in individual therapy because the social interactions can occur in a group context.
G-IPT for aggression showed significant differences in the total score and the
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scores of all subscales between the pre-treatment, post-treatment, and post-treatment 2 test time points. The impulsivity score in post-treatment 1 was obviously lower than that in the pre-treatment and further reduced in the post-treatment 2 test. This result was similar to the findings of (Bellino and Bozzatello, 2015). The score of hostility in
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the post-treatment 1 was obviously lower than that in the pre-treatment, but it slightly rebounded in the post-treatment 2 test. The result showed that using G-IPT could effectively eliminate hostility, mainly because it helped the participants more
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reasonably express their emotions and more effectively communicate with other
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people. The score of physical aggression in the post-treatment 1 was obviously lower than that in the post-treatment 1 and continued to decline in the post-treatment 2 test.
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This showed the positive effect of G-IPT in reducing physical aggression, and the
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effect was stable. The score of anger proneness in the post-treatment was obviously lower than that in the pre-treatment and continued to decline in the post-treatment 2
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test. This result was similar to a previous study (Jin and Chong, 2015). Therefore, the implementation of the G- IPT was effective in reducing aggression among Chinese college students.
In practice, some scientists have regarded IPT as an intervention guided by social support, (Brugha et al., 2008) and the theoretical discussions about the relationship 18
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between IPT and social support have developed. (Champion, 2012; Lipsitz, 2009) The statistical analysis of G-IPT for social support showed significant differences in the total score and the scores of objective support and utilization degree between pre-treatment, post-treatment 1, and post-treatment 2 test. Combined with the
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descriptive statistics, the implementation of the G-IPT significantly increased the objective support, utilization degree, and total social support. The score of objective support in the post-treatment 1 was obviously higher than that in the pre-treatment,
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but it slightly rebounded in the post-treatment 2 test. The score of subjective support in the post-treatment 1 was higher than that in the pre-treatment, but it did not reach the significance level. The post-treatment utilization degree score was obviously
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higher than that in the pre-treatment, and slightly rebounded in the post-treatment 2 test. However, when the effect size was calculated the effectiveness of G-IPT for
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increasing social support was not evident apart from utilization degree at
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post-treatment 1. Although social support is an effective interpersonal resource, the amount of objective and subjective social support acquired from a social context is
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different even in the same environment. Personality traits of individuals have a role in
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this process. For example, extraversion and neuroticism are related to objective social support and subjective social support. (Den Oudsten et al., 2010; Leskela et al., 2009; Swickert et al., 2010) It seems that personality may impact the sense of social support and the utilization of the interpersonal resource. This problem can be an objective for subsequent research. In sum, the results showed that the programs designed to
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decrease aggressive actions in college students should concentrate on providing more social support just like G-IPT.
The randomized controlled nature of this study provided some advantages. For example, the three universities to which participants belonged were in the same city,
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which reduced the effect of regional difference on the result. This was a long-term interventional study in which the participants lived and studied under natural conditions except participating in treatment. All treatments were arranged in the same
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place, and the researcher and assistants who participated in this study undertook unified training and adopted the same treatment program. This helped the study prevent selection bias, avoid subjective factors, control systemic errors, balance the
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influence of unexpected factors, and serve as the basis of inference statistics.
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Moreover, the questionnaires used in this study had high reliability and validity, and the two questionnaires were consistent in the three measures. The researcher added in
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two other questionnaires to prevent the influence of memory formed in the previous
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tests on the subsequent tests: Eysenck Personality Questionnaire and 16 Personality Factor Questionnaire. Therefore, the effects of instrumentation in this study could be
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controlled.
Although the results of this study had certain representativeness, they should not
be generalized. China has thousands of universities and colleges besides those in Hong Kong, Macao, and Taiwan. A wider range of participants and research is needed to make the results more representative. The researchers intend to promote this 20
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technology and make it an important part of the new campus violence prevention and
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control program.
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Acknowledgment
Not applicable.
Funding
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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Declarations of interest
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None
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Author Statement
The article has not been published previously, not under consideration for publication elsewhere, its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will
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not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder.
Declarations of interest
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None
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Mytton, J.A., DiGuiseppi, C., Gough, D.A., Taylor, R.S., Logan, S., 2002. School-based violence prevention programs: systematic review of secondary
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Olino, T.M., Seeley, J.R., Lewinsohn, P.M., 2010. Conduct disorder and psychosocial outcomes at age 30: early adult psychopathology as a potential mediator. Journal
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Pulkkinen, L. Finland: The search for alternative to aggression. New York: Pergaman, 1983.
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college students]. Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi 26, 943-946. Wilfley, D.E., MacKenzie, K.R., Welch, R.R., Ayres, V.E., Weissman, M.M. Interpersonal psychotherapy for group. New York: Basic Books, 2000.
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Wilfley, D.E., Welch, R.R., Stein, R.I., Spurrell, E.B., Cohen, L.R., Saelens, B.E., Dounchis, J.Z., Frank, M.A., Wiseman, C.V., Matt, G.E., 2002. A randomized comparison of group cognitive-behavioral therapy and group interpersonal
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psychotherapy for the treatment of overweight individuals with binge-eating disorder. Archives of general psychiatry 59, 713-721.
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Wiley, 2003.
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Chinese Journal of Clinical Psychology 16, 456-458.
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Yen, C.F., Ko, C.H., Yen, J.Y., Tang, T.C., Chang, Y.P., Cheng, C.P., 2010. Internalizing and externalizing problems in adolescent aggression perpetrators,
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victims, and perpetrator-victims. Comprehensive psychiatry 51, 42-48.
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Zhang, X.Y., Gao, D.G., Fu, H., 2011. Dialectical Thinking Reduces Aggressive Tendencies. . Acta Psychologica Sinica 43, 42-51.
Zhong, H., 2011. The reason analysis and prevention of crime among college students. . China Adult Education 6, 45-47.
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Table 1 Baseline data
Control group (n =30)
P value
Gender/male
14(46.7)
17(56.7)
0.438
Majority Science
15 (50.0)
15 (50.0)
1
Arts
15 (50.0)
15 (50.0)
1
Single parent family
3 (10.0)
2 (6.7)
1
Only child
12(40.0)
Birthplace urban
14(46.7)
rural
16(53.3)
Left-behind children
0(0)
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G-IPT group (n =30)
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13(43.3)
0.798
14(46.7)
1
16(53.3)
1
5(16.7)
0.052
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Table 2 Changes in aggression and social support scores with time
Control (n = 30)
T2-T1
T3-T1
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G-IPT (n = 30)
Effect P
T1
T2
T3
T1
T2
T3
size
Effect P
value size*
P
P
interaction
treatment
<
<
value P time
*
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Total Aggression
71.4 ± 5.6 53.3 ± 7.2 53.0 ± 9.4 72.3 ± 6.3
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aggression
19.7 ± 4.1 17.1 ± 4.2 17.7 ± 3.6 23.9 ± 4.3
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Hostility
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Impulsivity 22.6 ± 2.8 16.9 ± 3.9 17.1 ± 4.3 20.5 ± 4.7
69.8 ± 5.1
69.0 ± 6.4
2.00
0.000 1.55
< 0.000
0.001 0.001
<
20.3 ± 2.1 20.9 ± 2.4
1.22
0.000 1.07
0.001
<
0.000
0.006 0.001 0.001
<
22.3 ± 2.3 21.9 ± 2.4
0.12
0.650 0.09
0.743 0.001 0.883 0.001
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Physical
16.7 ± 5.0 19.0 ± 3.6 11.1 ± 3.6 10.7 ± 2.9 17.6 ± 5.7
16.6 ± 4.1
<
1.22
0.000 1.25
<
Anger 7.7 ± 2.6
7.5 ± 2.5
10.4 ± 2.6
proneness
Total Social
10.2 ± 2.3
0.62
65.8 ± 9.5 72.4 ± 9.5 70.2 ± 8.7 66.2 ± 11.3 66.6 ± 12.3 67.4 ± 12.6 0.45
0.017 0.002 0.013 0.001
0.084 0.22
0.395 0.134 0.241
0.131
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support
0.020 0.64
0.001
<
10.2 ± 2.4
9.9 ± 2.3
<
0.000
0.001 0.001
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aggression
social
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support
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Objective 23.7 ± 5.9 26.5 ± 4.0 26.1 ± 3.5 25.0±4.76 support
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Subjective
19.9 ± 3.6 21.2 ± 3.3 21.2 ± 3.1 19.2±3.66
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support
26.3±4.16
26.5±3.71
0.24
0.347 0.15
0.571 0.016 0.551
0.500
19.3±5.11
19.6±4.27
0.23
0.383 0.18
0.494 0.514 0.076
0.019
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Utilization 21.9 ± 4.8 24.7 ± 3.9 24.3 ± 4.2 22.0±5.12
21.0±6.14
21.2±6.77
0.56
0.035 0.46
0.083 0.438 0.668
0.022
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degree
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Notes: T1 indicates the pre-treatment score (1 week prior to the intervention), T2 indicates the post-treatment 1 score (1 week after the intervention), T3 indicates the tracking or post-treatment 2 score, (4 months after the intervention).
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Effect sizes were calculated to show the effect of the intervention. First the difference at T2 or T3 to T1 was calculated for each group then the mean difference between the two groups was calculated. The P values compare the differences to show if there was a significant difference
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between the groups i.e. an effect of the intervention.
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Figure 1. Plot of intervention effect on total aggression score.
The G-IPT group is indicated by the red line and received the intervention. The control group is represented by the green line and received no intervention. The
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results show that the intervention decreased total aggression scores in the G-IPT group more than the control group at the “after” time point (Post-treatment 1: 1 week
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after the intervention) and the effect was also seen at the “tracking” time point
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(Post-treatment 2: 4 months after intervention).
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Figure 2 Plot of intervention effect on the total social support score.
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The G-IPT group is indicated by the red line and received the intervention. The control group is represented by the green line and received no intervention. The results show that the intervention increased total social support scores in the G-IPT
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group more than the control group at the “after” time point (Post-treatment 1: 1 week
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after the intervention) but the effect was reduced at the “tracking” time point
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(Post-treatment 2: 4 months after intervention).
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Effectiveness of group interpersonal psychotherapy for decreasing aggression and increasing social support among Chinese university students: A randomized controlled study Yutong Li , Nor Aniza binti Ahmad , Zoharah binti Omar , Linyu Zhang , Samsilah bt Roslan PII: DOI: Reference:
S0165-0327(18)31245-X https://doi.org/10.1016/j.jad.2018.12.051 JAD 10371
To appear in:
Journal of Affective Disorders
Received date: Revised date: Accepted date:
7 June 2018 25 October 2018 16 December 2018
Please cite this article as: Yutong Li , Nor Aniza binti Ahmad , Zoharah binti Omar , Linyu Zhang , Samsilah bt Roslan , Effectiveness of group interpersonal psychotherapy for decreasing aggression and increasing social support among Chinese university students: A randomized controlled study, Journal of Affective Disorders (2018), doi: https://doi.org/10.1016/j.jad.2018.12.051
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Highlights
Aggressive behavior in childhood and adolescence is a risk factor for violent and antisocial behavior in adults.
Reducing aggression level may be effective in preventing violent crime.
G-IPT was effective in treating aggression and improving social support level,
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and the effect was stable.
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Effectiveness of group interpersonal psychotherapy for decreasing aggression and increasing social support among Chinese university students: A randomized controlled study.
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Running title: Psychotherapy for university students Abstract Yutong Li1 , Nor Aniza binti Ahmad2 , Zoharah binti Omar2 , Linyu Zhang3 Samsilah bt Roslan2*
Department of Psychology, Chengde Medical University, Hebei, China
2
Faculty of Educational Studies, Universiti Putra Malaysia, Selangor, Malaysia
3
Department of Psychology, Chengde Medical University, Hebei, China
*
Corresponding Author:
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Samsilah bt Roslan
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1
Faculty of Educational Studies, Universiti Putra Malaysia, Jalan Upm, 43400 Serdang,
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elangor, Malaysia
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Tel: +60 0192785705
Fax: +86-21-57643271
E-mail: [email protected]
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Abstract
Background: The objective of this randomized controlled experimental study was to determine the intervention effect of group interpersonal psychotherapy (G-IPT) for
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aggression and social support among Chinese first-grade university students.
Methods: Through stratified random sampling, 1469 students, aged 18–19 years, were enrolled. Participants whose score achieved the aggressive evaluation standard were selected and then 60 participants were randomly divided into 2 groups: G-IPT
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and control. The participants in the G-IPT group received 16 sessions of treatment, whereas the participants in the control group did not receive any intervention. All
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participants completed the assessment three times: before, after, and tracking.
Results: The results showed that the total score and the scores of all subscales of
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aggression dropped significantly (P < 0.01). Also, the total score and the scores of
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0.05).
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objective support and utilization degree of social support increased significantly (P <
Conclusion: G-IPT was effective in treating aggression and improving social support
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level, and the effect was stable.
Keywords:
Aggression;
Chinese
university
psychotherapy; social support
3
students;
group
interpersonal
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INTRODUCTION
Aggression is best described as any form of action aimed at hurting or damaging another living being who intends to avoid such action. (Bushman and Anderson, 2001) It is a destructive behavioral expression that can result in pain and discomfort to
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others or oneself. Aggression is extensive (Dodge et al., 2006) and develops from childhood to adolescence. (Farrell et al., 2005; Karriker-Jaffe et al., 2008) Health outcomes associated with damage across countries are similar. (Simpson et al., 2005)
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Aggressive behavior affects the youth, their family, and society. Both aggression perpetration and victimization increase the risks of externalizing and internalizing problems, such as emotional symptoms and conduct problems, in adolescents. (Cluver
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et al., 2010; Jansen et al., 2012; Yen et al., 2010) Highly aggressive youths usually
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face more internalization, such as withdrawal, anxiety and depression, and externalization, such as hyperactivity, obstacles compared with their less aggressive
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peers. (Walters et al., 2010) Aggressive behavior in childhood and adolescence is a
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risk factor for violent and antisocial behavior in adults.(Huesmann, 2007; Olino et al., 2010)
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A recent series of vicious incidents occurred in campuses of China which caused
an irreparable loss for school, family, and society. Nearly 18% of college students reported experiencing campus violence in the previous year. (Wang et al., 2005) In Beijing, criminal detention of college students increased 3.8 times in 2005 than in 2000, and the number of crimes among college students increased by 28.2%.(Ding, 4
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2009) Since 1999, crime related to aggression among Chinese college students has increased every year. (Sun, 2008; Zhong, 2011)
Reducing aggression level may be effective in preventing violent crime (Feindler and Engel, 2011; Hellwege, 1998; Loebert and Stouthamer-Loebert, 1987; Magnusson
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et al., 1983; Mytton et al., 2002; Pulkkinen, 1983) But, an imbalance exists between theory and practice.(Dobson and Beshai, 2013) In mainland China, most studies involve preliminary discussion from the theoretical perspective.(Chen and Qu, 2013;
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Zhang et al., 2011) Therefore, studies into interventions on aggression should be conducted.
Traditional psychotherapies are available for treating aggression including therapy,
behavioral
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psychodynamic
therapy,
and
cognitive
therapy.
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(Bowman-Edmondson and Cohen-Conger, 1996; Deffenbacher et al., 2000; Martin, 2002; Saini, 2009; Tafrate, 1995) However, traditional psychotherapy has some
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weaknesses such as separation on the time dimension of past–present–future continuum,
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one-sided view of cognition, behavior, and emotions, as well as rigid processing of the relationship between person, family, and society. Interpersonal psychotherapy (IPT) is
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one successful integration model that is mainly rooted in interpersonal theory that emphasizes an interpersonal relationship is a basic human need, and a healthy and positive interpersonal relationship is closely related to mental health; and attachment theory that indicates attachment anxiety or attachment avoidance is associated with negative self-image or image of others, negative affect, and interpersonal hostility. 5
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(Mikulincer et al., 2003) IPT is a focused intervention different from traditional and supportive psychotherapies. (Tantleff-Dunn et al., 2004) The characteristic of IPT is to completely review significant life events, fluctuations in mood and self-esteem, and the interpersonal process to determine aspects of social functioning associated with the
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development and maintenance of psychological symptoms.(Wilfley et al., 2000; Wilfley et al., 2003) IPT helps clients modify their specific relationships or their expectations of these relationships. The mechanism of IPT involves four changes: reducing
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interpersonal stress; increasing social support; enhancing interpersonal skills, and improving emotional processing .(Lipsitz and Markowitz, 2013)
G-IPT adopts the same basic structure and focus of IPT, though modified to
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employ the group format. This has some advantages. Groups, by definition, are
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interpersonal and therefore provide a natural delivery platform on which to apply the strategies of IPT. As the social interaction can occur in the context of groups,
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interpersonal skills developed in group therapy may be more easily transferred to
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clients‟ real life than one-on-one individual treatment. In addition, groups in which the membership is based on the similarity of disorder offer a fundamental altered social
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environment for clients who have become isolated from others. Group participation, therefore, may help clients break patterns of social isolation that contribute to the maintenance of the disorder. Moreover, the group context may help normalize clients‟ symptoms and alleviate concerns that they are alone in their psychiatric disorder .(Wilfley et al., 2000) 6
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The social network of children or adolescents is a major factor in predicting whether they will become aggressive. (Bandura et al., 2001) The adolescent, who has positive company and fine social network, is able to generate a sociable trend instead of antisocial action. Pressure and distress are the most common causes of aggression.
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(Krahe, 2001; Tremblay and Nagin, 2005). Therefore, social support is a major environmental resource for young people. Studies in students and teenagers suggest a significant negative correlation between aggression and social support.(Kashani and
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Shepperd, 1990; Rajesh et al., 2014);(Kase et al., 2014) These results suggest that improving life skills and increasing perceived social support could reduce aggression and promote mental health.
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Studies using IPT or G-IPT to treat aggression are not available in the literature.
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Based on the research on the relationship between social support and aggression, we believed that participants could use G-IPT to identify problems in their interpersonal
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relationships and through training, they could decrease the external stressors leading
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to aggressive behavior. Thus, reducing interpersonal pressure, facilitating processing of emotion, and enhancing interpersonal techniques to improve their social support
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and reduce their aggression.
Hence, the purpose of this study was to examine two hypotheses: (1) G-IPT is
effective in treating aggression, and the effect is stable; and (2) G-IPT is effective in improving social support, and the effect is stable.
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METHODS
Design and participants
This study investigated the short-term and long-term effects of G-IPT on
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aggression and social support. It was a randomized control group design. A series of arrangements were made in the experimental design to eliminate or control the influence of extraneous variables as much as possible.
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The target population of this study was the first-grade students of three universities in Hebei Province of China, comprising a comprehensive university, a university of medical sciences, and a normal university, and participants aged 18 and
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19 years. The participants who took part in the intervention met the following criteria: (1) a score in the aggression questionnaire that was higher than the mean+ standard
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deviation (SD) of the general student population and (2) agreed to participate in the
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study with willingness to enhance their own mental health. All participants signed
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informed consent.
A total of 8853 university students met the requirement of this study. After
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random sampling stratified to gender and majority, 1469 students were enrolled. The participants were selected through assessment using the Chinese College Students‟ Version of Buss–Perry Aggression Questionnaire (CC-BPAQ).(Lv et al., 2013) The 199 participants were assigned a number and then 60 participants (32 males and 28 females) were selected, considering the gender and majority by random number 8
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selection using a computer and divided into 2 groups: G-IPT and control.
Intervention
The researcher undertook professional training in G-IPT and obtained the
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corresponding qualification.
The G-IPT program involved 16 weekly sessions. Each group included 10 participants, and each session lasted for 60 min. The participants in the control group
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did not receive any intervention. They just participated in the assessments.
There were four phases in the G-IPT: (1) pretreatment assessment; (2) initial sessions; (3) intermediate sessions; and (4) termination. The pretreatment assessment
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was undertaken on an individual basis rather than in a group. This allowed the researcher to establish a preliminary therapeutic alliance with the participants,
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complete an assessment, and evaluate the participants‟ suitability for G-IPT. The
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nature of the IPT groups was homogeneous, structured, developmental, and closed.
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In the initial sessions (sessions 1–3), first, the researcher (leader) encouraged the group members to know and understand each other, clarified the goal and nature of
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the group, and formed the expectation as well as the aim of the group through a series of group activities such as „Snowball‟ where participants took turns to share personal information, but each time they first stated the information of everyone who had already participated. So, the second person repeated the information from the first participant, but the last person repeated the information from the whole group. Second, 9
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the leader used the means of interpretation, discussion, and role playing to further enhance the mutual understanding between the group members, helped them understand the features of aggression and anger, explored the causes of aggression and anger from the interpersonal perspective, and allowed them to master preliminary
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methods of reasonable emotional expression.
In the intermediate sessions (sessions 4–14), first, the leader helped the group members understand the usual interpersonal, emotional, and behavioral problems
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easily caused by interpersonal problems and the relationship between interpersonal crisis and maladaptive behaviors such as aggression. Second, the leader introduced and helped the group members understand the four categories of interpersonal
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problems (grief, role transition, role conflict, and interpersonal deficits) through group
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activities, discussions, and so on. Then, the leader clearly illustrated to the group members that the maladaptive behaviors, such as aggression, could be understood as a
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response to the current difficulties in relationships. In turn, aggression could also
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affect the quality of their relationships. Third, the leader helped the group members understand that interpersonal conflict was an important cause leading to aggressive
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behavior and high aggression would also lead to the deterioration of interpersonal relationships. Effective intervention goals and strategies were provided to solve grief, role transition, role conflict, and interpersonal deficit; and learn techniques for building new relationships, change negative view of interpersonal conflict, and construct basic skills to solve the interpersonal conflict. Finally, the leader learned and 10
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used the core techniques of IPT, such as role playing, communication analysis, and exploration to help the group members understand that identifying, handling, expressing emotions, as well as two-way communication, were the tasks of this intervention; he/she also improved the group members‟ interpersonal skills within the
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framework of the focal interpersonal problem areas.
In the termination sessions (sessions 15 and 16), the group members reviewed and consolidated the knowledge and skills learned in the previous sessions, accepted
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the feedback from the leader and the other group members, understood their own performance in the group as well as progress and improvement after the group process, and obtained suggestions for further improvement. The leader ended the group
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intervention.
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Measures
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All participants were asked to complete assessments three times: pre-treatment (1 week prior to the intervention), post-treatment 1 (1 week after the intervention), and
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post-treatment 2 (tracking), which was 4 months after the intervention.
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Aggression
The CC-BPAQ included 22 self-reporting items scored on a 5-point Likert scale
from extremely uncharacteristic to extremely characteristic. It is the Chinese revision of the Buss–Perry Aggression Questionnaire with good validity and internal consistency.(Lv et al., 2013) 11
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Social support
The Social Support Scale for University Students was used to measure the social support of the participants. This is a rating scale suitable for Chinese college students.(Ye and Dai, 2008) It contains 17 items belonging to 3 factors: subjective
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support, objective support, and utilization degree. The confirmatory factor analysis showed that the values of normal fit index (NFI), non-normal fit index (NNFI), and compared fitted indices (CFI) were more than 0.9 (approximate error root mean
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square [RMSEA] = 0.03). The test accorded with the requirement of psychometrics and the internal consistency was good. For the full scale, α was 0.906. The test–retest reliability was good.
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Data analysis
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The methods of statistical analysis used in this study mainly included analysis of
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variance (ANOVA) for repeated measures and t test with a Bonferroni method for post-hoc comparison. The All data analyses were performed using the SPSS 22.0
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(SPSS Inc., Chicago, IL, USA)
RESULTS
Participants Table 1 shows the baseline data for the two groups. All participants were 18 or 12
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19 years old. No significant differences in the basic demographic characteristics, such as age, gender, university course, or family background were found between the two groups (P > 0.05). The total score of CC-BPAQ was the screening index and the foundation of the follow-up work. We also checked the consistency of total score of
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social support between the treatment and control groups.
The t test showed that no significant differences in the total aggression and social support scores were found between the control and G-IPT groups (aggression: T
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=.585, P > 0.05; social support: T =.161, P > 0.05) at baseline; so, the participants were homogeneous. Therefore, the intervention effect could be examined through comparing the data of the measurements of the control and G-IPT groups.
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Table 2 displays the means and standard deviations of the total score of
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aggression and social support with time. The spherical test results were not significant
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(Table 2, P > 0.05), and single-factor variance analysis could be used.
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Changes in aggression
For the total aggression scores, in the G-IPT group, post-treatment 1 and
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post-treatment 2 scores were significantly lower than the pre-treatment score (P < 0.001 Figure 1).
Total aggression scores in the two groups were compared at different times, and this showed that the post-treatment 1 and post-treatment 2 scores were significantly lower in the G-IPT group than in the control group (P<0.001). 13
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Analysis of effect size was undertaken to establish whether the intervention had a greater effect than no intervention over time. The results showed the total aggression and all of the aggression sub-scores, except hostility, were significantly changed at both post-treatment 1 and post-treatment 2 compared to pre-treatment and the effect
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was more significant in the G-IPT group compared to the control group. Table 2 also shows the detailed analysis of P time which shows if the scores change over time, P interaction which shows if there was an interaction between time and treatment, and P
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treatment which shows the main effect of treatment. The results show that all three were significant for total aggression, impulsivity, physical aggression, and anger proneness. But while P time and P treatment were significant for hostility P
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Changes in social support
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interaction was not (P>0.05).
In the control group the total social support score did not change significantly. In
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contrast, the total social support score increased significantly in the G-IPT group
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(P<0.01, Figure 2).
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Total social support scores in the two groups were compared at different times, and this showed that the post-treatment 1 score was significantly lower in the G-IPT group than in the control group (P=0.045) but the difference was not significant at post-treatment 2 (P=0.311).
Analysis of effect size for social support scores showed that neither the total score or 14
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most of the sub-scale scores changed significantly at post-treatment 1 or post-treatment 2 from pre-treatment after intervention compared to the control. However, there was an effect of the treatment on the sub-scale of utilization degree at post-treatment 1. Overall, P time, P interaction, and P treatment were not significant
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for total social support score and for many of the sub-scores. P time was significant for objective support score and P treatment was significant for subjective support and
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utilization degree.
DISCUSSION
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The objective of this randomized controlled experimental study was to determine whether G-IPT intervention reduced aggression and increased social support among
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Chinese first-grade university students. The results showed that the total score and the
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scores of all subscales of aggression dropped significantly in the G-IPT group compared to the control group. Also, the total score and the scores of objective
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support and utilization degree of social support increased significantly in the G-IPT
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group compared to the control group. However, while the effect size of G-IPT for aggression was seen only utilization degree in the social support scales showed a difference.
In the present study, the choice of participants, the therapist's attitude, and the structure of group activities for G-IPT might disrupt or even destroy group therapy 15
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without careful planning and reasonable arrangement. After considering these factors, the researcher ensured the homogeneity of the groups of participants through implementing a series of methods. The therapist ensured that he/she was objective, warm, and unconditionally positive during the intervention, and informed the team
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that their problems could be solved. The therapist used group activities to help the group members learn how to solve interpersonal problems, providing minimal direct assurance and advice. This helped the team members cultivate the feeling of
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competence. The researcher attached great importance to the emotional expression of the team members. In the strategy of developing new relationships, expressing the emotions associated with others helped participants decide the priority of things. The
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researcher also paid attention to communication analysis. The goal of communication analysis was to help the group members learn more effective techniques of
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communication. Besides, the therapist consciously used a preset problem or situation
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to guide the team members to learn and master more effective ways to communicate
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through discussion, role playing, and sharing of feelings.
It was slightly surprising that the total aggression score dropped in the control
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group, compared with pre-treatment and in the subscales scores the hostility score decreased in the post-treatment 1 and post-treatment 2 tests. The reason for this mainly involved the internal validity of the design of the experiment.(Judd et al., 1991) In this study, all participants had just entered the universities. Their environment had changed compared with high school. In addition, the survey found that all three 16
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universities offered a College Students‟ Mental Health course in the first year. This might have affected the results of the study to some extent. As this study adopted a randomized control group design, the general history events that might have influenced the control group also produced similar effects on the G-IPT group after
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randomization. On the premise of participants with homogeneity and through a series of control measures, the researcher believed that the differences between groups were caused by the independent variables.
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IPT is an interpersonally focused and time-limited psychotherapy aimed at promoting interpersonal skills and relieving symptoms. In fact, much of the effects of IPT may come from its optimization and re-association of the common factors of
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different therapies.(Markowitz and Milrod, 2011) IPT was initially developed to treat
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depression, and soon afterward, adapted for curing bipolar disorder,(Frank et al., 2005) social anxiety disorder, (Lipsitz et al., 1999) binge eating disorder, (Wilfley et al.,
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2002) panic disorder, (Lipsitz et al., 2006) and posttraumatic stress disorder.(Bleiberg
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and Markowitz, 2005) The group format of IPT is developed on the basis of individual treatment and is better for work on interpersonal problems and improving
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interpersonal techniques with other individuals struggling with similar dilemmas. G-IPT provides many unique therapeutic benefits, and some of them are quite different from the individual format. For example, the interpersonal techniques learned in groups may be more easily transferred to the participants‟ real lives
17
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compared with those learned in individual therapy because the social interactions can occur in a group context.
G-IPT for aggression showed significant differences in the total score and the
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scores of all subscales between the pre-treatment, post-treatment, and post-treatment 2 test time points. The impulsivity score in post-treatment 1 was obviously lower than that in the pre-treatment and further reduced in the post-treatment 2 test. This result was similar to the findings of (Bellino and Bozzatello, 2015). The score of hostility in
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the post-treatment 1 was obviously lower than that in the pre-treatment, but it slightly rebounded in the post-treatment 2 test. The result showed that using G-IPT could effectively eliminate hostility, mainly because it helped the participants more
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reasonably express their emotions and more effectively communicate with other
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people. The score of physical aggression in the post-treatment 1 was obviously lower than that in the post-treatment 1 and continued to decline in the post-treatment 2 test.
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This showed the positive effect of G-IPT in reducing physical aggression, and the
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effect was stable. The score of anger proneness in the post-treatment was obviously lower than that in the pre-treatment and continued to decline in the post-treatment 2
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test. This result was similar to a previous study (Jin and Chong, 2015). Therefore, the implementation of the G- IPT was effective in reducing aggression among Chinese college students.
In practice, some scientists have regarded IPT as an intervention guided by social support, (Brugha et al., 2008) and the theoretical discussions about the relationship 18
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between IPT and social support have developed. (Champion, 2012; Lipsitz, 2009) The statistical analysis of G-IPT for social support showed significant differences in the total score and the scores of objective support and utilization degree between pre-treatment, post-treatment 1, and post-treatment 2 test. Combined with the
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descriptive statistics, the implementation of the G-IPT significantly increased the objective support, utilization degree, and total social support. The score of objective support in the post-treatment 1 was obviously higher than that in the pre-treatment,
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but it slightly rebounded in the post-treatment 2 test. The score of subjective support in the post-treatment 1 was higher than that in the pre-treatment, but it did not reach the significance level. The post-treatment utilization degree score was obviously
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higher than that in the pre-treatment, and slightly rebounded in the post-treatment 2 test. However, when the effect size was calculated the effectiveness of G-IPT for
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increasing social support was not evident apart from utilization degree at
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post-treatment 1. Although social support is an effective interpersonal resource, the amount of objective and subjective social support acquired from a social context is
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different even in the same environment. Personality traits of individuals have a role in
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this process. For example, extraversion and neuroticism are related to objective social support and subjective social support. (Den Oudsten et al., 2010; Leskela et al., 2009; Swickert et al., 2010) It seems that personality may impact the sense of social support and the utilization of the interpersonal resource. This problem can be an objective for subsequent research. In sum, the results showed that the programs designed to
19
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decrease aggressive actions in college students should concentrate on providing more social support just like G-IPT.
The randomized controlled nature of this study provided some advantages. For example, the three universities to which participants belonged were in the same city,
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which reduced the effect of regional difference on the result. This was a long-term interventional study in which the participants lived and studied under natural conditions except participating in treatment. All treatments were arranged in the same
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place, and the researcher and assistants who participated in this study undertook unified training and adopted the same treatment program. This helped the study prevent selection bias, avoid subjective factors, control systemic errors, balance the
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influence of unexpected factors, and serve as the basis of inference statistics.
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Moreover, the questionnaires used in this study had high reliability and validity, and the two questionnaires were consistent in the three measures. The researcher added in
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two other questionnaires to prevent the influence of memory formed in the previous
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tests on the subsequent tests: Eysenck Personality Questionnaire and 16 Personality Factor Questionnaire. Therefore, the effects of instrumentation in this study could be
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controlled.
Although the results of this study had certain representativeness, they should not
be generalized. China has thousands of universities and colleges besides those in Hong Kong, Macao, and Taiwan. A wider range of participants and research is needed to make the results more representative. The researchers intend to promote this 20
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technology and make it an important part of the new campus violence prevention and
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control program.
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Acknowledgment
Not applicable.
Funding
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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Declarations of interest
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None
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Author Statement
The article has not been published previously, not under consideration for publication elsewhere, its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will
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not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder.
Declarations of interest
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None
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Table 1 Baseline data
Control group (n =30)
P value
Gender/male
14(46.7)
17(56.7)
0.438
Majority Science
15 (50.0)
15 (50.0)
1
Arts
15 (50.0)
15 (50.0)
1
Single parent family
3 (10.0)
2 (6.7)
1
Only child
12(40.0)
Birthplace urban
14(46.7)
rural
16(53.3)
Left-behind children
0(0)
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G-IPT group (n =30)
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13(43.3)
0.798
14(46.7)
1
16(53.3)
1
5(16.7)
0.052
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Table 2 Changes in aggression and social support scores with time
Control (n = 30)
T2-T1
T3-T1
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G-IPT (n = 30)
Effect P
T1
T2
T3
T1
T2
T3
size
Effect P
value size*
P
P
interaction
treatment
<
<
value P time
*
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Total Aggression
71.4 ± 5.6 53.3 ± 7.2 53.0 ± 9.4 72.3 ± 6.3
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aggression
19.7 ± 4.1 17.1 ± 4.2 17.7 ± 3.6 23.9 ± 4.3
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Hostility
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Impulsivity 22.6 ± 2.8 16.9 ± 3.9 17.1 ± 4.3 20.5 ± 4.7
69.8 ± 5.1
69.0 ± 6.4
2.00
0.000 1.55
< 0.000
0.001 0.001
<
20.3 ± 2.1 20.9 ± 2.4
1.22
0.000 1.07
0.001
<
0.000
0.006 0.001 0.001
<
22.3 ± 2.3 21.9 ± 2.4
0.12
0.650 0.09
0.743 0.001 0.883 0.001
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Physical
16.7 ± 5.0 19.0 ± 3.6 11.1 ± 3.6 10.7 ± 2.9 17.6 ± 5.7
16.6 ± 4.1
<
1.22
0.000 1.25
<
Anger 7.7 ± 2.6
7.5 ± 2.5
10.4 ± 2.6
proneness
Total Social
10.2 ± 2.3
0.62
65.8 ± 9.5 72.4 ± 9.5 70.2 ± 8.7 66.2 ± 11.3 66.6 ± 12.3 67.4 ± 12.6 0.45
0.017 0.002 0.013 0.001
0.084 0.22
0.395 0.134 0.241
0.131
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support
0.020 0.64
0.001
<
10.2 ± 2.4
9.9 ± 2.3
<
0.000
0.001 0.001
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aggression
social
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support
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Objective 23.7 ± 5.9 26.5 ± 4.0 26.1 ± 3.5 25.0±4.76 support
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Subjective
19.9 ± 3.6 21.2 ± 3.3 21.2 ± 3.1 19.2±3.66
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support
26.3±4.16
26.5±3.71
0.24
0.347 0.15
0.571 0.016 0.551
0.500
19.3±5.11
19.6±4.27
0.23
0.383 0.18
0.494 0.514 0.076
0.019
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Utilization 21.9 ± 4.8 24.7 ± 3.9 24.3 ± 4.2 22.0±5.12
21.0±6.14
21.2±6.77
0.56
0.035 0.46
0.083 0.438 0.668
0.022
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degree
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Notes: T1 indicates the pre-treatment score (1 week prior to the intervention), T2 indicates the post-treatment 1 score (1 week after the intervention), T3 indicates the tracking or post-treatment 2 score, (4 months after the intervention).
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Effect sizes were calculated to show the effect of the intervention. First the difference at T2 or T3 to T1 was calculated for each group then the mean difference between the two groups was calculated. The P values compare the differences to show if there was a significant difference
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between the groups i.e. an effect of the intervention.
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Figure 1. Plot of intervention effect on total aggression score.
The G-IPT group is indicated by the red line and received the intervention. The control group is represented by the green line and received no intervention. The
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results show that the intervention decreased total aggression scores in the G-IPT group more than the control group at the “after” time point (Post-treatment 1: 1 week
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after the intervention) and the effect was also seen at the “tracking” time point
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(Post-treatment 2: 4 months after intervention).
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Figure 2 Plot of intervention effect on the total social support score.
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The G-IPT group is indicated by the red line and received the intervention. The control group is represented by the green line and received no intervention. The results show that the intervention increased total social support scores in the G-IPT
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group more than the control group at the “after” time point (Post-treatment 1: 1 week
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after the intervention) but the effect was reduced at the “tracking” time point
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(Post-treatment 2: 4 months after intervention).
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