Published online August 1, 2005
PEDIATRICS Vol. 116 No. 2 August 2005, pp. e247-e254 (doi:10.1542/peds.2004-2534)
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ELECTRONIC ARTICLE

Anger, Interpersonal Relationships, and Health-Related Quality of Life in Bullying Boys Who Are Treated With Outpatient Family Therapy: A Randomized, Prospective, Controlled Trial With 1 Year of Follow-up

Marius K. Nickel, MD*,{ddagger},§, Jakub Krawczyk, MD{ddagger}, Cerstin Nickel, MD*, Petra Forthuber*, Christian Kettler, MD*, Peter Leiberich, MD§, Moritz Muehlbacher, MD{ddagger}, Karin Tritt, PhD§, Ferdinand O. Mitterlehner*, Claas Lahmann, MD§, Wolfhardt K. Rother, MD* and Thomas H. Loew, MD§

* Clinic for Psychosomatic Medicine, Inntalklinik, Simbach/Inn, Germany
{ddagger} University Clinic for Psychiatry 1, PMU, Salzburg, Austria
§ Department of Psychosomatic Medicine, University Clinic, Regensburg, Germany

Objective. Ten to 30% of students engage in bullying behavior. Bullies stand out on account of increased anger, poor interpersonal relationships, and poor quality of life. Our aim was to determine the effectiveness of outpatient family psychotherapy as a monotherapy for anger reduction and improvement of behavior and interpersonal relationships and of health-related quality of life in male youths with bullying behavior.

Methods. Twenty-two boys with bullying behavior took part in a family therapy program for 6 months. The control group was also composed of 22 youths and took part in a placebo intervention program. Every 2 weeks, results were checked with the Adolescents Risky-Behavior Scale (ARBS), the State-Trait Anger Expression Inventory (STAXI), the Inventory of Interpersonal Problems (IIP-D), and the SF-36 Health Survey (SF-36). Follow-up testing took place 12 months after treatment.

Results. In comparison with the control group (according to the intention-to-treat principle), bullying behavior was reduced (family therapy group: from n = 22 to n = 6; control group: from n = 22 to n = 20). Significant changes on all ARBS scales and on the STAXI scales State-Anger, Trait-Anger, Anger-Out, and Anger-Control were observed after 6 months. In the IIP-D, significant differences were found on the scales for overly autocratic, overly competitive, overly introverted, overly expressive, and exploitable/compliant. In the SF-36, significant differences were observed in general health perceptions, vitality, social functioning, role-emotional, and mental health. The reduction in expression of anger correlated with a reduction in several scales of the ARBS, IIP-D, and SF-36. Follow-up after 1 year showed relatively stable, lasting treatment effects.

Conclusion. The results of this study show that outpatient family therapy seems to be an effective method of reducing anger and improving interpersonal relationships and health-related quality of life in male youths with bullying behavior.

Key Words: bullying • family interventions

Abbreviations: STAXI, State-Trait Anger Expression Inventory • IIP-D, Inventory of Interpersonal Problems • SF-36, SF-36 Health Survey • FamTh-G, family therapy–treated group • CG, control group • ARBS, Adolescents' Risky-Behavior Scale • PHFU, physical functioning • ROPH, role limitations as a result of physical health • BOPA, bodily pain • GEPE, general health perceptions • VITA, vitality • SOFU, social functioning • ROEM, role limitations as a result of emotional problems • PSYC, mental health

Accepted Feb 17, 2005.