Time on Task in Psychotherapeutic/Psychoeducational Intervention with Intermittent Explosive Disorder

Objective: Anger control has been seen as a set of learnable skills. How much time is necessary for such learning? Comparisons with time requirements for other skills make it plausible that for many people, learning anger control may require well over 100 hours of time on task. Research interventions have been shorter - a mean of 9 sessions was reported in one meta-analysis. In this study, our goal was to examine how much psychotherapeutic intervention is being delivered in the "real world" to patients with Intermittent Explosive Disorder. Method: We studied a de-identified electronic health record data from TriNetX, collected from 87 medical institutions. We studied 32,322 individuals with Intermittent Explosive Disorder. We examined the distribution of the number of individuals across numbers of sessions received. Results: The distribution for the numbers of sessions is highly skewed, resembling a curve of inverse proportion, or a Pareto function. The mode and the median were zero. Only about 25% of patients received any psychotherapy. For that subset, the median was 5 sessions, and the mean was 16. Approximately 10% received 9 visits or more; 5% 30 or more; 2% 50 or more. A large fraction of the psychotherapeutic labor was devoted to a small fraction of the patients: 80% of the sessions went to 7.5% of the patients. Conclusions: The ability of health care systems to reduce the societal problem of aggression, at least by psychotherapeutic intervention, appears limited by the factors leading to low, or no, time on task.