# Time on task limits psychotherapy's role in reducing the societal burden of aggression

## TL;DR

Psychotherapy for aggression is underutilized, with most patients receiving little or no treatment, suggesting broader societal solutions are needed.

## Contribution

Quantifies the limited psychotherapeutic time on task for individuals with impulsive aggression using real-world health data.

## Key findings

- Most patients with IED receive zero or very few psychotherapy sessions.
- A small percentage of patients account for the majority of psychotherapeutic labor.
- Traditional psychotherapy alone is insufficient to address aggression on a societal scale.

## Abstract

Aggression and violence, people's inhumanity to one another, are perhaps society's foremost problems. One approach to this problem is the provision of traditional clinical services through psychotherapy. Anger control is a learnable skill, but such learning requires “time on task.” Our goal was to shed light on the potential impact of psychotherapy as a public health remedy, by studying how much psychotherapeutic intervention is being delivered to patients with impulsive aggression classified as Intermittent Explosive Disorder (IED).

Using de-identified electronic health record data from TriNetX, collected from 87 medical institutions, we analyzed the distribution of psychotherapeutic sessions received by 32,322 individuals with IED.

The distribution of psychotherapeutic sessions is highly skewed, resembling a curve of inverse proportion. The mode and the median for sessions attended were zero; the mean was four sessions. Only about 25% of patients received any psychotherapy. Approximately 10% attended nine visits or more; 5% 30 or more; 2% 50 or more. Eighty percent of the psychotherapeutic labor went to the 7.5% of patients who could attend over 14 sessions; about half the psychotherapeutic labor went to the 2.5% of patients who could attend 40 or more sessions. Thus, a small subset of patients absorbed most of the psychotherapeutic labor, and most patients did not spend enough (or even any) psychotherapeutic time on task.

Traditional psychotherapy delivered through health care systems appears to deliver sufficient “time on task” to only a small subset of individuals with impulsive aggression. Multipronged public health solutions to aggression and violence must be pursued by society as a whole. The efforts of mental health professionals are important and necessary, but the job should not be delegated to clinicians alone.