The Effect of Modified "Aggression Replacement Training" Program on Self-efficacy of Adolescents with Insulin-dependent Diabetes

Document Type : Original Quantitative and Qualitative Research Paper


1 Evidence Based Care Research Centre, Department of Medical-Surgical Nursing, School of Nursing & Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

2 MS in Pediatric Nursing, School of Nursing & Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

3 Evidence Based Care Research Centre, Instuctor of Pediatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

4 Assistant Professor, School of Education and Psychology, Mashhad University of Ferdowsi, Mashhad, Iran

5 MD. Parsian Diabetes clinic. Mashhad, Iran


Background: Self-efficacy is a crucial factor in controlling adolescents with insulin-dependent diabetes mellitus (IDDM). Subsequently the negative behavioral reactions such as aggression adversely affect on self-efficacy. Therefore, interventions are essential to reduce the aggression and to improve the self- efficacy in these patients.
Aim: To determine the efficacy of the modified "aggression replacement training" program on self-efficacy of adolescents with insulin-dependent diabetes.
Methods: In this clinical trial, 70 adult subjects with IDDM who were referred to Parsian Diabetes clinic of Mashhad in 2014 were divided into two groups of intervention and control. The intervention program, including three aspects including: anger control training, social skills training and moral reasoning training was performed in five sessions, each 1.5-2 hours. A five-day interval was between the sessions and each group consisted of 8-10 individuals. The self-management standard questionnaire of “insulin-dependent diabetes management self-efficacy scale (IDMSE)” was filled before the intervention and two months afterwards. Data were analyzed using SPSS version 11.5 with paired and Independent t-tests.
Results: In this study, 38.5 and 61.5 percent of the subjects were boys and girls, respectively with total mean age of 15.9±2. The self-efficacy of the subjects before the intervention was not significantly different within the groups (p=0/57). Nevertheless in post-intervention assessment, the self-efficacy of the Intervention group significantly increased (49.0±11.1) compared to the control group (33.7±5.5) (p<0.001).
Conclusion: Our findings revealed the modified aggression replacement training programs can be effective in improving the self-efficacy of adolescents with insulin-dependent diabetes mellitus. Therefore, the implementation of the program is recommended as part of comprehensive treatment programs for management of IDDM.


Main Subjects

  1.  Moatari M, Ghobadi A, Beigi P, Pishdad GH. The Effect of Self-Management on Metabolic Indicators in Insulin-Dependent Diabetics. Iranian Journal of Diabetes and Lipid.2011؛10 (5):528-35.)Persian)
  2. Levitsky L, Misra M. Epidemiology, Presentation, and Diagnosis of Type 1 Diabetes Mellitus in Children and Adolescents [homepage on the Internet].C2013 [updated: Mar 22, 2013; cited 2014 Nov 9]. Available at:
  3. Kermansaravi F, Navidian A, AnsaryMoghadam. Quality of Life in Type 1 Diabetic Adolescents in Zahedan. Iranian Journal of Endocrinology and Metabolism. 2012؛13 (6):651-7 )Persian)
  4. Suzanne C S, Brenda G B, Janice L H, Kerry H C. Brunner and Suddarths Textbook of Medical-Surgical Nursing. Translate by Asadi Nooghabi A A, Dehghan Nayeri N. 12th ed.Tehran Andishe Rafi. 2010.
  5. Russell E, Deborah J, Cynthia D, Toober, Gillette. Psychosocial Barriers to Diabetes Self-Management and Quality of Life. Diabetes Spectr.2001; 14(1):33-41.
  6. Rezasefat Balesbaneh A, Mirhaghjou S.N, JafsriAsl M, Kohmanaee Sh, Kazemnejad Leili E, Monfared A. Correlation between Self-Care and Self-Efficacy in Adolescents with Type 1 Diabetes. Holistic Nursing and Midwifery.2014; 24(72):18-24. (Persian)
  7. Chih H A, Jan C F, Shu S G, Lue B H. Self-Efficacy Affects Blood Sugar Control Among Adolescents With Type I Diabetes Mellitus. Formos Med Assoc 2010; 109(7):503–10.
  8. Bandura A. Health Promotion from the Perspective of Social Cognitive Theory. Psychology Health. 1998; 13(4): 623-49.
  9. Zamanzadeh V, Rasouli E. S, Tabriz FJ. The Impact of the Empowerment Program on Psychosocial Aspects of Managing Diabetes Patients. Journal of Nursing and Midwifery Tabriz.2008؛11 (1):25-30.)Persian)
  10. Abdullahi B, Abduolrahim E. Empowerment of Staff. Tehran: Virayesh publication; 2006.p 97-111.
  11. Asadi M, Tirgari A, Hassanzadeh R. Comparative Effectiveness of Muscle Relaxation Training on Anger Reduction and Glycemic Control in Patients with Diabetes Type One and Two. Medical Journal of Mashhad.2011; 56(2):104-12.) Persian)
  12. Zheng X P, Chen S H. Psycho-Behavioral Changes in Children with Type 1 Diabetes Mellitus. World J Pediat.2013; 9(3):261-5.
  13. Stewart S M, Lee P, Waller D, Hughes C W. A Follow-Up Study of Adherence and Glycemic Control among Hong Kong Youths with Diabetes. J Pediatr Psychol.2003; 28(1):67-79.
  14. Torshizi M, Saadatjoo S A. Aggressivement and the Related Issue in Secondary School Students in Birjand. Modern Care, Scientific Quarterly of Birjand Nursing and Midwifery Faculty. 2012; 9 (4): 355-63. )Persian)
  15. Arezumanians S. Wong D .Wong nursing care of infants and children. Translated by ،Shoughi M،Sanjari M. 2th ed .Tehran: Salemi. 2009. (Persian)
  16. 16-Sayarpour M, Hazavehei M, Ahmadpanah M, Moeini B, Moghim Beigi A. The Relation between Aggression and Perceived Self -Efficacy in High Schools Students in Hamadan. Journal of Hamadan University of Medical Sciences.2011; 19(2):18-23. )Persian)
  17. Peyrot M, Rubin R, Lauritzen T, Snoek F, Matthews D ،Skovlund S. Psychosocial Problems and Barriers to Improved Diabetes Management: Results of the Cross-National Diabetes Attitudes. Diabet Med. 2005؛22 (1): 79–85.
  18. Gholami A, Bshlideh, Rafiei A. The Impact of Two Methods of Music Therapy and Relaxation on the Aggression in High School students. J Jahrom Univ Med Sci 2013; 11(2): 7-13. )Persian)
  19. Maleki S, Fallahi Khoshknab M, Rahgooi A, Rahgozar M. The Effect of Anger Management Training in Groups on Aggression of 12-15 Years Old Male Students. Iranian Journal Nursing. 2011; 24(69):26-35.)Persian)
  20. Ghanavati S.A, Neisi A.K. The Effect of Group Counseling Based on Cognitive – Behavioral on Aggressive Behaviors of Female Employees. New finding in psychology.2010; 5(14):69-79. )Persian)
  21. Naderi f, Pasha GH, Makundi F. The Impact of Social Skills Training on the Adjustment of the Individual - Social Aggression an Assertiveness of Female Students at Risk for School. Knowledge and research in psychology.2007; 10(33):37-62. )Persian)
  22. Bahrami F. Effective Problem-Solving Skills Training on Aggression in Girl Students. Journal of Psychiatry and Clinical Psychology.2005; 11(4):467-9. )Persian)
  23. Nasirzadeh R, Roshan R. The Effect of Storytelling on Aggression in Six to Eight-Year Old Boys. Iranian Journal of Psychiatry and Clinical Psychology. 2010; 16(2): 118-26. )Persian)
  24. Glick B، Gibbs J. Aggression Replacement Training: A Comprehensive Intervention for AggressiveYouth.3ed.Illinois:ResearchPress؛ 2010.
  25. Zahedifar Sh, Najarian M, Shokrkon H. Construction and Validation of a Scale to Measure Aggression. Journal of Education and Psychology.2000; 7 (2):73-102. )Persian)
  26. Gastal D A, Pinheiro R T, Vazquez D P. Self-Efficacy Scale for Brazilians with Type 1 Diabetes. Sao Paulo Med J. 2007; 125(2):96-101.
  27. Ojewola F O. Effect of Self-Efficacy Skills Training in Reducing Aggressive Behavior among In-School Adolescents in Ogbomoso-Nigeria. Journal of Education and Practice.2014; 5(13):173-9.
  28. Koposov R, Knut K. Gundersen, Svartdal F. Efficacy of Aggression Replacement Training among Children from North-West Russia. Int J Emot Educ.2014; 6(1):14-24.
  29. Abolghasemi A, Pourkord M, Narimani M. The Relationship Between Social Skills and Self-Efficacy Tend to Substance Use in Adolescents. Journal of Sabzevar University of Medical Sciences (Asrar).2009; 16(4):81-8.)Persian)
  30. Gundersen, K., & Svartdal, F. Aggression Replacement Training in Norway: Outcome Evaluation of 11 Norwegian Student Projects. Scandinavian Journal of Educational Research.2006; 50(1): 63-81
  31. Goldstein, A.P., Glick, and B. Aggression Replacement Training: A Comprehensive Intervention for Aggressive Youth. Champaign, IL: Research Press.1987; 2(3):12-6.
  32. Lombardo E, Tan G, Jensen M, Anderson K. Anger Management Style and Associations with Self-Efficacy and Pain in Male Veterans. J Pain. 2005; 6(11):765-70.
  33. Rasouli D, MohammadpourY, Safaei Z , Habibzadeh H, Jafarizadeh H. Comparison of Self Empowerment  Education Through, Training  Package and Training Workshop on the Empowerment  of Diabetic Patient in Diabetes  Center. The Journal of Urmia Nursing and Midwifery Faculty. 2014; 12(5):386-93. )Persian)