{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:45:03Z","timestamp":1785026703959,"version":"3.55.0"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T00:00:00Z","timestamp":1746662400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>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 \u201ctime on task.\u201d 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).<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Traditional psychotherapy delivered through health care systems appears to deliver sufficient \u201ctime on task\u201d 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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1570642","type":"journal-article","created":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T04:11:20Z","timestamp":1746677480000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Time on task limits psychotherapy's role in reducing the societal burden of aggression"],"prefix":"10.3389","volume":"13","author":[{"given":"Joseph","family":"Strayhorn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen V.","family":"Faraone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanli","family":"Zhang-James","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,8]]},"reference":[{"key":"B1","unstructured":"New York, NY\n          United Nations\n          Global Study on Homicide\n          \n          2023"},{"key":"B2","unstructured":"The top global causes of adolescent mortality and morbidity by age and sex\n          \n          2019"},{"key":"B3","unstructured":"Saad\n              L\n            \n          \n          Personal safety fears at three-decade high in U.S. Gallup News\n          \n          2025"},{"key":"B4","unstructured":"Lin\n              L\n            \n            \n              Parker\n              K\n            \n            \n              Horowitz\n              J\n            \n          \n          What's it like to be a teacher in America today? 4: Challenges in the classroom\n          \n          2024"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e1863","DOI":"10.1016\/S2214-109X(23)00417-5","article-title":"Prevalence and changes of intimate partner violence against women aged 15 to 49 years in 53 low-income and middle-income countries from 2000 to 2021: a secondary analysis of population-based surveys","volume":"11","author":"Ma","year":"2023","journal-title":"Lancet Glob Health."},{"key":"B6","first-page":"456","article-title":"Proposed algorithm for the pharmacotherapy of impulsive aggression","volume":"43","author":"Felthous","year":"2015","journal-title":"J Am Acad Psychiatry Law."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1421","DOI":"10.1080\/14656566.2019.1626825","article-title":"Aripiprazole for treating irritability associated with autism spectrum disorders","volume":"20","author":"Bartram","year":"2019","journal-title":"Expert Opin Pharmacother."},{"key":"B8","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.copsyc.2017.04.004","article-title":"Anger and aggression treatments: a review of meta-analyses","volume":"19","author":"Lee","year":"2018","journal-title":"Curr Opin Psychol."},{"key":"B9","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-00924-7","volume-title":"Effectiveness of Time Investments in Education: Insights from a Review and Meta-Analysis","author":"Scheerens","year":"2014"},{"key":"B10","unstructured":"Kidron\n              Y\n            \n            \n              Lindsay\n              J\n            \n          \n          The Effects of Increased Learning Time on Student Academic and Nonacademic Outcomes: Findings from a Meta-Analytic Review (REL 2014\u2013015).\n          \n          2014"},{"key":"B11","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1037\/\/0033-295X.100.3.363","article-title":"The role of deliberate practice in the acquisition of expert performance","volume":"100","author":"Ericsson","year":"1993","journal-title":"Psychol Rev."},{"key":"B12","volume-title":"Developing Talent in Young People","author":"Bloom","year":"1985"},{"key":"B13","unstructured":""},{"key":"B14","volume-title":"Time in School: A Conceptual Framework, Synthesis of the Causal Research, and Empirical Exploration","author":"Kraft","year":"2023"},{"key":"B15","unstructured":""},{"key":"B16","unstructured":""},{"key":"B17","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1111\/j.1469-7610.2010.02301.x","article-title":"Dynamic changes in anger, externalizing and internalizing problems: attention and regulation","volume":"52","author":"Kim","year":"2011","journal-title":"J Child Psychol Psychiatry."},{"key":"B18","author":"Glick","year":"2011","journal-title":"Aggression Replacement Training. 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