Accepted Manuscript

Reducing aggression with martial arts: A meta-analysis of child

and youth studies

Anna Harwood, Michal Lavidor, Yuri Rassovsky

PII: S1359-1789(17)30097-6
DOI: doi: 10.1016/j.avb.2017.03.001
Reference: AVB 1097
To appear in: Aggression and Violent Behavior
Received date: 9 May 2016
Revised date: 1 March 2017
Accepted date: 1 March 2017

Please cite this article as: Anna Harwood, Michal Lavidor, Yuri Rassovsky , Reducing
aggression with martial arts: A meta-analysis of child and youth studies. The address
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Reducing Aggression with Martial Arts: A Meta-Analysis of Child and Youth Studies

Anna Harwood a, Michal Lavidor a,b, and Yuri Rassovsky a,b,c

a
Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel

b
Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan
University, Ramat-Gan, Israel

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c
Department of Psychiatry and Biobehavioral Sciences, University of California, Los
Angeles (UCLA), 760 Westwood Plaza (C8-746), Los Angeles, CA 90095

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Running title: Reducing aggression with martial arts
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Correspondence concerning this article should be addressed to Yuri Rassovsky, Department
of Psychology, Bar-Ilan University, Ramat-Gan 52900 Israel. Email: yurir@biu.ac.il
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Telephone: +972 3 531 8174

Additional author information:

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Anna Harwood c/o Yuri Rassovsky, Department of Psychology, Bar Ilan University Ramat-
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Gan 52900 Israel. Email: annajudithharwood@gmail.com Telephone: +972 54 949 3779

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Michal Lavidor, Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research
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Center, Bar-Ilan University, Ramat-Gan, Israel, 52900. Email: michal.lavidor@gmail.com

Telephone: +972 3 531 8171
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Acknowledgements

This research was supported by the Ministry of Science, Technology & Space, Israel (Grant

#3-13631). This study was carried in the course of the PhD research conducted by Anna

Harwood at Bar Ilan University, Ramat Gan, Israel. No conflicts of interest exist for any of the

authors nor was any specific funding supplied for this study. Anna Harwood is a recipient of the

Presidential Scholarship Award from Bar-Ilan University.

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Abstract

Martial arts are becoming a mainstream sport for energetic youth and their popularity extends

globally. Following a comprehensive search of martial arts research, a critical review of the

field and the psychological implications was conducted. The resulting meta-analysis

examined the effect of martial arts on problematic externalizing behavior (aggression, anger,

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and violence). The final meta-analysis included twelve studies, with 507 participants (ages 6

to 18), where study type was a moderator. For nine intervention and longitudinal studies,

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there was a homogenous effect size of 0.65 (95% CI: 0.11, 1.03) indicating a medium effect,

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where martial arts improved aggression among the practicing youth. The other three one-time

comparisons studies did not yield a homogenous effect size. Based on these analyses, it
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appears that martial arts has a potential to reduce externalizing behaviors in youth, although
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further research is needed to determine the mechanisms of change and specify the most

relevant population groups for targeted interventions.

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Keywords: Martial arts; Meta-analysis; Externalizing behavior; Aggression; Adolescent.

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Reducing Aggression with Martial Arts: A Meta-Analysis of Child and Youth Studies

Introduction

Over the past half century, martial arts have gained increasing popularity in the west, as their

physical and mental health benefits have been demonstrated (Weiser, Kutz, Kutz, & Weiser,

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1995). Far from their negative connotations once exposed in the media (Fuller, 1988), martial

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arts are now seen in a much more positive light with both participation and research into their

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effects steadily increasing (Vertonghen & Theeboom, 2010).

Martial arts, the general term for those combat arts developed in the East, have a
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development shrouded in secrecy with techniques and practices initially designed for combat
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and to create a warrior who has spiritual, physical, and mental wellbeing. As these combat

arts began to permeate the West (particularly through increased travel to Eastern regions and

the stationing of US troops in Japan and Korea), they adapted to suit the needs of the
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participants whilst retaining the Eastern philosophy (Burke, Al-Adawi, Lee, & Audette,
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2007). The philosophy which permeates traditional martial arts is one of attaining the Zen

state of mushin, or “no mindedness,” a state whereby the participant is capable of fighting to
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their fullest extent but without aggressive feelings. This is carried out through ritualization of
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combat moves (katas), the requirement of respect to the teacher (sensei), to the practice space

and to one another, and also by highlighting the importance of meditation and philosophies

such as peace, benevolence, humanity, and self-restraint (Nosanchuk & MacNeil, 1989).

Research into martial arts focuses on those elements which are most valuable to the

targeted population. Research with adolescents and young adults examine the benefits of

martial arts in teaching self-control, enhancing self-esteem, teaching a more positive response

to physical challenges, and inducing greater emotional stability, self-confidence, and

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assertiveness. Martial arts provide an outlet for participants to channel energy into a

productive and self-enhancing activity (Twemlow & Sacco, 1998). They have also been

demonstrated to improve concentration and self-awareness in children (Lakes & Hoyt, 2004)

and tentatively aid executive functions (Diamond & Lee, 2011), including self-monitoring

and awareness (Haydicky, Wiener, Badali, Milligan, & Ducharme, 2012; Lothes, Hakan, &

Kassab, 2013) and cognitive-regulation (Lakes & Hoyt, 2004).

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Of current interest is the effect of martial arts on externalizing behaviors.

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Externalizing and antisocial behaviors amongst youth are of pressing concern and considered

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a major public health problem (Krug, Dahlberg, Mercy, Zwi, Anthony, & Lozano, 2002).

Birth-Cohort studies carried out internationally demonstrate close links between youth
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delinquency and adult crime (Farrington, 2000; Laubacher et al., 2014; Moffitt, 1993). It
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appears that while a minor level of delinquency and antisocial behavior increases gradually

through adolescence and decreases in adulthood, youth who show serious and persistent

antisocial behaviors are at the greatest risk of becoming lifelong offenders (Hoge, Vincent, &
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Guy, 2013; Moffitt, 1993).

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Treatments for externalizing behaviors in youth include interventions at an individual

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level such as cognitive behavior approaches (Barnes, Smith, & Miller, 2014; Cornet, De

Kogel, Nijman, Raine, & Van Der Laan, 2015), at a family level such as systemic therapy
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(Smith et al., 2004), and community interventions (Marans & Schaefer, 1998). Other more

novel approaches include dietary changes, such as increasing fish oil consumption (Raine,

Portnoy, Liu, Mahoomed, & Hibbeln, 2015) and overhauling classroom teaching methods

(Hawkins, Catalano, Kosterman, Abbott, & Hill, 1999). While treatment success rates vary,

current guidelines highlight the necessity of matching the most suitable intervention for the

cultural and social needs of the relevant community (Krug et al., 2002).
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Martial arts provide a novel intervention both because of the comparatively low cost

of implementation (just one martial arts instructor for a group as large as 15) and also because

of the novelty and ‘street-cred’ associated with the sport. As cognitive functions, specifically

executive functions, improve with training (Diamond & Lee, 2011), so too do externalizing

behaviors (Zhou et al., 2007). The more advanced a student becomes in the traditional martial

arts, the lower his or her aggression levels are reported on a range of measures (Nosanchuk &

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MacNeil, 1989). While martial arts appears to attract those children who have higher

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aggressive tendencies, it seems that throughout the training process assaultive hostility levels

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drop to below levels of those initially demonstrating normal hostility levels (Daniels &

Thornton, 1990). Indeed learning to understand one’s boundaries, developing self-control,

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and physically integrating mind and body can have deep psychological benefits (Weiser et

al., 1995).
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Recent, school-based martial arts programs have shown promising results in the

reduction of school-based aggression for troubled youth, with participants demonstrating

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significantly less violent behavior, as well as reductions in rule breaking and impulsive
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behaviors. Additionally, participants reported a more positive emotional state following

training and demonstrated significant improvement in attentional self-control (Zivin et al.,

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2001). Smaller scale studies have also indicated the positive effect of martial arts in at-risk
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youth on aggression levels (Palermo & Forno, 2006; Theeboom, De Knop, & Wylleman,

2008).

A previous review of the effect of martial arts of socio-psychological variables

(Vertonghen & Theeboom, 2010) demonstrated the variability of research pertaining to the

effect of martial arts on externalizing behaviors and highlighted the need for more extensive

research. They emphasized the positive outcomes of martial arts in a host of studies but also

drew attention to those studies demonstrating negative outcomes. A simple review of the
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studies these authors include in their analysis highlights the lack of segregation in this field of

research, with half the studies on aggression including mixed adult and youth samples. This

proves problematic when attempting to ascertain whether there are age effects within the

field. Likewise the majority of the research is with a male sample, although when females are

included they either show little (Lakes & Hoyt, 2004) or negative effects (Bjorkqvist &

Varhama, 2001).

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The goal of the current review is to estimate the effect size of martial arts training in

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youth on externalizing behaviors. In light of the large variability in the relevant studies, as

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discussed above, we will first review the sources of variability and potential moderators,

when considering the effect of martial arts on externalizing behaviors.

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Martial arts types
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Current research does not distinguish between different forms of martial arts. Studies that

include two types of martial arts generally combine them together for final analysis (Daniels
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& Thornton, 1992, 1990). The martial arts studied mostly conform to the ancient practices
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and include an internal reflection, ancient philosophies, and breathing practices. When these

aspects are contrasted with modern, fight-heavy martial arts, the traditional martial arts have
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superior effects, while modern martial arts may even be harmful (Trulson, 1986). Introducing

traditional, internally focused techniques, such as controlled breathing, can mediate this effect
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(Hernandez & Anderson, 2015).

Movement type

It has been hypothesized that the repetitive movements in martial arts can act as a container

for destructive aggression and a vehicle for embodiment of the mind (Twemlow, Sacco, &

Fonagy, 2008). This effect may be similar to the synchronized and unifying effect of
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movement expression in dance and movement therapies (Levy, 1988; Ritter & Low, 1996),

although there is little to no research to this effect in other fields (i.e., sports, educational

interventions, and criminology).

Gender

Current studies indicate that greater effects of martial arts practice for males than for females

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(Lakes & Hoyt, 2004; Twemlow, Biggs, et al., 2008). This could be due to the

overwhelmingly larger proportion of males demonstrating externalizing behavior problems,

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as opposed to females (Krug et al., 2002), but may also be due to the male dominated nature

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of the sport. NU
Age
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The majority of the studies on martial arts have been carried out on youth or university age

adults, with no intervention studies performed on a purely adult population. Externalizing

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behavior problems are generally not studied in elderly populations, but there is evidence
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demonstrating an improvement in emotional functioning following a karate intervention

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(Jansen & Dahmen-Zimmer, 2012). Given the heightened risk of violence amongst youth and

young adults (Dahlberg & Potter, 2001), it follows that interventions designed to reduce
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violence would show the greatest impact when levels are at their peak. Likewise, executive
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functions are demonstrated to develop from early childhood (Baddeley, 1996), only reaching

maturity in adulthood and demonstrating periods of rapid development occurring during

adolescence (Satterthwaite et al., 2013). Given the heightened potential for improvement

during this period, interventions targeting executive function improvement and reduction of

aggression generally target school age children (Diamond, 2013).

Training/intervention duration
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The effects of martial arts have been studied from as short as a two and a half week

intervention (Delva-Tauiliili, 1995), although the majority of examine programs lasting at

least ten weeks. Shorter interventions appear to have smaller effect sizes, and there is

evidence to demonstrate that the longer time spent in martial arts practice, the lower

aggression levels demonstrated (Daniels & Thornton, 1992; Skelton, Glynn, & Berta, 1991).

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Location of training

Intervention programs can be divided into those taking place in school and outside of school

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settings. School based intervention programs are wider reaching and target much larger

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samples of children (Lakes & Hoyt, 2004; Twemlow, Biggs, et al., 2008; Zivin et al., 2001).
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While other intervention studies target those already demonstrating severe disruptive

problems (Palermo & Forno, 2006), the advantage of school-based programs is that they
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target those at-risk but not yet demonstrating criminal levels of anti-social behaviors and

externalizing problems. Likewise, those studies taking place in a martial arts sports clubs
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show a wider range of results given the selection bias effects of participants choosing martial
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arts over less aggressive sports (Delva-Tauiliili, 1995; Lamarre & Nosanchuk, 1999; Reynes
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& Lorant, 2002b).

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Health or illness of participants

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There is not enough information concerning martial arts with patient populations, although

preliminary studies demonstrate a potential improvement in externalizing behaviors amongst

sufferers of schizophrenia (Hasson-Ohayon, Kravetz, Roe, Rozencwaig, & Weiser, 2006),

autism (Bahrami, Movahedi, Marandi, & Abedi, 2012), and epilepsy (Conant, Morgan,

Muzykewicz, Clark, & Thiele, 2008). Of course, externalizing behaviors may have different

neurological causes in different disorders.

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This current meta-analysis is intended to collate those studies providing usable data

on martial arts and externalizing behaviors among children and adolescents and generate a

picture of the current state of the field. If martial arts does appear to demonstrate beneficial

outcomes in reducing externalizing behaviors, then this will provide a platform on which to

base future intervention studies.

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Method

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Literature search
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The first step in conducting the meta-analytical review involved a selective literature search
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for papers published from 1980 until November 2015. We used the PsycNET, Google

Scholar and Web of Science databases. Literature was also sourced from published literature

reviews including the aforementioned 2010 literature review (Vertonghen & Theeboom,
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2010). Our key search term was ‘‘martial arts’’ with the limitation that manuscripts were
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written in English.
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Selection criteria
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Inclusion criteria

1. Studies evaluating the effect of martial arts on externalizing behaviors (i.e. Aggression,

anger, violence, hostility).

2. Effect of martial arts evaluated with a validated cognitive or behavioral measurement.

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3. The study analysis included data or statistical information which could be used to generate

an effect size (d-value).

4. The existence of either a control group or comparison group.

5. The study sample is composed of youth (up to and including 18 years).

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Exclusion criteria

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We did not include studies evaluating the effect of martial arts on physiological or

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neurological functions which were unrelated to psychological functioning such as fitness or
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vision. We did not include studies which only dealt with an elderly population nor did we

include studies which only had a female sample.

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Extraction of the outcome measures

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Statistical data including means and standard deviations, T test/F Anova/P values and number
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of subjects/df were extracted from each study. In cases there were several reported effect
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sizes for various measures in one study, we extracted only the larger effect size for the most

relevant measure. Analysis Effect sizes were calculated according to Rosenthal (1991). In
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order to assess homogeneity/heterogeneity, we examined the data using Q test (Sanchez-

Meca & Fulgencio, 1997; Shadish & Haddock, 1994) and I2 (Higgins & Thompson, 2002).

Accordingly, if the Q value is not significant, then the effect sizes are considered to be

homogeneous, and the mean effect size is the best estimation for the data; however, if the Q
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is significant, moderators should be suggested as the effect sizes are considered to be

heterogeneous.

All studies were coded and the data extracted by the first author and a random

subsample of papers were coded independently by the second author. Inter-rater reliability

was 100%. All data was extracted from papers and if there was a lack of sufficient

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information to calculate effect sizes, the authors were contacted (for standard deviations).

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Results
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Studies retrieval
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From the initial, broad, search criteria, 312 studies in English were retrieved. Forty-nine

publications which reviewed the psychological effects of martial arts were identified and
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carefully reviewed. Many of these studies were eliminated due to the inclusion and exclusion
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criteria. The majority of the eliminated studies focused on psychological characteristics other
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than externalizing behaviors, also other reasons for exclusion included inability to access
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relevant data (Nosanchuk & MacNeil, 1989; Rothpearl, 1980; Theeboom et al., 2008).Twelve

studies were deemed to fulfil inclusion and exclusion criteria (from unique publications).
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From each study, we took out the most significant results for behavioral measures; if the

result was not significant, we treated it as a zero effect size and included in the meta-analysis

(see Table 1).

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Meta-analysis results

We included twelve effect sizes. In the first step, the Q value was calculated based on all

effect sizes and revealed a Q value of 28.57, df = 11 (p<0.01) and I2 = 61.5, which reflect the

presence of a moderator or several moderators. We assumed that type of study could be a

moderator thus effect sizes were split into two groups: nine studies derived from intervention
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and longitudinal studies and three studies which were a one-time comparison of martial arts

participants with other sports on a number of behavioral and psychological measures.

Homogeneity tests for intervention and longitudinal studies yielded Q = 15.50, df = 8(p>

0.05) and I2 = 41.99, indicating that there is no need to search for another moderator and that

the results are homogeneous. A funnel plot of included studies did not show any asymmetry, an

indication that significant publication bias was not likely (Figure 1).

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160

140

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120
Participant Number

100
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80
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60

40

20
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0
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0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8

Effect Size
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Figure 1: Funnel plot showing effect sizes for martial arts meta-analysis delineated by
sample size.
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The final analysis of these studies revealed an average effect size of 0.65 (95% CI:

0.11, 1.03) indicating a medium effect size. These nine studies contained 507 participants

between the ages of 6 and 18 and were a combination of longitudinal, cross-sectional and

intervention studies. They were mainly comprised of normative youth or University age

students but they also included those with epilepsy (Conant et al., 2008), learning disabilities
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(Haydicky et al., 2012) and social or behavioral problems (Palermo & Forno, 2006; Zivin et

al., 2001).

The three comparison studies in the second group were not homogeneous (Q= 10.96,

df=2 [p<0.01], I2=81.75) and while they yielded a small effect size (d= 0.38, 95% CI: -0.35,

0.82), the small number of such studies limits concluding analysis.

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Of the studies included in the final analysis, four were deemed to be as close to

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randomly controlled trials as possible within this field of research. These studies were found

to be homogenous (Q=4.81, df=3 [p>0.05], I2= 37.6) and yielded the greatest average effect
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size of 0.73 (95%CI: 0.37, 0.79). The remaining studies remained homogenous (Q=7.88,

df=4 [p>0.05], I2=49.26).

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Discussion
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The present meta-analytic study found support for the relationship between martial arts and
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reduced aggression amongst a range of youth populations. This result supports the hypothesis

that martial arts can reduce aggressive tendencies in a range of populations and is a
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potentially worthwhile intervention for youth at risk of externalizing behavior problems.

There was no need for further moderator analysis following the removal of

comparison studies of martial arts participants with other sports participants. The studies

based on a martial arts intervention were found to be homogenous. Thus, based on studies

including over 500 youth, it is reasonable to conclude that the beneficial effects that martial

arts have on reducing externalizing behaviors do not depend on martial arts of participant
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type, location of practice, or duration of the program. That said, age may still be a potential

moderator, as this study only included youth.

The research on martial arts is sparse and many studies lack the statistic integrity to

include them in a robust meta-analysis. Vertonghen and Theeboom’s 2010 literature review

was the most comprehensive on this topic (Vertonghen & Theeboom, 2010). Unfortunately,

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of those studies which included a solely youth and young adult populations, studies such as

Nosanchuk’s (Nosanchuk, 1981) and Edelman’s (Edelman, 1994), none included usable

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statistical data that could be used in a meta-analysis. This left the current meta-analysis with a

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dearth of papers to be analyzed, and rather than subdivide the martial arts research into

definitive categories, the resulting analysis included the compilation of a wide range of
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martial arts in a variety of settings and populations.
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The studies included in the current analysis varied in their scope and quality. The

smallest effect was found, predictably, when youth participated in just two and a half weeks
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of training, albeit daily (Delva-Tauiliili, 1995), and the largest effect was generated in the
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longest intervention of 10 months (Palermo & Forno, 2006). When the youth taking part in
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various martial arts were deemed to be at risk and demonstrated significant behavior
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problems, the effect of martial arts varied dramatically (0.3 to 1.53, Palermo & Forno, 2006

and Zivin et al., 2001, respectively), and this variance is testament to both the varying
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techniques and externalizing behavior presentations. The analysis of such externalizing

behaviors also varied with some studies having aggression and aggressive behaviors as the

key measure (Reynes & Lorant, 2002a; Zivin et al., 2001), whereas others extracting the

analysis of externalizing behaviors from broader behavioral and temperamental measures

(Conant et al., 2008; Twemlow, Biggs, et al., 2008) and novel, though rarely used,

observation methods (Lakes, 2012; Lakes & Hoyt, 2004). While studies such as Haydicky et

al (2012) used naturally formed experimental groups comprised of those eligible for the
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intervention and those eligible but on a wait list others were self-selected participants (Conant

et al., 2008; Reynes & Lorant, 2002a; Skelton et al., 1991).

Just one study used full random assignment to the martial arts or physical activity

intervention (Lakes & Hoyt, 2004) though Palermo & Forno (2006) and Zivin et al (2001)

randomly assigned children referred to the martial arts program to either the test group or

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wait list (the later added participants to the test group at the school’s and parent’s request thus

reducing the level of randomization) and Twemlow et al (2008) used a sample taken from a

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school using the martial arts component from a wider RCT (Fonagy et al., 2009). When taken

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together, these studies produced an even larger effect size than when all intervention studies

were calculated.
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A limitation of all the included studies is that where attrition was documented, it was
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primarily as a result of absence from final testing (Lakes & Hoyt, 2004; Zivin et al., 2001)

and no study reports on the dosage or number of classes participated in from those offered
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during the study period. It seems improbable that especially during large scale studies taking
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place in schools with at-risk youth, that there would not be greater dropout or unwillingness
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to participate (indeed in Fonagy et al., 2009, the full RCT had just a 75% participation rate
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and 25% of the data was missing and computationally estimated).

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The question of whether martial arts increases or reduces externalizing behaviors is

crucial when planning interventions and attempting to further research into lowering

criminogenic behaviors. While the current meta-analysis included only one study with a

negative result (Reynes & Lorant, 2002a), it should be noted that the same sample was used

for two additional publications reporting negative findings that were not included in the

present analyses (as outlined above, one effect size was taken from each sample; Reynes &
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Lorant, 2002b, 2004). Similarly, of the three comparison studies not included in the final

analysis, Ziaee and colleagues found martial arts participants to demonstrate greater anger

(Ziaee, Lotfian, Amini, Mansournia, & Memari, 2012), although the other two studies

reported less hostility and aggression compared to other sports participants (Daniels &

Thornton, 1992; Roux & Steyn, 2009).

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A recent meta-analysis was published on the foundation of detangling whether these

negative effects were more significant than the positive effects cited (Gubbels, van der

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Stouwe, Spruit, & Stams, 2016). Although the findings were overall positive, as in the current

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meta-analysis, the resulting effect size was relatively small in stark contrast to the current

result. Further investigation revealed a number of questionable inclusions into their analyses,
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including a study which did not appear to include traditional martial arts (Kreager, 2007) and
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another whereby martial arts was grouped with boxing and other combat sports (Mutz, 2012).

The authors also did not include their self-generated effect sizes, making their analyses

impossible to replicate. These questionable inclusions highlight the dearth of research in this
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field, which also blights the current meta-analysis. Nonetheless, as there are very few studies
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in the field of martial arts and crime prevention, and yet more and more schools and youth

clubs are introducing them and citing beneficial effects, it is critical to stimulate additional
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rigorous research that accurately reflects the state of the field.

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While psychologically oriented programs often receive the bulk of the scientific

interest (James, Stams, Asscher, De Roo, & der Laan, 2013; Zagar et al., 2013), troubled

youth often do not cooperate with these traditional approaches. Martial arts, it has been

suggested, may both complement and form a basis for further cooperation in psychological

therapies (Weiser et al., 1995). Further research is needed to substantiate the tentative claims

of this meta-analysis and also provide a more thorough examination of why martial arts

training appears to be a beneficial intervention. It does not appear to matter which specific
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martial arts are used, but rather the common themes of repetitive movements, controlled

behaviors, and respect are present in all the studies outlined above. Furthermore these

positive effects have also been documented in reducing stereotypy in autism (Bahrami et al.,

2012), improving quality of life in schizophrenia (Hasson-Ohayon et al., 2006), and

increasing emotional mental state in the elderly (Jansen & Dahmen-Zimmer, 2012), thereby

adding further evidence to the wellbeing enhancing mechanisms of martial arts across a range

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of populations. Understanding the specific mechanisms of change in martial arts with at-risk

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youth will aid future program development and encourage the proliferation of this cost-

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effective, fun, and normative intervention.
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Highlights
• Martial arts are a popular activity for youth worldwide
• Martial arts appear to be a worthwhile intervention in reducing aggressive behavior
• Current research in to martial arts is lacking in depth and quality
• This meta-analysis demonstrates that martial arts reduce externalizing behavior
• Further research is needed given the lack of RCTs on therapeutic martial arts

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