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Anger Regulation Interventions: Research and Rationale . Karina Davidson, Ph.D. Columbia University College of Physicians & Surgeons. About the Instructor.

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Anger regulation interventions research and rationale

Anger Regulation Interventions: Research and Rationale

Karina Davidson, Ph.D.

Columbia University College of Physicians & Surgeons


About the instructor
About the Instructor

Karina Davidson, Ph.D. is an Associate Professor of Medicine and Intervention Research Director of the Behavioral Cardiovascular Health & Hypertension Program at Columbia College of Physicians and Surgeons in New York.


About the instructor1
About the Instructor

Dr. Davidson’s research focuses on psychosocial interventions with patients with cardiovascular disease. She is also interested in personality intervention at the primary, secondary, and tertiary stages of these diseases. She has conducted randomized controlled trials primarily in anger management but has recently developed an interest in depression reduction and subsequent improvement in cardiovascular parameters such as uncontrolled hypertension and silent ischemia.


About the instructor2
About the Instructor

She is the Chair of the Society of Behavioral Medicine committee on Evidence-based Behavioral-Medicine, a task force charged with improving and implementing evidence-based principles for behavioral medicine researchers, practitioners and students. She has taught evidence-based psychotherapy theory and practicum courses for a number of years to clinical psychology graduate students at both University of Alabama and Dalhousie University.


Learning objectives
Learning Objectives

You will learn:

  • Current controversies in Anger Disorder area

  • Anger and Anger Disorder diagnosis available

  • Evidence-based criteria for judging anger regulation interventions

  • Results from anger regulation intervention research


Performance objectives
Performance Objectives

  • Appreciate the need for better diagnoses within the Anger disorder area

  • Understand the importance of evidence-based criteria for evaluating trial results


Rationale for treating anger
Rationale for Treating Anger

  • Anger has often been linked to domestic violence (Brondolo, DiGiuseppe, & Tafrate, 1997)

  • U.S. has one of the largest homicide rates in the world (Eckhardt & Deffenbacher, 1995).

  • Anger can have a negative impact on interpersonal and familial relationships (Brondolo et al., 1997; Williams & Williams, 1993)


Why should you care about anger
Why should you care about anger?

  • 20% of Americans experience anger problems (Williams & Williams, 1993)

  • Angry clients experience a multitude of stressors

  • Angry clients are difficult to treat


Anger assessment
Anger Assessment

Anger

COGNITIVE

BEHAVIORAL

EMOTIONAL

ANGER

IN

NON-

VERBAL

VERBAL

CYNICAL

SUSPICIOUS

ANGER

EXPERIENCE


Anger assessment cont
Anger Assessment Cont.

ANGER

NON-

VERBAL

VERBAL

CONSTRUCTIVE

ANGER

OUT?

CONSTRUCTIVE

DISCUSSION

DESTRUCTIVE

ANGER

OUT

RUMINATIVE

DISCUSSION

DESTRUCTIVE

HOSTILE

STYLE

HOSTILE

CONTENT


Anger assessment cognitive
Anger Assessment: Cognitive

  • Cook-Medley Hostility Scale (Cook & Medley, 1954)

  • Cynicism/Mistrust subscale, Buss Durkee Hostility Scale (Buss & Durkee, 1957)

  • Anger-In subscale, Anger Expression Scale (Spielberger, Johnson, Russell, Crane, Jacobs, & Worden, 1985)


Anger assessment emotional
Anger Assessment: Emotional

  • Anger subscale, Aggression Questionnaire (Buss & Perry, 1992)

  • Anger Experience subscale, Multidimensional Anger Inventory (Siegel, 1986)

  • Trait Anger Scale (Spielberger, Jacobs, Russell, & Crane, 1983)


Anger assessment behavioral
Anger Assessment: Behavioral

  • Anger Out (Spielberger et al., 1985)

  • Physical and Verbal Aggression subscales, Aggression Questionnaire (Buss & Perry, 1992)

  • Positive and Negative Anger Discussion (Davidson, Chambers, Mason, MacGregor & Gidron, 1997)


Anger assessment observed
Anger Assessment: Observed

  • Modified Type A Structured Interview (Hall & Davidson, 1995a)

    • Potential for Hostility, Hostile Style (emotional and behavioral; Hall & Davidson, 1995b)

    • Observed Anger-In, Anger-Out (cognitive; behavioral; Gidron & Davidson, 1996)

    • Observed Constructive Anger Behavior--Verbal (behavioral; Davidson et al., 2000)


Anger disorders assessment
Anger Disorders Assessment

  • Ambiguity of the operational definition of anger disorders (DiGiuseppe, 1999).

  • Correlations between anger and other negative affective traits.


Anger disorders assessment1
Anger Disorders Assessment

  • Lack of diagnostic criteria in the DSM-IV.

  • Eckhardt and Deffenbacher (1995) have proposed three anger disorders they believe should be added to the DSM-IV

  • The authors employed the dimensions of angry affect, cognitive distortions, and physiological arousal to create the theoretical anger disorders.


Anger disorders assessment2
Anger Disorders Assessment

  • Adjustment Disorder with Angry Mood, is similar to Adjustment Disorder with Anxiety; however, it is characterized by an angry affect.

  • Situational Anger Disorder, With Aggression and Without Aggression appropriate for persons who experience intense anger reactions related to certain situations or themes.


Anger disorders assessment3
Anger Disorders Assessment

  • Generalized Anger Disorder, With and Without Aggression resembles Generalized Anxiety Disorder, except in this case, the person experiences persistent and pervasive anger (Eckhardt & Deffenbacher, 1995; Thomas, 1998)


Anger disorder assessment
Anger Disorder Assessment

  • The Anger Disorder Scale, 6th Revision (ADS-VI-R) is a self-report inventory that was developed based on the diagnostic criteria proposed by Eckhardt and Deffenbacher (1995).

  • The Anger Disorder Scale, Sixth Revision (ADS-VI-R; DiGiuseppe & Tafrate, 1999)


Evidence based criteria
Evidence-based Criteria

  • 1. Procedures for Identifying Relevant Treatment Outcomes

    • A. Literature reviewers

    • B. Literature search process

    • C. Acceptable sources in the literature: peer review required

    • D. Include refuting evidence and null findings

    • E. Obtaining missing information


Criteria for classification as a beneficial treatment 1
Criteria for Classification as a Beneficial Treatment1

  • A. At least two between‑group design studies of the same treatment treating the same target problem,with prospective design and random assignment of subjects to conditions

  • Findings must show the treatment to be (1) better the control or comparison groups on target problem assessments or (2) equivalent to an existing empirically supported treatment


Criteria for classification as a beneficial treatment
Criteria for Classification as a Beneficial Treatment

OR

  • B. At least two within group design studies of the same treatment treating the same target problem, showing the treatment to be better than the control or comparison conditions on target problem assessments following establishment of a reliable baseline


Criteria for classification as a beneficial treatment1
Criteria for Classification as a Beneficial Treatment

AND

  • C. The majority of applicable studies must support the treatment

  • D. The treatment procedures must show acceptable adherence to the treatment manual


Anger regulation interventions
Anger Regulation Interventions

  • Tafrate (1995) conducted a meta-analysis of treatment outcome studies focusing on anger

  • Only 17 studies found in the literature met inclusion criteria (e.g., adults seeking treatment for their anger problems, attendance at two sessions, and comparison with another experimental condition


Anger regulation interventions1
Anger Regulation Interventions

The studies were grouped into the following psychotherapy treatment strategies:

  • cognitive therapies (e.g., self-instructional training)

  • relaxation-based therapies (e.g., systematic desensitization)

  • skills-training therapies (e.g., assertiveness training)

  • multi-component treatments (e.g., stress inoculation and cognitive-behavioral)


Anger regulation interventions2
Anger Regulation Interventions

  • Systematic Desensitization was most effective in treating anger with an effect size of 1.63

  • followed by Multi-component and Self-instruction therapies, both of which had average effect sizes of 1.00

  • Cognitive therapy was also found to be effective with an effect size of .93


Anger intervention tailoring
Anger Intervention Tailoring

  • Cognitive

    • thought stopping

    • trust building

  • Behavioral

    • assertiveness training

      • constructive anger discussion

  • Emotional

    • distraction

    • relaxation


Intervention tailoring for specific populations
Intervention Tailoring for Specific Populations

  • Women

  • Minorities

  • Elderly

  • Adolescents

  • Medical patients

  • Physically Violent clients

  • Others?


Summary
Summary

  • Many clients will have anger issues

  • First step; Anger assessment

  • Second step; Motivation for treatment

  • Third step; Review evidence for anger intervention


Where to get more information
Where to get more information

  • http://pantheon.yale.edu/~tat22/empirically_supported_treatments.htm

  • http://www.eiconsortium.org/model_programs/wlliams_lifeskills_workshop.htm

  • http://www.therapeuticresources.com/82-38text.html


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