Models of anger: contributions from psychophysiology, neuropsychology and the cognitive behavioral perspective

The Psychosocial Impact of the COVID-19 Pandemic on Italian Families: The Perception of Quality of Life and Screening of Psychological Symptoms

Throughout the COVID-19 period, families were forced to stay indoors, adapting to online schooling, remote work, and virtual social engagements, inevitably altering the dynamics within households. There was a notable increase in mental health challenges in terms of anxiety and depression in children and adolescents. This study intended to explore the psychosocial effects of the COVID-19 pandemic on Italian families by adopting self- and proxy-report questionnaires on anxiety, anger, and health-related quality of life. The results showed that approximately 20% obtained a clinical anxiety score and only 10% obtained a clinical anger score. There was a difference in the perception of the quality of life reported by the child and that perceived by the parent. A stepwise regression model showed that total anxiety scores were predicted by sex, quality of life scores from the parents' self-report version, and the total anger score. Another stepwise regression model identified physiological and social anxiety as the best predictors that impact quality of life. Parental well-being actively influences the well-being of children, so it is fundamental to implement preventive programs and promote child well-being by providing parents the most adequate support possible.

Anger and substance use in HIV-positive patients with chronic pain

Chronic pain increases the risk of substance use in people living with HIV (PLWH). Depression and anxiety have also been identified as risk factors for substance use among PLWH. Relatedly, other negative mood states, such as anger, may influence chronic pain among PLWH. The current cross-sectional study examined whether the distinct negative mood state of anger is associated with substance use among 187 PLWH who report chronic pain. Using negative binomial regression analyses, we found higher levels of anger were positively associated with alcohol use. Higher levels of anger were inversely associated with benzodiazepine use. No association was found between anger and marijuana use, and there were no significant interactions between anger and pain severity on substance use. Our findings suggest that anger is an independent risk factor for substance use among PLWH and chronic pain. Addressing anger may be useful when adapting behavioral therapies in the treatment of pain among PLWH.

Psychometric properties of the Mexican version of the Driver's Angry Thoughts Questionnaire and analysis of invariance with the Romanian and Spanish versions

Research has shown the relevance of three axes in the study of violent behaviour: the emotional axis (anger), the behavioural axis (aggression), and the cognitive axis (hostility or aggressive thinking). In the field of driving, the first two axes have received a lot of attention, whereas the third one has been less studied. The current research aimed to analyse the psychometric properties of the Driver's Angry Thoughts Questionnaire (DATQ) in a Mexican sample. Besides, the structural invariance of this instruments was analysed with respect to both the Spanish and the Romanian versions. A sample of 294 participants taken from the general Mexican drivers population completed a set of measures including the DATQ and the Driving Survey, as a measure of risky driving, aggressive driving, and crash-related events. The results showed that the Mexican version of the DATQ replied the original five-factor structure, maintaining the 65 items likewise in both the Spanish and Romanian versions. Analyses of the invariance suggested the equivalence among the three versions, especially in the case of Mexican-Spanish. Moreover, the five factors were positive and mostly significantly related to each other, and with both risky driving and aggressive driving. Some significant relationships were attained also with crash-related events, especially in the case of those which happened in the last three months (short-termed). Finally, males showed higher scores than females in the five ways of aggressive thinking. Limitations of the study, practical implications and future research are discussed.

Supramodal neural networks support top-down processing of social signals

The perception of facial and vocal stimuli is driven by sensory input and cognitive top‐down influences. Important top‐down influences are attentional focus and supramodal social memory representations. The present study investigated the neural networks underlying these top‐down processes and their role in social stimulus classification. In a neuroimaging study with 45 healthy participants, we employed a social adaptation of the Implicit Association Test. Attentional focus was modified via the classification task, which compared two domains of social perception (emotion and gender), using the exactly same stimulus set. Supramodal memory representations were addressed via congruency of the target categories for the classification of auditory and visual social stimuli (voices and faces). Functional magnetic resonance imaging identified attention‐specific and supramodal networks. Emotion classification networks included bilateral anterior insula, pre‐supplementary motor area, and right inferior frontal gyrus. They were pure attention‐driven and independent from stimulus modality or congruency of the target concepts. No neural contribution of supramodal memory representations could be revealed for emotion classification. In contrast, gender classification relied on supramodal memory representations in rostral anterior cingulate and ventromedial prefrontal cortices. In summary, different domains of social perception involve different top‐down processes which take place in clearly distinguishable neural networks.

Profile of Anger in Acute Stroke: A Multifactorial Model of Anger Determinants

OBJECTIVE

Higher levels of anger can have a major impact on treatment and recovery among stroke patients.

METHODS

The authors identified the presence of anger in patients with acute stroke, as well as state and trait anger and anger expression and control, and analyzed its association with demographic, clinical, brain lesion, and psychosocial variables. The authors screened anger prospectively in 114 consecutive patients by using the State-Trait Anger Expression Inventory-2, which enabled them to distinguish between the experience, expression, and control of anger.

RESULTS

State anger was detected in 21 (18%) patients, whereas trait anger was present in 22 patients (20%). The best regression model revealed that age, hypertension, complaints about environment, anxiety symptoms, and disability were independent predictive factors for anger (R²=54%).

CONCLUSIONS

Anger appears to be explained by prestroke variables such as age, hypertension, and the profile of anger, stroke itself as a sudden and potentially disabling condition, the environment, and the psychological and functional consequences of stroke.

Emotions after stroke: A narrative update

AIM

In this narrative review we aimed to describe how stroke affects emotions and update the readers on the emotional disturbances that occur after stroke.

METHODS

We searched Medline from 1.1.2013 to 1.7.2019, personal files and references of selected publications. All retrieved systematic reviews and randomized controlled trials were included. Other references were selected by relevance.

SUMMARY OF REVIEW

The emotional response includes a reactive behavior with arousal, somatic, motivational and motor components, and a distinctive cognitive and subjective affective experience. Emotional category responses and experiences after stroke can show dissociations between the behavioral response and the cognitive and affective experiences. Emotional disturbances that often occur after stroke include fear, anger, emotional indifference, lack of understanding of other emotions, and lack of control of emotional expression. Emotional disturbances limit social reintegration of the persons with stroke and are a source of caregiver burnout. The evidence to support the management of the majority of emotional disorders in stroke survivors is currently weak and of low or very low methodologic quality. An exception are the disorders of emotional expression control where antidepressants can have a strong beneficial effect, by reducing the number and duration of the uncontrollable episodes of crying or laughing.

CONCLUSION

Our current knowledge of the emotional disorders that occurs in acute stroke patients and in stroke survivors is heterogeneous and limited. Joint efforts of different research approaches, methodologies and disciplines will improve our current understanding on emotional disorder after stroke and indicate rational pathways to manage them.

Hostility and cognitive control: Evidence of increased cardiovascular reactivity as a function of exposure to affective stress using a dichotic listening paradigm

Indices of cognitive control were examined in men with high and low levels of trait hostility as a function of exposure to affective and cognitive stress. A dual concurrent task paradigm was used whereby participants intentionally directed focus to the left or right ear under dichotic listening conditions before and after exposure to angry infant vocalizations. Analysis of the behavioral data supports the prediction of reduced right frontal regulatory control in men with high levels of hostility as indicated by diminished capacity to suppress report of phonemes presented to the language dominant left hemisphere (right ear) in the Focus Left condition. This diminishment in the capacity to suppress report of phonemes presented to the right ear in the Focus Left condition is suggestive of reduced cognitive control. With respect to the neurophysiological data, heart rate increased for only men with high levels of hostility in the Focus Left condition, and this was especially evident in the post-affective stress condition. This increase in right hemisphere arousal provides additional evidence of reduced cognitive control and support for the capacity model of hostility by implicating poor right frontal regulatory control over right posterior cerebral regions under dual task conditions. The results are discussed in terms of integrating the construct of cognitive control into the capacity model as well as providing implications regarding reductions in the capacity to suppress predominant aggressive responses in domestic settings.

The effect of anger expression style on cardiovascular responses to lateralized cognitive stressors

To determine the effects of self-reported anger expression style on cerebrally lateralized physiological responses to neuropsychological stressors, changes in systolic blood pressure and heart rate were examined in response to a verbal fluency task and a figural fluency task among individuals reporting either "anger in" or "anger out" expression styles. Significant group by trial interaction effects was found for systolic blood pressure following administration of verbal fluency [F(1,54) = 5.86, p < 0.05] and nonverbal fluency stressors [F(1,54) = 13.68, p < .001]. Similar interactions were seen for systolic heart rate following administration of verbal fluency [F(1,54) = 5.86, p < .005] and nonverbal fluency stressors [F(1,54) = 13.68, p < .001]. The corresponding results are discussed in terms of functional cerebral systems and potential implications for physiological models of anger. Given the association between anger and negative physical health outcomes, there is a clear need to better understand the physiological components of anger. The results of this experiment indicate that a repressive "anger in" expression style is associated with deregulation of the right frontal region. This same region has been shown to be intimately involved in cardiovascular recovery, glucose metabolism, and blood pressure regulation.

The anterior midcingulate cortex as a neural node underlying hostility in young adults

Anger typically manifests for only a short period of time, whereas hostility is present for a longer duration. However, both of these emotions are associated with an increased likelihood of psychological problems. The nodes within the neural networks that underlie hostility remain unclear. We presumed that specific nodes might include the anterior midcingulate cortex (aMCC), which seems to be essential for the cognitive aspects of hostility. Thus, the present study first evaluated the associations between regional gray matter density (rGMD) and hostility in 777 healthy young students (433 men and 344 women; 20.7 ± 1.8 years of age) using magnetic resonance imaging and the hostile behaviors subscale (HBS) of the Coronary-prone Type Scale (CTS) for Japanese populations. The HBS scores were positively correlated with rGMD in the aMCC and in widespread frontal regions from the dorsomedial/dorsolateral prefrontal cortices to the lateral premotor cortex at the whole-brain level. No significant correlation was observed between rGMD and the conjunction of HBS and Trait Anger/Anger-Out scores. Furthermore, no significant interaction effects of sex and HBS scores on rGMD were revealed, although the HBS scores of males were significantly higher than those of females. The present findings indicate that the neural correlates of hostility appear to be more distinct in rGMD than those of anger due to differences and duration.

Maltreatment and Delinquency in China: Examining and Extending the Intervening Process of General Strain Theory

Using a sample of 1,163 adolescents from four middle schools in China, this study explores the intervening process of how adolescent maltreatment is related to delinquency within the framework of general strain theory (GST) by comparing two models. The first model is Agnew's integrated model of GST, which examines the mediating effects of social control, delinquent peer affiliation, state anger, and depression on the relationship between maltreatment and delinquency. Based on this model, with the intent to further explore the mediating effects of state anger and depression and to investigate whether their effects on delinquency can be demonstrated more through delinquent peer affiliation and social control, an extended model (Model 2) is proposed by the authors. The second model relates state anger to delinquent peer affiliation and state depression to social control. By comparing the fit indices and the significance of the hypothesized paths of the two models, the study found that the extended model can better reflect the mechanism of how maltreatment contributes to delinquency, whereas the original integrated GST model only receives partial support because of its failure to find the mediating effects of state negative emotions.

Neuropsychological Deficits Are Not Predictive of Deficient Emotional Self-Regulation in Adults With ADHD

OBJECTIVE

To investigate whether neuropsychological deficits account for the association between deficient emotional self-regulation (DESR) and ADHD.

METHOD

DESR was identified in adults with and without ADHD who reported extreme frequency of items from the Barkley Current Behavior Scale (>95th percentile of control participants). A neuropsychological battery and structured diagnostic interview were administered to 113 adults with ADHD and DESR, 93 adults with ADHD without DESR, and 119 participants without ADHD or DESR.

RESULTS

Relative to adults with ADHD without DESR, adults with ADHD and DESR demonstrated lower scores on Wechsler Adult Intelligence Scale (WAIS) arithmetic but no other significant differences in neuropsychological performance. Relative to adults without ADHD, both ADHD groups demonstrated lower scores across several measures of executive function.

CONCLUSION

Our findings do not support the hypothesis that neuropsychological deficits are linked to DESR in adults with ADHD. This finding is consistent with the hypothesis that DESR could be a manifestation of ADHD, but further study of alternate hypotheses is necessary to support this conclusion.

The dynamic opponent relativity model: an integration and extension of capacity theory and existing theoretical perspectives on the neuropsychology of arousal and emotion

Arousal theory as discussed within the present paper refers to those mechanisms and neural systems involved in central nervous system activation and more specifically the systems involved in cortical activation. Historical progress in the evolution of arousal theory has led to a better understanding of the functional neural systems involved in arousal or activation processes and ultimately contributed much to our current theories of emotion. Despite evidence for the dynamic interplay between the left and right cerebral hemispheres, the concepts of cerebral balance and dynamic activation have been emphasized in the neuropsychological literature. A conceptual model is proposed herein that incorporates the unique contributions from multiple neuropsychological theories of arousal and emotion. It is argued that the cerebral hemispheres may play oppositional roles in emotion partially due to the differences in their functional specializations and in their persistence upon activation. In the presence of a threat or provocation, the right hemisphere may activate survival relevant responses partially derived from hemispheric specializations in arousal and emotional processing, including the mobilization of sympathetic drive to promote heightened blood pressure, heart rate, glucose mobilization and respiratory support necessary for the challenge. Oppositional processes and mechanisms are discussed, which may be relevant to the regulatory control over the survival response; however, the capacity of these systems is necessarily limited. A limited capacity mechanism is proposed, which is familiar within other physiological systems, including that providing for the prevention of muscular damage under exceptional demand. This capacity theory is proposed, wherein a link may be expected between exceptional stress within a neural system and damage to the neural system. These mechanisms are proposed to be relevant to emotion and emotional disorders. Discussion is provided on the possible role of currently applied therapeutic interventions for emotional disorders.

Ignorance isn't bliss: why patients become angry

Patients with cognitive limitations may struggle understanding complex arguments and feel overwhelmed by the need to choose among medical options that they poorly understand. Such struggle may result in frustration and anger directed at the physician. The aim of the present study is to explain the characteristics underlying such situations. A decision tree is modeled to capture the choice that every patient has to make after receiving medical advice. Patient choices are phrased in terms of a threshold probability for accepting or rejecting advice by physicians. To a patient with poor understanding of medical exigencies all differences between present or absent disease state, prognosis, and risks of intervention may seem largely arbitrary and meaningless. With little or no guidance to make an informed decision, taking any medical action is deemed wasted and harmful, whereas inaction leaves the underlying medical problem unsolved. Both choices appear equally ineffective with respect to the patient's symptoms and therefore unappealing. As shown by applying threshold analysis to a patient in a state of ignorance, no threshold probability for following medical advice exists. Patients with cognitive limitations will become frustrated and angry by a seemingly dismal situation without good alternatives to choose from.

Assessment of anger terms in Hebrew: a gender comparison

ABSTRACT Appraisal of anger terms is based on past experience recollections, social norms, and gender roles. The objectives of this study were to find combinations of emotional components presented by a new composite variable that will exhibit differences between genders and differentiate between anger terms in Hebrew. The sample was comprised of forty students, Hebrew native speakers who participated in a web based study. Participants were asked to rate eight anger terms in Hebrew on a number of features that comprised five emotional components: subjective feelings states body reactions, expressions, action tendencies, and cognitive evaluations. A two-factor between-subjects multivariate analysis of variance (MANOVA) was conducted. A simplified multivariate composite, defined as subjective experience minus regulation, explained 10% of the gender difference. Another simplified composite, which combines the additive effect of the subjective experience and the actions that accompany this emotional state, explained 14% of difference between the anger terms. The findings are discussed with respect to appraisal theory and social constructivist conceptualization.

Temporal and frontal lobe initiation and regulation of the top-down escalation of anger and aggression

The widespread, across-species strategy of stagewise escalation of aggression in agonistic encounters can be understood in terms of resource capture and control with least risk and cost. Human anger likely follows similar principles. As an adaptive phenomenon, escalation may involve particular neural circuitry. To advance beyond a standard view that the frontal lobe tonically inhibits subcortical circuits of aggression, a model is proposed which starts with the general rostrally directed flow of information in the brain. Earlier stage processing of visual and auditory input is transmitted from posterior and middle temporal cortices to anterior temporal lobe where rudimentary appraisals of threat and provocation are developed. These directly but diffusely activate cortical/subcortical anger/aggression response systems. At the same time, the anterior temporal loci transmit the modality-specific perceptual information to orbito-frontal cortex where it is integrated with information about, e.g., the opponent's relative dominance/social status and evaluated for likelihood of potential rewards and punishments associated with different modes of responding and so forth. These frontal areas then impose an inhibitory gating or modulation and focusing of activity initiated by the anterior temporal loci through their projections to GABAergic interneurons in the same cortical/subcortical circuits. Escalation occurs as the inhibition imposed by the frontal areas is progressively lifted. Exploration of the implications, applications and hypotheses flowing from this model will improve our understanding of the biologically important and socially significant phenomena of escalation.

Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS®): depression, anxiety, and anger

The authors report on the development and calibration of item banks for depression, anxiety, and anger as part of the Patient-Reported Outcomes Measurement Information System (PROMIS®). Comprehensive literature searches yielded an initial bank of 1,404 items from 305 instruments. After qualitative item analysis (including focus groups and cognitive interviewing), 168 items (56 for each construct) were written in a first person, past tense format with a 7-day time frame and five response options reflecting frequency. The calibration sample included nearly 15,000 respondents. Final banks of 28, 29, and 29 items were calibrated for depression, anxiety, and anger, respectively, using item response theory. Test information curves showed that the PROMIS item banks provided more information than conventional measures in a range of severity from approximately -1 to +3 standard deviations (with higher scores indicating greater distress). Short forms consisting of seven to eight items provided information comparable to legacy measures containing more items.

Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS®): depression, anxiety, and anger

The authors report on the development and calibration of item banks for depression, anxiety, and anger as part of the Patient-Reported Outcomes Measurement Information System (PROMIS®). Comprehensive literature searches yielded an initial bank of 1,404 items from 305 instruments. After qualitative item analysis (including focus groups and cognitive interviewing), 168 items (56 for each construct) were written in a first person, past tense format with a 7-day time frame and five response options reflecting frequency. The calibration sample included nearly 15,000 respondents. Final banks of 28, 29, and 29 items were calibrated for depression, anxiety, and anger, respectively, using item response theory. Test information curves showed that the PROMIS item banks provided more information than conventional measures in a range of severity from approximately -1 to +3 standard deviations (with higher scores indicating greater distress). Short forms consisting of seven to eight items provided information comparable to legacy measures containing more items.

The sad, the angry, and the asymmetrical brain: dichotic listening studies of negative affect and depression

Dichotic Listening (DL) is a valuable tool to study emotional brain lateralization. Regarding the perception of sadness and anger through affective prosody, the main finding has been a left ear advantage (LEA) for the sad but contradictory data for the anger prosody. Regarding an induced mood in the laboratory, its consequences upon DL were a diminished right ear advantage (REA) for the induction of sadness and an increased REA for the induction of anger. The global results fit with the approach-withdrawal motivational model of emotional processing, pointing to sadness as a right hemisphere emotion but anger processed bilaterally or even in the left hemisphere, depending on the subject's preferred mode of expression. On the other hand, the study of DL in clinically depressed patients found an abnormally larger REA in verbal DL tasks which was predictive of therapeutic pharmacological response. However, the mobilization of the available left hemisphere resources in these responders (reflected in a higher REA) would indicate a remission of the episode but would not assure the absence of new relapses.

Response style and vulnerability to anger-induced eating in obese adults

Emotional eating appears to contribute to weight gain, but the characteristics that make one vulnerable to emotional eating remain unclear. The present study examined whether two negative affect response styles, rumination and distraction, influenced palatable food intake following an anger mood induction in normal weight and obese adults. We hypothesized that higher rumination and lower distraction would be associated with greater vulnerability to anger-induced eating, particularly among obese individuals. Sixty-one participants (74% female, mean age=34.6) underwent neutral and anger mood inductions in counterbalanced order. Directly following each mood induction, participants were provided with 2400 kcal of highly palatable snack foods in the context of a laboratory taste test. Results revealed that distraction influenced energy intake following the mood induction for obese but not normal weight individuals. Obese participants who reported greater use of distraction strategies consumed fewer calories than those reporting less use of distraction strategies. These findings were independent of subjective hunger levels, individual differences in mood responses and trait anger, and other factors. Rumination did not account for changes in energy intake among obese or normal weight participants. Among obese individuals, the tendency to utilize fewer negative affect distraction strategies appears to be associated with vulnerability to eating in response to anger. Future research should determine whether coping skills training can reduce emotional eating tendencies.

On emotional conflict: interference resolution of happy and angry prosody reveals valence-specific effects

To comprehend emotional prosodic cues in speech is a critical function of human social life. However, it is common in everyday communication that conflicting information in emotional prosody and semantic content co-occur. Here, we sought to specify brain regions involved in conflict monitoring of these interfering communication channels. By means of functional magnetic resonance imaging, we obtained signal increases in the right dorsal anterior cingulate cortex and right superior temporal gyrus (STG) and superior temporal sulcus when participants listened to incongruous compared with congruous sentences. Moreover, valence-specific effects were found in the left inferior frontal gyrus and left STG for happily intoned sentences expressing a negative content. The left caudate nucleus along with the thalamus was active when angrily intoned sentences were coupled with positive semantic content. Our results suggest a brain network that monitors conflict in emotional prosody and emotional semantic content comprising of medial prefrontal areas that have previously been associated with cognitive conflict processing. Furthermore, our study extends the knowledge of these processes by suggesting valence-specific differences of emotional conflict processing.