Anger Treatment in Chemically-Dependent Inpatients: Evaluation of Phase Effects and Gender

Anger treatment via CBAT delivered remotely: Outcomes on psychometric and self-monitored measures of anger

Studies of anger treatment have often reported on reappraisal and relaxation techniques delivered in person to forensic and psychiatric samples. The present study evaluated an integrative programme of cognitive-behavioural affective therapy (CBAT) delivered remotely to chronic pain sufferers with comorbid anger. Volunteers (N = 54) were randomly assigned to either CBAT or an Emotional Education (EE) group, both receiving hour-long videorecorded sessions twice a week for 4 weeks plus weekly calls by telephone. At 1-month post-treatment, follow-up was conducted. Outcomes were measured using the Anger Parameters Scale (APS) and its five subscales (frequency, duration, intensity, latency and threshold) as well as daily self-monitored anger logs. As hypothesized, pre- to post-treatment decline in APS total scores was significant for CBAT, Hedges' g = 0.65, 95% CI [0.14, 1.16] but nonsignificant and small for EE, g = 0.17, CI [-0.41, 0.75]. At the primary endpoint (post-treatment), APS total scores were significantly lower for CBAT than for EE. Treatment gains were maintained till follow-up. On all five APS subscales, pre-post effect sizes were medium-sized for CBAT and generally small for EE. This picture was mirrored in the self-monitored frequency, duration and intensity of anger. Findings support the efficacy of CBAT over time, its comparative efficacy over EE and its ecological generalizability. Future research could expand sample size, reduce sample imbalance, extend follow-up and strengthen treatment potency with more sessions. The present study renews enthusiasm for teletherapy and is the first to demonstrate CBAT efficacy in treating maladaptive anger in the chronic pain population.

Sex-comparative study of gambling disorder regarding alexithymia and symptoms of depression, anxiety and hostility

BACKGROUND AND AIMS

Alexithymia and psychological symptomatology have been closely associated with gambling disorder (GD). However, sex differences remain underexplored. This study aims, firstly, to explore the differences between groups (GD and no-GD) and sexes (women vs. men) in alexithymia and psychological symptomatology (depression, anxiety and hostility). Secondly, the relationship between alexithymia and psychological symptomatology was analysed by gambling and sex groups. Thirdly, it examines the moderation role of sex and gambling in the relationship between alexithymia and each psychological symptom.

METHOD

The sample was composed of 80 people with GD diagnosis and 80 without GD (40 women and 40 men in each group).

RESULTS

The results showed that alexithymia is positively related to depression, anxiety and hostility, with significantly higher scores in people with GD. Moderation analyses showed a threefold interaction, in which higher alexithymia was related to higher depression for men with GD but not for GD-women. However, in women with GD, depression levels are higher than in people without GD and tend to be more stable over time, despite the lack of effect of alexithymia.

CONCLUSIONS

These results provide evidence indicating that dysfunctional psychological symptomatology affects people with GD to a greater extent than people without GD, but also that the aetiology and effect of underlying vulnerability factors on gambling is different according to sex. The need of prevention and treatment programmes that consider different psychological aspects depending on sex is reinforced.

A Clinically Useful Anger Outcome Scale

In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we describe the development and validation of the Clinically Useful Anger Outcome Scale (CUANGOS). Current anger measures vary in their psychometric quality, clinical utility, and clinically relevant content coverage, and no one scale addresses all three of these key considerations. We aimed to develop a brief, clinically useful anger scale that (a) assesses clinically relevant aspects of anger, (b) performs well across different patient populations, and (c) is brief, accessible, and easy to use in routine clinical practice either as a stand-alone measure or as part of an assessment battery. Analyses included data from 2710 psychiatric outpatients and 1397 partial hospitalization patients. We used data from randomly drawn subsamples to select items with good psychometric properties and sufficient distinction from measurements of other emotional dysfunction, resulting in a 5-item scale. In reliability and validity analyses using the remaining participants, CUANGOS scores showed high internal consistency and appropriate test-retest reliability, as well as excellent discriminant validity from measurements of depression and anxiety. CUANGOS scores converged strongly with clinician ratings of subjective and overt anger and differentiated across all or almost all levels of clinician-rated anger severity. CUANGOS scores were also significantly higher in patients with anger-related disorders versus patients with other psychiatric disorders. Results provide promising evidence for the CUANGOS as a reliable and valid measurement of anger in clinical populations. Moreover, the CUANGOS is brief and feasible to incorporate into routine clinical practice.

Explicit and Implicit Emotional Expression in Gambling Disorder Measured by a Serious Game: A Pilot Study

Behavioral addictions have been related with biased emotional reactions to risky choices. However, few studies have analyzed the role of both explicit and implicit emotional expression in gambling disorder (GD). This pilot study aims to examine emotion regulation in treatment-seeking patients with GD. The sample included n = 35 participants classified into three groups: patients with current GD, patients with GD in remission, and a control group without GD. Implicit emotional expressions were evaluated through a serious videogame (Playmancer) and explicit emotions were measured through self-reports. Patients in the current GD group had, compared to the remission and control groups, lower levels of implicit emotion expression and higher levels of explicit emotion expression. The patients in GD remission group endorsed better emotion regulation capacity in comparison to patients with current GD. We conclude that differences in emotion expression profiles (such as anger and anxiety) should be considered both in the development of screening and diagnostic measures and in the planning of prevention and treatment programs.

Concurrent Use of Alcohol and Crack Cocaine is Associated with High Levels of Anger and Liability to Aggression

Objective: To evaluate aggressiveness in individuals receiving treatment for alcohol and crack cocaine use, both alone and in combination with one another, in order to compare them to control subjects with no history of drug problems, using the State-Trait Anger Expression Inventory. Method: The sample consisted of 67 men aged 18-65 years, divided into four groups: alcohol (n = 13); crack cocaine (n = 25); crack cocaine + alcohol (n = 16) and controls (n = 13). Participants completed the following instruments: socioeconomic questionnaire, the Wechsler Abbreviated Scale of Intelligence and the State-Trait Anger Expression Inventory. Results: Individuals with alcohol dependence alone, or comorbid with crack cocaine dependence, showed elevated levels of aggression and anger, though these varied according to the drug of abuse. Concurrent users of alcohol and crack cocaine had the highest levels of aggression, followed by isolated alcohol users, suggesting an association between alcohol consumption and aggression. Conclusion: The present findings suggest that alcohol and aggression levels may be associated with violent behavior. Concurrent use of alcohol and crack cocaine was related to higher levels of aggression, which may be associated with more severe alterations in behavior and impulse control.

Anger while driving in Mexico City

This study aims to analyze the level of anger developed by drivers in Mexico City and also understand the behavior that those drivers use to express that anger, using four different survey methods. The first focuses on personal information, the second Driving Anger Expression Inventory (DAX), the third refers to a shorten version of Driving Anger Scale (DAS) and the fourth being the Dula Dangerous Driving Index (DDDI). These have previously been applied and validated in several different countries. The questionnaires were filled out online by 626 drivers. Using the data collected through the online platform, it was possible to identify the kind of reactions volunteers displayed while driving. Also, it was possible to identify that people in Mexico City developed anger depending on their driving area. Our analyses shows that in the Adaptive/Constructive Expression subscale, males and females show a significant difference in their mean score, with women express their anger in a more constructive way than males.

Anger parameters in parolees undergoing psychoeducation: Temporal stability, social desirability bias, and comparison with non-offenders

BACKGROUND

Anger is commonly measured as if it were a single, simple construct. This may be particularly unhelpful if the main purpose of a measure is to determine change and responsiveness to interventions.

AIMS

Our primary aim was to assess five anger parameters in parolees - frequency, duration, intensity, latency, and threshold - and to test for effects of psychoeducation and social desirability bias on parolees' scores. Average anger scores for the offender sample were compared with those in a non-offender sample.

METHODS

The offender sample was drawn from male parolees in San Antonio. Age-matched volunteers recruited at public libraries were engaged for baseline comparisons. The Anger Parameters Scale and the Marlow-Crowne Scale were used to assess anger and social desirability, respectively. Parole officers delivered a psychoeducation course to parolees over 12 weeks, and anger and social desirability measures were taken before and afterwards.

RESULTS

At baseline, parolees were angry more often, stayed angry longer, and reached higher levels of anger than the non-offenders, confirming their eligibility for the programme. Mean anger scores were not significantly different after psychoeducation than before it. Parolees' reported anger was significantly and negatively correlated with social desirability scores.

CONCLUSIONS

Only three of the five anger parameters were prominent among these offenders: frequency, duration, and intensity of their outbursts. Psychoeducation did not produce improvement, possibly because it was instructional rather than therapeutic, but also because group means may mask useful individual differences. Concurrent assessment of social desirability is likely to assist in interpretation of anger measures. Copyright © 2017 John Wiley & Sons, Ltd.

21st Century Cognitive Behavioural Therapy for Anger: A Systematic Review of Research Design, Methodology and Outcome

Background:Past reviews of cognitive behavioural therapy (CBT) for anger have focused on outcome in specific subpopulations, with few questions posed about research design and methodology. Since the turn of the century, there has been a surge of methodologically varied studies awaiting systematic review.Aims:The basic aim was to review this recent literature in terms of trends and patterns in research design, operationalization of anger, and covariates such as social desirability bias (SDB). Also of interest was clinical outcome.Method:After successive culling, 42 relevant studies were retained. These were subjected to a rapid evidence assessment (REA) with special attention to design (ranked on the Scientific Methods Scale) measurement methodology (self-monitored behaviour, anger questionnaires, and others’ ratings), SDB assessment, and statistical versus clinical significance.Results:The randomized controlled trial characterized 60% of the studies, and the State Trait Anger Expression Inventory was the dominant measure of anger. All but one of the studies reported statistically significant outcome, and all but one of the 21 studies evaluating clinical significance laid claim to it. The one study with neither statistical nor clinical significance was the only one that had assessed and corrected for SDB.Conclusions:Measures remain relatively narrow in scope, but study designs have improved, and the outcomes suggest efficacy and clinical effectiveness. In conjunction with previous findings of an inverse relationship between anger and SDB, the results raise the possibility that the favourable picture of CBT for anger may need closer scrutiny with SDB and other methodological details in mind.

Alterations in the Emotional Regulation Process in Gambling Addiction: The Role of Anger and Alexithymia

This study aims at the assessment of alexithymia and anger levels in 100 treatment-seeking pathological gamblers compared with controls, who were matched for age, gender and education. Furthermore a positive correlation between alexithymia, anger and severity of gambling disorder and a relationship between gambling behaviour and anger after controlling for alexithymia, are investigated. Finally the role that gender plays in anger in pathological gamblers was also evaluated. Psychological assessment includes the South Oaks Gambling Screen, State-Trait Anger Expression Inventory-2 and the twenty-item Toronto Alexithymia Scale. Statistical analysis of the results shows a higher level of anger in pathological gamblers than in controls, together with alterations in emotional processing. Severity of gambling behaviour positively correlates with alexithymia scores, state-anger and trait-anger. Moreover, a significant contribution of anger in predicting gambling behaviour was suggested after controlling for alexithymia. In conclusion, anger and alexithymia must be regarded as relevant components of the assessment of pathological gamblers, in order to select the best therapeutical strategies to prevent self-defeating behaviours and to reduce drop-out from treatments.

Hostility and Anger in Patients Dependent on Different Psychoactive Drugs

We assessed 311 participants with dependence on opioids, stimulants, alcohol, polysubstance dependence, and a control group with no dependence using clinical structured interview, Buss-Durkee Hostility Inventory, and State-Trait Anger Expression Inventory (STAXI). Our study results demonstrated that in all groups of dependent participants anger, verbal, physical and indirect aggression are significantly higher than in control group. We found that severity and forms of aggressive behaviour in dependent patients are correlated with the type of substance abused; aggressive behaviour appeared to be correlated with the characteristics of anger. Higher level of aggressiveness, anger and irritation were in groups of polysubstance and stimulant abusers. We also found specific predictors of anger and aggression for groups of subjects dependent on different drugs.

Comparative analysis of distinct phenotypes in gambling disorder based on gambling preferences

BACKGROUND

Studies examining gambling preferences have identified the importance of the type of gambling practiced on distinct individual profiles. The objectives were to compare clinical, psychopathological and personality variables between two different groups of individuals with a gambling disorder (strategic and non-strategic gamblers) and to evaluate the statistical prediction capacity of these preferences with respect to the severity of the disorder.

METHOD

A total sample of 2010 treatment-seeking patients with a gambling disorder participated in this stand-alone study. All were recruited from a single Pathological Gambling Unit in Spain (1709 strategic and 301 non-strategic gamblers). The design of the study was cross-sectional and data were collected at the start of treatment. Data was analysed using logistic regression for binary outcomes and analysis of variance (ANOVA) for quantitative responses.

RESULTS

There were significant differences in several socio-demographic and clinical variables, as well as in personality traits (novelty seeking and cooperativeness). Multiple regression analysis showed harm avoidance and self-directedness were the main predictors of gambling severity and psychopathology, while age at assessment and age of onset of gambling behaviour were predictive of gambling severity. Strategic gambling (as opposed to non-strategic) was significantly associated with clinical outcomes, but the effect size of the relationships was small.

CONCLUSIONS

It is possible to identify distinct phenotypes depending on the preference of gambling. While these phenotypes differ in relation to the severity of the gambling disorder, psychopathology and personality traits, they can be useful from a clinical and therapeutic perspective in enabling risk factors to be identified and prevention programs targeting specific individual profiles to be developed.

Anger in pathological gambling: clinical, psychopathological, and personality correlates

The aim of this study was to explore the association between pathological gambling (PG) and anger by assessing whether psychopathology and personality are related to PG and to evaluate gender differences. The sample comprised 71 PGs and 37 healthy controls. Anger, psychopathology and personality were assessed with the STAXI-2, SCL-90-R and TCI-R respectively. Gender did not affect anger expression after stratifying by diagnostic condition (p > .05). Among PG patients, anger, psychopathology and personality measures were correlated with good effect-size (r > .30). Scores in the Anger Temperament (B = 0.21, p = .038) and Anger External-Expression (B = 0.27, p = .029) scales were positively associated with PG severity scores. Anger expression in PG should be considered in future treatment programs.

Mental health correlates of anger in the general population: findings from the 2007 National Survey of Mental Health and Wellbeing

OBJECTIVE

The aim of the present study is to examine the mental health correlates of anger in the general population using data collected as part of the 2007 Australian National Survey of Mental Health and Wellbeing (2007 NSMHWB).

METHOD

The 2007 NSMHWB was a nationally representative household survey of 8841 Australians aged between 16 and 85 years. The survey assessed for 30-day DSM-IV mental health disorders and 30-day anger symptoms.

RESULTS

A range of mood, anxiety and substance use disorders were found to be independently associated with symptoms of anger after controlling for demographics and comorbidity. These included major depressive disorder, bipolar disorder, social phobia, generalised anxiety disorder, obsessive compulsive disorder, post-traumatic stress disorder, and alcohol and drug use disorders.

CONCLUSIONS

This study is the first epidemiological investigation of the mental health correlates of anger in the Australian general population. Anger can have extremely maladaptive effects on behaviour and can lead to serious consequences for the individual and for the community. The findings of the present study denote the importance of assessing anger symptoms among individuals presenting with these common mental health disorders.

Brief anger interventions with offenders may be ineffective: A replication and extension

Anger-management interventions are widely delivered in the criminal justice and forensic mental health systems. Whilst previous research has generally supported the thesis that anger management is an effective intervention for anger problems in general there remains a need to determine its effectiveness with offender populations. This paper reports the results of a controlled outcome study of a 20 h anger-management program offered to offenders. Those receiving treatment showed improvements in their knowledge about anger, but showed little change on measures of anger and anger expression when compared to waiting-list controls. Scores on measures of treatment readiness and level of need for treatment were however, correlated with post-treatment improvement. These findings are discussed in terms of their implications for the assessment and selection of appropriate participants for offender anger-management programs.