Anger Management Treatment – REBT, Relaxation, and Response Prevention
Abstract of Anger Management Treatment Study
Anger episodes are associated with aggression, interpersonal dysfunction, poor decision making, substance abuse, and when intense enough even stroke and heart attack. Various anger management techniques have been employed to reduce dysfunctional anger. Relaxation, cognitive restructuring, and skills based approaches have all produced significant decreases in self-reported anger. These have been based on general Cognitive Behavior Therapy (CBT). Fewer studies have collected physiological measures of anger with regard to changes in coping with anger. Perhaps more importantly it is even less common for an anger episode to be recorded physiologically while an individual engages in a particular coping strategy. Typically, a measure such as blood pressure is taken at pre- and post, not during an anger episode.
Understanding the phenomenological aspects of both an anger episode and the influence of modes of coping will better inform clinicians and clients alike. This experiment was conducted in order to obtain data while participants were both experiencing an anger episode and coping with it. The effects of four coping strategies in response to verbal provocation on self-reported anger, heart rate (HR), and Galvanic skin response (GSR) were examined in this study. The four coping strategies were rational coping (Rational Emotive Behavior Therapy, REBT), diaphragmatic breathing, typical coping, and a no-response control. The rational group rehearsed four rational statements. The breathing group took four deep diaphragmatic breaths. The typical group recited four common irrational beliefs that most of us would engage in after being provoked. The no-response control remained quiet and was not directed to modulate their cognitions.
Forty university students who scored in the upper quartile of the Trait Anger Scale participated. They were randomly assigned to one of the four conditions. Their ages ranged from 17 to 22 years. Students who reported a medical problem, which might have affected anger or indicated a health risk were excluded. A 4 X 3 mixed design was used. There were four levels of treatment and three levels of time. With regard to time, psychophysiological measures were taken during a baseline period and during a verbal provocation period, which was separated into two equal periods, intra-test #1 and intra-test #2. The State Anger Scale was administered to assess self-reported anger experience before and after anger was provoked. An experimenter provoked anger by verbally insulting participants. Forty-five verbal provocations, referred to as barbs (Kaufman & Wagner, 1972), were delivered separated by a 25 second interval during which the participants responded with the assigned coping response. One experimenter administered the State Anger Scales, informed consent forms, and attached and monitored the physiological recording devices. A second experimenter had no contact with the participant until entering the laboratory to deliver the barbs.
Anger Management Hypotheses
Main effects for time and treatment on the physiological measures (HR and GSR) and self-reported state anger were expected. In addition, it was hypothesized that participants in the diaphragmatic breathing and rational statement conditions would experience less anger than participants in the no-response control condition and the typical statement condition on the state anger scales. Preliminary analyses confirm these hypotheses. Further analyses will examine the time issue to evaluate if there was an increase from baseline to time #1 and a decrease from time #1 to time #2 on HR and GSR. Additionally, comparisons by treatment will determine if participants in the rational statement rehearsal condition and diaphragmatic breathing condition scored lower than participants in the typical statement rehearsal condition and the no-response control conditions on state anger as well as HR and GSR during the verbal insult phase.
The preliminary findings indicate that the verbal insults did elicit a physiological response as well as a self-reported increase of anger experience. It also indicates that engaging in diaphragmatic breathing and reciting rational coping (REBT) statements are useful techniques while reciting “typical” irrational beliefs aloud or simply not responding verbally, result in an increased anger response.
These results further bolster evidence that cognitive behavioral techniques reduce self-reported anger experience. More importantly they indicate that these techniques mitigate dangerous physiological responses during an anger episode. Therefore, given that cardiac reactivity is considered one mechanism associated with cardiovascular health, further research is needed to assess the impact of anger management techniques on the physical health of angry individuals who are at-risk for stroke, heart attacks, and hypertension.