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Anger Management: Cognitive Therapy Interventions
Anger Management: Cognitive Behavioral Interventions - 10 CEUs

Section 26
Cognitive-Behavior Treatment of Expressed Anger
in Adolescents with Conduct Disorders

CEU Question 26 | CEU Answer Booklet | Table of Contents | Anger Management
Counselor CEUs, Psychologist CEs, Social Worker CEUs, MFT CEUs

The effectiveness of a school-based cognitive-behavioral program in treating components of anger expression in a small sample of 14 to 16 year-old adolescents with conduct disorder is evaluated. A paired samples t-test was used to evaluate significance of difference between pretest and posttest scores on the State-Trait Anger Expression Inventory. Results indicated significant differences on measures of anger expression, anger control and state anger. No significant difference was noted for trait anger. Limitations of the research design are discussed, and recommendations for additional research are provided.

The incidence of school violence and aggression continues to be of concern to educators, parents, community members, researchers, and legislators. Recent surveys indicate that the American public looks upon violence and lack of discipline as the first and second most serious problems facing education today, respectively. Yet, educators often have few alternatives when treating the problems of anger that precipitate acts of aggression.

Purpose of the study.
This study examined the effectiveness of a school-based cognitive-behavioral intervention program in reducing expressions of anger and increasing strategies of anger control. The sample consisted of eight male students ages 14 to 16 previously diagnosed by mental health personnel with conduct disorder, early childhood onset, with severe symptoms.

Conduct disorder is described as a repetitive and persistent pattern of behavior in which the basic rights of others or major age appropriate societal norms or rules are violated. Early childhood onset indicates that these repetitive and persistent behaviors were evident prior to the age of 10 years, and the behaviors were considered severe in comparison to other children with this disorder.

Methodology.

A single subject pretest/posttest research design was used to assess treatment efficacy. The eight male students were pretested with Spielberger's (1991) State Trait Anger Expression Inventory (STAXI) prior to beginning their participation in 24 sessions of one-hour cognitive-behavioral intervention over eight weeks. At the conclusion of the intervention, all eight students retook the STAXI, with results analyzed by a paired samples t-test for significance of difference between pretest and posttest scores.

Treatment consisted of cognitive-behavioral intervention utilizing Selman's social cognitive principles of Pair Therapy and Lineham's cognitive-behavioral principles of Dialectical Behavior Therapy. Each student was paired with one other student and met with a counselor for twenty-four one-hour sessions over eight weeks. Each pair consisted of students having experienced similar anger expression difficulties, however, one student was slightly older, more mature, and somewhat less severe in symptomatology.

Students would discuss situations during which others had allegedly precipitated their feelings of anger, and they would then discuss their perceptions of others' thoughts, feelings, motivations, and behavior. Role-playing and role-reversals were frequently used to assist student ability to understand the perspectives of other people.

The counselor's role shifted from onset to conclusion of the 24 sessions. In the beginning stage, the counselor empowered students to develop a sense of power, efficacy and control over the therapeutic process. In the middle stage, the therapist mediated the student's ability to engage in reciprocal problem-solving by encouraging each pair to (1) recognize and identify a problem, (2) consider possible options and outcomes, (3) choose a problem-solving strategy, and (4) plan on how to evaluate outcome.

These problem-solving strategies often used rating forms provided by Lineham (1993), including an emotional regulation worksheet and a distress tolerance worksheet. In the last stage, the counselor enabled the student's ability to engage in mutually shared reflection. Throughout the three stages of counseling, the counselor worked with pairs of students to help them develop a more global perspective of the social problem and an understanding of others who were involved in the problem situation.

The manual for the State-Trait Anger Expression Inventory (STAXI) provides reliability and validity coefficients of sufficient direction and magnitude for use with male adolescents. STAXI provides a number of scales measuring components of anger. The STAXI Anger Expression scale provides a general index of the frequency by which anger is expressed, and is based on responses to items in scales measuring anger control, anger-in, and anger-out. The STAXI Anger Control scale measures the frequency with which attempts are made to control expressions of anger. The STAXI Anger-in scale measures the frequency with which angry feelings are suppressed. The STAXI Anger-out scale measures the frequency with which angry feelings are expressed to others.
The STAXI State Anger scale measures intensity of angry feelings at a particular time and situation. The STAXI Trait Anger scale measures the disposition to experience anger over time; and also includes a temperamental scale (viz., STAXI Trait/Temperament), which measures a general propensity to express anger without any provocation; and a reactive anger scale (STAXI Trait/Reaction), which measures a disposition to express anger when treated unfairly by other individuals.

Alpha level .05 was originally selected to analyze significance of difference between pretest and posttest means. STAXI allows for eight separate comparisons. Therefore, a Bonferroni correction was used to control for Type I error, resulting in an alpha level of .0063 required for significance of difference between pretest and posttest means.

Results.

The paired samples t-tests indicated mixed results across STAXI scales when using a Bonferroni correction for multiple comparisons requiring an alpha level of .0063. The eight students in the anger management program demonstrated significantly reduced anger expression from pretest to posttest, t(7) = 7.20, p < .001; and they demonstrated a significant increase in anger control, t (7) = 4.58, p = .003. Anger-in expression did not change from pretest to posttest, t (7) = 1.528, p = .170; however, anger-out expression was significantly lower at posttest than pretest, t (7) = 4.965, p = .002.

The eight students in the anger management program demonstrated a significant reduction in state anger from pretest to posttest, t (7) = 6.619, p < .001. However, there was no significant reduction in trait anger, t (7) = 2.966, p < .021; which also included no significant difference for trait anger-temperament, t (7) = 1.426, 11 < .197, and for trait anger-reactivity, t (7) = 2.646, 11 = .033.

Discussion.

Violence in the schools has posed a vivid problem warranting the attention of educators, parents, community members, legislators, and researchers, and the incidence of aggressive acts has accentuated a need to assess the effectiveness of programs designed to treat youths with predispositions to commit acts of aggression. This study looked at the effectiveness of one such program.

Results from the study show that students demonstrating inappropriate expressions of anger can benefit from a cognitive-behavioral intervention program.

In particular, students receiving cognitive behavioral intervention based upon social cognitive understanding and dialectical behavioral problem-solving were able to reduce the inappropriate expressions of anger and maintain more adequate control of angry feelings. These results suggest that anger management programs can have effective outcomes at the school site.

Despite these positive results, the data demonstrate that an eight week intervention program may be more successful in treating the situational aspects of anger expression than treating the underlying dispositions of anger expression. To this extent, brief exposure to anger management may be insufficient for youth with a history of conduct problems.

This study was based on a single small sample of 14 to 16 year-old male adolescents with a history of severe conduct problems. Additional study of this topic would benefit from the use of comparison groups to better establish treatment conditions contributing to the treatment's internal validity. The use of larger groups of students with a broader age range and involving both males and females with a variety of anger-severity levels can help with questions of external validity. In this way, subsequent research holds much promise for identifying the cognitive, behavioral, and psychodynamic factors of treatment that best modify the thoughts, feelings, motivations and behaviors of students predisposed to acts of violence.
 -Dykeman, Bruce. Education, Winter2000, Vol. 121 Issue 2, p298
The article above contains foundational information. Articles below contain optional updates.

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Personal Reflection Exercise #12
The preceding section contained information about Cognitive-Behavior Treatment of Expressed Anger in Adolescents with Conduct Disorders. Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 26
How did Dykeman's study results suggest that brief exposure to anger management may be insufficient for youth with a history of conduct problems? Record the letter of the correct answer the CEU Answer Booklet

 
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