A Literature Review
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Modern Psychological Studies Volume 12 Number 1 Article 5 2006 Effectiveness of treatment interventions for adults suffering from anger disorders: a literature review Amy Levitt Muhlenberg College Mark J. Sciutto Muhlenberg College Follow this and additional works at: https://scholar.utc.edu/mps Part of the Psychology Commons Recommended Citation Levitt, Amy and Sciutto, Mark J. (2006) "Effectiveness of treatment interventions for adults suffering from anger disorders: a literature review," Modern Psychological Studies: Vol. 12 : No. 1 , Article 5. Available at: https://scholar.utc.edu/mps/vol12/iss1/5 This articles is brought to you for free and open access by the Journals, Magazines, and Newsletters at UTC Scholar. It has been accepted for inclusion in Modern Psychological Studies by an authorized editor of UTC Scholar. For more information, please contact [email protected]. Effectiveness of Treatment In- terventions for Adults Suffer- Amy Levitt ing from Anger Disorders: A Advisor: Professor Mark J. Sciutto, Ph.D. Literature Review Muhlenberg College Anger is a Common Problem medical problems that result from suppressed Anger plays a significant role in everyday anger are artery disease, cancer and hypertension life. Defined, it is a feeling "produced by active (Greer & Morris, 1975). processes, including remembrances of the past, expectations of the future, awareness of current Anger Should be More Frequently Addressed behavioral and physiological responses and in Treatment Outcome Literature comparison of actual to desired behaviors and Even though anger has been shown to be judgments of what others are thinking" detrimental to oneself and others, various treat- (Kassinove & Sukhodolsky, 1995, p. 177). ment outcome research expressing methods to Referred to as a harmful, phenomenological or decrease its prevalence have been extremely internal feeling state, anger encompasses percep- scarce. Therapists find it particularly odd that tual and cognitive distortions such as anger is a neglected topic in treatment literature misattributions of blame, feelings of injustice, since anger is a frequent subject in psycho- subjective labeling, negative physiological therapy. Evidence for this lack of support for alterations and tendencies to engage in socially treatment outcome research is that the primary destructive behavior. The totality of cognitive interest in the past twenty-five years based on and feeling states differentiates anger from other keywords in PsycINFO has been on anxiety and similar feelings such as sadness and anxiety. depression (Chambless & Hollon, 1998). The Sometimes anger is brief and fairly intense. neglect of anger in past literature renders little However, at other times, it is unrelenting, severe empirical help to clinical practitioners. and highly disruptive in one's life as well the As the detrimental effects of anger have been lives of loved ones, co-workers and others in known for a long time, it is imperative that a one's social network. Overt anger, also known review of treatment outcome research be per- as aggression, can lead to a negative self-con- formed to assess treatments — pharmacological cept, pessimistic judgments by others, feelings of and psychological — with the greatest efficacy. low self-worth, inability to function in the To prove efficacy, researchers should establish workplace, physical and verbal injury to self or empirically supported treatments (ESTs), i.e. others, destruction of property and family con- treatments shown to be valuable in controlled flict (Deffenbacher & Stark, 1992). Anger is research with a clearly defined population also problematic when suppressed. Examples of (Chambless & Hollon, 1998). Controlled re- 30 search allows the experimenter to infer that the dependent on his or her interpretations, thoughts effects of an experiment are due to the treatment and self-statements of real-life experiences, and not to chance or confounding factors such as desire to help patients recognize and dispute the incidence of conditions with very similar their irrational and imprecise thoughts to con- participants in terms of attitudes or physical struct more adaptive cognitions (Beck, 1976). health, or passage of time (Campbell & Stanley, This type of treatment for anger has produced an 1963). average effect size of .93, which is a large Efficacy is also best demonstrated in random- treatment effect. ized clinical trials (RCTs) — group designs in Another form of treatment that has been which individuals are randomly assigned to a proven effective in the healing of anger is Anger treatment (Chambless & Hollon, 1998). Also Management Training (Richardson & Suinn, critical to prove efficacy is replication by two or 1972). The client is asked to re-construct past more independent researchers. Replication helps experiences that have provoked angry feelings, protect from drawing incorrect assumptions of such as an argument with a significant other or the efficacy of a treatment based on one unusual co-worker. The therapist helps the patient finding. arrange these experiences in a hierarchical To identify a population for research, many fashion, with increasing levels of severity. have used the Diagnostic and Statistical Manual Concurrently, the therapist teaches the client of Mental Disorders (DSM-IV-TR) because the ways to relax him or herself. Once capable to diagnostic labels in the manual are standardized, display these relaxation techniques, the client is allowing reliable diagnoses to be made that are instructed to re-enact the least anger-provoking familiar to both clinicians and researchers. experience. Repetition ensues, with the patient Another way to identify a population for re- honing skills in associating the anger-provoking search is through cutoff scores on reliable and experience with relaxation, both in therapy and valid questionnaires or interviews identifying the at home. Relaxation is successively paired with problem of interest. However, the question arises increasing levels of anger-provoking contexts. that some internal experiences of the human The authors illustrated that Anger-management being that a researcher may desire to investigate training also has shown to be very effective, with such as anger have not been classified in the an average effect size of 1.01. DSM-IV-TR. Given the potential severity of anger-related problems, it is surprising that anger The Present Study: Comparison of Effect has received such little attention in the psycho- Sizes for Recent Treatment Outcome Re- logical literature. It is therefore imperative to search on Anger, 1995 - 2005 compare and contrast treatment intervention Despite the previous lack of treatment out- outcomes for this common physiological, behav- come studies on anger, there appears to be an ioral, cognitive and socially reinforced experi- increase in the quality of the literature and the ence, with the goal of not only finding the most number of studies within the past ten years. effective treatment programs when anger is Effect sizes for these studies and others were excessive and disruptive but possibly a separate computed to assess which measures are most categorization in the DSM-IV-TR manual. effective in the assessment of anger (self-report, physiological and behavioral), which popula- What We Know about Treatment Strategies tions were most likely to comply with treatment for Anger (voluntary versus mandated/offender), which We do have some information regarding the studies included a control/comparison group, the effectiveness of various treatments for anger. most frequently indicated treatment (Cognitive- Cognitive therapies, based on the hypothesis that Behavioral, Anger Management Training and the emotional functioning of an individual is pharmacotherapy), the range of follow-up period 31 (smallest, largest, and median duration), the sixty-one individuals participated in Anger average treatment period (smallest, largest, and Management Training, with an average sample median duration), average sample sizes and size of 140.3 per study. Other treatments used dropout, effect sizes for various measures of were Dialectical Behavior Therapy, in which the anger (anger-in, anger-out, anger control, aggres- therapist discusses recent unhealthy or danger- sion/violence) and comparison of effect sizes of ous behaviors with the client in a hierarchical treatments solely targeting anger versus anger/ manner, from its precursors to cognitive and aggression. Therefore, the purpose of this litera- behavioral barriers that prevented the client from ture review was to assess more recent research to choosing more positive behaviors, to exploring outline factors that might affect treatment out- various alternative options that the client can use come for anger, with an ultimate goal of deter- in the future. This therapy had a sample size of mining which treatments are most efficacious for eight participants. The two pharmacotherapies the treatment of anger. used were Citalopram and Topiramate. Citalopram, a selective serotonin reuptake Method inhibitor (S SRI) that is taken primarily for depression, contained forty-five participants. Materials Topiramate, an anticonvulsant, included twenty- Effect sizes, which measure the magnitude of nine participants. Both pharmacotherapies a treatment effect, were computed using a pro- significantly increased anger control. gram called POWPAL and ZUMASTAT The longest duration of a study was eleven (Gorman, Primavera, & Allison, 1995; ZumaStat months, while the shortest time period