Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Psychology Dissertations Student Dissertations, Theses and Papers 2007 Mindfulness-based and Cognitive-behavior Therapy for Anger-management : an Integrated Approach Jeffrey R. Kelly Philadelphia College of Osteopathic Medicine, [email protected] Follow this and additional works at: http://digitalcommons.pcom.edu/psychology_dissertations Part of the School Psychology Commons Recommended Citation Kelly, Jeffrey R., "Mindfulness-based and Cognitive-behavior Therapy for Anger-management : an Integrated Approach" (2007). PCOM Psychology Dissertations. Paper 68. This Dissertation is brought to you for free and open access by the Student Dissertations, Theses and Papers at DigitalCommons@PCOM. It has been accepted for inclusion in PCOM Psychology Dissertations by an authorized administrator of DigitalCommons@PCOM. For more information, please contact [email protected]. PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE DEPARTMENT OF PSYCHOLOGY Dissertation Approval This is to certify that the thesis presented to us by Jeffrey Kelly on the 30th day of May, 2006, in partial fulfillment of the requirements for the degree of Doctor of Psychology, has been examined and is acceptable in both scholarship and literary quality. Committee Members' Signatures: Diane Smallwood, Psy.D. , Chairperson George McCloskey, Ph.D. Vincent R. Stranges, Ph.D Robert A. DiTomasso, Ph.D., ABPP, Chair, Department of Psychology 111 Acknowledgements I would like to express my gratitude and appreciation to Dr. Diane Smallwood for her encouragement, guidance, and time with this dissertation project. The interest and enthusiasm she had for this project was the catalyst that kept this work moving forward. I would like to thank Dr. George McCloskey for the guidance, insight, and time he dedicated to this dissertation project. I would like to thank Dr. Rosemary Mennutti for giving me the opportunity to continue my educational career in the Doctor of Psychology in School Psychology program at the Philadelphia College of Osteopathic Medicine. I would like to thank Dr. Vincent Stranges for time and guidance he dedicated to this dissertation project. His mentoring since I started in the field of school psychology has helped me become the professional I am today. His contributions to the development of beginning psychologists and to the field of psychology should be commended. Finally, I would like to express my thanks and indebtedness to my parents, Jeffrey and Rose Kelly, without parenting and support n~ne of this would have been possible. iv Abstract This monograph presents an anger-management treatment manual utilizing mindfulness and cognitive-behavior approaches. This program was implemented and evaluated in accordance with Chen's (2005) recommendations for program evaluation. This study employed a single-subject design with a high-school aged individual. Post-session and post-program evaluation forms from the subject and program facilitator, along with pre- and post-program measures in the form of State-Trait Anger Expression Inventory (STAXI) scores, discipline records, and survey/assessment questionnaires from the parent and a teacher were obtained. The Mindfulness-Based and Cognitive-Behavioral Therapy for Anger­ Management program manual received positive ratings for the structure of the sessions, for the content in sessions, for the usefulness of the manual in implementing activities and exercises, and for the suggested readings indicated throughout the manual. Outcome measures for the participant suggested improvements in personal and social functioning. The current study suggests that the integration of mindfulness-based and cognitive-behavioral approaches to treat adolescents with anger-related difficulties is a promising intervention approach that warrants further research. v Table of Contents Chapter One 1 Introduction 1 Statement of the Problem 1 Purpose of the Study 2 Rationale for this Study 3 Anticipated Results 4 Chapter Two 6 Literature Review 6 ~ff 6 Anger Assessment 7 Operational Definition of Anger-Management 11 Anger-Management 12 Cognitive-Behavioral Therapy and Anger-Management 15 Multicultural Issues Within Anger-Management 24 Ethical Issues in Anger-Management 26 Mindfulness 28 Mindfulness-Based Therapy 29 Chapter Three 41 Mcthod 41 Design 41 Participant 42 Materials 43 vi Facilitator Training 50 Measures 52 Consent Forms 55 Procedure 56 Analysis 58 Chapter Four 60 Results 60 State-Trait Anger Expression Inventory 60 Discipline Refenals 62 Pre-Intervention Survey and Questionnaire-Parent 63 Post-Intervention Survey and Questionnaire-Parent 64 Pre-Intervention Survey-Teacher 65 Post-Intervention Survey-Teacher 67 Session One 68 Session Two 70 Session Three 72 Session Four 74 Session Five 77 Session Six 79 Session Seven 81 Session Eight 83 Session Nine 86 Session Ten 88 vii Post-Program Evaluation Forms 90 Chapter Five 94 Discussion 94 The Participant 94 Mindfulness-Based and Cognitive-Behavior Therapy for Anger-Management Program 97 Limitations 102 Future Research 104 Conclusion 106 References 108 Appendix A The Mindfulness-Based and Cognitive-Behavior Therapy For Anger-Management Manual 118 Appendix B The Mindfulness-Based and Cognitive-Behavior Therapy For Anger-Management Manual (Revised) 181 Appendix C Post-Session Evaluation Form-Participant 246 Appendix D Post-Session Evaluation Form-Facilitator 263 Appendix E Post-Program Evaluation Form-Participant 282 Vlll Appendix F Post-Program Evaluation Form-Facilitator 284 Appendix G Pre-Intervention Survey and Questionnaire-Parent 286 Appendix H Post-Intervention Survey and Questionnaire-Parent 288 Appendix I Pre-Intervention Survey-Teacher 289 Appendix J Post-Intervention Survey-Teacher 290 Appendix K Informed Consent Form 291 Appendix L Student Assent Form 297 Appendix M Recruitment Letter-School 299 Appendix N Recruitment Letter-Guardian/Student 301 ix List of Tables Table 1 PrelPost-Program Scores on the State-Trait Anger Expression Inventory 61 Table 2 Parent Pre/Post-Intervention Surveys and Questionnaires 66 Table 3 Teacher Pre/Post-Intervention Surveys 68 Table 4 Session One Post-Session Evaluation Forms 69 Table 5 Session Two Post-Session Evaluation Forms 71 Table 6 Session Three Post-Session Evaluation Forms 73 Table 7 Session Four Post-Session Evaluation Forms 75 Table 8 Session Five Post-Session Evaluation Forms 78 Table 9 Session Six Post-Session Evaluation Forms 80 Table 10 Session Seven Post-Session Evaluation Forms 82 x Table 11 Session Eight Post-Session Evaluation Forms 84 Table 12 Session Nine Post-Session Evaluation Forms 87 Table 13 Session Ten Post-Session Evaluation Forms 89 Table 14 Post-Program Evaluation Forms from the Facilitator and Participant 91 Mindfulness-Based 1 Mindfulness-Based and Cognitive-Behavior Therapy For Anger-Management: An Integrated Approach Chapter One Introduction Statement ofthe Problem Dealing with violence in the schools has become an important issue in most school districts across the United States. The highly publicized occurrences of mass killings, like the incidents in Littleton, Colorado; Jonesboro, Arkansas; and Edinboro, Pennsylvania, perpetrated by our youth upon their peers and other members of the school community have brought significant attention to the problem. However, smaller incidences of violence and aggression occur in many schools on a daily basis. The Indicators ofSchool Crime and Safety (Devoe, Peter, Kaufman, Ruddy, Miller, Planty, Snyder, & Rand, 2003) reported that 1.5 million violent incidents occurred in public elementary and secondary schools in 1999-2000. Furthermore, seventy-one percent of public schools had one or more violent incidents during that same time period. School administrators, guidance counselors, social workers, and school psychologists are some of the participants faced with the daunting task of decreasing the frequency of violent and aggressive behavior in our schools. How to effectively deal with anger and subsequent aggression has been explored and researched throughout many circles and from many perspectives (Herrman & McWhirter, 2003; Kellner & Bry, 1999; Robinson, Smith, & Miller, 2002; Webster-Stratton & Reid, 2003; Wilde, 2001). Legislation on the national and state levels has played an integral role in spurring the research in this area Mindfulness-Based 2 (Limber & Small, 2003). This has yielded a substantial amount of research in the field. From this research, school officials have implemented various initiatives including anti-bullying programs (Stevens, De Bourdeaudhuij, & Van Oost, 2001), peer mediation programs (Johnson & Johnson, 1996), and anger­ management counseling services, to highlight a few. Are these programs working? It appears that time and close monitoring will answer that question. However, the research to this point has been optimistic. Devoe et a1. (2003) reported that violent victimization declined from 48 incidents per 1,000 students to 28 per 1,000 students between the years 1992 and 2001. Although the research has been optimistic to this point, there continues to be a need for further intervention strategy development that can be used in a school setting to decrease violent and aggressive behavior invoked by anger. This monograph examines the context, assessment, and treatment of anger. Based on a review of the literature, this monograph then provides an evaluation of a pilot study that is designed to treat anger. Purpose ofthe Study This pilot study facilitated the development and refining of a mindfulness­