Reductions in aggression and violence following cognitive behavioural anger treatment for detained patients with intellectual disabilities.

BACKGROUND: Aggression is a significant problem amongst people with intellectual disabilities (ID), particularly those residing in hospital settings. Anger is related to aggression in secure services working people with ID, and the effectiveness of psychological interventions in reducing anger has been demonstrated in this population. However, no studies have systematically examined whether levels of aggression reduce following anger treatment with people with ID detained in secure settings. METHOD: This programme evaluation study concerns individually delivered cognitive anger treatment delivered to 50 patients (44 men and 6 women) with mild to borderline ID, delivered twice weekly for 18 sessions in a specialist forensic hospital service. Aggressive incidents and physical assault data were obtained from records 12 months pre-treatment and 12 months post-treatment. RESULTS: Following completion of treatment, the total number of aggressive incidents recorded in patients' files fell by 34.5%, and the post-treatment reduction in the number of physical assaults was 55.9%. Analysis of the data partitioned into 6-month blocks over the 24-month study period showed that significant reductions in aggressive and violent incidents occurred in the assessment intervals following anger treatment. CONCLUSIONS: These findings reinforce the efficacy of cognitive behavioural anger treatment for detained patients with ID and histories of aggression; and despite its methodical limitations the study indicates the ecological validity of this treatment approach.

Systems conceptualization and treatment of anger.

Clinicians, researchers, and patients tend to view anger as attributable to immediate circumstances and current thoughts. In contrast, systems-oriented thinking approaches anger as a contextual and dynamic phenomenon. Personal dispositional systems of anger (cognitive, physiological, and behavioral) are embedded in an interdependent network of interpersonal and environmental systems. Anger coevolves with and is in equilibrium with these systems. The more adaptive and embedded it is within a system, the greater will be its inertia or resistance to change. The automaticity of anger further challenges its regulation, as does its transfer across domains. Other troublesome systems phenomena associated with anger and aggression are escalation and threshold effects. Anger arousal, as a deviation from homeostasis, is inhibited and counteracted by various negative feedback loops that are properties of internal, interpersonal, and environmental systems. Treatment augments anger-regulatory mechanisms. Interventions aimed at anger reduction should consider the systems in which anger is embedded and the adaptive functions anger serves within those systems. These and other systems concepts are explicated and are illustrated with material from two clinical cases.

Cognitive-behavioral treatment for severe anger in posttraumatic stress disorder.

With a randomized group design, a 12-session anger treatment was evaluated with severely angry Vietnam War veterans suffering combat-related posttraumatic stress disorder (PTSD). Eight participants in anger treatment and 7 in a routine clinical care control condition completed multiple measures of anger control, anger reaction, and anger disposition, as well as measures of anxiety, depression, and PTSD at pre- and posttreatment. Controlling for pretreatment scores, significant effects were found on anger reaction and anger control measures but not on anger disposition or physiological measures. Eighteen-months follow-up (for both completers and dropouts) supported the posttreatment anger control findings. The challenges of treatment research with this refractory population are discussed.

Anger regulation deficits in combat-related posttraumatic stress disorder.

We describe a typology of regulatory deficits associated with anger in combat-related posttraumatic stress disorder (PTSD). Cognitive, arousal, and behavioral domain deficits in anger regulation were observed clinically in PTSD patients with high levels of anger who were participating in a multi-year trial of a structured anger treatment. We also describe a category of patients whose anger type we have termed "ball of rage." These patients exhibit regulatory deficits in all three domains of anger regulation. We offer a conceptual framework to advance the understanding of anger associated with PTSD and to guide its effective treatment.

Using ECA survey data to examine the effect of job layoffs on violent behavior.

OBJECTIVE: The study examined two hypotheses: that being laid off increases the likelihood of violence and that being employed in an industry in which employment is unexpectedly low decreases the likelihood of violence. METHODS: Logistic regression analyses were used to examine data for more than 4,000 persons who participated in initial and follow-up interviews as part of the Epidemiologic Catchment Area survey. Data for persons who were working and not violent at the time of the initial interview but who were unemployed at reinterview were examined, as were data for persons who remained employed in industries with low employment levels. RESULTS: The risk of violent behavior of those who were laid off was nearly six times higher than that of their employed counterparts. Controlling for concurrent psychiatric disorder did not reveal a lower risk. The risk of violent behavior was reduced among those who remained employed in industries where layoffs were occurring. CONCLUSIONS: Economic contraction seems to affect violence in the community in two countervailing processes--one process increases violence and one reduces it. However, the net effect may well be that violence decreases in communities experiencing economic contraction.

Home environmental consequences of commute travel impedance.

The physical and perceptual dimensions of commuting travel impedance were again found to have stressful consequences in a study of 99 employees of two companies. This quasi-experimental replication study, which focuses here on home environment consequences, investigated the effects of physical impedance and subjective impedance on multivariate measures of residential satisfaction and personal affect in the home. Both sets of residential outcome measures were significantly related to the two impedance dimensions. As predicted, gender was a significant moderator of physical impedance effects. Women commuting on high physical impedance routes were most negatively affected. Previously found subjective impedance effects on negative home mood, regardless of gender, were strongly replicated with several methods and were buttressed by convergent results with objective indices. The theoretical conjecture that subjective impedance mediates the stress effects of physical impedance was supported by the personal affect cluster but only for one variable in the residential satisfaction cluster. Traffic congestion has increased in metropolitan areas nationwide, and commuters, families, and organizations are absorbing associated hidden costs. The results are reviewed in terms of our ecological model, and the moderating effects of gender are discussed in terms of choice and role constraints.

Objective and subjective dimensions of travel impedance as determinants of commuting stress.

The stressful characteristics of commuting constraints are conceptualized in terms of both physical and perceptual conditions of travel impedance. This study develops and operationalizes the concept of subjective impedance, as a complement to our previously developed concept of impedance as a physically defined condition of commuting stress. The stress impacts of high-impedance commuting were examined in a study of 79 employees of two companies in the follow-up testing of a longitudinal study. Subjective impedance was overlapping but not isomorphic with physical impedance, and these two dimensions have differential relationships with health and well-being outcomes. The physical impedance construct received further confirmation in validational analyses and in predicted effects on various illness measures and job satisfaction. The newly constructed subjective impedance index was significantly related to evening home mood, residential satisfaction, and chest pain. Job change was also influenced primarily by commuting satisfaction. The results are discussed within an ecological framework emphasizing interdomain transfer effects and situational moderators of commuting stress.

Transportation, stress, and community psychology.

Conditions of transportation were investigated as sources of psychological stress as they affect the physiology, task performance, and mood of commuters. Participants in the study were 100 employees of industrial firms. Traffic congestion was construed as a behavioral constraint in terms of the concept of impedance which is defined by the parameters of distance and time. It was expected that the effects of impedance would be mediated by personality factors, such as locus of control. Multivariate tests of the internal validity of the impedance factor were significant. However, significant main effects for impedance were obtained only for mood and residential adaptation. The predicted interactions of impedance with locus of control were obtained across task performance indices. In multiple regression analyses, the distance and speed of the commute to work were found to account for significant proportions of variation in blood pressure, while several indices of personal control had significant regression effects on the task measures. The implications of the results for research in community psychology are discussed.

A stress inoculation approach to anger management in the training of law enforcement officers.

Consultation with law enforcement personnel in the area of conflict-management has typically been concerned with interpersonal rather than intrapersonal conflict. An approach to anger management that is based on cognitive self-control techniques is described as it has been used in the training of police officers. The approach follows a procedure called "stress inoculation" that has been applied to anxiety and pain (Meichenbaum, 1975). Data are presented on the anger experiences of policemen, and suggestions are offered for the selection of police candidates regarding their proneness for provocation.

The functions and regulation of the arousal of anger.

Anger is paradoxically one of the most talked about but least studied of human emotions. The author presents a model of anger arousal that emphasizes the adaptive as well as the maladaptive roles of anger in terms of the diverse functions anger serves in affecting behavior. In light of the fact that competence in anger management involves dealing with stress situations that require patience, composure, and constructive thought for their resolution, he discusses cognitive self-control processes affecting the regulation of anger.