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Anger Regulation
Interventions:
Research and Rationale
Karina Davidson, Ph.D.
Columbia University College of
Physicians & Surgeons
About the Instructor
Karina Davidson, Ph.D. is
an Associate Professor of
Medicine and Intervention
Research Director of the
Behavioral Cardiovascular
Health & Hypertension
Program at Columbia
College of Physicians and
Surgeons in New York.
About the Instructor
Dr. Davidson’s research focuses on
psychosocial interventions with patients with
cardiovascular disease. She is also interested
in personality intervention at the primary,
secondary, and tertiary stages of these
diseases. She has conducted randomized
controlled trials primarily in anger
management but has recently developed an
interest in depression reduction and
subsequent improvement in cardiovascular
parameters such as uncontrolled
hypertension and silent ischemia.
About the Instructor
She is the Chair of the Society of Behavioral
Medicine committee on Evidence-based
Behavioral-Medicine, a task force charged
with improving and implementing evidencebased principles for behavioral medicine
researchers, practitioners and students. She
has taught evidence-based psychotherapy
theory and practicum courses for a number
of years to clinical psychology graduate
students at both University of Alabama and
Dalhousie University.
Learning Objectives
You will learn:
 Current controversies in Anger Disorder
area
 Anger and Anger Disorder diagnosis
available
 Evidence-based criteria for judging anger
regulation interventions
 Results from anger regulation
intervention research
Performance Objectives
Appreciate the need for better diagnoses
within the Anger disorder area
 Understand the importance of evidencebased criteria for evaluating trial results

Rationale for Treating Anger
Anger has often been linked to domestic
violence (Brondolo, DiGiuseppe, &
Tafrate, 1997)
 U.S. has one of the largest homicide rates
in the world (Eckhardt & Deffenbacher,
1995).
 Anger can have a negative impact on
interpersonal and familial relationships
(Brondolo et al., 1997; Williams &
Williams, 1993)

Why should you care about
anger?
20% of Americans experience anger
problems (Williams & Williams, 1993)
 Angry clients experience a multitude of
stressors
 Angry clients are difficult to treat

Anger Assessment
Anger
COGNITIVE
BEHAVIORAL
EMOTIONAL
ANGER
IN
CYNICAL
SUSPICIOUS
ANGER
EXPERIENCE
NONVERBAL
VERBAL
Anger Assessment Cont.
ANGER
NONVERBAL
DESTRUCTIVE
ANGER
OUT
CONSTRUCTIVE
ANGER
OUT?
DESTRUCTIVE
HOSTILE
STYLE
VERBAL
CONSTRUCTIVE RUMINATIVE
DISCUSSION
DISCUSSION
HOSTILE
CONTENT
Anger Assessment: Cognitive
Cook-Medley Hostility Scale (Cook &
Medley, 1954)
 Cynicism/Mistrust subscale, Buss Durkee
Hostility Scale (Buss & Durkee, 1957)
 Anger-In subscale, Anger Expression
Scale (Spielberger, Johnson, Russell,
Crane, Jacobs, & Worden, 1985)

Anger Assessment: Emotional
Anger subscale, Aggression
Questionnaire (Buss & Perry, 1992)
 Anger Experience subscale,
Multidimensional Anger Inventory
(Siegel, 1986)
 Trait Anger Scale (Spielberger, Jacobs,
Russell, & Crane, 1983)

Anger Assessment: Behavioral
Anger Out (Spielberger et al., 1985)
 Physical and Verbal Aggression
subscales, Aggression Questionnaire
(Buss & Perry, 1992)
 Positive and Negative Anger Discussion
(Davidson, Chambers, Mason,
MacGregor & Gidron, 1997)

Anger Assessment: Observed

Modified Type A Structured Interview
(Hall & Davidson, 1995a)
– Potential for Hostility, Hostile Style
(emotional and behavioral; Hall &
Davidson, 1995b)
– Observed Anger-In, Anger-Out (cognitive;
behavioral; Gidron & Davidson, 1996)
– Observed Constructive Anger Behavior-Verbal (behavioral; Davidson et al., 2000)
Anger Disorders Assessment

Ambiguity of the operational definition
of anger disorders (DiGiuseppe, 1999).

Correlations between anger and other
negative affective traits.
Anger Disorders Assessment
Lack of diagnostic criteria in the DSMIV.
 Eckhardt and Deffenbacher (1995) have
proposed three anger disorders they
believe should be added to the DSM-IV
 The authors employed the dimensions of
angry affect, cognitive distortions, and
physiological arousal to create the
theoretical anger disorders.

Anger Disorders Assessment
Adjustment Disorder with Angry Mood,
is similar to Adjustment Disorder with
Anxiety; however, it is characterized by
an angry affect.
 Situational Anger Disorder, With
Aggression and Without Aggression
appropriate for persons who experience
intense anger reactions related to certain
situations or themes.

Anger Disorders Assessment

Generalized Anger Disorder, With and
Without Aggression resembles
Generalized Anxiety Disorder, except in
this case, the person experiences
persistent and pervasive anger (Eckhardt
& Deffenbacher, 1995; Thomas, 1998)
Anger Disorder Assessment
The Anger Disorder Scale, 6th Revision
(ADS-VI-R) is a self-report inventory
that was developed based on the
diagnostic criteria proposed by Eckhardt
and Deffenbacher (1995).
 The Anger Disorder Scale, Sixth Revision
(ADS-VI-R; DiGiuseppe & Tafrate, 1999)

Evidence-based Criteria

1. Procedures for Identifying Relevant
Treatment Outcomes
– A. Literature reviewers
– B. Literature search process
– C. Acceptable sources in the literature:
peer review required
– D. Include refuting evidence and null
findings
– E. Obtaining missing information
Criteria for Classification as a
1
Beneficial Treatment
A. At least two between-group design
studies of the same treatment treating the
same target problem,with prospective
design and random assignment of
subjects to conditions
 Findings must show the treatment to be
(1) better the control or comparison
groups on target problem assessments or
(2) equivalent to an existing empirically
supported treatment

Criteria for Classification as a
Beneficial Treatment
OR
 B. At least two within group design
studies of the same treatment treating the
same target problem, showing the
treatment to be better than the control or
comparison conditions on target problem
assessments following establishment of a
reliable baseline
Criteria for Classification as a
Beneficial Treatment
AND
 C. The majority of applicable studies
must support the treatment

D. The treatment procedures must show
acceptable adherence to the treatment
manual
Anger Regulation Interventions
Tafrate (1995) conducted a meta-analysis
of treatment outcome studies focusing on
anger
 Only 17 studies found in the literature
met inclusion criteria (e.g., adults seeking
treatment for their anger problems,
attendance at two sessions, and
comparison with another experimental
condition

Anger Regulation Interventions
The studies were grouped into the following
psychotherapy treatment strategies:
– cognitive therapies (e.g., selfinstructional training)
– relaxation-based therapies (e.g.,
systematic desensitization)
– skills-training therapies (e.g.,
assertiveness training)
– multi-component treatments (e.g., stress
inoculation and cognitive-behavioral)
Anger Regulation Interventions
Systematic Desensitization was most
effective in treating anger with an effect
size of 1.63
 followed by Multi-component and Selfinstruction therapies, both of which had
average effect sizes of 1.00
 Cognitive therapy was also found to be
effective with an effect size of .93

Anger Intervention Tailoring
Cognitive
– thought stopping
– trust building
 Behavioral
– assertiveness training

» constructive anger discussion

Emotional
– distraction
– relaxation
Intervention Tailoring for
Specific Populations
Women
 Minorities
 Elderly
 Adolescents
 Medical patients
 Physically Violent clients
 Others?

Summary
Many clients will have anger issues
 First step; Anger assessment
 Second step; Motivation for treatment
 Third step; Review evidence for anger
intervention

Where to get more information
http://pantheon.yale.edu/~tat22/empirical
ly_supported_treatments.htm
 http://www.eiconsortium.org/model_prog
rams/wlliams_lifeskills_workshop.htm
 http://www.therapeuticresources.com/8238text.html
