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Anger is a ubiquitous and potentially destructive emotion, and problem anger is at least as common across community, clinical and forensic contexts as mood or anxiety disorders. Yet anger has been relatively neglected in the world of psychology—it is strangely overlooked in abnormal psychology courses and in current psychopathology classification systems; and current anger treatments, while promising, lag behind comparable treatments for mood or anxiety disorders in terms of their theoretical rationales, evidence base and effectiveness. Cognitive appraisal models of anger are well supported by emotion research as well as gaining support in clinical treatment studies. However, very few current cognitive treatments for anger adequately target the appraisals hypothesised to be driving anger, namely construals of external blame and illegitimacy. A new, more theoretically robust treatment for anger is therefore sorely needed. In the broader clinical world, there has been an increasing trend toward flexibly-delivered self-help treatment modalities, developed to improve dissemination and reduce treatment costs. Such pragmatic advantages are especially relevant for an anger treatment because current mental health practitioners frequently lack training and experience in this area, and very few specialized services exist for angry populations. Self-help treatments, predominantly in the medium of bibliotherapy, have been shown to be effective across a wide range of treatments and disorders, but are untested for anger. To remedy this, with the help of Associate Professor Ross Menzies, I have developed a new cognitive treatment for anger. self-help book for anger, a 155-page treatment manual entitled The Anger Fallacy (which has since been published, Laurent & Menzies, 2013). In addition to cognitively challenging anger-provoking appraisals, this book also attempts to challenge positive meta-beliefs about anger’s utility, and strong image identification with anger. This thesis presents the rationale for and development of this treatment, as well as its initial trial. Participants: 24 adults from around Australia were recruited via social media announcements of a treatment trial for anger. They were found to be largely in the “high” or “very high” ranges on measures of trait anger at pre-assessment. Pre/post measures: Trait anger, as well as indices of anger expression and control, were measured at pre and post-intervention and at nine-month follow-up using the State-Trait Anger Expression Inventory, 2nd Edition (STAXI-2) and the Novaco Anger Scale and Provocation Inventory (NAS-PI). Procedure: After pre-assessment, all participants were sent a hard copy of the bibliotherapy anger program to read at their own pace. They reported reading progress as well as weekly anger Likert ratings and Depression, Anxiety and Stress Scale (DASS) scores in response to weekly email prompts. “Post” was defined as immediately after the participant completed the book, or at three months (whichever came first). Follow-up assessment was taken at nine months after completion. Results: A linear mixed models analysis was run to compare pre- and post- scores, as well as preand follow-up scores. Participants showed a high rate of book completion (average pages read was 108 of 155). There were marked pre-post improvements on almost all measures, with effect sizes of 1.42 and 1.68 on Trait Anger and NAS total scores respectively. At follow-up, improvements were maintained on the whole, with some slight regression on some measures. DASS scores also improved slightly over the course of reading, suggesting that there was no unintended distress occasioned by the book. Exploratory analyses of chapter-by-chapter change scores, as well as changes in anger ratings examined at various intermediary parts of the book additionally suggested there were no subsections of the book that significantly aggravated or disturbed the readers. |
