ANGER
ANGER
MANAGEMENT
MANAGEMENT
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment
www.samhsa.gov
for Substance Abuse and
Mental Health Clients
for Subst ance Abuse and
Ment al Heal t h Cl i ent s
A Cogni t i ve Behavi or al Ther apy Manual
Patric k M. Re illy, Ph.D. Mic hae l S. Sho pshire , Ph.D.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substanc e Abuse and Me ntal He alth Se rvic e s Administratio n Ce nte r fo r Substanc e Abuse Tre atme nt
Ro c kwall II
Substanc e use and abuse o fte n c o e xist with ange r and vio le nc e . Data fro m the Substanc e Abuse and Me ntal He alth Se rvic e s Administratio n’ s Natio nal Ho use ho ld Surve y o n Drug Abuse , fo r e xample , indic ate d that 4 0 pe rc e nt o f fre que nt c o c aine use rs re po rte d e ngaging in so me fo rm o f vio le nt be havio r. Ange r and vio le nc e o fte n c an have a c ausal ro le in the initiatio n o f drug and alc o ho l use and c an also be a c o nse que nc e asso c iate d with substanc e abuse . Individuals who e xpe rie nc e traumatic e ve nts, fo r e xample , o fte n e xpe rie nc e ange r and ac t vio -le ntly, as we ll as abuse drugs o r alc o ho l.
Clinic ians o fte n se e ho w ange r and vio le nc e and substanc e use are linke d.
Many substanc e abuse and me ntal he alth c lie nts are vic tims o f traumatic life e ve nts, whic h, in turn, le ad to substanc e use , ange r, and vio le nc e .
De spite the c o nne c tio n o f ange r and vio le nc e to substanc e abuse , few tre atme nts have be e n deve lo pe d to addre ss ange r and vio le nc e pro ble ms amo ng pe o ple who abuse substanc e s. Clinic ians have fo und the de arth o f tre atme nt appro ac he s fo r this impo rtant issue dishe arte ning.
To pro vide c linic ians with to o ls to he lp de al with this impo rtant issue , the Ce nte r fo r Substanc e Abuse Tre atme nt o f the Substanc e Abuse and Me ntal He alth Se rvic e s Administratio n is
ple ase d to pre se nt Ange r Manage me nt fo r Substanc e Abus e and Me ntal He alth Clie nts : A Co gnitive Be havio ral The rapy Manualand its c o mpanio n bo o k Ange r Manage me nt fo r Substanc e Abus e and Me ntal He alth Clie nts : Partic ipant Wo rkbo o k.
The ange r manage me nt tre atme nt de sign in this manual, whic h has be e n de live re d to hun-dre ds o f c lie nts o ve r the past 8 ye ars, has be e n po pular with bo th c linic ians and c lie nts. This tre atme nt de sign c an be use d in a varie ty o f c linic al se ttings and will be be ne fic ial to the fie ld.
Charle s G. Curie , M.A., A.C.S.W. Administrato r
Substanc e Abuse and Me ntal He alth Se rvic e s Administratio n
H. We stle y Clark, M.D., J.D., M.P.H., CAS, FASAM Dire c to r
Ce nte r fo r Substanc e Abuse Tre atme nt Washingto n, D.C.
Fo re wo rd . . . iii
Intro duc tio n . . . 1
Ho w To Use This Manual . . . 5
Se ssio n 1 Ove rvie w o f Gro up Ange r Manage me nt Tre atme nt. . . 7
Se ssio n 2 Eve nts and Cue s: A Co nc e ptual Frame wo rk fo r Unde rstanding Ange r . . . 1 5 Se ssio n 3 Ange r Co ntro l Plans: He lping Gro up Me mbe rs De ve lo p a Plan fo r Co ntro lling Ange r . . . 2 1 Se ssio n 4 The Aggre ssio n Cyc le : Ho w To Change the Cyc le . . . 27
Se ssio n 5 Co gnitive Re struc turing: The A-B-C-D Mo de l and Tho ught Sto pping . . . . 3 3 Se ssio n 6 Re vie w Se ssio n # 1 : Re info rc ing Le arne d Co nc e pts . . . 37
Se ssio ns 7 & 8 Asse rtive ne ss Training and the Co nflic t Re so lutio n Mo de l: Alte rnative s fo r Expre ssing Ange r . . . 3 9 Se ssio ns 9 & 1 0 Ange r and the Family: Ho w Past Le arning Can Influe nc e Pre se nt Be havio r. . . 4 5 Se ssio n 1 1 Re vie w Se ssio n # 2 : Re info rc ing Le arne d Co nc e pts . . . 4 9 Se ssio n 1 2 Clo sing and Graduatio n: Clo sing Exe rc ise and Awarding o f Ce rtific ate s . . . 51
Re fe re nc e s . . . 5 3 Appe ndix: Autho rs’ Ac kno wle dgme nts . . . 57
This manual was de signe d fo r use by qualifie d substanc e abuse and me ntal he alth c linic ians who wo rk with substanc e abuse and me ntal he alth c lie nts with c o nc urre nt ange r pro ble ms. The manual de sc ribe s a 1 2 -we e k c o gnitive be havio ral ange r manage me nt gro up tre atme nt. Eac h o f the 1 2 9 0 -minute we e kly se ssio ns is de sc ribe d in de tail with spe c ific instruc tio ns fo r gro up le ade rs, table s and figure s that illustrate the ke y c o nc e ptual c o mpo ne nts o f the tre at-me nt, and ho at-me wo rk assignat-me nts fo r the gro up partic ipants. An ac c o mpanying Partic ipant Wo rkbo o k is available (se e Ange r Manage me nt fo r Substanc e Abus e and Me ntal He alth Clie nts : Partic ipant Wo rkbo o k, Re illy, Sho pshire , Durazzo , & Campbe ll, 2 0 0 2 ) and sho uld be use d in c o njunc tio n with this manual to e nable the partic ipants to be tte r le arn, prac tic e , and inte grate the tre atme nt strate gie s pre se nte d in the gro up se ssio ns. This inte rve ntio n was de ve l-o pe d fl-o r studie s at the San Franc isc l-o Ve te rans Affairs (SFVA) Me dic al Ce nte r and San
Franc isc o Ge ne ral Ho spital.
Co gnitive be havio ral the rapy (CBT) tre atme nts have be e n fo und to be e ffe c tive , time -limite d tre atme nts fo r ange r pro ble ms (Be c k & Fe rnande z, 1 9 9 8 ; De ffe nbac he r, 1 9 9 6 ; Trafate , 1 9 9 5 ). Fo ur type s o f CBT inte rve ntio ns, the o re tic ally unifie d by princ iple s o f so c ial le arning the o ry, are mo st o fte n use d whe n tre ating ange r diso rde rs:
• Re laxatio n inte rve ntio ns ,whic h targe t e mo tio nal and physio lo gic al c o mpo ne nts o f ange r
• Co gnitive inte rve ntio ns , whic h targe t c o gnitive pro c e sse s suc h as ho stile appraisals and attributio ns, irratio nal be lie fs, and inflammato ry thinking
• Co mmunic atio n s kills inte rve ntio ns , whic h targe t de fic its in asse rtive ne ss and c o nflic t re so -lutio n skills
• Co mbine d inte rve ntio ns ,whic h inte grate two o r mo re CBT inte rve ntio ns and targe t multiple re spo nse do mains (De ffe nbac he r, 1 9 9 6 , 1 9 9 9 ).
Me ta-analysis studie s (Be c k & Fe rnande z, 1 9 9 8 ; Edmo ndso n & Co nge r, 1 9 9 6 ; Trafate , 1 9 9 5 ) c o nc lude that the re are mo de rate ange r re duc tio n e ffe c ts fo r CBT inte rve ntio ns, with ave rage e ffe c t size s ranging fro m 0 .7 to 1 .2 (De ffe nbac he r, 1 9 9 9 ). Fro m the se studie s, it c an be
infe rre d that the ave rage partic ipant unde r CBT c o nditio ns fare d be tte r than 76 pe rc e nt o f c o n-tro l partic ipants. The se re sults are c o nsiste nt with o the r me ta-analysis studie s e xamining the e ffe c tive ne ss o f CBT inte rve ntio ns in the tre atme nt o f de pre ssio n (Do bso n, 1 9 8 9 ) and anxie ty (Van Balko m e t al., 1 9 9 4 ).
The tre atme nt mo de l de sc ribe d in this manual is a c o mbine d CBT appro ac h that e mplo ys re lax-atio n, c o gnitive , and c o mmunic lax-atio n skills inte rve ntio ns.
The ange r manage me nt tre atme nt sho uld be de live re d in a gro up se tting. The ide al numbe r o f fo r in-de pth instruc tio n and individualize d be havio ral re he arsal.
me ntal he alth tre atme nt. Ce rtain issue s, suc h as ange r re late d to c lie nts’ family o f o rigin and past le arning, fo r e xample , may be st be e xplo re d in individual and gro up the rapy o utside the ange r manage me nt gro up.
Finally, the autho rs stre ss the impo rtanc e o f pro viding o ngo ing ange r manage me nt afte rc are gro ups. Partic ipants at the SFVA Me dic al Ce nte r re pe ate dly aske d to atte nd afte rc are gro ups whe re the y c o uld c o ntinue to prac tic e and inte grate the ange r manage me nt strate gie s the y le arne d in this tre atme nt. At the SFVA Me dic al Ce nte r, bo th an o ngo ing dro p-in gro up and a mo re struc ture d 1 2 -we e k phase -two gro up we re pro vide d as afte rc are c o mpo ne nts. The se gro ups he lp partic ipants maintain (and furthe r re duc e ) the de c re ase d le ve l o f ange r and aggre ssio n the y ac hie ve d during the initial 1 2 -we e k ange r manage me nt gro up tre atme nt. Partic ipants c an also be re fe rre d to ange r manage me nt gro ups in the c o mmunity.
It is ho pe d that this ange r manage me nt manual will he lp substanc e abuse and me ntal he alth c linic ians pro vide e ffe c tive ange r manage me nt tre atme nt to c lie nts who e xpe rie nc e ange r pro b-le ms. Re duc tio ns in fre que nt and inte nse ange r and its de struc tive c o nse que nc e s c an b-le ad to impro ve d physic al and me ntal he alth o f individuals and familie s.
The info rmatio n pre se nte d in this manual is inte nde d to allo w qualifie d me ntal he alth and sub-stanc e abuse pro fe ssio nals to de live r gro up c o gnitive be havio ral ange r manage me nt tre atme nt to c lie nts with substanc e abuse and me ntal he alth diso rde rs. Eac h o f the 1 2 9 0 -minute we e kly se ssio ns is divide d into fo ur se c tio ns:
• Instruc tio ns to Gro up Le ade rs
• Che c k-In Pro c e dure (be ginning in the se c o nd se ssio n)
• Sugge ste d Re marks
• Ho me wo rk Assignme nts.
The Instruc tio ns to Gro up Le ade rs se c tio n summarize s the info rmatio n to be pre se nte d in the se ssio n and o utline s the ke y c o nc e ptual c o mpo ne nts. The Che c k-In Pro c e dure se c tio n pro vide s a struc ture d pro c e ss by whic h gro up me mbe rs c he c k in at e ac h se ssio n and re po rt o n the pro gre ss o f the ir ho me wo rk assignme nts fro m the pre vio us we e k. The Sugge ste d Re marks se c -tio n pro vide s narrative sc ripts fo r the gro up le ade r pre se nting the mate rial in the se ssio n.
Altho ugh the gro up le ade r is no t re quire d to re ad the s c ripts ve rbatim, the gro up le ade r s ho uld de live r the info rmatio n as c lo s e ly as po s s ible to the way it is in the s c ript.The Ho me wo rk Assignme nt se c tio n pro vide s instruc tio ns fo r gro up me mbe rs o n what tasks to re vie w and prac -tic e fo r the ne xt me e ting. Se ssio n 1 also inc lude s a spe c ial se c tio n that pro vide s an o ve rvie w o f the ange r manage me nt tre atme nt and o utline s the gro up rule s.
This manual sho uld be use d in c o njunc tio n with the Ange r Manage me nt fo r Substanc e Abus e and Me ntal He alth Clie nts : Partic ipant Wo rkbo o k (Re illy, Sho pshire , Durazzo , & Campbe ll, 2 0 0 2 ). The wo rkbo o k pro vide s gro up me mbe rs with a summary o f the info rmatio n pre se nte d in e ac h se ssio n, wo rkshe e ts fo r c o mple ting ho me wo rk assignme nts, and spac e to take no te s dur-ing e ac h se ssio n. The wo rkbo o k will fac ilitate the c o mple tio n o f ho me wo rk assignme nts and he lp re info rc e the c o nc e pts pre se nte d o ve r the c o urse o f the ange r manage me nt tre atme nt pro gram.
Altho ugh partic ipants are ke pt busy in e ac h se ssio n, 9 0 minute s sho uld be e no ugh time to c o mple te the tasks at hand. The gro up le ade r ne e ds to mo nito r and, at time s, limit the re spo nse s o f partic ipants, ho we ve r. This c an be do ne by re dire c ting the m to the que stio n o r ac tivity.
The Pro ble m o f Ange r: So me Ope ratio nal De finitio ns
aggre ssio n is a be havio r, ho stility is an attitude that invo lve s disliking o the rs and e valuating the m ne gative ly. he alth standpo int, avo iding physic al illne ss is a mo tivatio n fo r c o ntro lling ange r.
One diffic ulty pe o ple have whe n le arning to use the ange r me te r is misunde rstanding the me aning o f a 1 0 . A 1 0 is re se rve d fo r instanc e s whe n an individual suffe rs (o r c o uld suffe r) ne gative c o nse que nc e s. An e xample is whe n an individual assaults ano the r pe rso n and is arre ste d by the po lic e .
A se c o nd po int to make abo ut the ange r me te r is that pe o ple may inte rpre t the numbe rs o n the sc ale diffe re ntly. The se diffe re nc e s are ac c e ptable . What may be a 5 fo r o ne pe rso n may be a 7 fo r so me o ne e lse . It is muc h mo re impo rtant to pe rso nalize the ange r me te r and be c o me c o mfo rtable and familiar with yo ur re adings o f the numbe rs o n the sc ale . Fo r the gro up, ho we ve r, a 1 0 is re se rve d fo r instanc e s whe n so me o ne lo se s c o ntro l and suffe rs (o r c o uld suffe r) ne gative c o nse que nc e s.
Exhibit 1 . The Anger Meter
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• Explo sio n • Vio le nc e
• Lo ss o f Co ntro l
• Ne gative Co nse que nc e s • Yo u Lo se !
• Yo u have a c ho ic e ! • Use yo ur ange r c o ntro l
plan to avo id re ac hing 1 0 !
Hom ework Assignm ent
Have gro up me mbe rs re fe r to the partic ipant wo rkbo o k. Ask the m to re vie w the gro up’ s pur-po se , rule s, de finitio ns o f ange r and aggre ssio n, myths abo ut ange r, ange r as a habitual re spo nse , and the ange r me te r. Ask the m to mo nito r the ir le ve ls o f ange r o n the ange r me te r during the upc o ming we e k and re po rt the ir highe st le ve l o f ange r during the Che c k-In
Pro c e dure o f ne xt we e k’ s se ssio n.
A Concept ual Fr amewor k for Under st andi ng Anger
Session 2
Instructions to Group Leaders
This se ssio n te ac he s gro up me mbe rs ho w to ana-lyze an ange r e piso de and to ide ntify the e ve nts and c ue s that indic ate an e sc alatio n o f ange r. Be gin the se ssio n with a c he c k in (fo llo wing up o n the ho me wo rk assignme nt fro m the last we e k, name ly, have gro up me mbe rs re po rt o n the highe st le ve l o f ange r the y re ac he d o n the ange r me te r during the past we e k) and fo llo w with
a pre se ntatio n and disc ussio n o f e ve nts and c ue s. A mo re c o mple te Che c k-In Pro c e dure will be use d in se ssio n 3 afte r me mbe rs have be e n taught to ide ntify spe c ific ange r-pro vo king e ve nts and the c ue s that indic ate an e sc alatio n o f ange r.
Afte r the Che c k-In Pro c e dure , ask gro up me mbe rs to list spe c ific e ve nts that trigge r the ir ange r. Pay spe c ial atte ntio n to he lping the m distinguish be twe e n the e ve nts and the ir inte rpre tatio n o f the se e ve nts. Eve nts re fe r to fac ts. Inte rpre tatio ns re fe r to o pinio ns, value judgme nts, o r pe r-c e ptio ns o f the e ve nts. Fo r e xample , a gro up me mbe r might say, “My bo ss r-c ritir-c ize d me be c ause he do e sn’ t like me .” Po int o ut that the spe c ific e ve nt was that the bo ss c ritic ize d the gro up me mbe r and that the be lie f that his bo ss do e sn’ t like him is an inte rpre tatio n that may o r may no t be ac c urate .
Be aware o f ge nde r diffe re nc e s. Wo me n partic ipants o fte n ide ntify re latio nships with the ir bo yfrie nd o r partne r o r pare nting c o nc e rns as e ve nts that trigge r the ir ange r. Me n, ho we ve r, may rare ly ide ntify the se issue s as trigge rs.
Finally, pre se nt the fo ur c ue s to ange r c ate go rie s. Afte r de sc ribing e ac h c ate go ry, ask gro up me mbe rs to pro vide e xample s. It is impo rtant to e mphasize that c ue s may be diffe re nt fo r e ac h individual. Me mbe rs sho uld ide ntify c ue s that indic ate an e sc alatio n o f the ir ange r.
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Outline of Session 2
• Instructions to Group Leaders
• Suggested Rem arks
– Events That Trigger Anger
– Cues to Anger
• Explaining the Check-In
Suggested Rem arks
(Us e the fo llo wing s c ript o r put this in yo ur o wn wo rds .)
Eve nts That Trigge r Ange r
Whe n yo u ge t angry, it is be c ause an e ve nt has pro vo ke d yo ur ange r. Fo r e xample , yo u may ge t angry whe n the bus is late , whe n yo u have to wait in line at the gro c e ry sto re , o r whe n a ne ighbo r plays his ste re o to o lo ud. Eve ryday e ve nts suc h as the se c an pro vo ke yo ur ange r.
Many time s, spe c ific e ve nts to uc h o n se nsitive are as in yo ur life . The se se nsitive are as o r “re d flags” usually re fe r to lo ng-standing issue s that c an e asily le ad to ange r. Fo r e xample , so me o f us may have be e n slo w re ade rs as c hildre n and may have be e n se nsitive abo ut o ur re ading ability. Altho ugh we may re ad we ll no w as adults, we may c o ntinue to be se nsitive abo ut this issue . This se nsitivity may be re ve ale d whe n so me o ne rushe s us while we are c o mple ting an applic atio n o r re vie wing a me mo randum and may trigge r ange r be c ause we may fe e l that we are be ing c ritic ize d o r judge d as we we re whe n we we re c hildre n. This se nsitivity may also sho w itse lf in a mo re dire c t way, suc h as whe n so me o ne c alls us “slo w” o r “stupid.”
In additio n to e ve nts e xpe rie nc e d in the he re -and-no w, yo u may also re c all an e ve nt fro m yo ur past that made yo u angry. Yo u might re me mbe r, fo r e xample , ho w the bus always se e me d to be late be fo re yo u le ft ho me fo r an impo rtant appo intme nt. Just thinking abo ut ho w late the bus was in the past c an make yo u angry in the pre se nt. Ano the r e xample may be whe n yo u re c all a situatio n invo lving a family me mbe r who be traye d o r hurt yo u in so me way. Re me mbe ring this situatio n, o r this family me mbe r, c an raise yo ur numbe r o n the ange r me te r. He re are e xample s o f e ve nts o r issue s that c an trigge r ange r:
• Lo ng waits to se e yo ur do c to r
• Traffic c o nge stio n
• Cro wde d buse s
• A frie nd jo king abo ut a se nsitive to pic
• A frie nd no t paying bac k mo ne y o we d to yo u
• Be ing wro ngly ac c use d
• Having to c le an up so me o ne e lse ’ s me ss
• Having an untidy ro o mmate
• Having a ne ighbo r who plays the ste re o to o lo ud
• Be ing plac e d o n ho ld fo r lo ng pe rio ds o f time while o n the te le pho ne
• Be ing give n wro ng dire c tio ns
pro ble ms, this se lf-talk is usually ve ry c ritic al and ho stile in to ne and c o nte nt. It re fle c ts be lie fs abo ut the way the y think the wo rld sho uld be ; be lie fs abo ut pe o ple , plac e s, and things.
Clo se ly re late d to tho ughts and se lf-talk are fantasie s and image s. We vie w fantasie s and image s as o the r type s o f c o gnitive c ue s that c an indic ate an e sc alatio n o f ange r. Fo r e xample , we might fantasize abo ut se e king re ve nge o n a pe rc e ive d e ne my o r imagine o r visualize o ur spo use having an affair. Whe n we have the se fantasie s and image s, o ur ange r c an e sc alate e ve n mo re rapidly.
Can yo u think o f o the r e xample s o f c o gnitive o r tho ught c ue s?
Explaining the Check-In Procedure
In this se ssio n, gro up me mbe rs be gan to mo nito r the ir ange r and ide ntify ange r-pro vo king e ve nts and situatio ns. In e ac h we e kly se ssio n, the re will be a Che c k-In Pro c e dure to fo llo w up o n the ho me wo rk assignme nt fro m the pre vio us we e k and to re po rt the highe st le ve l o f ange r re ac he d o n the ange r me te r during the we e k.
Have partic ipants ide ntify the e ve nt that trigge re d the ir ange r, the c ue s that we re asso c iate d with the ir ange r, and the strate gie s the y use d to manage the ir ange r in re spo nse to the e ve nt. The y will be using the fo llo wing que stio ns to c he c k in at the be ginning o f e ac h se ssio n:
1 . What was the highe st numbe r yo u re ac he d o n the ange r me te r during the past we e k?
2 . What was the e ve nt that trigge re d yo ur ange r?
3 . What c ue s we re asso c iate d with the ange r-pro vo king e ve nt? Fo r e xample , what we re the physic al, be havio ral, e mo tio nal, o r c o gnitive c ue s?
4 . What strate gie s did yo u use to avo id re ac hing 1 0 o n the ange r me te r?
The y will also be aske d to mo nito r and re c o rd the highe st numbe r the y re ac h o n the ange r me te r fo r e ac h day o f the upc o ming we e k afte r e ac h se ssio n.
Exhibit 2. Cues to Anger: Four Cue Categories
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1 . Physical
(e xample s: rapid he artbe at, tightne ss in c he st, fe e ling ho t o r flushe d)2. Behavioral
(e xample s: pac ing, c le nc hing fists, raising vo ic e , staring)3. Emotional
(e xample s: fe ar, hurt, je alo usy, guilt)Hom ework Assignm ent
Have gro up me mbe rs re fe r to the partic ipant wo rkbo o k. Ask the m to mo nito r and re c o rd the ir highe st le ve l o f ange r o n the ange r me te r during the upc o ming we e k. In additio n, ask the m to ide ntify the e ve nt that made the m angry and list the c ue s that we re asso c iate d with the ange r-pro vo king e ve nt. Te ll partic ipants the y sho uld be pre pare d to re po rt o n the se assignme nts dur-ing the Che c k-In Pro c e dure in ne xt we e k’ s se ssio n.
and pro gre ssive musc le re laxatio n. Furthe r e xplain that e xpe rie nc e sho ws that gro up me mbe rs are mo re like ly to use the se simple fo rms o f re laxatio n.
Check-In Procedure
Ask gro up me mbe rs to re po rt the highe st le ve l o f ange r the y re ac he d o n the ange r me te r during the past we e k. Make sure the y re se rve the numbe r 1 0 fo r situatio ns whe re the y lo st c o ntro l o f the ir ange r and e xpe rie nc e d ne gative c o nse que nc e s. Ask the m to de sc ribe the ange r-pro vo king e ve nt that le d to the ir highe st le ve l o f ange r. He lp the m ide ntify the c ue s that o c c urre d in re spo nse to the ange r-pro vo king e ve nt, and he lp the m c lassify the se c ue s into the fo ur c ue c ate go rie s.
Exhibit 3. Event, Cues, and Strategies Identified
During the Check-In Procedure
Suggested Rem arks
(Us e the fo llo wing s c ript o r put this in yo ur o wn wo rds .)
Ange r Co ntro l Plans
Up to this po int, yo u have be e n fo c using o n ho w to mo nito r yo ur ange r. In the first se ssio n, yo u le arne d ho w to use the ange r me te r to rate yo ur ange r. Last we e k, yo u le arne d ho w to ide ntify the e ve nts that trigge r ange r, as we ll as the physic al, be havio ral, e mo tio nal, and c o gnitive c ue s asso c iate d with e ac h e ve nt. To day, yo u will be gin to disc uss ho w to de ve lo p an ange r c o ntro l plan and ho w yo u c an use spe c ific strate gie s, suc h as time o uts and re laxatio n, to c o ntro l yo ur ange r. In late r se ssio ns, yo u will c o ve r o the r strate gie s, suc h as le arning to c hange ne gative o r ho stile se lf-talk and using the Co nflic t Re so lutio n Mo de l (se e page 3 9 ). The se mo re advanc e d strate gie s c an be use d alo ng with time o uts and re laxatio n.
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Exhibit 4. Sam ple of an Anger Control Plan
Re laxatio n Thro ugh Bre athing
We have disc usse d the physic al c ue s to ange r, suc h as an inc re ase d he artbe at, fe e ling ho t o r flushe d, o r musc le te nsio n. The se type s o f physic al c ue s are e xample s o f what is c o mmo nly c alle d the stre ss re spo nse . In the stre ss re spo nse , the ne rvo us syste m is e ne rgize d, and in this agitate d state , a pe rso n is like ly to have tro uble re turning to lo we r le ve ls o n the ange r me te r. In this state , additio nal ange r-pro vo king situatio ns and e ve nts are like ly to c ause a furthe r e sc ala-tio n o f ange r.
An inte re sting aspe c t o f the ne rvo us syste m is that e ve ryo ne has a re laxatio n re spo nse that c o unte rac ts the stre ss re spo nse . It is physic ally impo ssible to be bo th agitate d and re laxe d at the same time . If yo u c an re lax suc c e ssfully, yo u c an c o unte rac t the stre ss o r ange r re spo nse .
We will e nd this se ssio n by prac tic ing a de e p-bre athing e xe rc ise as a re laxatio n te c hnique . In se ssio n 4 , we will prac tic e pro gre ssive musc le re laxatio n as a se c o ndary type o f re laxatio n te c hnique .
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Anger Control Plan
1 . Take a time o ut (fo rmal o r info rmal)
2 . Talk to a frie nd (so me o ne yo u trust)
3 . Use the Co nflic t Re so lutio n Mo de l to e xpre ss ange r
4 . Exe rc ise (take a walk, go to the gym, e tc .)
5 . Atte nd 1 2 -Ste p me e tings
Note to Group Leader:
Lead a Breathing Exercise
(Us e this s c ript o r put this in yo ur o wn wo rds .)
Ge t c o mfo rtable in yo ur c hair. If yo u like , c lo se yo ur e ye s; o r just gaze at the flo o r.
Take a fe w mo me nts to se ttle yo urse lf. No w make yo urse lf aware o f yo ur bo dy. Che c k yo ur bo dy fo r te nsio n, be ginning with yo ur fe e t, and sc an upward to yo ur he ad. No tic e any te n-sio n yo u might have in yo ur le gs, yo ur sto mac h, yo ur hands and arms, yo ur sho ulde rs, yo ur ne c k, and yo ur fac e . Try to le t go o f the te nsio n yo u are fe e ling.
No w, make yo urse lf aware o f yo ur bre athing. Pay atte ntio n to yo ur bre ath as it e nte rs and le ave s yo ur bo dy. This c an be ve ry re laxing.
Le t’ s all take a de e p bre ath to ge the r. No tic e yo ur lungs and c he st e xpanding. No w slo wly e xhale thro ugh yo ur no se . Again, take a de e p bre ath. Fill yo ur lungs and c he st. No tic e ho w muc h air yo u c an take in. Ho ld it fo r a se c o nd. No w re le ase it and slo wly e xhale . One mo re time , inhale slo wly and fully. Ho ld it fo r a se c o nd, and re le ase .
No w o n yo ur o wn, c o ntinue bre athing in this way fo r ano the r c o uple o f minute s. Co ntinue to fo c us o n yo ur bre athing. With e ac h inhalatio n and e xhalatio n, fe e l yo ur bo dy be c o ming mo re and mo re re laxe d. Use yo ur bre athing to wash away any re maining te nsio n.
(Allo w gro up me mbe rs to prac tic e bre athing fo r 1 to 2 minute s in s ile nc e .)
No w le t’ s take ano the r de e p bre ath. Inhale fully, ho ld it fo r a se c o nd, and re le ase . Inhale again, ho ld, and re le ase . Co ntinue to be aware o f yo ur bre ath as it fills yo ur lungs. Onc e mo re , inhale fully, ho ld it fo r a se c o nd, and re le ase .
Whe n yo u fe e l re ady, o pe n yo ur e ye s.
Ho w was that? Did yo u no tic e any ne w se nsatio ns while yo u we re bre athing? Ho w do yo u fe e l no w?
This bre athing e xe rc ise c an be sho rte ne d to just thre e de e p inhalatio ns and e xhalatio ns. Eve n that muc h c an be e ffe c tive in he lping yo u re lax whe n yo ur ange r is e sc alating. Yo u c an prac tic e this at ho me , at wo rk, o n the bus, while waiting fo r an appo intme nt, o r e ve n while walking. The ke y to making de e p-bre athing an e ffe c tive re laxatio n te c hnique is to prac tic e it fre que ntly and to apply it in a varie ty o f situatio ns.
Hom ework Assignm ent
Have gro up me mbe rs re fe r to the partic ipant wo rkbo o k. Ask the m to mo nito r and re c o rd the ir highe st le ve l o f ange r o n the ange r me te r during the upc o ming we e k. Ask the m to ide ntify the e ve nt that made the m angry, the c ue s that we re asso c iate d with the ange r-pro vo king e ve nt, and the strate gie s that the y use d to manage the ir ange r in re spo nse to the e ve nt. Ask the m to prac tic e the de e p-bre athing e xe rc ise , pre fe rably o nc e a day during the upc o ming we e k, and de ve lo p a pre liminary ve rsio n o f the ir ange r c o ntro l plans. Info rm gro up me mbe rs that the y sho uld be pre pare d to re po rt o n the se assignme nts during the Che c k-In Pro c e dure at the ne xt we e k’ s se ssio n.
How To Change t he Cycl e
Session 4
Instructions to Group Leaders
This se ssio n pre se nts the aggre ssio n c yc le and intro duc e s pro gre ssive musc le re laxatio n. As in the pre vio us two se ssio ns, be gin with the Che c kIn Pro c e dure . The n pre se nt the thre e -phase aggre ssio n c yc le , whic h c o nsists o f e sc a-latio n, e xplo sio n, and po ste xplo sio n. It se rve s as a frame wo rk that inc o rpo rate s the c o nc e pts o f the ange r me te r, c ue s to ange r, and the ange r c o ntro l plan.
End the se ssio n by pre se nting a pro gre ssive musc le re laxatio n e xe rc ise . Pro gre ssive musc le re laxatio n is ano the r te c hnique that has be e n e ffe c tive in re duc ing ange r le ve ls. An alte rnative to the de e p-bre athing e xe rc ise intro duc e d in last we e k’ s se ssio n, it is straightfo rward and e asy to le arn.
Check-In Procedure
Ask gro up me mbe rs to re po rt the highe st le ve l o f ange r the y re ac he d o n the ange r me te r during the past we e k. Make sure the y re se rve the numbe r 1 0 fo r situatio ns whe re the y lo st c o ntro l o f the ir ange r and e xpe rie nc e d ne gative c o nse que nc e s. Ask the m to de sc ribe the ange r-pro vo king e ve nt that le d to the ir highe st le ve l o f ange r. He lp the m ide ntify the c ue s that o c c urre d in re spo nse to the ange r-pro vo king e ve nt, and he lp the m c lassify tho se c ue s into the fo ur c ue c ate go rie s. Inc lude , as part o f the Che c k-In Pro c e dure , a fo llo wup o n the ho me wo rk assignme nt fro m the pre vio us we e k’ s se ssio n. Ask partic ipants to re po rt o n the spe c ific ange r manage me nt strate gie s liste d, thus far, o n the ir ange r c o ntro l plans. In additio n, inquire
whe the r the y prac tic e d the de e p-bre athing e xe rc ise that was intro duc e d in last we e k’ s se ssio n.
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Outline of Session 4
• Instructions to Group Leaders
• Check-In Procedure
• Suggested Rem arks
– The Aggression Cycle
– Progressive Muscle Relaxation
by sho uting at o r thre ate ning o the r pe o ple . Re gardle ss o f the se individual diffe re nc e s, the e xplo sio n phase is syno nymo us with lo sing c o ntro l and be c o ming ve rbally o r physic ally aggre ssive .
No tic e that the e sc alatio n and e xplo sio n phase s o f the aggre ssio n c yc le c o rre spo nd to the le v-e ls o n thv-e angv-e r mv-e tv-e r. Thv-e po ints bv-e lo w 1 0 o n thv-e angv-e r mv-e tv-e r rv-e prv-e sv-e nt thv-e v-e sc alatio n phase , the building up o f ange r. The e xplo sio n phase , o n the o the r hand, c o rre spo nds to 1 0 o n the ange r me te r. Again 1 0 o n the ange r me te r is the po int at whic h o ne lo se s c o ntro l and e xpre sse s ange r thro ugh ve rbal o r physic al aggre ssio n that le ads to ne gative c o nse que nc e s.
One o f the primary o bje c tive s o f ange r manage me nt tre atme nt is to ke e p fro m re ac hing the e xplo sio n phase . This is ac c o mplishe d by using the ange r me te r to mo nito r c hange s in yo ur ange r, atte nding to the c ue s o r warning signs that indic ate ange r is building, and e mplo ying the appro priate strate gie s fro m yo ur ange r c o ntro l plans to sto p the e sc alatio n o f ange r. If the e xplo sio n phase is pre ve nte d fro m o c c urring, the po ste xplo sio n phase will no t o c c ur, and the aggre ssio n c yc le will be bro ke n. If yo u use yo ur ange r c o ntro l plans e ffe c tive ly, yo ur ange r sho uld ide ally re ac h be twe e n a 1 and a 9 o n the ange r me te r. This is a re aso nable go al to aim fo r. By pre ve nting the e xplo sio n phase (1 0 ), yo u will no t e xpe rie nc e the ne gative c o nse que nc e s o f the po ste xplo sio n phase , and yo u will bre ak the c yc le o f aggre ssio n.
Exhibit 5. The Aggression Cycle
* Base d o n the Cyc le o f Vio le nc e by Le no re Walke r (1 97 9 ). The Batte re d Wo man. Ne w Yo rk: Harpe r & Ro w.
Hom ework Assignm ent
Have gro up me mbe rs re fe r to the partic ipant wo rkbo o k. During the c o ming we e k have the m mo nito r and re c o rd the ir highe st le ve l o f ange r o n the ange r me te r. Ask the m to ide ntify the e ve nt that made the m angry, the c ue s asso c iate d with the ange r-pro vo king e ve nt, and the strate gie s the y use d to manage the ir ange r in re spo nse to the e ve nt. Ask the m to re vie w the aggre ssio n c yc le and prac tic e pro gre ssive musc le re laxatio n, pre fe rably o nc e a day, during the c o ming we e k. Re mind the m to c o ntinue to de ve lo p the ir ange r c o ntro l plans.
Suggested Rem arks
xam-give me appro val.” If yo u ho ld suc h a be lie f, yo u are like ly to ge t upse t and angry whe n yo u fac e re je c tio n. Ho we ve r, if yo u dispute this irratio nal be lie f by saying, “I c an’ t ple ase e ve ryo ne ; so me pe o ple are no t go ing to appro ve o f e ve rything I do ,” yo u will mo st like ly start to c alm do wn and be able to c o ntro l yo ur ange r mo re e asily.
Ano the r c o mmo n irratio nal be lie f is, “I must be re spe c te d and tre ate d fairly by e ve ryo ne .” This also is like ly to le ad to frustratio n and ange r. Mo st fo lks, fo r e xample , live in an urban so c ie ty whe re the y may, at time s, no t be give n the c o mmo n c o urte sy the y e xpe c t. This is unfo rtunate , but fro m an ange r manage me nt pe rspe c tive , it is be tte r to ac c e pt the unfairne ss and lac k o f inte rpe rso nal c o nne c te dne ss that c an re sult fro m living in an urban so c ie ty. Thus, to dispute this be lie f, it is he lpful to te ll yo urse lf, “I c an’ t be e xpe c te d to be tre ate d fairly by e ve ryo ne .”
Othe r be lie fs that may le ad to ange r inc lude “Eve ryo ne sho uld fo llo w the rule s,” o r “Life sho uld be fair,” o r “Go o d sho uld pre vail o ve r e vil,” o r “Pe o ple sho uld always do the right thing.” The se are be lie fs that are no t always fo llo we d by e ve ryo ne in so c ie ty, and, usually, the re is little yo u c an do to c hange that. Ho w might yo u dispute the se be lie fs? In o the r wo rds, what tho ughts that are mo re ratio nal and adaptive and will no t le ad to ange r c an be substitute d fo r suc h be lie fs?
Fo r pe o ple with ange r c o ntro l pro ble ms, the se irratio nal be lie fs c an le ad to the e xplo sio n phase (1 0 o n the ange r me te r) and to the ne gative c o nse que nc e s o f the po ste xplo sio n phase . It is o fte n be tte r to c hange yo ur o utlo o k by disputing yo ur be lie fs and c re ating an inte rnal dialo g o r se lf-talk that is mo re ratio nal and adaptive .
Exhibit 6. The A-B-C-D Model
* Base d o n the wo rk o f Albe rt Ellis, 1 97 9 , and Albe rt Ellis and R.A. Harpe r, 1 97 5 .
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A -B-C-D M o d el *
A = Activating Situation or Event
B = Belief System
What yo u te ll yo urse lf abo ut the e ve nt (yo ur se lf-talk)
Yo ur be lie fs and e xpe c tatio ns o f o the rs
C = Consequence
Ho w yo u fe e l abo ut the e ve nt base d o n yo ur se lf-talk
D = Dispute
Tho ught Sto pping
A se c o nd appro ac h to c o ntro lling ange r is c alle d tho ught sto pping. It pro vide s an imme diate and dire c t alte rnative to the A-B-C-D Mo de l. In this appro ac h, yo u simply te ll yo urse lf (thro ugh a se rie s o f se lf-c o mmands) to sto p thinking the tho ughts that are ge tting yo u angry. Fo r e xample , yo u might te ll yo urse lf, “I ne e d to sto p thinking the se tho ughts. I will o nly ge t into tro uble if I ke e p thinking this way,” o r “Do n’ t buy into this situatio n,” o r “Do n’ t go the re .” In o the r wo rds, inste ad o f trying to dispute yo ur tho ughts and be lie fs as o utline d in the A-B-C-D Mo de l
de sc ribe d abo ve , the go al is to sto p yo ur c urre nt patte rn o f angry tho ughts be fo re the y le ad to an e sc alatio n o f ange r and lo ss o f c o ntro l.
Hom ework Assignm ent
Have gro up me mbe rs re fe r to the partic ipant wo rkbo o k. Ask the m to mo nito r and re c o rd the ir highe st le ve l o f ange r o n the ange r me te r during the c o ming we e k. Ask the m to ide ntify the e ve nt that made the m angry, the c ue s that we re asso c iate d with the ange r-pro vo king e ve nt, and the strate gie s the y use d to manage the ir ange r in re spo nse to the e ve nt. Ask me mbe rs to re vie w the A-B-C-D Mo de l and to re c o rd at le ast two irratio nal be lie fs and ho w the y wo uld dis-pute the se be lie fs. In additio n, instruc t the m to use the tho ught-sto pping te c hnique , pre fe rably o nc e a day during the c o ming we e k. Re mind the m to c o ntinue to de ve lo p the ir ange r c o ntro l plans.
Rei nfor ci ng Lear ned Concept s
Session 6
Instructions to Group Leaders
Co n f l i c t Reso l u t i o n M o d el
Fo r e xample , the inte rac tio n may so und like this:
Jo e : He y, Frank, s o rry I’m late .
Frank: Hi, Jo e . Can I talk to yo u abo ut that?
Jo e : Sure . Is s o me thing wro ng?
Frank: Jo e , I’ve no tic e d yo u’ve be e n late fo r the last fe w days whe n I’ve c o me to
pic k yo u up. To day, I re alize d that I was starting to fe e l frustrate d and a
bit take n fo r grante d. Whe n yo u are late , we are bo th late fo r the me e ting,
whic h make s me unc o mfo rtable . I like to be o n time . I’m wo nde ring if yo u
c an make an e ffo rt to be o n time in the future .
Jo e : Frank, I didn’t re alize ho w bo the re d yo u we re abo ut that. I apo lo gize fo r
be ing late , and I will be o n time in the future . I’m glad yo u bro ught this
pro ble m up to me .
Of c o urse , this is an ide alize d ve rsio n o f an o utc o me that may be ac hie ve d with the Co nflic t Re so lutio n Mo de l. Jo e c o uld have re spo nde d unfavo rably, o r de fe nsive ly, by ac c using Frank o f making a big de al o ut o f no thing. Jo e may have minimize d and disc o unte d Frank’ s fe e lings, le aving the c o nflic t unre so lve d.
The Co nflic t Re so lutio n Mo de l is use ful e ve n whe n c o nflic ts are no t re so lve d. Many time s, yo u will fe e l be tte r abo ut trying to re so lve a c o nflic t in an asse rtive manne r rathe r than ac ting pas-sive ly o r aggre spas-sive ly. Spe c ific ally, yo u may fe e l that yo u have do ne all that yo u c o uld do to re so lve the c o nflic t. In this e xample , if Frank de c ide d no t to give Jo e a ride in the future , o r if Frank de c ide d to e nd his frie ndship with Jo e , he c o uld do so kno wing that he first trie d to re so lve the c o nflic t in an asse rtive manne r.
Exhibit 7. The Conflict Resolution Model
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1 . Ide ntify the pro ble m that is c ausing the c o nflic t
2 . Ide ntify the fe e lings that are asso c iate d with the c o nflic t
3 . Ide ntify the impac t o f the pro ble m that is c ausing the c o nflic t
4 . De c ide whe the r to re s o lve the c o nflic t
5 . Wo rk fo r re s o lutio n o f the c o nflic t
Ho w wo uld yo u like the pro ble m to be re so lve d?
Have the gro up me mbe rs prac tic e using the Co nflic t Re so lutio n Mo de l by ro le playing. Be c are -ful no t to push gro up me mbe rs into a ro le play situatio n if the y are no t c o mfo rtable abo ut it o r re ady. Exe rc ise yo ur c linic al judgme nt.
The fo llo wing are so me to pic s fo r ro le plays:
• De aling with a rude o r unhe lpful sale sc le rk
• De aling with a physic ian who will no t take the time to e xplain ho w a me dic atio n wo rks
• De aling with a supe rviso r who do e s no t liste n to yo u
• De aling with a c o unse lo r who re pe ate dly c anc e ls yo ur the rapy/ c o unse ling se ssio ns
• De aling with a frie nd who do e s no t re spe c t yo ur privac y.
Hom ework Assignm ent
Have gro up me mbe rs re fe r to the partic ipant wo rkbo o k. Ask the m to mo nito r and re c o rd the ir highe st le ve l o f ange r o n the ange r me te r during the c o ming we e k. Ask the m to ide ntify the e ve nt that made the m angry, the c ue s that we re asso c iate d with the ange r-pro vo king e ve nt, and the strate gie s the y use d to manage the ir ange r in re spo nse to the e ve nt. Ask the m to re vie w the de finitio ns o f asse rtive ne ss, aggre ssio n, and passivity. Instruc t the m to prac tic e using the Co nflic t Re so lutio n Mo de l, pre fe rably o nc e a day during the c o ming we e k. Re mind the m to c o ntinue to de ve lo p the ir ange r c o ntro l plans.
How Past Lear ni ng Can Infl uence Pr esent Behavi or
that family issue s may bring up diffic ult and painful me mo rie s that c o uld po te ntially trigge r anxie ty, de pre ssio n, o r re lapse to drug and alc o ho l use . It is impo rtant, the re fo re , to te ll gro up me mbe rs that the y are no t re quire d to answe r any que stio ns if the y fe e l that the y wo uld be e mo tio nally o ve rwhe lme d by do ing so . Inste ad, te ll the m that the y c an pursue the se and o the r issue s with the ir individual o r gro up the rapist.7. What be havio rs, tho ughts, fe e lings, and attitude s c arry o ve r into yo ur re latio nships as adults to day? What purpo se do the se be havio rs se rve ? What wo uld happe n if yo u gave up the se be havio rs? (The gro up le ade r sho uld he lp gro up me mbe rs se e the c o nne c tio n be twe e n past so c ial le arning and the ir c urre nt be havio r.)
Hom ework Assignm ent
Have gro up me mbe rs re fe r to the partic ipant wo rkbo o k. Ask the m to mo nito r and re c o rd the ir highe st le ve l o f ange r o n the ange r me te r during the c o ming we e k. Ask the m to ide ntify the e ve nt that made the m angry, the c ue s asso c iate d with the ange r-pro vo king e ve nt, and the strate gie s the y use d to manage the ir ange r in re spo nse to the e ve nt. Re mind the m to c o ntinue to de ve lo p the ir ange r c o ntro l plans.
Rei nfor ci ng Lear ned Concept s
Session 11
Instructions to Group Leaders
In this se ssio n, the basic c o nc e pts o f ange r man-age me nt that we re pre se nte d are re vie we d and summarize d. Give spe c ial atte ntio n to c larifying and re info rc ing c o nc e pts (i.e ., the ange r me te r, c ue s
to ange r, ange r c o ntro l plans, the aggre ssio n c yc le , c o gnitive re struc turing, and c o nflic t re so lutio n). Pro vide e nc o urage me nt and suppo rt fo r e ffo rts to de ve lo p ange r c o ntro l plans and to balanc e c o gnitive , be havio ral, imme diate , and pre ve ntive strate gie s.
Check-In Procedure
Ask gro up me mbe rs to re po rt the highe st le ve l o f ange r the y re ac he d o n the ange r me te r during the past we e k. Make sure the y re se rve 1 0 fo r situatio ns whe re the y lo st c o ntro l o f the ir ange r and e xpe rie nc e d ne gative c o nse que nc e s. Ask the m to de sc ribe the ange r-pro vo king e ve nt that le d to the ir highe st le ve l o f ange r. He lp the m ide ntify the c ue s that o c c urre d in re spo nse to the ange r-pro vo king e ve nt, and he lp the m c lassify the se c ue s into the fo ur c ue c ate go rie s. Ask the m to re po rt o n the o ngo ing de ve lo pme nt o f the ir ange r c o ntro l plans.
Suggested Rem arks
(Us e the fo llo wing s c ript o r put this in yo ur o wn wo rds .)
This se ssio n invo lve s a se c o nd re vie w o f the ange r manage me nt mate rial c o ve re d in all the se ssio ns. We will re vie w e ac h c o nc e pt and c larify any que stio ns that yo u may have . We e nc o ur-age disc ussio n during this re vie w, and we will be asking yo u fo r yo ur unde rstanding o f the ange r manage me nt c o nc e pts.
Hom ework Assignm ent
Have gro up me mbe rs re fe r to the partic ipant wo rkbo o k. Ask the m to mo nito r and re c o rd the ir highe st le ve l o f ange r o n the ange r me te r during the c o ming we e k. Ask the m to ide ntify the e ve nt that made the m angry, the c ue s that we re asso c iate d with the ange r-pro vo king e ve nt, and the strate gie s the y use d to manage the ir ange r in re spo nse to the e ve nt. Ask the m to update the ir ange r c o ntro l plans and to be pre pare d to pre se nt the m in the final se ssio n ne xt we e k.
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Outline of Session 11
• Instructions to Group Leaders
• Check-In Procedure
• Suggested Rem arks
Cl osi ng Exer ci se and Awar di ng of Cer t i fi cat es
Session 1 2
Instructions to Group Leaders
In the final se ssio n, gro up me mbe rs re vie w the ir
ange r c o ntro l plans, rate the tre atme nt c o mpo ne nts fo r the ir use fulne ss and familiarity, and c o mple te a c lo sing e xe rc ise . Re vie w e ac h ange r c o ntro l plan to balanc e c o gnitive , be havio ral, imme diate and pre ve ntive strate gie s. Give c o rre c tive fe e dbac k if ne c e ssary. Co ngratulate the gro up me mbe rs fo r c o mple ting the ange r manage me nt tre atme nt. Pro vide e ac h me mbe r with a c e rtific ate o f c o mple tio n (se e sample o n the fo llo wing page ).
Suggested Rem arks
(Us e the fo llo wing s c ript o r put this in yo ur o wn wo rds .)
1 . What have yo u le arne d abo ut ange r manage me nt?
2 . List ange r manage me nt strate gie s o n yo ur ange r c o ntro l plan. Ho w c an yo u use the se strate gie s to be tte r manage yo ur ange r?
3 . In what ways c an yo u c o ntinue to impro ve yo ur ange r manage me nt skills? Are the re spe c ific are as that ne e d impro ve me nt?
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Outline of Session 12
• Instructions to Group Leaders
Ame ric an Psyc hiatric Asso c iatio n. (1 9 9 4 ). Diagno stic and Statistic al Manual o f Me ntal He alth Dis o rde rs .4 th e d. Washingto n, DC: Ame ric an Psyc hiatric Asso c iatio n. 1 9 9 4 .
Barkle y, R.A. (1 9 97 ). De fiant Childre n: A Clinic ian’s Manual fo r As s e s s me nt and Pare nt Training.2 nd e d. Ne w Yo rk: Guilfo rd Pre ss.
Be c k, R., and Fe rnande z, E. (1 9 9 8 ). Co gnitive be havio ral the rapy in the tre atme nt o f ange r: A me ta-analysis. Co gnitive The rapy and Re s e arc h, 2 2 , 6 3 -74 .
Be rko witz, L. (1 97 0 ). Expe rime ntal inve stigatio ns o f ho stility c atharsis. Jo urnal o f Co ns ulting and Clinic al Ps yc ho lo gy, 3 5 , 1 -7.
Carro ll, K.M.; Ro unsaville , B.J.; and Gawin, F.H. (1 9 9 1 ). A c o mparative trial o f psyc ho the rapie s fo r ambulato ry c o c aine abuse rs: Re lapse pre ve ntio n and inte rpe rso nal psyc ho the rapy.
Ame ric an Jo urnal o f Drug and Alc o ho l Abus e, 17 , 2 2 9 -247.
Clark, H.W.; Re illy, P.M.; Sho pshire , M.S.; and Campbe ll, T.A. (1 9 9 6 ). Ange r manage me nt tre at-me nt in c ulturally dive rse substanc e abuse patie nts. In: NIDA Re s e arc h Mo no graph: Pro ble ms o f Drug De pe nde nc e , Pro c e e dings o f the 5 8 th Annual Sc ie ntific Me e ting, Co lle ge o n Pro ble ms o f Drug De pe nde nc e . Ro c kville , MD: Natio nal Institute o n Drug Abuse .
De ffe nbac he r, J.L. (1 9 9 6 ). Co gnitive be havio ral appro ac he s to ange r re duc tio n. In: Do bso n, K.S., and Craig, K.D. (Eds.), Advanc e s in Co gnitive Be havio ral The rapy(pp. 31 -6 2 ). Tho usand Oaks, CA: Sage Public atio ns.
De ffe nbac he r, J.L. (August 1 9 9 9 ). Ange r re duc tio n inte rve ntio ns as e mpiric ally s uppo rte d inte r-ve ntio n pro grams. Pape r pre se nte d at the 1 07 th Annual Co nve ntio n o f the Ame ric an
Psyc ho lo gic al Asso c iatio n, Bo sto n.
Do bso n, K.S. (1 9 8 9 ). A me ta-analysis o f the e ffic ac y o f c o gnitive the rapy fo r de pre ssio n.
Jo urnal o f Co ns ulting and Clinic al Ps yc ho lo gy, 57 , 41 4 -41 9 .
Duc harme , J.M.; Atkinso n, L.; and Po ulto n, L. (2 0 0 0 ). Suc c e ss-base d, no nc o e rc ive tre atme nt o f o ppo sitio nal be havio r in c hildre n fro m vio le nt ho me s. Jo urnal o f the Ame ric an Ac ade my o f Child and Ado le s c e nt Ps yc hiatry, 3 9 (8 ), 9 9 5 -1 0 0 4 .
Edmo ndso n, C.B., and Co nge r, J.C. (1 9 9 6 ). A re vie w o f tre atme nt e ffic ac y fo r individuals with ange r pro ble ms: Co nc e ptual, asse ssme nt, and me tho do lo gic al issue s. Clinic al Ps yc ho lo gy Re vie w, 1 0 , 2 51 -27 5 .
Ellis, A. (1 97 9 ). Ratio nal-e mo tive the rapy. In: Co rsini, R. (Ed.), Curre nt Ps yc ho the rapie s (pp. 1 8 5 -2 2 9 ). Itasc a, Il: Pe ac o c k Publishe rs.
Sho pshire , M.S.; Re illy, P.M.; and Ouao u, R.H. (1 9 9 6 ). Ange r manage me nt strate gie s asso c iat-e d with diat-e c riat-e asiat-e d angiat-e r in substanc iat-e abusiat-e c liiat-e nts. In: NIDA Re s e arc h Mo no graph: Pro ble ms o f Drug De pe nde nc e , Pro c e e dings o f the 5 8 th Annual Sc ie ntific Me e ting (p. 2 2 6 ), Co lle ge o n Pro ble ms o f Drug De pe nde nc e . Ro c kville , MD: Natio nal Institute o n Drug Abuse .
Smo ko wski, P.R., and Wo darski, J.S. (1 9 9 6 ). Co gnitive be havio ral gro up and family tre atme nt o f c o c aine addic tio n. In: The Hathe rle igh Guide to Tre ating Substanc e Abus e, Part 1 . (pp. 171 -1 8 9 ). Ne w Yo rk: Hathe rle igh Pre ss.
Straus, M.; Ge lle s, R.; and Ste inme tz, S. (1 9 8 0 ). Be hind Clo s e d Do o rs : Vio le nc e in the Ame ric an Family. Garde n City, NY: Do uble day.
Trafate , R.C. (1 9 9 5 ). Evaluatio n o f tre atme nt strate gie s fo r adult ange r diso rde rs. In: Kassino ve , H. (Ed.), Ange r Dis o rde rs : De finitio n, Diagno s is , and Tre atme nt(pp. 1 0 9 -1 3 0 ). Washingto n, DC: Taylo r and Franc is.
Van Balko m, A.J.L.M.; Van Oppe n, P.; Ve rme ule n, A.W.A.; Van Dyc k, R.; Nauta, M.C.E.; and Vo rst, H.C.M. (1 9 9 4 ). A me ta-analysis o n the tre atme nt o f o bse ssive c o mpulsive diso rde r: A c o mpari-so n o f antide pre ssants, be havio r, and c o gnitive the rapy. Clinic al Ps yc ho lo gy Re vie w, 1 4 , 3 5 9 -3 8 1 .
Walke r, L. (1 97 9 ). The Batte re d Wo man. Ne w Yo rk: Harpe r & Ro w.
We bste r-Stratto n, C., and Hammo nd, M. (1 9 97 ). Tre ating c hildre n with e arly-o nse t c o nduc t pro ble ms: A c o mpariso n o f c hild and pare nt training inte rve ntio ns. Jo urnal o f Co ns ulting and Clinic al Ps yc ho lo gy, 6 5 (1 ), 9 3 -1 0 9 .
Yalo m, I.D. (1 9 9 5 ). The The o ry and Prac tic e o f Gro up Ps yc ho the rapy. 4 th e d. Ne w Yo rk: Basic Bo o ks, Inc .
Aut hor s’ Acknowl edgment s
The autho rs wo uld like to ac kno wle dge the fo llo wing c linic ians and re se arc he rs fo r the ir vario us c o ntributio ns to the de ve lo pme nt o f this manual:
Ro be rt Awalt, Psy.D., Pe te r Banys, M.D., To rri Campe ll, Ph.D., Darc y Co x, Ph.D., Jo hn Co yne , M.A., Timo thy Durazzo , Ph.D., Sharo n Hall, Ph.D., Antho ny Janne tti, Ph.D., Mo nika Ko c h, M.D., Pe g Maude -Griffin, Ph.D., Ro be rt Ouao u, Ph.D., Te ro n Park, Ph.D., Amy Ro se n, Psy.D., She ila Shive s, M.A., Jame s So re nse n, Ph.D., David Tho mso n, LCSW, Do nald Tuse l, M.D., David Wasse rman, Ph.D., and Lisa Wasse rman, M.A.
We wo uld also like to ac kno wle dge H. We stle y Clark, M.D., J.D., M.P.H., CAS, FASAM, Dire c to r o f the Ce nte r fo r Substanc e Abuse Tre atme nt, fo r his valuable c o ntributio ns to the e arly stage s o f this tre atme nt manual and the ange r manage me nt pro je c t. Dr. Durazzo assiste d in e diting the manual.
Jo hnso n, Bassin & Shaw, Inc ., pe rso nne l invo lve d in the pro duc tio n o f this manual and the ac c o mpanying partic ipant wo rkbo o k inc lude d Barbara Fink, M.P.H., Pro je c t Dire c to r; Nanc y He gle , Quality Co ntro l Manage r; Franc e s Ne be sky, M.A., Edito r; and Te rrie Yo ung, Graphic De signe r.
