Anger Management Interventions for Adolescents: CBT and Beyond

Introduction

Anger is a common emotional response to events that are unexpected and unpleasant. However, sometimes this emotional response takes a more sustained and intense course, which is when it becomes dangerous. There is a real dearth of research material and very limited literature pertaining to anger management — a significant gap given that adolescent anger is a major indicator of adult violence. Even the DSM does not indicate any specific diagnostic features that characterize anger as an emotional disorder. Unchecked impulses and the absence of anger management interventions are strongly associated with adolescent violent behavior.

Over the last decade there has been an increasing incidence of violence in schools. Horrific incidents such as the Columbine school massacre have made the identification and effective control of emotional disturbances among adolescents a high priority. Some studies on the subject of anger management have shown promising results in arresting violent behavior among adolescents. The following sections examine research studies that discuss the effectiveness of various anger management methods.

Efficacy of Group Therapy: Intensive Short-Term Therapy

Snyder et al. (1999) studied the positive effects of brief intervention in the form of group therapy on adolescent subjects exhibiting severe anger. The researchers included 50 adolescent participants (28 males and 22 females) from a university psychiatric hospital. These subjects were carefully chosen after a screening of the hospital's patients, and only those adolescents who scored above 75% on the anger scale of the State-Trait Anger Expression Inventory (STAEI) qualified for the research. They were randomly assigned to either treatment groups or control groups. A four-session anger management training program was provided for adolescents in the experimental group. All subjects were rated for their anger levels, control, and aggressive behavior under experimental or control conditions. Their anger management skills and their behavior in social settings were recorded during the pre- and post-treatment phases. After two weeks of training in anger management skills, the subjects were discharged from the hospital and their progress observed in social settings.

These subjects were rated for their post-treatment behaviors by adults representing varied social settings, including nurses, schoolteachers, and parents. This follow-up stretched over a period of four to six weeks and the results were then assessed. The participants were evaluated on the Minnesota Multiphasic Personality Inventory–Adolescent (MMPI-A) anger content scale, with scores ranging from 0 to 17. An ANOVA table was constructed using the independent variables of experimental and control group membership and pre- and post-treatment time frames, while the self-reported scores of participants formed the dependent variables. Inference from the ANOVA table showed a considerable effect of the treatment method (F_1,48 = 14.3, p < .01). While the experimental group showed a decline in scores from 9.92 to 8.04, the control group registered an increase from 9.92 to 10.64, clearly indicating the efficacy of the treatment.

Ratings from nurses, teachers, and parents were also used to construct a separate ANOVA, which likewise indicated a clear improvement for the treatment subjects compared with the control group. Both the self-reported ratings and the adult ratings showed a marked reduction in disruptive behavior for the experimental group (F_1,48 = 4.43, p < .05). It was also demonstrated from the ratings for the experimental group that the gains achieved during the treatment period were successfully carried over into social settings. The results of this study indicate a positive effect of short-term intensive group therapy (Snyder et al., 1999).

Sukhodolsky et al. (2000) observed the effect of a cognitive behavioral therapy-based anger control intervention on fourth and fifth graders. A total of 33 subjects aged between 9 and 11 were chosen and separated into groups of four to seven members each. The participants received either cognitive behavioral therapy or no treatment at all. The experimental group was provided with cognitive behavioral training to analyze the factors that trigger anger in them, along with strategies for controlling the emotion. All subjects were rated on the Pediatric Anger Expression Scale, a self-reported inventory of anger, and a teacher rating scale, both before and after completion of the training program.

Cognitive Behavioral Therapy for Anger Control

The results of the study were encouraging. The teacher assessment scale showed a significant drop in aggressive behavior (p < .02) in the experimental group who received cognitive behavioral therapy compared to the control group. The experimental group also showed greater improvement (p < .05) based on self-reported anger control data (Sukhodolsky et al., 2000).

In this 1998 meta-analysis, Beck and Fernandez chose 50 studies that fulfilled the conditions of more than four subjects per study and involved CBT as one of the treatment components. In total, the 50 studies covered 1,640 patients. For each study, individual effect sizes were calculated after computing the standard deviation. The effect sizes for the individual studies were derived from self-reports of anger, behavioral ratings on aggression, and other dependent variables. With a standard deviation of 0.43, effect sizes varied from -0.32 to 1.57, and the mean effect size was .70.

Conclusion

Academic institutions and clinical settings have a significant responsibility in helping adolescents with emotional management problems and consequent disorderly behavior. Targeting anger management programs at the adolescent population provides an effective barrier against antisocial activities. The efficacy of CBT and other psychoeducational interventions as anger management methods has been demonstrated by the studies discussed above. Early intervention is paramount in preventing uncontrolled and undertrained emotions in adolescents from developing into violent and antisocial behaviors in adulthood.