Background: In mood and anxiety (emotional) disorders, the presence of dysregulated anger is associated with a number of notable consequences including greater disorder severity and a lower likelihood of responding to treatment. Unfortunately, anger remains under recognized in this context and is rarely addressed in treatment for these disorders. Transdiagnostic treatments such as the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) have gained attention as an efficacious method for treating the range of emotional disorders. Despite being designed to be applicable to a range of pathological emotions, studies thus far have not examined the UP’s effects on emotions other than sadness or anxiety. The current study sought to further replicate the existing literature regarding associations of anger with disorder severity and examine whether the UP produced change in anger. We predicted that 1) anger would be positively associated with symptom severity and a lower likelihood of responding to treatment, and 2) the UP would produce reductions in anger.
Method: The data for this study were derived from a randomized controlled trial comparing the UP to single diagnosis protocols for the treatment of anxiety disorders. 35 patients completed an anger measure at baseline allowing for an examination of the associations between anger and symptom severity; 12 of these patients received the UP and their data were used for an examination of the effects the UP on anger. Measures used included: the hostility (anger) subscale of the Positive and Negative Affect Schedule, clinical severity rating from the Anxiety Disorders Interview Schedule, the Overall Depression Severity and Impairment Scale, and the Overall Anxiety Severity and Impairment Scale.
Results: Anger was positively associated with greater overall anxiety (r = .44, p = .008) and depression severity (r = .52, p = .001), as well as clinical severity (r - .67, p < .001) at baseline. Additionally, odds ratios indicated that when anger increased by one unit, the likelihood of responding to treatment decreased by 17% (OR = 0.17, 95% CI [0.03, 0.94]) in the overall sample. A standardized mean gain effect size indicated that the UP produced a small, but significant reduction in anger (ESsg = -0.32, SEsg = 0.16, 95% CI [-0.64 : -.001]).
Discussion: Consistent with our predictions and the current literature, anger was associated with greater disorder severity, greater overall severity of depression and anxiety symptoms at baseline, and a lower likelihood of responding to treatment. Additionally, as predicted, the UP produced a significant reduction in anger. These results suggest that the UP may be applicable to interfering emotions beyond anxiety and sadness. This finding makes strong conceptual sense as the UP was developed to target underlying mechanisms that produce a range of distressing and interfering emotions. This study has several limitations including its small sample size. Given these limitations, additional research evaluating the effect of transdiagnostic treatment on anger is warranted. The findings from this study will be discussed in relation to the application of transdiagnostic treatments to dysregulated anger.
Clair Robbins– Graduate Student, Boston University, Boston, Massachusetts
Shannon Sauer-Zavala– Research Assistant Professor, Boston University, Boston, Massachusetts
Julianne Wilner– Clinical Psychology Doctoral Student, Boston University
Kate Bentley– Massachusetts General Hospital/Harvard Medical School
Laren R. Conklin– Chalmers P. Wiley VA ACC
Todd Farchione– Research Associate Professor, Center for Anxiety and Related Disorders, Boston University, Boston, Massachusetts
David H. Barlow– Center for Anxiety and Related Disorders at Boston University
Research Assistant Professor
Research Associate Professor
Center for Anxiety and Related Disorders, Boston University