Category: Anger

Symposium

Role of Dysregulated Anger on Cognitive Processing Therapy Outcomes and Its Effect on Therapeutic Processes

Saturday, November 18
12:00 PM - 1:30 PM
Location: Cobalt 501, Level 5, Cobalt Level

Keywords: Anger / Irritability | Trauma | Therapeutic Alliance
Presentation Type: Symposium

Problematic anger is correlated with higher PTSD symptom severity, even after controlling for anger as a diagnostic criterion for PTSD (Lasko et al., 1994; Novaco & Chemtob, 2002). For those seeking treatment for PTSD, some research indicates that elevated anger predicts poorer treatment response (Forbes et al., 2003; Lloyd et al., 2013); though this effect has not been consistent across studies (Elliot et al., 2005). It remains unclear how poorly controlled anger interferes with the therapeutic process.  Hypotheses include the disruptive effects of poorly controlled anger on therapeutic alliance as well as its role in negative cognitions about others, one’s safety, traumatic events and one’s coping self-efficacy.


In a secondary analysis of data from 126 women veterans and civilians, we investigated the effects of anger on changes in PTSD symptoms and therapeutic alliance among women receiving Cognitive Processing Therapy (CPT).  Self-reported anger symptoms were measured at pre- and immediately post-treatment using the Trait scale of the State-Trait Anger Expression Inventory. Participants and clinicians provided therapeutic alliance ratings at sessions 2, 6 and 12 using the Working Alliance Inventory.  PTSD symptoms were assessed using the Clinician-Administered PTSD Scale for DSM-IV (CAPS) and posttraumatic cognitions were measured using the Posttraumatic Cognition Inventory.


A linear regression model found the higher baseline anger and less change in anger during CPT, predicted higher PTSD severity ratings at post-treatment.  Those with dysregulated anger at baseline scored, on average, 12.5 CAPS point higher at post-treatment than those with lower anger. Next, we modeled whether baseline anger or changes in anger during CPT predicted changes in posttraumatic cognitions or therapeutic alliance.  We found that elevated anger did not disrupt alliance but its effect on CAPS outcomes were mediated through smaller reductions in posttraumatic cognitions during CPT.  Results suggest that dysregulated anger influences poorer PTSD treatment outcomes; although those who did resolve anger during CPT also had greater treatment benefits.  These findings will be discussed in the context of implications for PTSD clinical when anger is a prominent presentation. Future research direction will be explored.

Margaret-Anne Mackintosh

Clinical Research Psychologist
National Center for PTSD

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