Cognitive-Behavior Treatment of Expressed Anger in Adolescents with Conduct Disorders

Article excerpt

The incidence of school violence and aggression continues to be of concern to educators, parents, community members, researchers, and legislators. Recent surveys indicate that the American public looks upon violence and lack of discipline as the first and second most serious problems facing education today, respectively (Rose & Gallup, 1998). Yet, educators often have few alternatives when treating the problems of anger that precipitate acts of aggression.

Purpose of the study. This study examined the effectiveness of a school-based cognitive-behavioral intervention program in reducing expressions of anger and increasing strategies of anger control. The sample consisted of eight male students ages 14 to 16 previously diagnosed by mental health personnel with conduct disorder, early childhood onset, with severe symptoms.

Conduct disorder is described as a repetitive and persistent pattern of behavior in which the basic rights of others or major age appropriate societal norms or rules are violatedi (American Psychiatric Association, 1994, p. 85). Early childhood onset indicates that these repetitive and persistent behaviors were evident prior to the age of 10 years, and the behaviors were considered severe in comparison to other children with this disorder.

Methodology. A single subject pretest-posttest research design was used to assess treatment efficacy. The eight male students were pretested with Spielberger's (1991) State Trait Anger Expression Inventory (STAXI) prior to beginning their participation in 24 sessions of one-hour cognitive-behavioral intervention over eight weeks. At the conclusion of the intervention, all eight students retook the STAXI, with results analyzed by a paired samples t-test for significance of difference between pretest and posttest scores.

Treatment consisted of cognitive-behavioral intervention utilizing Selman's social cognitive principles of Pair Therapy (Selman, 1980; Selman & Schultz, 1990) and Lineham's cognitive-behavioral principles of Dialectical Behavior Therapy. Each student was paired with one other student and met with a counselor for twenty-four one-hour sessions over eight weeks. Each pair consisted of students having experienced similar anger expression difficulties, however, one student was slightly older, more mature, and somewhat less severe in symptomatology. Students would discuss situations during which others had allegedly precipitated their feelings of anger, and they would then discuss their perceptions of others' thoughts, feelings, motivations, and behavior. Role-playing and role-reversals were frequently used to assist student ability to understand the perspectives of other people.

The counselor's role shifted from onset to conclusion of the 24 sessions. In the beginning stage, the counselor empowered students to develop a sense of power, efficacy and control over the therapeutic process. In the middle stage, the therapist mediated the student's ability to engage in reciprocal problem-solving by encouraging each pair to (1) recognize and identify a problem, (2) consider possible options and outcomes, (3) choose a problem-solving strategy, and (4) plan on how to evaluate outcome. These problem-solving strategies often used rating forms provided by Lineham (1993), including an emotional regulation worksheet and a distress tolerance worksheet. In the last stage, the counselor enabled the student's ability to engage in mutually shared reflection. Throughout the three stages of counseling, the counselor worked with pairs of students to help them develop a more global perspective of the social problem and an understanding of others who were involved in the problem situation.

The manual for the State-Trait Anger Expression Inventory (STAXI) provides reliability and validity coefficients of sufficient direction and magnitude for use with male adolescents (Spielberger, 1991). STAXI provides a number of scales measuring components of anger. …