Therapy for AngerTherapy for Anger

Chap 21Chap 21

IntroductioIntroductionn

The treatment of anger-based disordersThe treatment of anger-based disorders

PurposePurpose

Describe the further development of a cognitive Describe the further development of a cognitive behavior therapy: stress inoculationbehavior therapy: stress inoculation

Apply to a hospitalized depressive with anger problemApply to a hospitalized depressive with anger problem

Prior application: Prior application: Anxiety, Pain Anxiety, Pain

MethodMethod

Treatment ProcedureTreatment Procedure Cognitive PreparationCognitive Preparation

Skill Acquisition and RehearsalSkill Acquisition and Rehearsal

Application PracticeApplication Practice

MethodMethod

Treatment ProcedureTreatment Procedure Cognitive PreparationCognitive Preparation

Shared language systemShared language system

Introduce rationale of the treatment Introduce rationale of the treatment approachapproach

Instruction manual: nature & functions Instruction manual: nature & functions of angerof anger

MethodMethod

Treatment ProcedureTreatment Procedure Skill Acquisition and RehearsalSkill Acquisition and Rehearsal

Alternative view situations of provocationAlternative view situations of provocation Cognitive: task orientationCognitive: task orientation self-instructionself-instruction Affective: relaxation skillsAffective: relaxation skills sense of humorsense of humor Behavioral goals: Behavioral goals:

effective communication of feelingseffective communication of feelingstask-oriented, problem-solving task-oriented, problem-solving

actionaction

MethodMethod

Treatment ProcedureTreatment Procedure Application PracticeApplication Practice

ExposedExposed to manageable doses of anger stimuli to manageable doses of anger stimuli

Imaginal, then role-playing inductionsImaginal, then role-playing inductions

Hierarchy of anger situationsHierarchy of anger situations

MethodMethod

Case HistoryCase History Subject’s work situationSubject’s work situation SymptomsSymptoms HospitalizationHospitalization Reaction to stressful situationsReaction to stressful situations Previous treatmentPrevious treatment

MethodMethod Dependent MeasuresDependent Measures

Behavior ratingBehavior rating by clinical psychologist with 9 years of postdoctoralby clinical psychologist with 9 years of postdoctoral

Dichotomous ratingsDichotomous ratings− Expression of anger: Expression of anger: 1414 項行為描述項行為描述 (Antagonism-upset)(Antagonism-upset)− Constructive coping: Constructive coping: 88 項行為描述項行為描述

Scaled ratingsScaled ratings (8-point scale)(8-point scale)− RelaxedRelaxed− Demonstrated angerDemonstrated anger− Restrained angerRestrained anger

MethodMethod

Dependent MeasuresDependent Measures Self-monitored ratingsSelf-monitored ratings 7-point scale7-point scale

Frequency of angerFrequency of anger

Degree of arousalDegree of arousal

Degree of managementDegree of management

住院時期住院時期 : : 只測週末回家時只測週末回家時 出院之後出院之後 : : 每天測量每天測量

結果結果

Figure 1Figure 1

Figure 2Figure 2

問題問題 Single-subject design in clinical studieSingle-subject design in clinical studie

s s 該有的特殊考慮？該有的特殊考慮？ 為何必須提供完整的 為何必須提供完整的 case historycase history ？？ 該研究如何確認實驗處理的效果？該研究如何確認實驗處理的效果？ 該研究的 該研究的 baseline baseline 較短，為何如此設計？較短，為何如此設計？有何利弊得失？有何利弊得失？