Sexuality and the middle-aged cardiac patient.

Counseling for the resumption of sexual activity deserves as much attention in a cardiac rehabilitation program as walking or jogging. Research findings enable the counselor to give specific sexual advice. The energey expenditure during coitus for long-married couples is equivalent to that of climbing stairs, and consequently the risk of heart attack is low. However, clustering of psychosocial and physiologic demands, such as illicit affairs, outbursts of anger, alcohol, and hearty meals, may precipitate reinfarction or death. A sexual activities program is successful only if each partner is committed to give and receive pleasure. Knowledgeable and sensitive counseling will enable the couple to explore extra-coital options for lovemaking prior to the resumption of intercourse. This writer has observed that once couples are "turned on" to the pleasuring exercises, coital activity is attempted at an earlier date without untoward side effects in the cardiac patient.     

Anger management style and associations with self-efficacy and pain in male veterans.

Despite the high prevalence of anger and maladaptive anger management among persons with chronic pain, the association between pain and anger has received little empirical attention. The purpose of the current study was to investigate the relationship between pain and anger management style and test for the hypothesized role of self-efficacy as a moderator of this association. Five hundred sixty-four veterans with chronic pain were administered measures of pain, self-efficacy, and anger management. As expected, the results demonstrated a significant positive relationship between pain intensity and maladaptive anger management and a significant negative association between self-efficacy and maladaptive anger. Furthermore, pain intensity and the interaction of self-efficacy and pain intensity were significant predictors of maladaptive anger management. Surprisingly, patients reporting high self-efficacy and high pain intensity demonstrated more maladaptive anger management than individuals reporting high self-efficacy and low pain intensity. Patients reporting low self-efficacy demonstrated high levels of maladaptive anger management, regardless of pain intensity level. PERSPECTIVE: Maladaptive anger management is associated with pain intensity and self-efficacy beliefs. Additional research is needed to explore the interaction of pain and self-efficacy and its impact on anger management.     

Development and validation of Yoga Module for Anger Management in adolescents

BackgroundDevelopment of anger management programs and in particular, yoga module for anger management has not been well researched. Being a complex emotion, anger poses serious challenges in developing a comprehensive anger management program. While various theories of anger are dealt in modern psychology, several anger management techniques are set forth in Indian traditional texts. Yoga, which is considered as a holistic and integrated approach is explored in this study to develop and validate a school-based yoga program for anger management in adolescence.Materials and methodsIntegrated Approach to Yoga Therapy (IAYT) principles and literary review formed the basis for deriving the concepts of anger management. The methodology includes construction of the yoga module, validation of the module by 22 experts followed by a pilot non-randomised control study (n-50) to assess feasibility and initial effectiveness. Content Validity Ratio (CVR) and paired t-test were employed to analyse the experts’ rating and pilot-study data respectively.ResultsEmergence of IAYT based yoga program for anger management. Based on CVR ratio, 16 out of 18 yogic techniques qualified for the final module. The pilot study revealed viability of the module and its recognition as an anger management program. Significant reduction of anger scores in yoga group substantiates initial effectiveness of the module.ConclusionThe developed and validated yoga module for anger management is recognised as a well-accepted and effective yoga program for anger management in adolescents.     

Childhood Anger: So Common, Yet So Misunderstood

PURPOSE. To review findings of recent research studies on anger in children and adolescents, the outcomes of mishandled anger and interuentions to promote appropriate anger management.
SOURCE. Published literature.
CONCLUSIONS. Anger may be a healthy or unhealthy response in children experiencing small frustrations or great injustices. Research findings vary and there is a need to clearly define anger and the correlates of anger in children and adolescents. In addition, there are limited studies on anger management strategies and theiv efctiveness that would assist healthcare professionals.     

Cognitive–Behavioural Treatment of Anger Intensity among Offenders with Intellectual Disabilities

Background Aggressive behaviour has been identified as a significant problem amongst people with intellectual disabilities living in institutional settings. Anger is a key activator of aggressive behaviour, as well as being an important element of clinical distress related to adverse life experiences. There is some evidence for the value of cognitive–behavioural treatments for anger problems with people having intellectual disabilities. No controlled studies of anger treatment involving intellectually disabled offenders living in secure settings have been conducted to date. A pilot study of an elaborated anger treatment protocol for this client population was undertaken, comparing the specialised anger treatment with routine care. Methods Detained men with intellectual disabilities and histories of offending were allocated to specially modified cognitive–behavioural anger treatment (n = 9) or to routine care waiting‐list control (n = 10) conditions. Eighteen sessions of individual treatment were delivered over a period of 12 weeks. Treatment outcome was evaluated by participants' self‐report of anger intensity to an inventory of provocations and by staff‐ratings of the anger attributes of participants' ward behaviour. Results Participants' reported anger intensity was significantly lower following the anger treatment, compared to the routine care wait‐list condition. There were largely no treatment condition effects in staff‐rated anger. Limited evidence for the effectiveness of anger treatment was provided by the staff ratings of participant behaviour post‐treatment. Conclusions Detained offenders with intellectual disabilities can benefit from intensive individual cognitive–behavioural anger treatment. Further research is required to examine the mechanisms for change and their sustainability.     

Exploration of Anger Constructs in Acute and Chronic Pain Patients vs. Community Patients

Objectives: (1) Determine and compare prevalence of forms of anger (FOA; anger, hostility, aggression, anger‐in, anger‐out, chronic anger) in community nonpatients (n = 478), community patients (n = 158), acute pain patients (APPs; n = 326), chronic pain patients (CPPs; n = 341); and (2) develop FOA predictor models in APPs and CPPs. Design: A large set of items containing the FOA items was administered to the above groups, who were compared statistically for FOA endorsement. APPs and CPPs affirming the anger and chronic anger items were compared with those not affirming on all available variables including the Battery for Health Improvement (BHI‐2) with significant variables (P ≤ 0.001) utilized in predictor models for anger and chronic anger in APPs and CPPs. Setting community plus rehabilitation facilities. Results: FOA affirmation ranged from 8.28% for chronic anger in nonpatients to 37.54% for anger in CPPs. Only CPPs were more likely to affirm anger (P ≤ 0.04) and chronic anger (P ≤ 0.01) at a significantly higher rate than community patients. In both APPs and CPPs, all FOA items except anger management‐in were significantly correlated with other FOA items. For anger and chronic anger for CPPs and APPs, hostility was the strongest predictor. All models predicted anger and chronic anger significantly better than the base rate prediction. Conclusion: According to the results of this study anger and chronic anger are more frequently found in CPPs vs. community patients supporting the clinical perception that many CPPs are angry. As such,clinicians should actively screen CPPs for the presence of anger in order to engage these CPPs in anger management treatment.     

Don't look back in anger: neural correlates of reappraisal, analytical rumination, and angry rumination during recall of an anger-inducing autobiographical memory

Despite the enormous costs associated with unrestrained anger, little is known about the neural mechanisms underlying anger regulation. Behavioral evidence supports the effectiveness of reappraisal in reducing anger, and demonstrates that rumination typically maintains or augments anger. To further understand the effects of different anger regulation strategies, during functional magnetic resonance imaging 21 healthy male and female undergraduates recalled an anger-inducing autobiographical memory. They then engaged in three counterbalanced anger regulation strategies: reappraisal, analytical rumination, and angry rumination. Reappraisal produced the least self-reported anger followed by analytical rumination and angry rumination. Rumination was associated with increased functional connectivity of the inferior frontal gyrus with the amygdala and thalamus. Understanding how neural regions interact during anger regulation has important implications for reducing anger and violence.     

Emotion induction moderates effects of anger management style on acute pain sensitivity

Anger management style (AMS) is related to both acute and chronic pain intensity. Recent work suggests that an anger expressive AMS in particular may influence acute pain, and that this effect may be most pronounced during anger provocation. The present study examined whether AMS was related to subsequent pain sensitivity without regard to prior emotion induction, only when a strong negative emotion was evoked, or only when anger was provoked. Sixty-four healthy normals partook in semi-structured interviews in which they recalled and verbally described an event in which either anger, sadness, or joy was elicited. They then underwent a cold pressor pain task. Results of hierarchical multiple regressions showed that an anger expressive AMS was related positively to pain threshold only for participants in the anger-recall condition, and that this effect was largely accounted for by their low SBP reactivity during emotion induction. An anger suppressive AMS was related positively to increases in self-reported pain severity, irrespective of emotion-induction condition, and this effect was not accounted for by reactivity in any cardiovascular index. Results extend those of previous studies by illuminating the potential importance of behavioral anger expression for individuals prone to express anger in modulating their reactivity and pain sensitivity. Findings suggest that the detrimental effects of an anger expressive style on pain sensitivity may be ameliorated under conditions in which behavioral anger expression occurs. Results are discussed in terms of recent work suggesting that an expressive AMS is associated with endogenous opioid dysfunction in the absence of behavioral anger expression.     

Anger and cancer: an analysis of the linkages

The purposes of this article are to review literature on anger's link to cancer, to analyze the state of the science in this area, and to propose some directions for future research. Extremely low anger scores have been noted in numerous studies of patients with cancer. Such low scores suggest suppression, repression, or restraint of anger. There is evidence to show that suppressed anger can be a precursor to the development of cancer, and also a factor in its progression after diagnosis. Some studies indicate that it may be beneficial for patients to mobilize anger to battle their cancer. However, there is a paucity of research on the outcomes of various anger interventions. Longitudinal studies that repeatedly measure anger and other moods over the disease trajectory are needed.     

An Application of Beck's Cognitive Therapy to General Anger Reduction

Beck's cognitive therapy (CT) was compared to a no-treatment control in the reduction of anger in college students. CT lowered trait anger, anger reactivity to many potential provocations, anger in the individual's most angering ongoing situation, daily anger, anger-related physiological arousal, anger suppression, and outward negative expression. CT also enhanced positive forms of anger expression. Treatment effect sizes were medium to large, with many being quite large, and significantly more CT participants met an index of clinically significant change. Moreover, CT lowered trait anxiety and depression. Reductions of anger and trait anxiety were maintained at 15-month follow-up. CT was judged an effective, promising treatment for anger reduction.     

Theoretical and empirical perspectives on anger

This article reviews theoretical and empirical perspectives on anger as well as conceptualizations of anger through history. Although anger was once considered a sin or a madness to be avoided, Darwinian evolutionary theory and Freudian theory gave rise to a ventilationist approach that views expression of anger as an unequivocal good. However, global facilitation of anger can be harmful, and its benefits are not supported by research evidence. Other myths and assumptions about anger are challenged in this literature review. To the extent that psychiatric/mental-health nursing practice is based on inadequate theories or dated or flawed research, or both, our clients are not well served.     

Anger management training: the effects of a structured programme on the self-reported anger experience of forensic inpatients with learning disability

Within the current political climate, there is an increasing burden on mental health professionals to achieve accuracy in risk assessment and prediction. The accurate assessment and treatment of anger can make a valuable contribution towards alleviating this burden as part of a comprehensive treatment package. This study describes an anger management training programme provided to a group of three forensic inpatients with learning disability. An ABA single case study design was used, with anger levels assessed at weekly intervals before, during and after the programme. The results suggested that anger management training is useful with this client group, with established tools, such as the Novaco Anger Scale, the Spielberger State-Trait Anger Expression Inventory and the Modified Overt Aggression Scale, allowing the impact of the programme on anger levels to be evaluated. There is an indication that maintenance treatment is required to prevent anger levels increasing to pretest levels following treatment.     

Anger in early adolescent boys and girls with health manifestations

BACKGROUND: Some theorists suggest that boys and girls might experience and express anger in different ways, while others do not, making the study of sex differences in anger an important area for investigation. Further, much has been written theoretically about the health implications of anger, but there is a paucity of studies that have examined the relationship between anger and health variables in early adolescent boys and girls separately. OBJECTIVES: The objectives of this study were to examine sex differences in anger in early adolescents, and to examine the relationship between anger and several health variables, e.g., current health status, clinical health, eudaimonistic health for boys and girls separately. METHODS: This study compared differences in five anger variables between boys and girls, and examined relationships between the anger variables and health variables for boys and girls separately. The final sample consisted of 148 seventh and eighth graders, ages 12 to 14; 81 were girls and 67 were boys. They responded to the State-Trait Anger Expression Inventory and instruments measuring three health variables. RESULTS: Using multisample analysis via LISREL 7 and independent t tests, findings indicated that boys and girls did not differ in the experience and expression of anger. Pearson correlations were used to examine the relationships between the anger variables and the health variables for boys and girls separately. Of the 30 relationships examined, 12 were statistically significant; seven of these correlations were for girls, while five were for boys. CONCLUSIONS: Early adolescent boys and girls may not differ in any meaningful way in self-reported experiences and expressions of anger, but they may differ in health outcomes in relation to various types of anger.     

It hurts most around the heart: a phenomenological exploration of women's anger

Women's anger experience has been poorly understood and insufficiently researched. Yet the emotion of anger is vitally important to women's physical and mental health, and to the quality of their relationships. This phenomenological study was undertaken as an expansion and extension of the Women's Anger Study, the first large survey of the genesis, manifestations and correlates of anger in American women. Although the earlier study contributed to understanding of anger, a deeper examination of the context and meanings of anger experience was sought. Twenty-nine Caucasian women ranging in age from 21 to 66 years were interviewed. Illustrative occupations ranged from homemaker, student, waitress to business executive, professor, and human service professional. Analysis involved thematizing by the researchers independently and within a multidisciplinary phenomenological research group. The thematic structure of women's anger involved a building over time of a confusing mixture of feelings (hurt, frustration, disillusionment) precipitated by a violation of the core values of the self. The precipitant of anger was unfair and/or disrespectful treatment or lack of reciprocity in relationships. When the anger was confined within self, the woman felt helpless and powerless. However, powerlessness was also evident when anger was externalized in an outburst. To the study participants, an angry outburst meant a loss of control rather than ability to achieve control. Women reported a sense of power when using anger to restore justice, respect, and relationship reciprocity. Clinicians can assist women to reflect on their core values and use the power of their anger effectively. Further studies are in progress to examine the relevance of these findings for women of other races and cultural contexts.     

Behavioural first-aid advice on canine house-soiling problems — Part 2

ABSTRACT:

In this, the second of two articles giving first aid advice to enable nursing staff to help the owner of the house-soiling dog, we consider initial advice for owners of dogs whose house-soiling activity may be associated with anxiety or fear. The welfare of such dogs is a particular concern, as any frustration or anger that owners display on returning home to a mess will further enhance the dog's distress and may exacerbate the problem. Although such problems will need the intervention of a behaviourist who can assist the family in modifying their pet's environment and its behaviour, first aid advice is essential in helping owners to understand what should be done immediately, why they should remain calm and why specialist help is necessary.     

Perceived stress, trait anger, modes of anger expression, and health status of college men and women

Relationships among perceived stress, trait anger (general propensity to become angry), modes of anger expression, and health status were examined in a sample of 720 college students. Although stress was significantly correlated with trait anger and all four modes of anger expression, most correlations were of low magnitude. College men and women did not differ in trait anger, anger-in, or anger-out. Significant gender differences were found in only two modes of anger expression--discussing anger and expressing it somatically (women scoring higher on both). The contribution of anger variables to the variance in health status was negligible.     

Differences in Trait Anger Among Children with Varying Levels of Anger Expression Patterns

PROBLEM: Little research has been done with children to determine effects of using various patterns of anger expression on trait anger. The purpose was to examine differences in trait anger of children who indicated high, moderate, or low use of three patterns of anger expression. METHODS: A convenience sample of 1,060 third through sixth graders completed trait anger and patterns of expressing anger instruments. FINDINGS: High users of anger-out (anger expressed outwardly) had the highest trait anger for every grade while high users of anger-reflection/control had the lowest. CONCLUSIONS: Anger-reflection/control may be more effective than anger-out in reducing trait anger in school-age children.     

Two different faces of threat. Comparing the neural systems for recognizing fear and anger in dynamic body expressions

Being exposed to fear or anger signals makes us feel threatened and prompts us to prepare an adaptive response. Yet, while fear and anger behaviors are both threat signals, what counts as an adaptive response is often quite different. In contrast with fear, anger is often displayed with the aim of altering the behavior of the agent to which it is addressed. To identify brain responses that are common or specific to the perception of these two types of threat signals, we used functional magnetic resonance imaging and asked subjects to recognize dynamic actions expressing fear, anger and neutral behaviors. As compared with neutral actions, the perception of fear and anger behaviors elicited comparable activity increases in the left amygdala and temporal cortices as well as in the ventrolateral and the dorsomedial prefrontal cortex. Whereas the perception of fear elicited specific activity in the right temporoparietal junction, the perception of anger triggered condition-specific activity in a wider set of regions comprising the anterior temporal lobe, the premotor cortex and the ventromedial prefrontal cortex, consistent with the hypothesis that coping with threat from exposure to anger requires additional contextual information and behavioral adjustments.     

Cognitive and cognitive-relaxation treatments of anger

The effectiveness of cognitive and cognitive-relaxation conditions in reducing general anger were compared. By the 5-week follow-up, no differences were found between the two treatments. Relative to controls, both treatments reported significantly less general anger, anger across different situations, person-specific anger, anger-related physiological reactivity, and trait anxiety. In an analogue provocation, both groups reported less unconstructive coping than controls. Subjects in the cognitive condition reported significantly less tendency to suppress anger than controls; cognitive-relaxation subjects did not differ from cognitive or control subjects on this measure. No between-group differences were found for state anger and pulse rates in the analogues though both were low in the initial assessment, daily anger intensities, or the tendency to express anger outwardly, though the latter approached significance. A 15-month follow-up revealed maintenance of anger and anxiety reduction relative to controls, and no differences between active treatments. Implications for the treatment of general anger are discussed.