Psychomotor therapy targeting anger and aggressive behaviour in individuals with mild or borderline intellectual disabilities: A systematic review

Background: Poor anger regulation is considered a risk factor of aggression in individuals with mild or borderline intellectual disabilities. Psychomotor therapy (PMT) targets anger regulation through body- and movement-oriented interventions. This study aims to inform practitioners on efficacy and research-base of PMT in this population.

Method: This systematic review evaluated nine studies which met inclusion criteria in terms of participants, intervention procedures, outcomes and certainty of evidence.

Results: Seven studies revealed a substantial reduction of aggressive behaviour or anger. Certainty of evidence was rated inconclusive in most cases due to absence of experimental control.

Conclusions: We can conclude that body-oriented PMT, involving progressive relaxation and meditation procedure “Soles of the Feet”, is a promising approach. However, the paucity of studies and methodological limitations preclude classifying it as an evidence-based practice. This suggests stronger methodological research and research aimed at PMT’s mechanisms of action (e.g., improved interoceptive awareness) is warranted.     

Psychological,situational, and gender predictors of cardiovascular reactivity to stress: A multivariate approach

This study examined whether relationships between anger expression, hostility, social evaluative anxiety, and a presumed mechanism for coronary heart disease development, cardiovascular reactivity (CVR) to stress, are moderated by stress situation and gender and whether such relationships are attenuated by inadequate assessments. Subjects (47 men, 47 women) were assigned randomly to either a Harassment or a Social Evaluation condition, under which they performed a reaction time task. SBP, DBP, and HR measures were recorded during baseline and task. Multiple regression analyses indicated that expressed anger was related to CVR only among men in the Harassment condition; that hostile men who express anger showed the most CVR across situations, and that the traits assessed here did not predict CVR among women. Results suggest that assessments of coronary-risk and interventions to reduce risk may need to take into account attitudes, styles of emotional expression, environmental factors, and gender.This research was supported in part by an NIMH predoctoral fellowship (F31MH09836) awarded to John W. Burns and by a grant from the American Heart Association (89-01-3G) awarded to Edward S. Katkin.     

Anger Management Style and Hostility: Predicting Symptom-Specific Physiological Reactivity Among Chronic Low Back Pain Patients

It was hypothesized that anger management style (anger-in or anger-out) and hostility affect the aggravation of chronic low back pain (CLBP) through symptom-specific (i.e., lower paraspinal muscle) reactivity during stress. Subjects were 102 CLBP patients who performed mental arithmetic and an Anger Recall Interview (ARI) while trapezius and lower paraspinal EMG, SBP, DBP, and HR were recorded. Results showed anger-in × hostility and anger-out × gender interactions for lower paraspinal but not trapezius reactivity, and only during the ARI. Further analyses revealed that (1) hostility was related positively to lower paraspinal reactivity among high anger suppressors, (2) hostility was related negatively to lower paraspinal reactivity among low anger suppressors, and (3) anger expression was related positively to lower paraspinal reactivity only among men. Anger management style and hostility may contribute to the exacerbation of CLBP by influencing stress reactivity only in muscles near the site of pain or injury.     

Anger Cognitions and Cardiovascular Recovery Following Provocation

The current study describes the creation and validation of the Anger Cognitions Inventory (ACI) to assess the cognitive appraisals associated with resentful and reflective anger. The ACI was created based on a content analysis of self-reports of participants' thoughts and feelings following anger provocation in the laboratory. Exploratory and confirmatory factor analyses on two separate college student samples (N = 267 and N = 276, respectively) revealed five subscales which could validly be grouped into resentful and reflective anger. Convergent and divergent validity data showed that resentful anger correlated positively with anger-out/trait anger and reflective anger correlated positively with anger-in/brooding. A second study showed positive correlations between rumination and delayed cardiovascular recovery following anger provocation. Limitations of both studies include restricted samples which limit generalizability of results and cardiovascular recovery data collected in Study II which does not include assessment of autonomic balance between vagal and sympathetic responsivity.     

Coping strategies,hostility, and depressive symptoms: A path model

Previous studies of coping, hostility, and depressive symptoms have highlighted the significant relations between all possible pairs of these 3 variables. To more completely explore the nature of depressive symptoms, we link them all together in this study by testing a coping→hostility→depressive symptoms path model. One hundred forty participants completed psychological questionnaires measuring coping strategies, hostility, and depressive symptoms. While controlling age and social class as covariates, SPSS stepwise regression analyses were used to examine relations among these 3 constructs. Results suggest that coping has a direct relation with depressive symptoms as well as an indirect relation mediated by hostility. Passive coping may lead to increased hostility, resulting in depressive symptoms. Active coping may have the opposite effect. These findings suggest that the inclusion of measures of both coping strategies and hostility yields a more thorough understanding of concomitants of depressive symptoms. From a clinical perspective, knowing what coping strategies a person uses and how much anger they experience and express may be useful in guiding the management of depressive symptoms.     

Treating Anger and Aggression in Military Populations: Research Updates and Clinical Implications

Anger is a common symptom among military populations with posttraumatic stress disorder (PTSD); yet, anger treatment has received relatively little attention in the literature. This discrepancy is surprising given that excessive anger is a key predictor of treatment outcome in PTSD. This study seeks to (a) build a case for the importance of a more explicit approach to understanding and treating anger in our military and veteran populations, (b) summarize the current literature base on treatment factors and treatment outcomes for treating anger and related symptoms among veterans, and (c) offer clinical and research implications and recommendations based on current findings and on the expertise of the authors in completing a large‐scale study of anger treatment with veterans.     

Modifying a social problem‐solving program with the input of individuals with intellectual disabilities and their staff

Social problem‐solving programs have shown success in reducing aggressive/challenging behaviors among individuals with intellectual disabilities in clinical settings, but have not been adapted for health promotion in community settings. We modified a social problem‐solving program for the community setting of the group home. Multiple sequential methods were used to seek advice from community members on making materials understandable and on intervention delivery. A committee of group home supervisory staff gave advice on content and delivery. Cognitive interviews with individuals with intellectual disabilities and residential staff provided input on content wording and examples. Piloting the program provided experience with content and delivery. The process provides lessons on partnering with vulnerable populations and community stakeholders to develop health programs. © 2012 Wiley Periodicals, Inc. Res Nurs Health 35:610–623, 2012