Fernandez, E., Iwuala, E. Perez, B., Sun, R., Garza, R., White, K.M., Kolaparthi, K., Barnes, W., Dorvil, N., & Wu, W. (in press). CBAT outcomes on anger and opioid misuse in chronic pain patients. International Journal of Pain .
How was anger treated? CBT
In the late 20th century, Cognitive Behavioral Therapy (CBT) became the treatment of choice for anger. Two main strategies were used – relaxation to de-arouse and reappraisal to reframe. Meta-analysis (Beck & Fernandez, 1998) and systematic review (Fernandez et al., 2018) showed CBT to be more effective than control groups in reducing anger.
Beck, R., & Fernandez, E. (1998b). Cognitive Behavioral Therapy in the treatment of anger: A meta-analysis. Cognitive Therapy and Research, 22, 63-74 [Also abstracted in Evidence-Based Mental Health, 1998, Vol. 1, No. 4, p.105].
Fernandez, E., Malvaso, C., Day, A., & Guharajan, D. (2018). 21st century Cognitive Behavioral Therapy for anger: A systematic review of research design, methodology, and outcome. Behavioral and Cognitive Psychotherapy, 46, 385-404.
How is anger treated? CBAT
This century, it became evident that the conventional two-pronged approach of CBT could be greatly enhanced by many additional techniques tried and tested in other areas of clinical psychology (e.g., thought-stopping, attention-diversion, behavioral contracts, rehearsal, response prevention, stimulus control etc). Furthermore, a major affective component could be added as in emotion-focused therapy; examples range from written disclosure and empty chair to expressive art, humor, and forgiveness. About 20 techniques in total are carefully sequenced in a programmatic fashion as described in the following articles from our team.
Fernandez, E., Perez, B., Sun, R., Kolaparthi, K., Pham, T., Iwuala, E., Garza, R., Shattuck, E. & Wu, W. (2024). Anger treatment via CBAT delivered remotely: outcomes on psychometric and self-monitored measures of anger. Clinical Psychology and Psychotherapy . DOI: https://doi.org/10.1002/cpp.2907
Fernandez, E. (2013). Anger dysfunction and its treatment. In E. Fernandez, (Ed.) Treatments for anger in specific populations: Theory, application, and outcome (pp.1-14). New York: Oxford University Press.
Fernandez, E. (2010). Toward an integrative psychotherapy for maladaptive anger. In M. Potegal, G. Stemmler, & C. Spielberger (Eds.). The International Handbook of Anger: Constituent and Concomitant Biological, Psychological, and Social Processes (pp.499-514). New York: Springer.
Fernandez, E., & Scott, S. (2009). Anger treatment in chemically-dependent inpatients: Evaluation of phase effects and gender. Behavioural and Cognitive Psychotherapy , 37, 431-447.
What are the phases of CBAT?
CBAT is not a smorgasboard of techniques. Rather, it is theoretically-grounded in a process model of anger i.e. anger runs its course from onset through progression to offset, each requiring different regulatory strategies. The onset of anger is tackled by prevention, the escalation or progression of anger is handled by intervention, and the residual (left over) feelings of anger are addressed by affective techniques.
Week 1:
Orientation
Week 2:
Psychoeducation
Week 3:
Prevention
Week 4:
Intervention
Week 5:
Postvention
Week 6:
Follow-Up and Certificate
How is CBAT delivered?
CBAT can be delivered in-person or online through videoconferencing and recorded sessions. When delivered remotely, CBAT is ideally supplemented with brief weekly phone calls to promote acquisition and practice of skills.
What is the outcome or effect of CBAT on anger?
Results as in the publications cited above, indicate that the CBAT program reduces multiple parameters of psychometrically measured anger as well as anger self-monitored in naturalistic settings. Its efficacy has been evidenced in college students, adults from the community, individuals with substance dependence, and patients with chronic pain.
Conclusion
Cognitive Behavioral Affective Therapy (CBAT) is a highly enhanced and sequentially integrated program of numerous anger regulation skills. We view it as the state of the art and state of the science in anger management.
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