An investigation of the functional and treatment mechanisms relating to anger in emotional disorders
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In the context of emotional (e.g., anxiety, depression, and related) disorders, dysregulated anger (i.e., associated with functional impairment) is frequently present, but under recognized. Notably, it is associated with a lower likelihood of responding to treatment. The factors important to the development and maintenance of this anger as well as the most useful ways to treat it remain unexplored. This project consisted of two studies that aimed to begin addressing these gaps in the literature. The first was a qualitative study of a diagnostically heterogeneous sample (N = 15, 8 male, mean age 40.5, range 24-76 years), each of whom endorsed dysregulated anger. This study examined a theoretical model describing dysregulated anger. It was hypothesized that the four-function model, an existing framework that identifies processes maintaining unhelpful behaviors, would describe dysregulated anger well. Patients completed questionnaires about their anger daily. The results did not support the four-function model, suggesting instead that anger was better characterized by an operant model, which describes whether a behavior is rewarding or punishing. The second study explored the effects of two treatment skills (mindfulness and behavior change) in isolation and combination as interventions for anger using single-case experimental design. Patients were a subsample from the first study (N = 10; 3 male, mean age 35.5, range 24 - 67 years). The hypotheses were that each intervention would produce a meaningful reduction in anger, and that patients who did not respond to the first skill would experience reductions in anger after the second skill, with order of first skill randomized. No patients responded to the first intervention alone, allowing for an assessment of whether the order of skill delivery impacted outcomes. Results indicated that patients who received the behavior change module followed by mindfulness fared better in treatment than those who received the reverse skill order. Together, these two studies provide guidance for addressing dysregulated anger in emotional disorders by aiding in its conceptualization and suggesting an order in which to provide treatment skills.