Internet treatment for rabies works

Summary: A four-week online anger management program helps reduce anger and aggression and improve emotional regulation in those who engage in aggressive behaviors.

Source: Karolinska Institute

Problems with anger management can have serious consequences for the afflicted individual and their loved ones.

A new study from the Center for Psychiatry Research at Karolinska Institutet in Sweden shows that four weeks of therapy delivered over the Internet can help people with anger and aggression.

The results were published in Journal of Counseling and Clinical Psychology.

The study, which the researchers chose to call the “anger study,” is the first to compare different Internet-mediated emotion regulation strategies against anger. The results should be important for understanding emotion regulation and for disseminating evidence-based methods.

Easy recruitment of participants

“It is usually very difficult to recruit participants for treatment studies. For the rabies study, however, it was very easy, and we had to shut down the recruiting site after a few weeks due to the high number of applicants. This suggests that there is a pent-up need for psychological treatment of anger.

“Many people who have anger issues are ashamed and we think the internet format suits this group particularly well because they don’t have to wait in a reception room or sit face-to-face with a therapist and talk about their anger,” says Johan Bjureberg, assistant professor at Karolinska Institutet’s Center for Psychiatry Research and lead researcher on the study, which was conducted in collaboration with researchers at Örebro University in Sweden.

The anger study evaluated the effect of two emotion regulation strategies: conscious emotion awareness; And cognitive reevaluation. Mindful emotional awareness focuses on the ability to notice and accept your feelings and thoughts without judging them or acting on them. Cognitive reappraisal, on the other hand, focuses on being able to reinterpret thoughts and situations and identify alternative thoughts that don’t trigger difficult feelings.

The 234 participants, all with significant anger issues, were randomly assigned to four weeks of mindful emotional awareness, cognitive reappraisal, or a combination of these two strategies. All treatments were of approximately equal duration and were associated with a decrease in self-reported anger and aggression at the end of treatment.

The most effective combination therapy

The combined treatment resulted in significantly lower levels of outward anger expression, aggression, and anger rumination, but not anger suppression, compared with conscious emotional awareness or cognitive reappraisal alone. The combination was especially effective for participants who were experiencing very high levels of anger at the start of the study.

This shows an angry man
The results should be important for understanding emotion regulation and for disseminating evidence-based methods. Image is public domain

The findings strengthen research and theories suggesting that difficulties in regulating emotions and interpreting events and situations may be a major contributing factor to anger management problems.

“Our results suggest that a very short treatment of just four weeks delivered over the Internet with minimal therapist support is effective in reducing anger problems. Our hope is that follow-up studies support this finding and that the treatment can be widely offered as part of regular care,” explains Johan Bjureberg.

Financing: The study was funded by the Knut and Alice Wallenberg Foundation. No conflicts of interest have been reported.

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About this news about anger management and psychology research

Author: Press office
Source: Karolinska Institute
Contact: Press Office – Karolinska Institute
Image: Image is public domain

Original research: Access closed.
Targeting maladaptive anger with Internet-delivered, therapist-supported brief emotion regulation treatments: A randomized controlled trialby Johan Bjureberg et al. Journal of Counseling and Clinical Psychology


Targeting maladaptive anger with Internet-delivered, therapist-supported brief emotion regulation treatments: A randomized controlled trial

Objective: To evaluate the relative impact of three brief emotion regulation treatments provided by Internet therapists for maladaptive anger (conscious emotional awareness [MEA]cognitive reevaluation [CR]and mindful emotional awareness + cognitive reappraisal [MEA + CR]) and to test whether baseline levels of rabies pathology moderate treatment outcome.

Method: Treatments were evaluated in a randomized controlled trial. In total, 234 participants (59% female; mean age = 41.1, SD = 11.6) with maladaptive anger were randomized to MEA (n = 78), CR (n = 77), or MEA + CR (n = 79). Self-reported primary and secondary outcomes were followed up at the primary endpoint, 3 months after the end of treatment (88% retention). Primary outcomes were also assessed weekly during an extended baseline phase (4 weeks) and active treatment phase (4 weeks).

Results: At the primary endpoint, the MEA+CR was superior in terms of anger expression (d = 0.27 95% confidence interval, CI [0.03, 0.51]), aggression (d = 0.43 [0.18, 0.68]) and anger rumination (d = 0.41 [0.18, 0.63]). MEA + CR was particularly effective in reducing anger expression (d = 0.66 [0.21, 1.11]), aggression (d = 0.90 [0.42, 1.39]) and anger rumination (d = 0.80 [0.40, 1.20]) for people who reported high (+1 SD) baseline outcomes.

Conclusions: Brief MEA and CR treatments delivered by Internet therapists are effective interventions for maladaptive anger. The combination of MEA and CR is particularly effective in reducing anger expression and aggression, particularly in individuals reporting higher levels of initial anger pathology. The present study highlights the importance of emotion regulation as an important treatment target to reduce maladaptive anger.