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In a meta-analysis of 50 studies with a total of more than 1600 sub-
jects using cognitive-behavioral therapy (CBT) with clients experiencing
abnormal levels of anger, Beck and Fernandez (1998) found that 76% of
the clients treated with CBT had greater improvement in anger control
than that achieved by the control groups. The authors conclude that the
use of CBT has been proven to an extent that it is the primary treatment
approach for use with anger issues.
Tafrate, Kassinove, and Dundin (2002) found that people with histori-
cally high levels of anger have anger reactions that are more frequent,
intense, and enduring and report more physical aggression, negative verbal
responses, drug use, and negative consequences of their anger. Their anger
negatively affects their relationships, their health, and their jobs. Tafrate
et al. found that cognitive therapy and relaxation techniques were able to
reduce levels of anger in college-age drivers from the 85th percentile to
normal by training clients in progressive relaxation until they can quickly
use personal cues, such as words, phrases, or images to relax in situations
that might normally make them angry. Tafrate et al. believe that new com-
binations of treatment will incorporate four stages of change:
1. Preparing for change by helping clients increase their motivation and
awareness of their anger;
2. Actual change that includes assertiveness training, avoiding and escap-
ing from situations that often create angry responses, and triggering
anger and then teaching clients to relax;
3. Teaching clients to rethink what sets off their anger, forgiving others,
and avoiding grudges;
4. Making long-term plans to prevent relapses because new situations
may reignite anger.
One of the primary problems that result from acts of violence is the develop-
ment of PTSD. According to the DSM-IV ( American Psychiatric
Association [APA], 1994 ), the core criteria for PTSD include distressing
symptoms of (a) re-experiencing a trauma through nightmares and intrusive
thoughts; (b) numbing by avoiding reminders of the trauma, or feeling aloof
or unable to express loving feelings for others; and (c) persistent symptoms
of arousal as indicated by two or more of the following: sleep problems, irri-
tability and angry outbursts, difficulty concentrating, hypervigilance, and
exaggerated startle response, with a duration of more than a month, causing
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