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The Role of Anger in Generalized Anxiety Disorder
Abstract
Little is known about the role of anger in the context of anxiety disorders, particularly with generalized anxiety disorder (GAD). The aim of study was to examine the relationship between specific dimensions of anger and GAD. Participants (N = 381) completed a series of questionnaires, including the Generalized Anxiety Disorder Questionnaire (GAD-Q-IV; Newman et al., 2002, Behavior Therapy, 33, 215-233), the State-Trait Anger Expression Inventory (STAXI-2; Spielberger 1999, State-Trait Anger Expression Inventory-2: STAXI-2 professional manual, Odessa, FL: Psychological Assessment Resources) and the Aggression Questionnaire (AQ; Buss & Perry 1992, Journal of Personality and Social Psychology, 63, 452-459). The GAD-Q-IV identifies individuals who meet diagnostic criteria for GAD (i.e. GAD analogues) and those who do not (non-GAD). The STAXI-2 includes subscales for trait anger, externalized anger expression, internalized anger expression, externalized anger control and internalized anger control. The AQ includes subscales for physical aggression, verbal aggression, anger and hostility. The GAD-Q-IV significantly correlated with all STAXI-2 and AQ subscales (r's ranging from .10 to .46). Multivariate analyses of variance revealed that GAD analogues significantly differed from non-GAD participants on the combined STAXI-2 subscales (η(2) = .098); high levels of trait anger and internalized anger expression contributed the most to GAD group membership. GAD analogue participants also significantly differed from non-GAD participants on the combined AQ subscales (η(2) = .156); high levels of anger (affective component of aggression) and hostility contributed the most to GAD group membership. Within the GAD analogue group, the STAXI-2 and AQ subscales significantly predicted GAD symptom severity (R (2) = .124 and .198, respectively). Elevated levels of multiple dimensions of anger characterize individuals who meet diagnostic criteria for GAD.
... Most of these works focused on anxiety disorders; specifically, on generalized anxiety disorder (GAD) and social anxiety disorder (SAD). Regarding GAD, a positive and significant relationship with anger and hostility was found [18][19][20]. As regards SAD, several works also identified a positive and significant association with anger and hostility [18,[20][21][22][23]. ...
... The review of previous research examining the relationship between forms of anxiety and the components of aggression has shown, first, that the Buss and Perry [9] model has been used in a few studies. Thus, only three works [19,21,27] considered the components of aggressive behavior: physical and verbal aggression, anger, and hostility. Secondly, anxiety disorders and school anxiety have been analyzed, but these studies have not addressed forms of anxiety developed in the school setting to understand its possible relationship with aggressive behavior. ...
... Moreover, an attempt will be made to establish possible statistically significant differences between the anxious profiles identified and the scores in the components of aggressive behavior: physical and verbal aggression, anger, and hostility. Given that previous studies suggest a positive and significant relationship between GAD or school anxietSy and all or some of the components of aggression [18][19][20]27,28], it is expected that the profile with the highest levels of GA and anxiety in the school setting (i.e., AA and SA) will obtain significantly higher scores in physical aggression, verbal aggression, anger, and hostility. ...
Children tend to develop forms of anxiety that can be associated with school violence. However, the previous scientific literature on anxiety and aggression is scarce. In addition, it has only focused on examining differential relationships between both variables. This study aimed to analyze the relationships between three forms of anxiety (anticipatory anxiety, school-based performance anxiety, and generalized anxiety) and the components of aggression (physical and verbal aggression, anger, and hostility) by adopting a person-centered approach. The sample consisted of 1161 Spanish students from 8 to 11 years old (M = 9.72, SD = 1.14); 46.2% were boys. Informed written consent from the parents or legal guardians was obtained. The Visual Analogue Scale for Anxiety—Revised and the Aggression Questionnaire were used. The latent profile analysis technique identified three profiles of anxious children: Low Anxiety, High School-based Performance Anxiety, and High Anxiety. The High Anxiety group scored significantly higher than the Low Anxiety group in all components of aggression, with effect sizes ranging from moderate to large (d = 0.59 to 0.99). The High Anxiety profile showed significantly higher scores than the high school-based performance anxiety profile only in anger (d = 0.56) and hostility (d = 0.44). The results have relevant implications for practice, since there is evidence that different intervention strategies should be applied according to the risk profile.
... Por otro lado, son pocos los estudios que han examinado la relación entre la ira y la ansiedad generalizada (Deschênes, Dugas, Fracalanza y Koerner, 2012). Esto es sorprendente debido a que la irritabilidad, que se caracteriza por una disminución del umbral para la ira (DiGiuseppe y Tafrate, 2007), es un síntoma de la ansiedad generalizada (Deschênes et al., 2012). ...
... Por otro lado, son pocos los estudios que han examinado la relación entre la ira y la ansiedad generalizada (Deschênes, Dugas, Fracalanza y Koerner, 2012). Esto es sorprendente debido a que la irritabilidad, que se caracteriza por una disminución del umbral para la ira (DiGiuseppe y Tafrate, 2007), es un síntoma de la ansiedad generalizada (Deschênes et al., 2012). Los estudios indican que las personas con ansiedad generalizada presentan también mayores niveles de ira, expresión de ira externa, expresión de ira internalizada y un menor control de la ira (Erdem, Celik, Yetkin y Ozgen, 2008). ...
... La percepción de dominio que tenga el individuo sobre la situación amenazante predice su tipo de reacción. Es así que un alto dominio percibido predice la ira, mientras que un bajo dominio percibido predice la ansiedad (Deschênes et al., 2012). En general, estos hallazgos sugieren que la ira puede ser una emoción importante asociada con la ansiedad generalizada. ...
Resumen
Introducción y objetivos
La ira está relacionada con la salud mental y física, por lo que su evaluación es importante para muchas ciencias de la salud donde se han implementado intervenciones para la regulación de la ira. En ese sentido, el objetivo del estudio fue traducir al español, evaluar la estructura factorial, confiabilidad e invariancia factorial con respecto al género del Dimensions of Anger Reactions (DAR-5), así como examinar la validez convergente y discriminante del DAR-5 con base en sus correlaciones con otra medida de propensión a la ira, bienestar, atención plena y ansiedad en estudiantes universitarios.
Material y método
Se realizó un análisis factorial confirmatorio para explorar la estructura interna de la escala y un análisis factorial multigrupo para probar la invariancia a través de género en una muestra de 420 estudiantes universitarios (Medad = 21.14, DT = 3.01) que contestaron las siguientes escalas: el DAR-5, Escala de propensión a la ira de García (APS-G), Mindful Attention Awareness Scale (MAAS-5), Satisfaction with Life Scale (SWLS) y Generalized Anxiety Disorder Scale-2 (GAD-2).
Resultados
Los resultados indicaron que el DAR-5 es un instrumento esencialmente unidimensional y que proporcionan puntajes precisos (ω = .86 para la muestra total, ω = .87 para la submuestra de mujeres y ω = .86 para la submuestra de hombres). Se comprobó la invarianza configural, métrica y escalar del DAR-5, lo que lleva a asumir que mide el mismo constructo en hombres y mujeres. Asimismo, elevados niveles de ira se asociaron con una mayor ansiedad generalizada y una disminución de la satisfacción con la vida y la atención plena.
Conclusión
El DAR-5 es una medida de ira confiable, válida e invariante entre los estudiantes universitarios y puede recomendarse como un indicador de ajuste psicológico en esta población.
... In terms of anxiety-related problems, shame has been suggested to be a vulnerability for generalized anxiety disorder (GAD), worry, and social anxiety disorder (Fergus et al., 2010). Not only has anger been proposed to be associated with similar anxiety symptoms (Deschênes et al., 2012), but a strong correlation between shame and anger has also been formulated (Elison et al., 2014). ...
... As another vulnerability factor, anger has been widely examined in externalizing problems, yet it has received less attention in the context of anxiety. Recent research demonstrated elevated anger in different anxiety disorders (e.g., de Bles et al., 2019;Deschênes et al., 2012). The relation between anger and anxiety may be clarified with shared systems in which both emotions are involved in flight or fight responses (Kunimatsu & Marsee, 2012), and both emotions tend to be intensified with biased information processing such as selective attention and intolerance to ambiguity (Owen, 2011). ...
Although the role of parenting on offspring’s anxiety has burgeoned attention in the literature, a limited number of researches have taken into consideration maternal and paternal influence separately. Besides, the need for knowledge about the mechanisms involved in the continuity of this relationship remains. Therefore, the present study aimed to explore the relationship between perceived parenting practices and trait anxiety during adulthood through difficulty in emotion regulation (ER), shame, and anger. The study was carried out with a community sample comprised of 544 adults (408 females and 136 males) aged between 18 and 50 (M = 26.52, SD = 7.30). Data was collected through the online administration of self-report measures including Short EMBU-Own Memories of Upbringing, Test of Self-Conscious Affect-3, Trait Anger Scale, Difficulties in Emotion Regulation Scale, State-Trait Anxiety Inventory-Trait Form. The results of the hierarchical regression analysis revealed that only paternal rejection and maternal overprotection were the predictors of adult anxiety. In addition, difficulty in ER, shame, and anger all had significant mediator roles in these associations. Current findings highlight the different maternal and paternal parenting that might play a role in the origin of offspring’s anxiety and provide an emotional model that might explain the endurance of this impact during adulthood.
... Recently, more attention has been given to the involvement of 'hostility' and 'anger' in the depressed state [13,14], which refers to an emotional state varying from mild annoyance to rage [15]. Moreover, elevated levels of multiple dimensions of anger characterize individuals who meet diagnostic criteria for GAD [16]. Here intolerance of uncertainty could be a critical construct underlying the pathophysiology of GAD, and maladaptive behavioral and cognitive reactivity (e.g., biased contextual interpretations of the situation, poor decision-making) may not only increase worry and anxiety [17], but intolerance of uncertainty may also mediate the relationship between GAD symptoms and anger [18]. ...
... In addition, GAD may lead to emotional dysregulation, including unsuppressed anger and low tolerance to frustration [42]. In addition, higher levels of anger and hostility contributed and predicted GAD symptom severity and elevated levels of multiple dimensions of anger characterized individuals who met the diagnostic criteria for GAD [16]. ...
Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are severe and difficult-to-treat psychiatric illnesses with high rates of comorbidity. Although both disorders are treated with serotonergic based psychotropic agents, little is known on the influence of the serotonergic neurotransmitter system on the occurrence of comorbid GAD when clinically depressed. To investigate this poorly understood clinical question, we examined the involvement of frontolimbic post-synaptic 5-HT2A receptors in 20 medication-resistant depressed (MRD) patients with half of them diagnosed with comorbid GAD with ¹²³I-5-I-R91150 SPECT. To explore whether 5-HT2A receptor-binding indices (BI) associated with comorbid GAD could be related to distinct psychopathological symptoms, all were assessed with the symptom Checklist-90-Revised (SCL-90-R). MRD patients with comorbid GAD displayed significantly higher 5-HT2A receptor BI in the hippocampal–amygdala complex, compared to MRD patients without GAD. Correlation analyses revealed that the 5-HT2A receptor BI in these areas were significantly related to the SCL-90-R subscale hostility (HOS), especially for those MRD patients with comorbid GAD. Comorbid MRD-GAD may be characterized with increased hippocampal–amygdala 5-HT2A receptor BI which could represent enhanced levels in hostility in such kinds of patients. Adapted psychotherapeutic interventions may be warranted.
... Higher levels of internal anger, external anger expression, and trait anger, as well as lower levels of anger control, have been reported for adults with different anxiety disorders [1,2]. For example, a subset of individuals with social Electronic supplementary material The online version of this article (https ://doi.org/10.1007/s0078 ...
... Moreover, our study is based on a specific behavioural aspect of anger. In literature, in addition to trait and state anger, several dimensions of anger have been considered: hostility (the cognitive component of anger), aggression (the behavioural component of anger), internalized anger expression (the tendency to suppress angry feelings), externalized anger expression (the tendency to outwardly express angry feelings), and anger control (the ability to regulate anger) [1,36]. Thus, in future research, it would be interesting to study genetic and environmental contributions for every specific anger phenotype, as well as the relationship between these components and anxiety in childhood. ...
Higher levels of anger expression, as well as lower levels of anger control, have been reported for adults with anxiety disorders compared to individuals without anxiety disorders. Different to the research on adults, very few studies examined the relationship between anxiety and anger in childhood. In our study, we investigated 398 Italian twin pairs (74 MZ male, 70 MZ female, 134 same-sex dizygotic-53 male, 81 female-, and 120 unlike-sex dizygotic twin pairs), aged 8–17 (mean 13.06 ± 2.59): (i) the heritability of a childhood anger phenotype; (ii) the association between five anxiety domains and anger; (iii) the role of possible common etiological factors in explaining the observed comorbidity and overlap in the risk between anxiety phenotypes and anger. The study demonstrated that anger, assessed by CBCL items, is heritable in children at a similar rate to prior studies (40%). Our research found low to moderate rate of correlation between anger and anxiety (from 0.10 to 0.19). Finally, the present study found that the majority of etiological influences on anxiety and anger are independent of each other. Data showed that shared environmental influences have some small effects on the phenotypic covariation between the anxiety phenotypes and anger (12%); whereas unique environmental influences have an almost negligible effect (1%). Our analyses did not reveal the effect of genetic effects in explaining the covariation between these phenotypes.
... anger that is felt inside but not outwardly expressed), externally expressed anger (e.g. yelling), lower anger control, and higher hostility (Deschênes et al., 2012;Erdem et al., 2008). Thus, individuals with GAD tend to show higher vulnerability to facets of anger than healthy control individuals. ...
... However, in the study of Erwin et al. (2003), individuals with social anxiety disorder had comparable anger control levels to individuals without a psychological disorder, thus there may have been less 'room to improve' on the ability to regulate anger. On the other hand, prior research suggests that individuals with GAD have lower anger control skills than non-clinical controls (Deschênes et al., 2012), and individuals with GAD in the present study had levels of anger control comparable to those with GAD in prior studies. Thus, it may be that the levels of anger experienced and consequently expressed by individuals with GAD in the present study were implicitly impacted by CBT (e.g. by improving thoughts that generate anger, or by reducing general arousal fueling irritability); however, as participants in GAD treatment did not learn skills to intentionally modulate anger, their sense of direct control over their anger may remain unchanged. ...
Background
Individuals with generalized anxiety disorder (GAD) have elevated intolerance of uncertainty (IU) and anger, and IU mediates the relationship between GAD symptoms and anger.
Aims
The current pilot study examined whether group cognitive behavioural therapy (CBT) improves anger in people with GAD, and the degree to which change in IU mediates improved anger.
Method
Individuals diagnosed with GAD completed measures of worry, IU, and facets of anger, before and at the end of group CBT for GAD.
Results
Worry, IU, and internally felt and outwardly expressed anger, reduced significantly over treatment, but anger control (inwardly and outwardly) did not. CBT for GAD led to improvement in both internally felt and outwardly expressed anger, even though anger is not directly targeted in this treatment. Improvement in IU significantly mediated improvement in internally felt and outwardly expressed anger.
Conclusions
This preliminary study contributes to the literature on the importance of IU in understanding worry and other symptoms such as elevated anger, experienced by people with excessive worry.
... By using multidimensional assessments of anger we will explore which aspects of anger are most important in predicting QoL. The STAXI-2 [29] separates out the different processes which might be involved in the internal experience of anger (AX-I) from the outward expression of anger through aggression (AX-O). It also assesses how people control their anger: whether through internal control strategies such as counting to ten (AC-I), or through the active suppression of outward expression (AC-O). ...
... In the present study all scales were administered (totalling 41 items) with the exception of the State Anger scale; as pilot work in the department has indicated that it revealed floor effects [33]. The STAXI-2 has been found to be a valid, reliable measure of the constructs it was intended to represent [29]. ...
... be expressed differently depending on anxiety diagnosis. For example, clients with GAD may experience angry feelings but suppress them (i.e., internalized anger) more often than healthy controls, leading to higher levels of anxiety severity (Deschênes, Dugas, Fracalanza, & Koerner, 2012;Fracalanza, Koerner, Deschênes, & Dugas, 2014). ...
... We also examined whether higher levels of anger THE RELATIONSHIP BETWEEN ANGER AND ANXIETY were related to higher instances of GAD diagnoses, as irritability, a related construct to anger, is a diagnostic component of GAD but not of other anxiety disorders. We hypothesized that elevated internalized anger would be related to higher likelihood of GAD diagnosis due to past research in adult samples (Deschênes et al., 2012;Fracalanza et al., 2014). ...
This study examined the relationship between anger and anxiety in youth in an
outpatient anxiety treatment clinic. Participants included 40 primarily female and
Caucasian youth, all diagnosed with a primary anxiety disorder. Youth provided ratings
of anger, anxiety, and depressive symptoms. We also obtained parent and clinician
ratings of anxiety severity. Analyses supported a significant relationship between trait
anger and anxiety severity. When rated by youth, trait anger was significantly related to
physical symptoms of anxiety and harm avoidance. Youth report of anger symptoms
was not related to parent or clinician report of youth anxiety severity. Assessing
symptoms of anger in youth with anxiety disorders may be important, as it may be
related to higher anxiety symptom severity for some youth. Future research in larger
samples is needed to understand the co-occurrence of different components of anger
and anxiety disorders and its impact on prognosis and treatment process.
... " Findings from several studies conducted by different research groups indicate that the associations of IU to high trait worry and high GAD symptoms are robust (e.g. Berenbaum, Bredemeier, & Thompson, 2008;Buhr & Dugas, 2002;Deschênes, Dugas, Fracalanza, & Koerner, 2012;Koerner & Dugas, 2008;Rassin & Muris, 2005) and that modifying IU using a cognitive-behavioral treatment that encourages repeated exposure to and acceptance of uncertainty leads to large changes in trait worry and in the symptoms that characterize GAD (e.g. Dugas et al., 2003;van der Heiden, Muris, & van der Molen, 2012). ...
... The PSWQ mean and standard deviation in the Non-GAD group were similar to those of other samples of individuals low in worry and anxiety (e.g. Behar, Alcaine, Zuellig, & Borkovec, 2003;Deschênes et al., 2012). ...
A number of studies have examined the association of intolerance of uncertainty (IU) to trait worry and generalized anxiety disorder (GAD). However, few studies have examined the extent of overlap between IU and other psychological constructs that bear conceptual resemblance to IU, despite the fact that IU-type constructs have been discussed and examined extensively within psychology and other disciplines. The present study investigated (1) the associations of IU, trait worry, and GAD status to a negative risk orientation, trait curiosity, indecisiveness, perceived constraints, self-oriented and socially prescribed perfectionism, intolerance of ambiguity, the need for predictability, and the need for order and structure and (2) whether IU is a unique correlate of trait worry and of the presence versus absence of Probable GAD, when overlap with other uncertainty-relevant constructs is accounted for. N = 255 adults completed self-report measures of the aforementioned constructs. Each of the constructs was significantly associated with IU. Only IU, and a subset of the other uncertainty-relevant constructs were correlated with trait worry or distinguished the Probable GAD group from the Non-GAD group. IU was the strongest unique correlate of trait worry and of the presence versus absence of Probable GAD. Indecisiveness, self-oriented perfectionism and the need for predictability were also unique correlates of trait worry or GAD status. Implications of the findings are discussed, in particular as they pertain to the definition, conceptualization, and cognitive-behavioral treatment of IU in GAD.
... In addition, Erdem, Celik, Yetkin, and Ozgen (2008) found that relative to non-anxious individuals, those with GAD reported higher trait anger, outward anger expression, and anger suppression, as well as lower anger control. Similarly, Deschênes, Dugas, Fracalanza, and Koerner (2012) found that elevated trait anger, hostility, and anger suppression predicted greater GAD symptom severity. Together, these studies suggest that elevated anger seems to be a symptom frequently comorbid to GAD, independently of other psychological conditions, such as mood disorders or other anxiety disorders. ...
... Thus, we hypothesized that GAD analogues would report greater threatening interpretations and hostile attributions than less anxious individuals, and that these effects would be increased in the worry or anger conditions relative to the relaxation condition. Finally, given the association between trait anger and symptoms of GAD (e.g., Deschênes et al., 2012;Erdem et al., 2008), we expected that these effects would not be due to shared associations between GAD symptoms and trait anger, and would therefore remain when accounting for trait anger. ...
Individuals with generalized anxiety disorder (GAD) frequently report elevated anger. Information processing biases may underlie this finding. We examined the effects of worry (n = 51) and anger rumination (n = 50) inductions, relative to relaxation (n = 49), on information processing biases associated with GAD and trait anger using an experimental design. We also examined whether participants who met diagnostic criteria for GAD via self-report (n = 41) exhibited greater negative information processing styles than less anxious individuals (n = 109) following the mood inductions. Participants completed tasks assessing threatening interpretations of ambiguous situations and hostile and benign attributions of ambiguous intent. There were no differences in information processing across the three conditions. However, GAD analogues demonstrated greater threatening interpretations and hostile attributions than their less anxious counterparts, regardless of experimental condition. This suggests that GAD symptoms relate to both threatening interpretation and hostile attribution biases.
... In our sample, male respondents demonstrated higher levels of self-reported physical aggression compared with females and female participants exhibited higher scores in self-reported levels of anger and hostility, in agreement with other research [146]. There is consensus in the literature that anxiety symptoms tend to be associated with increased levels of anger and hostility [147,148], although most people with anxiety problems are less likely to express themselves with overt aggression due to the fear of negative evaluation by others. Sometimes people in their work environment are potentially confronted with morally injurious experiences, which may challenge fundamental ethical principles, placing them at increased risk of presenting symptoms of anxiety and behavioral problems such as anger and hostility [149,150]. ...
... For example, higher levels of impulsivity appear to be strongly associated with self-harm and suicide attempts in patients with BPD (Rawlings et al., 2015;Soloff et al., 1994;Terzi et al., 2017). Social rejection is associated more strongly with anger and irritability in individuals with BPD, than those with anxiety disorders (Gutz et al., 2016;Rusch et al., 2007); although some research suggests that GAD may be associated with anger problems as well (Deschenes et al., 2012;Hawkins and Cougle, 2011). Hopelessness is typically defined as disconnect from meaning or disconnect from life (Miller et al., 2020), and studies focusing on hopelessness find it is associated with suicidal behaviours in BPD (Berk et al., 2007). ...
Borderline personality disorder (BPD) is a psychiatric condition characterized by severe instability in affect, impulse control, and interpersonal functioning. Existing literature has confirmed that BPD is highly comorbid with other psychiatric conditions, including anxiety disorders. Despite this, little research has investigated the nature of the relationship between generalized anxiety disorder (GAD) and BPD. The aim of this systematic review and meta-analysis is to synthesize the literature concerning the prevalence and clinical outcomes of BPD and GAD comorbidity in adults. The following three databases were searched on October 27, 2021: PsycINFO, PubMed, and Embase. Twenty-four studies were included (n = 21 reporting on prevalence of the comorbidity, n = 4 reporting on clinical outcomes associated with the comorbidity), 9 of which were included in a meta-analysis. The meta-analysis showed that the pooled prevalence for current GAD in individuals with BPD was 16.4% (CI 95%: 1.9%; 66.1%) in inpatient samples, and 30.6% (CI 95%: 21.9%; 41.1%) in outpatient or community samples. The pooled lifetime prevalence of GAD in individuals with BPD was 11.3% (CI 95%: 8.9%; 14.3%) in inpatient samples, and 13.7% (CI 95%: 3.4%; 41.4%) in outpatient or community samples. Comorbidity between BPD and GAD was associated with worse outcomes on measures of BPD severity, impulsivity, anger, and hopelessness. In conclusion, this systematic review and meta-analysis indicate that comorbid GAD and BPD is highly prevalent, although the pooled prevalence rates should be interpreted with caution considering the large and overlapping confidence intervals. Further, this comorbidity is associated with worse BPD symptom severity.
... It is widely known that anger is present in a wide variety of psychopathologies (Novaco 2010) and displays a strong and specific associations with externalizing disorders as well as with paranoia/suspiciousness trait (Watson and O'Hara 2017). Studies revealed that high levels of internalized anger contributed the most to Generalized Anxiety Disorder (GAD) in adults (Deschênes et al. 2012) and was associated with higher psychosomatic symptoms in women (Choi 2009) as well as with higher depression (Cautin et al. 2001). Based on these findings concerning personality traits and anger levels, it could be speculated that these subjects are more likely to perceive work-related events as stressful, to respond negatively to stressors (over reactivity), and to experience intense emotions (like anger), that they may suppress. ...
Objective The association between adverse working conditions and mental disorders is well established. In addition to psychopathological symptoms, this study aimed at investigating anger and personality traits in a clinical sample of subjects referring negative interpersonal experiences in workplaces.
Methods 1676 workers attending a Centre for Occupational Stress in Milan (from 2014 to 2016) were administered an assessment protocol including SCL-90 for general psychopathology, STAXI for anger intensity and expression, and MMPI-2 for personality traits. A qualitative checklist was used to collect negative experiences in workplaces.
Results Patients reported they were exposed to “threats to the task or the professional career” more than to “attacks to the person”. Over 80% scored above the cutoff in all the subscales of the SCL-90, with highest scores in Depression, Obses- sive–Compulsive Disorder, Anxiety, Somatization and Paranoia. 60% scored above the 90th percentile in the AX/in subscale, showing intense anger feelings that they mostly suppress. Abnormal elevations at the MMPI scales of Hypochondria, Depres- sion, Hysteria, and Paranoia were found in over 50% of the sample. Women reported higher psychological difficulties and internalized anger than men. Anger towards objects and people, instead, was more common in males. No differences were observed by work sector or employment status.
Conclusions In addition to severe psychological difficulties, individuals reporting negative interpersonal experiences in workplaces have high levels of internalized anger and a distinctive profile of personality traits. While a deeper investigation is needed, anger expression should be considered in future treatment programs.
... Gelingtder Aufbau einer therapeutisch stabilen Arbeitsbeziehung, geht es um die Bearbeitung von negativen Affekten und ungeklärten Konflikten in Beziehungen im gegenwärtigen Alltag (Deschênes et al. 2012), die oft als unverlässlich und/oder manipulativ erlebt werden. Im Rahmen von Paargesprächen sollten Beziehungs-muster in der Partnerbeziehung, bei denen es überwiegend um überfürsorglichausnutzbares, emotional zurückweisendes oder submissives Verhalten geht (Salzer et al. 2011), geklärt und ggf. ...
The corona pandemic has led many people to experience an existential threat and has triggered different forms of coping with this persistent stress situation. The risk for the development of a generalized anxiety disorder (GAD) in particular has significantly increased. The established concepts of cognitive behavioral therapy (CBT) are only moderately effective in the treatment of GAD. Therefore, an integrative therapy concept is developed with reference to the biopsychosocial approach. This mediates a reference to early influences in the primary family (insecure ambivalent attachment, suppression of curiosity behavior) even during the psychoeducation as the cause of a permanent worrying and the underlying intolerance of uncertainty. The initial priority is on establishing a sustainable therapeutic relationship (alliance) in which the patient’s autonomy and self-efficacy are promoted. Of central importance to therapeutic progress is the promotion of experiences that enhance self-efficacy and the reduction of avoidance behavior through exposure and behavioral experiments. The reduction of maladaptive anxiety coping through worry chains and reassurance behavior occurs through the development of an increasingly greater tolerance of uncertainty in actual daily life. Essential for the prognosis are the consideration of metacognitions and dysfunctional relationship patterns in the couple relationship as well as carrying out relaxation procedures and correctly dosed exercises. Finally, it is a matter of the processing of dysfunctional coping strategies, which promote chronification.
... Moreover, future research could consider the inclusion of different types of emotions that were not measured in the current study. In addition to fear and sadness, a close relationship has been reported between depression, GAD, and anger (Deschênes, Dugas, Fracalanza, & Koerner, 2012;Winkler, Pjrek, & Kasper, 2005). Findings also suggest a high correlation between symptoms of obsessive-compulsive disorder and disgust (Shapira et al., 2003). ...
According to the Contrast Avoidance model (CAM), worry causes increased and sustained negative affect and such negative affect enables avoidance of a future sharp increase in negative emotion. However, only pathological worriers (vs. controls) view worry as a positive coping strategy to avoid a negative emotional contrast (NEC). We examined if rumination, which is another type of repetitive negative thought, would function similarly. Individuals with selfreported symptoms of generalized anxiety disorder (GAD; n = 90), depression (MDD; n = 85), and non-anxious/non-depressed controls (HC; n = 93) were randomly assigned to conditions where they were asked to worry, ruminate, or relax. Emotional and physiological changes were measured during worry and subsequent exposure to fearful and sad videos. We also assessed participant group differences in preference for worry or rumination as a strategy to cope with negative affect during the negative emotional video exposures. Consistent with CAM, regardless of the group, both worry and rumination enabled avoidance of NEC. Whereas worry led to greater avoidance of a fear contrast, rumination led to greater avoidance of a sadness contrast. On the other hand, relaxation enhanced NEC. Skin conductance also indicated patterns in line with CAM. In the subjectively perceived preference, the GAD group reported a greater preference for worry in coping with a fear contrast than HC. However, such a salient pattern was not found for the MDD group. Treatment implications of these findings are discussed.
... Moreover, future research could consider the inclusion of different types of emotions that were not measured in the current study. In addition to fear and sadness, a close relationship has been reported between depression, GAD, and anger (Deschênes, Dugas, Fracalanza, & Koerner, 2012;Winkler, Pjrek, & Kasper, 2005). Findings also suggest a high correlation between symptoms of obsessive-compulsive disorder and disgust (Shapira et al., 2003). ...
According to the Contrast Avoidance model (CAM), worry causes increased and sustained negative affect and such negative affect enables avoidance of a future sharp increase in negative emotion. However, only pathological worriers (vs. controls) view worry as a positive coping strategy to avoid a negative emotional contrast (NEC). We examined if rumination, which is another type of repetitive negative thought, would function similarly. Individuals with self-reported symptoms of generalized anxiety disorder (GAD; n = 90), depression (MDD; n = 85), and non-anxious/non-depressed controls (HC; n = 93) were randomly assigned to conditions where they were asked to worry, ruminate, or relax. Emotional and physiological changes were measured during worry and subsequent exposure to fearful and sad videos. We also assessed participant group differences in preference for worry or rumination as a strategy to cope with negative affect during the negative emotional video exposures. Consistent with CAM, regardless of the group, both worry and rumination enabled avoidance of NEC. Whereas worry led to greater avoidance of a fear contrast, rumination led to greater avoidance of a sadness contrast. On the other hand, relaxation enhanced NEC. Skin conductance also indicated patterns in line with CAM. In the subjectively perceived preference, the GAD group reported a greater preference for worry in coping with a fear contrast than HC. However, such a salient pattern was not found for the MDD group. Treatment implications of these findings are discussed.
... A positive relationship was found between anxiety and depression in the study showing that younger persons (20 years of age) experienced depression as anxiety score increased more than adults (40-60 years of age) in the study. This supports the statistics from the Substance Abuse and Mental Health Services Administration (SAMHSA) of 2017 which estimated depressive disorder to be 7.1% for adults and 13.3% for adolescents/teens (45). Anxiety disorders and major depression occur during development with anxiety disorders beginning during preadolescence and early adolescence, while major depression tends to emerge during adolescence and early to mid-adulthood (38)(39)(40). ...
Background: Low-income earners are particularly vulnerable to mental health, consequence of the coronavirus disease 2019 (COVID-19) lockdown restrictions, due to a temporary or permanent loss of income and livelihood, coupled with government-enforced measures of social distancing. This study evaluates the mental health status among low-income earners in southwestern Uganda during the first total COVID-19 lockdown in Uganda.
Methods: A cross-sectional descriptive study was undertaken amongst earners whose income falls below the poverty threshold. Two hundred and fifty-three ( n = 253) male and female low-income earners between the ages of 18 and 60 years of age were recruited to the study. Modified generalized anxiety disorder (GAD-7), Spielberger's State-Trait Anger Expression Inventory-2 (STAXI-2), and Beck Depression Inventory (BDI) tools as appropriate were used to assess anxiety, anger, and depression respectively among our respondents.
Results: Severe anxiety (68.8%) followed by moderate depression (60.5%) and moderate anger (56.9%) were the most common mental health challenges experienced by low-income earners in Bushenyi district. Awareness of mental healthcare increased with the age of respondents in both males and females. A linear relationship was observed with age and depression ( r = 0.154, P = 0.014) while positive correlations were observed between anxiety and anger ( r = 0.254, P < 0.001); anxiety and depression ( r = 0.153, P = 0.015) and anger and depression ( r = 0.153, P = 0.015).
Conclusion: The study shows the importance of mental health awareness in low resource settings during the current COVID-19 pandemic. Females were identified as persons at risk to mental depression, while anger was highest amongst young males.
... Higher scores indicate greater anxiety. 35 While not the same psychological constructs, anger and anxiety have shown to be positively correlated with each other [45][46][47] and can be used as identifiers of emotional distress. 48 Optimism. ...
Introduction:
Psychological factors have been associated with knee osteoarthritis pain severity and treatment outcomes, yet their combined contribution to phenotypic heterogeneity is poorly understood. In particular, empirically derived psychological profiles must be replicated before they can be targeted or considered for treatment studies. The objectives of this study were to (1) confirm previously identified psychological profiles using unsupervised clustering methods in persons with knee osteoarthritis pain, (2) determine the replicability of profiles using supervised machine learning in a different sample, and (3) examine associations with clinical pain, brain structure, and experimental pain.
Methods:
Participants included two cohorts of individuals with knee osteoarthritis pain recruited as part of the multisite UPLOAD1 (n = 270, mean age = 56.8 ± 7.6, male = 37%) and UPLOAD2 (n = 164, mean age = 57.73 ± 7.8, male = 36%) studies. Similar psychological constructs (e.g. optimism, coping, somatization, affect, depression, and anxiety), sociodemographic and clinical characteristics, and somatosensory function were assessed across samples. UPLOAD2 participants also completed brain magnetic resonance imaging. Unsupervised hierarchical clustering analysis was first conducted in UPLOAD1 data to derive clusters, followed by supervised linear discriminative analysis to predict group membership in UPLOAD2 data. Associations among cluster membership and clinical variables were assessed, controlling for age, sex, education, ethnicity/race, study site, and number of pain sites.
Results:
Four distinct profiles emerged in UPLOAD1 and were replicated in UPLOAD2. Identified psychological profiles were associated with psychological variables (ps < 0.001), and clinical outcomes (ps = 0.001-0.03), indicating good internal and external validation of the cluster solution. Significant associations between psychological profiles and somatosensory function and brain structure were also found.
Conclusions:
This study highlights the importance of considering the biopsychosocial model in knee osteoarthritis pain assessment and treatment.
... How one manifests and expresses anger has been linked with several psychopathologies and chronic health conditions in both non-pregnant and pregnant samples. Outwardly negative and poorly controlled expressions of anger are associated with depression, aggression, and worse self-reported health, whereas the suppression of angry feelings has been linked to cardiovascular morbidity and generalized anxiety disorder (Deschenes et al. 2012;Suls 2013). Both outward and inward expressions of anger are associated with an increased risk for hypertension, a higher prevalence of metabolic syndrome, and worse coronary heart disease prognosis among women (Laszlo et al. 2010). ...
Objectives
Most studies examining psychosocial factors contributing to preterm birth (PTB) have focused on negative life events. Studies examining the influence of negative emotion, in particular maternal anger, remain sparse. We examined associations of maternal trait anger expression and lifetime traumatic and non-traumatic experiences with the risk of PTB.
Methods
Mother-newborn pairs were enrolled in the PRogramming of Intergenerational Stress Mechanisms pregnancy cohort based in Boston and New York City. Women completed the State-Trait Anger Expression Inventory-2 (STAXI-2), Life Stressor Checklist-Revised (LSC-R), and Childhood Trauma Questionnaire (CTQ) in pregnancy. We used modified Poisson regression to estimate the relative risk (RR) of PTB (1) in relation to continuous STAXI-2 Anger Expression-In (AX-I) and Anger Expression-Out (AX-O) subscales, (2) in relation to continuous LSC-R scores, and (3) between women who did versus did not experience childhood sexual, emotional, and/or physical abuse in six separate models. We also examined interactions between maternal anger expression and lifetime stress/childhood trauma.
Results
Younger, single, minority women had higher outward anger expression and inward anger suppression. AX-I and AX-O scores were higher among women who experienced abuse in childhood and who had higher lifetime stress. Maternal lifetime stress, outward anger expression, and inward anger suppression were associated with an increased risk of PTB in separate models; however, stress, trauma and anger did not interact to further increase the risk of PTB.
Conclusions for Practice
Higher anger expression and higher lifetime stress experiences were associated with an increased risk of PTB among a racially and ethnically diverse sample of pregnant women.
... These trajectories of marital instability may exacerbate negative emotions, such as anxiety, anger, sadness, and fear. Such feelings of anger and irritability can contribute to poor psychological health, particularly anxiety symptoms (Deschênes et al., 2012;Hawkins & Cougle, 2011), which is consistent with research demonstrating a strong association between marital distress and a wide range of mood and anxiety disorder symptoms (Whisman, 2007). Consequently, over their early middle years, we expect that couples' marital instability trajectories are positively associated with husbands' and wives' subsequent trajectories of anxiety symptoms (measuring trajectories through growth curve modeling to refer to the initial level in 1990 and change over time from [1990][1991][1992][1993][1994]. ...
Objective
To examine psychological health as a mechanism linking economic pressure and marital instability in the early middle years to poor physical health in later life.
Background
Although previous research suggests that sustained stressful marital experience may lead to mental and physical health problems, little is known about how contextual factors, such as economic pressure, impact marital outcomes, and how changes in marital attributes influence health outcomes in a longitudinal and dyadic context.
Method
Utilizing an actor‐partner interdependence model within a latent growth curve approach and prospective data from couples in enduring marriages, we examined the associations between family economic pressure, marital instability, and mental health over their early middle years (1989–1994) and subsequent physical health in later adulthood (2015). Analyses assessed a couple‐level pathway and an individual pathway involving within‐spouse and between‐spouse effects.
Results
During the middle years, family financial difficulties were linked to reduced marital stability, which was associated with increased mental health challenges. The findings also reinforced the salient role of psychological distress for subsequent physical health outcomes as husbands' and wives' anxiety symptoms over their early middle years contributed to declines in their physical health outcomes in later adulthood. A partner effect was noted between husbands' anxiety and wives' physical health.
Conclusion
For couples, experiences of financial and marital stress in their early middle years can have long‐lasting detrimental impacts on their physical health in later adulthood.
... This evidently pointed out to an existence of a correlation between anger and anxiety. This was congruent with the findings of Deschênes et al. (2012)that pointed out that there was a high correlation between anger and anxiety. Despite the fact that Deschênes looked at the relationship between anger in general and anxiety, this study keenly pointed out to the correlation between state anger and anxiety as well trait anger and anxiety. ...
Anger is a disruptive emotion that manifests in an individual and aggravates symptoms of other psychiatric conditions. Previous studies have shown that anger deepens symptoms of generalized anxiety disorder, a condition that impacts negatively on millions of people in the world. These studies had pointed out that there seems to be a link between anger investigate the correlation between anger and anxiety among students in public secondary schools in Nakuru sub County, Kenya. A group 100 students (50 boys and 50 girls) challenged with extreme anger were assigned either Behavioral Therapy (MBCBT) treatment or to a control group which continued with Therapy as Usual. Data was collected at three levels: pretest, posttest and follow revealed that at pretest, participants in experimental group scored high in state anger (33.74 ±7.842SD), trait anger (24.90 ± 4.537SD), and anxiety (26.6 Correlation run revealed a positive correlation, though low, betw p=0.423) and (r=0.137, p=0.343) for experimental and control groups respectively. Similarly, statistically significant correlation between trait anger and anxiety (r=0.337, p=0.017) and (r=0.254, p=0.035) for experimen Copyright©2018, Jared Menecha et al. This is an open use, distribution, and reproduction in any medium, provided
... Moscovitch, McCabe, Antony, Rocca, and Swinson (2008) found that individuals with panic disorders and those with social phobia disorders were more likely to experience feelings of anger compared to control groups. Similarly, another study showed that individuals who met the criteria for generalized anxiety disorder (GAD) reported higher levels of trait anger and hostility compared to those who did not (Deschênes, Dugas, Fracalanza, & Koerner, 2012). Deschênes and colleagues also found that the measures of anger and hostility were significant predictors of the overall severity of the anxiety symptoms. ...
Research shows that social anxiety disorder (SAD) is prevalent in the United States, and may interfere with many aspects of a person’s life. Although numerous psychological instruments have been developed to measure presence and intensity levels of social anxiety, these instruments fail to capture the range of responses individuals utilize to mitigate the negative affect associated with the anxiety, namely alcohol use and anger distress. Recently, the Multidimensional Social Anxiety Response Inventory – 21 (MSARI-21) was developed to address this limitation and increase our understanding of the complexity of social anxiety. We expand on this work by evaluating the psychometric properties of the instrument, using a combination of exploratory structural equation and bi-factor modeling, and item response techniques. Across two studies, data indicated the presence of a strong, 3-factor structure (i.e., Anger Distress, Alcohol Reliance, and Social Avoidance), strong internal consistency, and evidence of both convergent and discriminant validity. In addition, results showed that the MSARI-21 multidimensional structure was invariant across gender. We conclude that the MSARI-21 is a valid and valuable tool for assessing individuals’ responses to social anxiety, and that future research should evaluate the instrument within other samples to ensure its utility across clinical and subclinical populations.
... Indeed, the STAI total score and the ARS total score were highly correlated in the present study (r = 0.71, p < .001). Research has also shown that internalized anger can be characteristic of those with GAD (Deschênes et al., 2012). Furthermore, research has shown that anxiety and related disorders are characterized by the pervasive disposition to experience a range of negative emotions (Watson, Clark, & Carey, 1988). ...
Although anger has been observed in obsessive-compulsive disorder (OCD), it remains unclear if rumination about anger is characteristic and/or unique to OCD. The present study examines whether types of anger rumination are endorsed more strongly by OCD patients compared to clinical and nonclinical controls. Patients with OCD (n = 30), generalized anxiety disorder (GAD; n = 29), and non-clinical controls (NCC; n = 30) completed measures of OCD symptoms, anger rumination, and trait anxiety. Patients with OCD and GAD significantly differed from NCC's (all ps <.001), but not each other (all ps >.10), in anger afterthoughts, thoughts of revenge, angry memories, and understanding causes of anger. However, the group differences were no longer significant when controlling for trait anxiety. A dimensional approach revealed that OCD symptoms were correlated with anger rumination domains overall. However, these associations were also no longer significant after controlling for trait anxiety. These findings suggest that anger rumination may emerge in OCD largely as an artifact of trait anxiety/negative affect that is associated with but not unique to the disorder. The implications of these findings for conceptualizing emotion and its regulation in OCD are discussed.
... Anxiety and anger are linked through shared physiological reactions to stress, since individuals may react either with anger or anxiety ("fight" or "flight" response) when confronted with threats. From a clinical point of view, irritability, defined as a lowered threshold for anger, is a symptom of Generalized Anxiety Disorder, and high levels of anger, internalized anger expression, and lower anger control were found in anxious individuals (Deschênes, Dugas, Fracalanza, & Koerner, 2012). Both anxiety and anger lead to enhanced vigilance toward the external and/or internal environments for detecting potential threats; this, along with the emotional arousal, involves the activation of the sympathetic nervous system (Smith, Ruiz, & Uchino, 2000); a relative hyperfunction of the sympathetic activity concomitant with a relative hypofunction of the parasympathetic activity have been described in anxiety disorders (Brown, Chorpita, & Barlow, 1998), and in IBS, in which the increased sympathetic tone seems to enhance visceral hypersensitivity (Ng, Malcolm, Hansen, & Kellow, 2007). ...
There are conflicting data on peculiar negative emotional patterns in Irritable Bowel Syndrome subtypes. Our study was aimed to determine possible differences in depression, anxiety and anger in patients suffering from Irritable Bowel Syndrome constipation, diarrhoea and mixed subtypes. The sample underwent a psychometric examination for the assessment of depression (Hamilton Rating Scale Depression), anxiety (Hamilton Rating Scale Anxiety), and anger (State-Trait Anger Expression Scale 2). Differences among groups were assessed using the Analysis of variance with Bonferroni post hoc comparisons, or the χ²-test if requested. 111 subjects (diarrhoea subtype =37; constipation subtype=34; mixed subtype=40) were included in the study. The severity of depressive symptoms was "moderate" in patients with constipation subtype and "mild" in patients with diarrhoea and mixed subtypes (17.15±6.7 vs 14.24±6.6 vs 12.50±4.9); no statistically significant differences were documented among subtypes. Severity of anxiety symptoms was "mild to moderate" in patients with constipation subtype (mean = 18.53 ± 7.7), and mild in patients with diarrhoea (mean = 13.35 ± 7.1) and mixed subtypes (mean = 13.25 ± 4.7); statistically significant differences among subgroups were found (Constipation vs Diarrhoea: p=0.004; Constipation vs Mixed: p=0.003). Regarding anger, significant differences among subgroups emerged at State Anger Feeling Angry and Anger In variables, both higher in constipation subtype group than in mixed subtype group (State Anger Feeling Angry: p=0.002; Anger In: p=0.001). Results showed that IBS-C patients were characterized by higher levels of anxiety than the other two subgroups, and that a consistent number of subjects from the IBS-C subgroup had anxiety scores within the pathological range. Furthermore, IBS-C patients showing a trend to experience more depressive symptoms than IBS-D and IBS-M patients.
... Hal lain juga diungkapkan oleh Cox, et al. (2004) bahwa perempuan yang mengekspresikan rasa marahnya dengan cara menekan perasaan marahnya cenderung rentan terhadap depresi dan kecemasan yang berlebihan. Kemarahan juga merupakan hal yang berkaitan erat dengan gangguan kecemasan (Deschenes, et al., 2011). ...
p align="center"> Abstrak
Penelitian ini dilatarbelakangi oleh tingginya angka kejadian kanker ginekologi yang direspon secara psikologis berupa kemarahan maladaptif oleh perempuan yang mengidap kanker ginekologi. Tujuan dari penelitian ini adalah untuk mengetahui gambaran kemarahan pada perempuan kanker ginekologi di salah satu rumah sakit di Kota Bandung. Penelitian dilakukan dengan desain deskriptif kuantitatif, variabelnya adalah kemarahan perempuan kanker ginekologi. Responden yang dilibatkan berjumlah 50 orang diambil berdasarkan accidental sampling yang diambil dalam tiga minggu. Instrumen yang digunakan dalam penelitian ini adalah STAXI-2 yang telah diadaptasi ke dalam bahasa Indonesia dengan validitas sebesar 0,85 dan reliabilitas sebesar 0,89. Data dianalisis menggunakan nilai mean dan disajikan dalam bentuk distribusi frekuensi. Hasil dari penelitian menunjukkan hampir seluruh responden (92%) memiliki intensitas kemarahan ( state anger ) yang rendah, hampir seluruhnya (94%) memiliki sifat kemarahan ( trait anger ) rendah, sebagian besar responden (78%) memiliki nilai control out sedang dan control in sedang (84%), dan seluruh (100%) responden memiliki nilai indeks ekspresi kemarahan rendah. Sebagian besar responden memiliki intensitas dan sifat kemarahan rendah dan kurang mampu mengekspresikan kemarahannya. Responden cenderung menekan rasa marah tetapi sewaktu-waktu akan muncul dalam intensitas yang cukup kuat,. Disarankan untuk perawat agar dapat memberikan konsultasi dan terapi bagi pasien kanker ginekologi agar mereka dapat mengekpresikan kemarahannya secara adaptif.
Abstract
The background of this research is the high rate of gynecology cancer prevalence which influences the psychological effect called maladaptive anger response in women diagnosed with gynecology cancer. The purpose of this research is to identify the representation of anger in women diagnosed with gynecology cancer at one of the hospital in Kota Bandung . This research used a descriptive design which variable is anger in women diagnosed with gynecology cancer. This research involved 50 respondents were taken based on accidental sampling as long as three weeks. The instrument was using STAXI-2 which had already adopted in Indonesia and the validity is 0,85 and the reliability value is 0,89. The data analyzed using mean and serves in a frequencies distribution form. The result showed that almost all of the respondents ( 92% ) has low state anger, almost all the respondents ( 94% ) has low trait anger, most of respondents ( 78% ) has moderate control out and moderate ( 84% ) control in, and all the respondents ( 100% ) has low index angry expression. Most of the respondents has low intensity of anger, state anger, and also they can’t express their anger adaptively. Respondents prefer push their anger to themselves but in time, anger will appear in a strong enough intensity. Suggested a nurse can develope and give some consultation and therapy to patients diagnosed with gynecology cancer, so they can express their anger in an adaptive way. </p
... En el presente estudio no se observan diferencias significativas de estas escalas para cada uno de los percentiles de grasa corporal en los que fue clasificada la muestra. Por lo tanto, apoyándonos en los resultados del estudio de Deschênes et al. (2012), es posible que la implicación de la ira, en sus respectivas escalas y subescalas, en estos sujetos se deba en mayor medida a su contribución al desarrollo de sentimientos de ansiedad y falta de autocontrol que a la grasa corporal o al IMC. ...
Physical activity provides benefits, both to healthy as to ill population, but can also lead to psychological and emotional problems in response to stress. Furthermore, those athletes with lower body weight have higher indicators of depression and anger. We propose to relate body fat on the expression of anger and to understand the relationship between different psychological behaviours in physically active people. 264 subjects completed the Anger Expression Inventory State Trait version 2 (STAXI-2), which studies the characteristics of anger and its effects on mental and physical health. Anthropometric measurements (weight, height, BMI, percent body fat, fat-free mass) were taken. Various body fat percentiles, < 45, 45 to 55 and > 55 were calculated according to gender and age, classifying participants into three percentile groups. Different behaviors were recorded in relation to STAXI-2 and percentiles, but with no significant differences between anger and those groups. © Copyright 2017: Servicio de Publicaciones de la Universidad de Murcia Murcia (España).
... There is some existing evidence to suggest that anger may be a common feature of mood and anxiety disorders such as GAD and MDD (Deschênes, Dugas, Fracalanza, & Koerner, 2012;Fisher et al., 2015). Fava and Rosenbaum (1998) found that one third of outpatients with MDD experience attacks of anger that include autonomic symptoms, such as elevated heart rate and sweating. ...
Individual variation is increasingly recognized as important to psychopathology research. Concurrently, new methods of analysis based on network models are bringing new perspectives on mental (dys)function. This current work analyzed idiographic multivariate time series data using a novel network methodology that incorporates contemporaneous and lagged associations in mood and anxiety symptomatology. Data were taken from 40 individuals with generalized anxiety disorder (GAD), major depressive disorder (MDD), or comorbid GAD and MDD, who answered questions about 21 descriptors of mood and anxiety symptomatology 4 times a day over a period of approximately 30 days. The model provided an excellent fit to the intraindividual symptom dynamics of all 40 individuals. The most central symptoms in contemporaneous systems were those related to positive and negative mood. The temporal networks highlighted the importance of anger to symptomatology, while also finding that depressed mood and worry—the principal diagnostic criteria for GAD and MDD—were the least influential nodes across the sample. The method’s potential for analysis of individual symptom patterns is demonstrated by 3 exemplar participants. Idiographic network-based analysis may fundamentally alter the way psychopathology is assessed, classified, and treated, allowing researchers and clinicians to better understand individual symptom dynamics.
... Moreover, future research could consider the inclusion of different types of emotions that were not measured in the current study. In addition to fear and sadness, a close relationship has been reported between depression, GAD, and anger (Deschênes, Dugas, Fracalanza, & Koerner, 2012;Winkler, Pjrek, & Kasper, 2005). Findings also suggest a high correlation between symptoms of obsessive-compulsive disorder and disgust (Shapira et al., 2003). ...
The Contrast Avoidance (CA) model (Newman & Llera, 2011) proposed that individuals with generalized anxiety disorder (GAD) fear sharp emotional shifts (or contrasts), such as the shift from a pleasant or neutral state to one of sudden distress following a negative event. Further, the model suggests that chronic worry is employed by those with GAD to sustain negative emotionality as a means to avoid sudden shifts into negativity. The model has received empirical support; however, no validated measure exists to assess CA tendencies. In this paper we developed and tested two measures of CA: one focusing on worry, and another examining broader mechanisms of CA that could be used test whether CA is applicable to other disorders. In Study 1, Part 1, we used 3 samples of participants (each N = 410) to perform item reduction, exploratory factor analysis, and confirmatory factor analysis. In Study 1, Part 2, we performed tests of construct validity. In Study 2, we used a new sample (N = 126) to determine test-retest reliability. All data point to the strong psychometric properties of the CA questionnaires and their relationship to GAD. Both measures distinguished between participants reporting clinical levels of GAD symptoms and nonanxious controls, demonstrating their utility as complementary measures of CA tendencies.
... 68 The link between irritability and GAD and substance use disorders in the BCOS is supported by other studies. 8,65,[69][70][71] The direction of these associations is, however, uncertain. Irritability, for example, could develop as a result of substance use, or people might use substances to self-medicate and reduce irritable dysphoria. ...
Objectives:
Many people experience irritability when manic, hypomanic, or depressed, yet its impact on illness severity and quality of life in bipolar and schizoaffective disorders is poorly understood. This study aimed to examine the relationship between irritability and symptom burden, functioning, quality of life, social support, suicidality, and overall illness severity in a naturalistic cohort of people with bipolar I or schizoaffective disorder.
Methods:
We used data from 239 adult outpatients with bipolar I or schizoaffective disorder in the Bipolar Comprehensive Outcomes Study (BCOS) - a non-interventional observational study with a 2-year follow-up period. Baseline demographic and clinical characteristics of participants with and without irritability were compared. A mixed-model repeated measures analysis was conducted to examine the longitudinal effect of irritability on clinical and quality-of-life variables over follow-up using significant baseline variables.
Results:
At baseline, 54% of participants were irritable. Baseline irritability was associated with illness severity, mania, depression, psychotic symptoms, suicidality, poor functioning, and quality of life, but not diagnosis (schizoaffective/bipolar disorder). Participants with irritability were less likely to have a partner and perceived less adequate social support. On average, over follow-up, those with irritability reported more symptoms, functional impairment, and suicidality. Furthermore, the effects of irritability could not be fully explained by illness severity.
Conclusions:
Irritability was associated with more negative symptomatic, functional, and quality-of-life outcomes and suicidality. The identification, monitoring, and targeted treatment of irritability may be worth considering, to enhance health and wellbeing outcomes for adults with bipolar and schizoaffective disorders.
... Convergent validity was supported by the positive relationships between STAXI AX/Out and AX/In, and state/trait anger and personality measures. Concurrent validity was supported by moderate positive correlations among AX/Out and subscale measures of the Aggression Questionnaire (AQ; Buss and Perry 1992), such as Aggression Questionnaire-Physical, and -Verbal Aggression Subscales, as well as weak to moderate positive correlations among AX/In and Aggression Questionnaire-Anger, and -Hostility Subscales of the AQ, and zero to weak correlations among AX/In and Aggression Questionnaire-Physical, and -Verbal Aggression Subscales (Deschênes et al. 2012). In the current study, the internal consistency for the scales was acceptable as evidenced by the Cronbach's alphas, .74 for AX/Out and .74 ...
The current study investigated how differentiation of self (Bowen in Family therapy in clinical practice. Jason Aronson, New York, 1978; Kerr and Bowen in Family evaluation. W. W. Norton and Company, New York, 1988) was related to interpersonal conflict and depression, and tested mediation hypotheses involving anger expression. The results revealed that anger expressed outwardly partially mediated the relationship between emotional reactivity and interpersonal conflict, and that anger expressed inwardly fully mediated the relationship between emotional cutoff and depression among 260 college students attending an urban university located in Midwestern United States.
... However, the picture is more complicated with the anxiety disorders. GAD has been characterized by a higher incidence of violence within the past 12 months [6], higher anger and aggression measure scores [10], and greater 30-day anger expression-related impairment [11], although Pulay et al. found that there was no significant relationship between a diagnosis of GAD and increased violence since age fifteen [9]. Inconsistent findings have also been found for PTSD [6,11], obsessive-compulsive disorder (OCD) [4,6,12], social phobia [4,6,9,11,12], panic disorder [4,6,9,11,12], and specific phobia [6,9,11,12]. ...
Background:
The attention given to anger and aggression in psychiatric patients pales in comparison to the attention given to depression and anxiety. Most studies have focused on a limited number of psychiatric disorders, and results have been inconsistent. The present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project sought to replicate and extend prior findings examining which psychiatric disorders and demographic characteristics were independently associated with elevated levels of anger and aggression.
Method:
3800 individuals presenting to the Rhode Island Hospital Department of Psychiatry outpatient practice underwent a semi-structured interview to determine current Axis I (N=3800) and Axis II (N=2151) pathology. Severity of subjective anger and overt aggression within the past week were also assessed for each patient, and odds ratios were determined for each disorder. Multiple regression analyses were conducted to determine which diagnoses independently contributed to increased levels of anger and aggression.
Results:
Almost half of the sample reported moderate-to-severe levels of current subjective anger, and more than 20% endorsed moderate-to-severe levels of current overt aggression. The frequency of anger was similar to the frequencies of depressed mood and psychic anxiety. Anger and aggression were elevated across all diagnoses except adjustment disorder. Anger and aggression were most elevated in patients with major depressive disorder, panic disorder with agoraphobia, post-traumatic stress disorder, intermittent explosive disorder, and cluster B personality disorders.
Conclusions:
Anger is as common as depressed mood and psychic anxiety amongst psychiatric outpatients, and problems with anger cut across diagnostic categories. Given the high prevalence of problems with anger in psychiatric patients, more research should be directed towards its effective treatment.
... Beaton et al. (2006) interpreted similar blunted reactivity of both genders as adaptive, allowing socially-anxious individuals to more effectively address threatening situations, as Saxbe et al. (2012) suggested of family members in aggressive homes. Deschênes et al. (2012) also reported evidence of an association between anger and generalized anxiety. While anxiety related to salivary cortisol stress responses (Leininger and Skeel 2012), questions arise as to its role in stress reactivity bifurcation. ...
Attachment, affect, and sex shape responsivity to psychosocial stress. Concurrent social contexts influence cortisol secretion, a stress hormone and biological marker of hypothalamic–pituitary–adrenal axis activity. Patterns of attachment, emotion status, and sex were hypothesized to relate to bifurcated, that is, accentuated and attenuated, cortisol reactivity. The theoretical framework for this study posits that multiple individual differences mediate a cortisol stress response. The effects of two psychosocial stress interventions, a modified Trier Social Stress Test for Teens and the Frustration Social Stressor for Adolescents were developed and investigated with early adolescents. Both of these protocols induced a significant stress reaction and evoked predicted bifurcation in cortisol responses; an increase or decrease from baseline to reactivity. In Study I, 120 predominantly middle-class, Euro-Canadian early adolescents with a mean age of 13.43 years were studied. The girls’ attenuated cortisol reactivity to the public performance stressor related significantly to their self-reported lower maternal-attachment and higher trait-anger. In Study II, a community sample of 146 predominantly Euro-Canadian middle-class youth, with an average age of 14.5 years participated. Their self-reports of higher trait-anger and trait-anxiety, and lower parental attachment by both sexes related differentially to accentuated and attenuated cortisol reactivity to the frustration stressor. Thus, attachment, affect, sex, and the stressor contextual factors were associated with the adrenal-cortical responses of these adolescents through complex interactions. Further studies of individual differences in physiological responses to stress are called for in order to clarify the identities of concurrent protective and risk factors in the psychosocial stress and physiological stress responses of early adolescents.
... Estos datos además se muestran coherentes con lo planteado en la literatura, específicamente con el estudio publicado por Deschênes et al. (2012) y por Erdem et al. (2008) quienes señalan que mayores niveles de ira, específicamente en las dimensiones (ira-rasgo y expresión interna de la ira), se asocian con preocupación y ansiedad. ...
La ira y la ansiedad están relacionadasa través dela vulnerabilidadbiológicasubyacente en ambos constructos, ya que los individuos reaccionan ante una amenaza conirao ansiedad. Pero ¿tiene la ira la capacidad para predecir la ansiedad? En este estudio nos hemos propuesto analizar esta capacidad predictiva de la ira sobre la ansiedad escolar en una muestra de 1131estudiantes chilenos de Educación Secundaria, 560 chicos y 571 chicas (49,51% y 51,49%, respectivamente) todos ellos con edades comprendidas entre los 13 y los 18 años (M=15.30; DE=1.10). La expresión de la ira se midió con el State-Trait Anger Expression Inventory for Children and Adolescents (STAXI-NA) y la Ansiedad Escolar con el Inventario de Ansiedad Escolar (IAES). Los análisis de regresión logística revelaron que altas puntuaciones en sentimientos de ira, temperamento de ira, expresión interna de ira, ira-estado e ira-rasgo predicen la alta ansiedad. Estos resultados sugieren la necesidad de diseñar y desarrollar programas educativos que ayuden a los estudiantes a canalizar la expresión de la ira y disminuyan los niveles de ansiedad escolar.
... 393). Also, Deschênes, Dugas, Fracalanza, and Koerner (2012) reported that the STAXI-2 significantly predicted generalized anxiety disorder severity. Coates and Pretty (2003) reported that the STAXI-2 Trait Anger and Anger-Out scales significantly predicted future arthritic health status. ...
Anger and hostility are described with special attention to their cognitive-motivational properties. Varying operational definitions related to anger self-report and behavioral observation are presented. The idea that anger can be maladaptive is now widely accepted as in DSM and alternative classifications of dysfunctional anger. The idea that maladaptive anger raises risks for hypertension and coronary heart disease is reviewed with reference to empirical findings on mediators such as atherosclerosis, cardiovascular reactivity, immune system changes, and unhealthy lifestyles. Given that anger is a relational emotion, it is not surprising that it befalls many interpersonal relations including close/intimate relationships. Dimensions of affiliation and control in relationships are presented as a framework for understanding how anger and hostility can develop and persist in these contexts. The further connection between such anger and cardiovascular function is illustrated. Fortunately, maladaptive anger is treatable, as explained with meta-analytic evidence on cognitive behavioral therapy (CBT). Also available are recent enhancements like CBAT that involve sequencing multiple cognitive, behavioral, and affective strategies appropriate to the process of anger from onset, through progression, to offset. Finally, traditional interpersonal therapies and newer therapeutic formulations such as acceptance and commitment therapy may address major themes in interpersonal conflict underlying the onset and maintenance of cardiovascular disease. Yet, many of these potential applications still await research and implementation in the field of psychocardiology.
... The co-occurrence and the discernibility between the emotional qualities of anger and anxiety is an important caveat in the present study. Although it has been shown that negatively valenced emotions tend to co-occur (Kuppens et al. 2003), especially anger and anxiety seem to be affected by this, as both emotions are a response to stressful situations (Deschênes et al. 2012). Accordingly, in the aggression condition of Study 1, we acknowledge that ratings increase in items reflecting stress experience (e.g., stressed, under pressure) and anxiety and sadness (e.g., nervous, disappointed) in association with aggression and its emotional, behavioral, and motivational constituents. ...
The ability to detect conspecifics that represent a potential harm for an individual represents a high survival benefit. Humans communicate socially relevant information using all sensory modalities, including the chemosensory systems. In study 1, we investigated whether the body odor of a stranger with the intention to harm serves as a chemosignal of aggression. Sixteen healthy male participants donated their body odor while engaging in a boxing session characterized by aggression-induction methods (chemosignal of aggression) and while performing an ergometer session (exercise chemosignal). Self-reports on aggression-related physical activity, motivation to harm and angry emotions selectively increased after aggression induction. In study 2, we examined whether receivers smelling such chemosignals experience emotional contagion (e.g., anger) or emotional reciprocity (e.g., anxiety). The aggression and exercise chemosignals were therefore presented to 22 healthy normosmic participants in a double-blind, randomized exposure during which affective/cognitive processing was examined (i.e., emotion recognition task, emotional stroop task). Behavioral results indicate that chemosignals of aggression induce an affective/cognitive modulation compatible with an anxiety reaction in the recipients. These findings are discussed in light of mechanisms of emotional reciprocity as a way to convey not only affective but also motivational information via chemosensory signals in humans.
This article uses 10 case studies to illustrate the information needs, various communication approaches, and the communicator's role in explaining environmental health risks from a variety of hazards, to a variety of audiences, over time frames from days to years, using in person consultation, lectures, zooms, and email formats. Events often had a long history before the communication began and may have had a long tail afterward. Audiences may be public officials, companies, workers, communities, or individuals. Each individual may have their own understanding or mental model regarding the hazard, exposure, and risk. The communicator's role or intention may be to reassure an audience that has unrealistic exaggerated concerns or fears or to protect a listener if the fears are realistic. Or it may be altruistic to inform a complacent audience to take the risks it faces more seriously. Although risk assessment research has advanced the techniques for communicating abstruse probabilities to audiences with low numeracy, in my experience, audiences are unimpressed by precise‐sounding probability numbers, and are more interested in whether exposure is occurring or may occur and how to stop it. Often audiences have reason to be outraged and may be more concerned about punishing wrong doers than about the hazard itself, particularly when the exposure is past and cannot be undone. Thus, there is a difference between discussing the riskiness of a situation (risk communication) and what you are going to do about the situation (risk management). Risk communication is successful when the audience responds as intended, calming down or taking action. These case studies are drawn from a large number of risk communication experiences that I and my Rutgers colleagues have engaged in over the past four decades. Through the 20th century, New Jersey was the most densely industrialized State in United States. New Jersey experienced growth of the chemical and petrochemical industries and the unfortunately profligate disposal of toxic wastes. Having the most Superfund sites of any state is a dubious distinction, but New Jersey also has the most experience in evaluating and responding to these hazards.
Gaming addiction is now a prevalent and persistent phenomenon in modern society. This study aimed to assess the metacognitive model of desire thinking and craving in explaining problematic video game use and to examine the role that specific motives for gaming have towards positive metacognitions about desire thinking. A sample of participants (N = 186) aged between 18 and 58 years old, who were primarily male (81.8%), played online games and met the inclusion criteria for Inter-net gaming disorder, completed an online survey, and the data were cross-sectionally analysed. Specifically, path analysis confirmed that the metacognitive model of desire thinking and craving was predictive of gaming-related cognitions and cravings. Furthermore, an expanded model, which included measures of psychopathology, suggested that anger and anxiety may magnify the driving metacognitive and cognitive processes underlying cravings. Finally, a multiple regression revealed that gaming for escapism, coping and skill development associated with stronger positive metacognitions about desire thinking. The findings of this study reinforced the importance of understanding motive when exploring problematic gaming and provided support for the role of metacognitions about desire thinking in shaping video game use cravings. Such findings could benefit both research and practice in their approach to understanding and intervening on problematic gaming behaviours.
BACKGROUND. To this day, relatively little is known about the specifics and mechanisms by which psychological factors, such as a general tendency to anger and the style of expressing anger, can be associated with pro-inflammatory processes and visceral hypersensitivity, which contribute to the appearance of signs of irritable bowel syndrome and lead to its refractory course. AIM. The purpose of the work. to identify the specifics of differences in the presence and severity of depression, anxiety, anger expression and satisfaction with the quality of life in women (average age 39.210.6) with refractory IBS of constipated, diarrheal and mixed types (duration of the disease 33.848.1 months), based on the hypothesis that women with different types of IBS may have different styles of expressing negative emotions (for example, anger) and ways of controlling behavior. MATERIAL AND METHODS. PHQ-15 Patient Health Questionnaire-15; GAD-7 General Anxiety Disorder-7; PHQ-9 Patient Health Questionnaire-9; IBS-QOL Irritable Bowel Syndrome Quality of Life; STAXI StateTrait Anger Expression Inventory. RESULTS. Correlations between subtypes of IBS and negative aspects of the emotional sphere are observed and it is shown that subtypes of IBS-C and IBS-D demonstrate affective profiles characterized by a higher level of anxiety, depression and changes in the expression of anger with difficulties of expression both verbally and nonverbally. All types are characterized by autoaggression, suppression of anger, but these aspects are more pronounced in IBS-D and IBS-C. There is intense control of anger expression. With IBS-C and IBS-M, there is greater control over the expression of anger externally than with IBS-D. Women with IBS-C have more pronounced indicators of anger as a mental state. There are difficulties in verbal expression of anger, hetero- and autoaggression. Anger is a trait of character and is included in the structure of temperament. Women with IBS-D have pronounced indicators of anger as a reaction to a current life event, autoaggression, anger control inside. The level of affect somatization, the presence and severity of generalized anxiety disorder, depression, changes in life satisfaction are among the predictors that determine both the level of anger and the ways of its expression. CONCLUSION. Intestinal motility can be considered as an indicator of behavior control, as an indicator of the regulatory function of the patient, the intensity of affective involvement in a particular situation. Changes in the cognitive, emotional and executive components of the mental organization play only a significant role in the refractory course of IBS.
Recovering after traumatic surgical procedures can bring about adverse effects to the person. Despite some undesirable upshots, something good may come out of it. This evocative autoethnographic study centers on my personal transition as I move from being a patient to that of the nurse. It chronicles the shift of my point of views from episodes of denial to the eminent acceptance that utilizes narrative prose and photovoice as methods. This study has relevance because it describes the process of how an ordinary patient takes ownerships of self-improvement. The findings show that experience can take many forms which proved to demonstrate that I am just one of the many forms that could be similar or different to those who had the experience. Don't feel defeated if you need help. Some people need help to bounce back emotionally. That's not a failure. Success involves caring for yourself and those you love enough to do whatever is necessary to rebound (Pick, 2016). Indeed, success, aside from requiring work, it does not come from oneself or others but a product of both. Recovery and being scarred for life is one of those things that need a lot of work and acceptance.
The main problems in Generalized Anxiety Disorder (GAD) are emotional difficulties, which are usually explained without taking into account the personality pathology in the context of which GAD occurs. The approach described here proposes a deeper understanding of the emotional problems associated with GAD, and presents the psychodynamic concept of the level of personality organization (LPO). The aim of this research was to identify the significance of the level of personality organization for emotional processing in GAD. It was expected: 1) that emotional processing difficulties in generalized anxiety would be more severe among those with lower personality organization than among those with higher personality organization; 2) and that the level of personality organization would mediate the link between emotional difficulties and the severity of GAD. The Generalized Anxiety Disorder Questionnaire IV, the Borderline Personality Inventory, and the Emotional Processing Scale were applied to a sample of 287 undergraduates. The results showed significantly greater emotional dysregulation in GAD when it is comorbid with a lower level of personality organization, and a significant mediating role of personality between emotional processing and generalized anxiety. The results are discussed, emphasizing the significance of bringing together the phenomenological and structural levels of description.
While chronic worry is typically associated with cautious and harm-avoidant behaviours, there is evidence that people high in chronic worry are characterised by negative urgency (NU), that is, the propensity to act rashly when experiencing negative affect. The present study was a preliminary examination of how rash action and impulsive decision-making manifest for chronic worriers compared to individuals low in worry. In total, 93 participants who endorsed high and low worry and NU responded to open-ended questions about their experience of NU on Amazon Mechanical Turk. Themes were identified using a data-driven approach. Participants high in chronic worry endorsed significantly greater NU compared to those low in worry. However, the types of NU behaviours were similar across participants, with a majority of responses involving initiating interpersonal conflict. Other themes included spending money, excessive eating, alcohol use, and aggressive behaviours. The manifestations of NU were largely consistent with those described in the model of NU. Although individuals higher in chronic worry engaged in NU behaviours to a greater extent, the types of behaviours were similar to those reported by people lower in worry. More research is needed to understand the characteristics of NU-motivated behaviour in individuals high in chronic worry.
In recent decades, psychological research on the effects of mindfulness-based interventions has greatly developed and demonstrated a range of beneficial outcomes in a variety of populations and contexts. Yet, the question of how to foster subjective well-being and happiness remains open. Here, we assessed the effectiveness of an integrated mental training program The Art of Happiness on psychological well-being in a general population. The mental training program was designed to help practitioners develop new ways to nurture their own happiness. This was achieved by seven modules aimed at cultivating positive cognition strategies and behaviors using both formal (i.e., lectures, meditations) and informal practices (i.e., open discussions). The program was conducted over a period of 9 months, also comprising two retreats, one in the middle and one at the end of the course. By using a set of established psychometric tools, we assessed the effects of such a mental training program on several psychological well-being dimensions, taking into account both the longitudinal effects of the course and the short-term effects arising from the intensive retreat experiences. The results showed that several psychological well-being measures gradually increased within participants from the beginning to the end of the course. This was especially true for life satisfaction, self-awareness, and emotional regulation, highlighting both short-term and longitudinal effects of the program. In conclusion, these findings suggest the potential of the mental training program, such as The Art of Happiness , for psychological well-being.
Introduction
According to traditional Chinese medicine (TCM), anger is closely related to the liver. This review was conducted to comprehend liver-associated patterns that manifest as anger syndromes in TCM.
Methods
Data regarding preclinical and clinical studies extracted from the China National Knowledge Infrastructure were reviewed to investigate whether it is justifiable and possible to define liver-associated patterns as anger syndrome. TCM patterns from two standard data sources—the World Health Organization standardization of terminologies in TCM and the pattern diagnosis standards of TCM—were analyzed for liver-associated patterns with the anger symptom. The direction, duration, and severity of anger symptoms of the extracted patterns were classified according to the TCM theory concepts such as yin and yang and excess and deficient by two independent authors.
Results
Among 18 liver-associated patterns involving anger symptoms from the two data sources, 12 were associated with outward-focused anger (tendency to express anger verbally and/or behaviorally), four with inward-focused anger (tendency to suppress anger), and two with both outward-focused and inward-focused anger (a problem of anger control). All studies retrieved from the database were examined for the relationship between the liver and anger, with few or no studies examining the relationship between the other four viscera and anger.
Conclusions
This review suggests that using liver-associated patterns in TCM may be a useful strategy for understanding and managing anger syndromes. However, because this study presents only a theoretical framework and preliminary review, further studies linking liver-associated patterns with various anger states are warranted.
Background and objectives:
Research indicates that greater variability in affect and emotion over time is associated with depression and anxiety. However, it remains unclear whether individuals with generalized anxiety disorder (GAD) experience greater affect variability due to individual differences or differences in the stimuli they encounter. The current study investigated whether individuals with analogue GAD demonstrate greater affect variability in response to a standardized set of stimuli.
Methods:
Participants were 134 (95 female) undergraduate participants with analogue GAD (endorsing DSM-IV criteria A, B, C, and E on the GAD-Q-IV; n = 66) or with no symptoms of GAD (n = 68). Participants reported affective reactions (positive affect, negative affect, affective arousal, and affective dominance) to each of nine sets of standardized images varying in valence (positive, neutral, or negative) and arousal (low, medium, or high).
Results:
In a logistic regression model controlling for baseline measurements, higher variability of affective arousal across the nine sets of images uniquely predicted analogue GAD status, whereas variability in positive affect, negative affect, and affective dominance did not. Additional analyses revealed that lower mean affective arousal also uniquely predicted analogue GAD.
Limitations:
Limitations include using self-report measures to determine analogue GAD status; using a short laboratory session for the assessment of affect variability; and potential repeated testing effects.
Conclusions:
These findings suggest that individuals with GAD symptoms experience higher levels of affective arousal variability, even when the stimuli presented are held constant. Assessing variability in affective arousal may be helpful in both conceptualizing and treating individuals with GAD symptoms.
Background:
Patients with various psychiatric disorders may suffer from feelings of anger, sometimes leading to maladaptive (e.g., aggressive) behaviors. We examined to what extent depressive and anxiety disorders, relevant clinical correlates, and sociodemographics determined the level of trait anger and the prevalence of recent anger attacks.
Methods:
In the Netherlands Study of Depression and Anxiety (NESDA), the Spielberger Trait Anger Subscale and the Anger Attacks Questionnaire were analyzed in patients with depressive (n = 204), anxiety (n = 288), comorbid (n = 222), and remitted disorders (n = 1,107), as well as in healthy controls (n = 470) based on DSM-IV criteria.
Results:
On average, participants were 46.2 years old (SD = 13.1) and 66.3% were female. Trait anger and anger attacks were most prevalent in the comorbid group (M = 18.5, SD = 5.9, and prevalence 22.1%), followed by anxiety disorder, depressive disorder, remitted disorder, and controls (M = 12.7; SD = 2.9, and prevalence 1.3%). Major depressive disorder, social phobia, panic disorder, and generalized anxiety disorder were most strongly associated to trait anger and anger attacks.
Limitations:
Due to a cross-sectional design, it was not possible to provide evidence for temporal or causal relationships between anger and depressive and anxiety disorders.
Conclusions:
Trait anger and anger attacks are linked to depressive and anxiety disorders, although the strength of the relationship differed among both anger constructs.
This paper is a practice reflection by two medical social workers. It describes insights from interviews with older adults recovering from illness. The clients were 32 survivors of hospitalization for critical illness and 50 home health patients. Our practice discussions explored a counterintuitive concept: patients with more sources of support reported more anxiety during their illness recovery. Patient anxiety was measured using the DSM-5 and HADS-A criteria. A brief literature review describes the difficulties of quantifying and defining support. Case vignettes are presented to describe three categories of patients who experienced anxiety connected to their support systems. The importance of a social work approach to understanding and individualizing client supports is highlighted. Practical practice suggestions and interventions are provided.
Though anger and anxiety are related, putative explanations for this association remain unclear. Beliefs about one's state of uncertainty may be a pathway-the belief that one's uncertain state is unavoidable might lead to anxiety, whereas the belief that one's uncertain state is avoidable might lead to both anxiety and anger. To test this hypothesis, participants experienced an uncertainty induction and were then assigned to the avoidable uncertainty condition (experimental group) or the unavoidable uncertainty condition (control group). State anger and anxiety were assessed at baseline, following the uncertainty induction, and following the "avoidableness" manipulation. The uncertainty induction was successful; participants reported higher levels of anxiety at post-induction compared to baseline. As expected, the experimental group reported increases in anger from post-induction to post-manipulation whereas the control group reported decreases in anger. These findings suggest that when one's state of uncertainty is avoidable, anger is experienced alongside anxiety.
Anger plays a prominent definitional role in some psychological disorders currently widely scattered across DSM-5 categories (e.g., intermittent explosive disorder, borderline personality disorder). But the presence and consequences of anger in the emotional disorders (e.g., anxiety disorders, depressive disorders) remain sparsely examined. In this review, we examine the presence of anger in the emotional disorders and find that anger is elevated across these disorders and, when it is present, is associated with negative consequences, including greater symptom severity and worse treatment response. Based on this evidence, anger appears to be an important and understudied emotion in the development, maintenance, and treatment of emotional disorders.
At the root of many controversies surrounding therapy is one key question: What works? Is efficacy based on the singular curative powers of specialized techniques, or do other variables account for patient change? This book proposes the answer, which is not to be found in the languages, theories, or procedural differences of the field's warring camps. Instead, the answer lies in pantheoretical, or common factors—the ingredients of effective therapy shared by all orientations.
More than 40 yrs of outcome research is pointing the way to what really matters in the therapist's day-to-day work. The editors have assembled researchers and practitioners in the field to analyze the extensive literature on common factors and to offer their own evaluations of what those data mean for therapy, therapists, and consumers. Consistent patterns are revealed in findings from multiple perspectives—clinical, research, quantitative and qualitative, individual and family, and medical and school. The result is a book that interprets the empirical foundation of how people change. Clinicians will especially appreciate the wealth of practical suggestions for using the common factors to improve their daily practice. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Anger has semantic, conceptual, and empirical links to psychopathology. It has long been associated with madness, a diseased
mind, and behavioral dyscontrol; claims of temporary insanity and the “heat of passion” defense feature anger. As an eruptive
and turbulent emotion, anger activates violent behavior among psychiatric patients, before, during, and after hospitalization.
Unlike anxiety and depression, there is no diagnostic category for anger, except perhaps intermittent explosive disorder,
for which the criterion is aggressive behavior. Being intrinsically related to threat perception, anger is manifested in a
wide variety of psychiatric disorders. With the inherent functionality of anger as point of departure, its involvement in
adult psychopathology is presented. Anger emerges in conjunction with delusions and command hallucinations in psychotic disorders,
the emotional instability attributes of personality disorders, irritability and “attacks” in mood disorders, impulse control
disorders, intellectual disabilities, dementia, and exotic cultural-bound syndromes. As anger often results from trauma, it
can be salient in PTSD, significantly affecting the severity and course of PTSD symptoms. The central characteristic of anger
in the broad context of clinical disorders is dysregulation – its activation, expression, and experience occur without appropriate
controls. Cautions against pathologizing an important emotional state are discussed, along with gains being made in anger
treatment.
The present study tested the reliability of a self-report diagnostic measure of generalized anxiety disorder (GAD) based on DSM criteria. Among two samples of undergraduate students, 47-80% of the GAD diagnoses by questionnaire were confirmed by diagnostic interview, with the higher rate being associated with DSM-IV criteria. Categorization of a participant as Non-GAD by questionnaire was found to be 100% reliable by interview. Given these findings as well as prior empirical support for the validity of the measure, this questionnaire has utility for identifying analogue GAD and Non-GAD participants from undergraduate populations for use in preliminary investigations of the mechanisms and functions associated with chronic worry and GAD.
The comorbidity of current and lifetime DSM-IV anxiety and mood disorders was examined in 1,127 outpatients who were assessed with the Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV-L). The current and lifetime prevalence of additional Axis I disorders in principal anxiety and mood disorders was found to be 57% and 81%, respectively. The principal diagnostic categories associated with the highest comorbidity rates were mood disorders, posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). A high rate of lifetime comorbidity was found between the anxiety and mood disorders; the lifetime association with mood disorders was particularly strong for PTSD, GAD, obsessive-compulsive disorder, and social phobia. The findings are discussed in regard to their implications for the classification of emotional disorders.
Although organizational justice scholars often describe unfairness as an emotionally laden experience, the role of emotion is underresearched. In a study of individuals who experienced being laid off (N = 173), the authors found that outcome favorability interacts with both procedural and interactional justice to predict participants' emotions. The pattern of interaction differed for inward-focused (i.e., shame and guilt) and outward-focused (i.e., anger and hostility) negative emotions. Attributions of blame mediated the relationship between fairness perceptions and outward-focused negative emotion. Outward-focused emotion mediated the relationship between fairness perceptions and retaliation.
This meta-analysis synthesizes the available data on the strength of association between anger and posttraumatic stress disorder (PTSD) and between hostility and PTSD, covering 39 studies with trauma-exposed adults. Effect sizes did not differ for anger and hostility, which could therefore be combined; effect sizes for anger expression variables were analyzed separately. The analyses revealed large effects. The weighted mean effect size (r) was .48 for anger-hostility, .29 for anger out, .53 for anger in, and -.44 for anger control. Moderator analyses were conducted for anger-hostility, showing that effect sizes were substantially larger with increasing time since the event and that effect sizes were larger in samples with military war experience than in samples that had experienced other types of traumatic events.
Using clinical data and a variety of case studies, this title argues for a new diagnostic classification, Anger Regulation and Expression Disorder, that will help bring about clinical improvements and increased scientific understanding of anger. After situating anger in both historical and emotional contexts, it reports research that supports the existence of several subtypes of the disorder and review treatment outcome studies and new interventions to improve treatment. This title fully explores anger as a clinical phenomenon and provides a reliable set of assessment criteria, it represents a major step toward establishing the clear definitions and scientific basis necessary for assessing, diagnosing, and treating anger disorders.
Cognitive-Behavioral Treatment for Generalized Anxiety Disorder: From Science to Practice provides a review of the empirical support for the different models of GAD. It includes a detailed description of the assessment and step-by-step treatment of GAD (including many examples of therapist-client dialogue), data on treatment efficacy in individual and group therapy, and concludes with a description of maintenance and follow-up strategies.
The comorbidity of current and lifetime DSM-IV anxiety and mood disorders was examined in 1,127 outpatients who were assessed with the Anxiety Disorders Interview Schedule for DSM-IV :Lifetime version (ADIS-IV-L). The current and lifetime prevalence of additional Axis I disorders in principal anxiety and mood disorders was found to be 57% and 81%, respectively. The principal diagnostic categories associated with the highest comorbidity rates were mood disorders, posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). A high rate of lifetime comorbidity was found between the anxiety and mood disorders; the lifetime association with mood disorders was particularly strong for PTSD, GAD, obsessive-compulsive disorder, and social phobia. The findings are discussed in regard to their implications for the classification of emotional disorders.
A new questionnaire on aggression was constructed. Replicated factor analyses yielded 4 scales: Physical Aggression, Verbal Aggression, Anger, and Hostility. Correlational analysis revealed that anger is the bridge between both physical and verbal aggression and hostility. The scales showed internal consistency and stability over time. Men scored slightly higher on Verbal Aggression and Hostility and much higher on Physical Aggression. There was no sex difference for Anger. The various scales correlated differently with various personality traits. Scale scores correlated with peer nominations of the various kinds of aggression. These findings suggest the need to assess not only overall aggression but also its individual components.
Objective: In patients with generalized anxiety disorder, emotional reactions appear easier, faster and more intense than other people. Anger is an emotion that is useful when appears in a short time and mild severity but it may be destructive when it becomes continuous or severe. The aim of this study was to compare the anger level and expression of the subjects with generalized anxiety disorder and healthy control group. Methods: Forty consecutive generalized anxiety disorder patients who attended to outpatient psychiatry unit were included in the present study. A control group of 40 healthy persons, matched for age, gender and education with study group was also included. To evaluate anxiety levels, trait anger and anger expression, State-Trait Anxiety Inventory and Trait Anger Expression Inventory were used respectively. Results: In patients with generalized anxiety disorder, trait anger, anger in and anger out subscale scores were higher than the controls; anger control subscale scores were lower than controls. In addition, in patients with generalized anxiety disorder, the trait anxiety level correlated positively with anger in and anger out subscale scores, and correlated negatively with anger control scores. Discussion: The findings of the present study indicated that trait anger levels and anger expression significantly influence the development of the generalized anxiety disorder and the level of anxiety. Therefore understanding and coping with the anger of GAD patients may contribute much to the management of these cases.
Students and beginning researchers often discover that their introductory statistics and methods courses have not fully equipped them to plan and execute their own behavioral research studies. This indispensable book bridges the gap between coursework and conducting independent research. With clarity and wit, the author helps the reader build needed skills to formulate a precise, meaningful research question; understand the pros and cons of widely used research designs and analysis options; correctly interpret the outcomes of statistical tests; make informed measurement choices for a particular study; manage the practical aspects of data screening and preparation; and craft effective journal articles, oral presentations, and posters. Including annotated examples and recommended readings, most chapters feature theoretical and computer-based exercises; an answer appendix at the back of the book allows readers to check their work.
This study examined the relations between self-esteem, social problem-solving ability, and aggression in a sample of 205 college students. The Social Problem-Solving Inventory-Revised was used to measure five different dimensions of social problem-solving ability (viz., positive problem orientation, negative problem orientation, rational problem solving, impulsivity/carelessness style, & avoidance style) and the Aggression Questionnaire was used to measure four different dimensions of aggression (viz., physical aggression, verbal aggression, anger, & hostility). Self-esteem and social problem-solving ability were measured at the same time, whereas aggression was measured six to seven weeks later. Low self-esteem was found to be related to anger and hostility, and several specific problem-solving dimensions were found to be related to anger, hostility, and physical aggression. A series of path analyses found support for a mediational model in which the link between self-esteem and anger is fully mediated by negative problem orientation. In addition, the results also suggested that negative problem orientation partially mediates the relationship between self-esteem and hostility. The theoretical, research, and clinical implications of the findings are discussed.
While the emotion of anger has become an increasingly important part of clinical assessment, the theoretical and psychometric adequacy of the instruments used to assess anger and hostility have long been questioned. In the present review, we first provide definitions of anger and hostility in order to provide a theoretical context from which to evaluate the scope of current measures of these constructs. Second, we review the major self-report scales used to assess anger and hostility in light of these definitions and provide a detailed evaluation of psychometric evidence concerning their reliability and validity. Finally, we offer specific recommendations concerning how anger and hostility assessment instruments can be improved and expanded. In particular, we note the need for (a) an expansion of anger assessment methods beyond traditional endorsement approaches, (b) scales to assess specific domains of anger experience, (c) scales that assess unique content domains of anger experience and expressions, such as spouse-specific or driving-related anger scales, and (d) scales that assess the clinical aspects of the anger construct.
The present study examined social anxiety, anger, and depression among 234 persons with social anxiety disorder and 36 nonanxious controls. In addition to greater social anxiety, persons with social anxiety disorder exhibited more severe depression, greater anger, and poorer anger expression skills than did nonanxious control participants. Analyses investigating attrition and response to cognitive-behavioral group treatment (CBGT) among a subset of 68 persons treated for social anxiety disorder indicated that patients who experienced anger frequently, perceived unfair treatment, and were quick-tempered were less likely to complete a 12-session course of CBGT. Among treatment completers, significant reductions in the frequent experience of anger to perceived negative evaluation and in anger suppression were noted. However, those who suppressed anger responded less favorably to CBGT. Future directions and clinical implications are discussed.
This article proposes that anger has received less attention in the behavior therapy literature than other emotional disorders. Little research exists to guide clinical practice on the effectiveness of interventions to treat anger. Suggestions are made for treating angry clients. These suggestions are presented as researchable hypotheses. It is proposed that angry clients often fail to establish a therapeutic alliance with their therapists. Failure to agree on the goal of changing their anger is the component of the alliance which is most problematic. Strategies to develop the therapeutic alliance with angry clients are proposed. Script theories of emotions are presented as an important tool for understanding clients' reluctance to change and in establishing the alliance with clients of different cultural backgrounds. The creation of new scripts that are acceptable to the client's cultural group is presented as one strategy to establish a therapeutic alliance. It is suggested that the use of exposure based treatment may be a promising treatment for anger.
The present study examined the role of internalized anger, externalized anger, and anger control (Spielberger, 1991) as predictors of depressive, anxious, and hostile symptoms. Based on regression analyses, internalized anger, followed by lack of anger control, was found to play an important role in predicting both depressive and anxious symptoms. However, for depressive symptoms, sex and externalized anger were also found to play a significant role in predicting this outcome. In contrast, hostility was predicted by externalized anger, followed by lack of anger control and internalized anger. These results are taken to support the validity of distinguishing between measures of depression, anxiety, and hostility.
This study examined the Generalized Anxiety Disorder Questionnaire-IV (GAD-Q-IV), a revised self-report diagnostic measure of generalized anxiety disorder (GAD) based on the 4th edition of the Diagnostic and Statistical Manual. Subjects were undergraduates (aged 17-41 yrs). GAD-Q-IV diagnoses were compared to structured interview diagnoses of individuals with GAD, social phobia, panic disorder, and nonanxious controls. Using Receiver Operating Characteristics analyses, the GAD-Q-IV showed 89% specificity and 83% sensitivity. The GAD-Q-IV also demonstrated test-retest reliability, convergent and discriminant validity, and kappa agreement of .67 with a structured interview. Students diagnosed with GAD by the GAD-Q-IV were not significantly different on 2 measures than a GAD community sample, but both groups had significantly higher scores than students identified as not meeting criteria for GAD, demonstrating clinical validity of the GAD-Q-IV.
• Fear, rage and pain, and the pangs of hunger are all primitive experiences which human beings share with the lower animals. These experiences are properly classed as among the most powerful that determine the action of men and beasts. A knowledge of the conditions which attend these experiences, therefore, is of general and fundamental importance in the interpretation of behavior. During the past four years there has been conducted, in the Harvard Physiological Laboratory, a series of investigations concerned with the bodily changes which occur in conjunction with pain, hunger and the major emotions. A group of remarkable alterations in the bodily economy have been discovered. Because these physiological adaptations are interesting both in themselves and in their interpretation, it has seemed worth while to gather together in convenient form the original accounts of the experiments, which have been published in various American medical and physiological journals. I have, however, attempted to arrange the results and discussions in an orderly and consecutive manner, and I have tried also to eliminate or incidentally to explain the technical terms, so that the exposition will be easily understood by any intelligent reader even though not trained in the medical sciences. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
• Fear, rage and pain, and the pangs of hunger are all primitive experiences which human beings share with the lower animals. These experiences are properly classed as among the most powerful that determine the action of men and beasts. A knowledge of the conditions which attend these experiences, therefore, is of general and fundamental importance in the interpretation of behavior. During the past four years there has been conducted, in the Harvard Physiological Laboratory, a series of investigations concerned with the bodily changes which occur in conjunction with pain, hunger and the major emotions. A group of remarkable alterations in the bodily economy have been discovered. Because these physiological adaptations are interesting both in themselves and in their interpretation, it has seemed worth while to gather together in convenient form the original accounts of the experiments, which have been published in various American medical and physiological journals. I have, however, attempted to arrange the results and discussions in an orderly and consecutive manner, and I have tried also to eliminate or incidentally to explain the technical terms, so that the exposition will be easily understood by any intelligent reader even though not trained in the medical sciences. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Previous research examining anger problems among the anxiety disorders has been limited by the use of nonrepresentative samples, univariate analyses, as well as low sample size. The current study examined the association between posttraumatic stress disorder (PTSD), panic disorder (PD), social anxiety disorder, specific phobia (SP), and generalized anxiety disorder (GAD) and anger experience and expression. We hypothesized that greater anger experience and expression would be associated with all anxiety disorders, but that it would be most consistently associated with PTSD and PD diagnoses, and that these relationships would remain significant after controlling for demographics (i.e. age, gender, ethnicity, marital status, and income) and comorbid disorders.
Participants included 5,692 (54% female) adults from the National Comorbidity Survey-Replication, a large, nationally representative survey.
Our data suggest that there are unique relationships between multiple anxiety disorders and various indices of anger experience and expression that are not better accounted for by psychiatric comorbidity. Contrary to predictions, PTSD and PD were not consistently associated with anger experience and expression.
Overall, these findings lend support to the emerging literature demonstrating a potentially important relationship between anxiety disorders and anger problems.
Trait anger is a personality construct that refers to stable individual differences in the propensity to experience anger as an emotional state. The objective of this paper is to review relevant empirical studies in order to determine whether the transdiagnostic cognitive processes that have been identified across the DSM-IV Axis I disorders (specifically, selective attention, memory biases, reasoning biases and recurrent negative thinking) are also an underlying characteristic of high trait anger. On the basis of the review it is concluded that, whilst the research base is limited, there is good evidence that high trait anger is associated with selective attention to hostile social cues, the tendency to interpret the behaviour of others as indicating potential hostility and the tendency to ruminate over past anger-provoking experiences. The range of cognitive processes identified in high trait anger is consistent with those identified in the Axis I disorders. It is concluded that these findings provide support for (i) the broad applicability of the transdiagnostic approach as a theoretical framework for understanding a range of psychological conditions, not limited to the Axis I disorders, and (ii) the validity of conceptualising high trait anger as an aspect of personality functioning that is maintained, at least in part, by cognitive processes. Cognitive and motivational factors (specifically, beliefs and goals) that may underlie the hostile information-processing biases and recurrent negative thinking associated with high trait anger are discussed, and consideration is given to the clinical relevance of the findings of the review.
The available empirical literature suggests that anger may be characteristic of posttraumatic stress disorder (PTSD). Meta-analytic strategies were used to evaluate the extent to which the experience of anger is specific to PTSD rather than anxiety disorders in general. Thirty-four anxiety disorder patient samples (n=2,169) from 28 separate studies were included in the analysis. Results yielded a large effect size indicating greater anger difficulties among anxiety disorder patients versus controls. Compared to control samples, a diagnosis of PTSD was associated with significantly greater difficulties with anger than was any other anxiety disorder diagnosis. Other anxiety disorder diagnoses did not differ significantly from each other. However, the specific association between PTSD and anger did vary depending on the anger domain assessed. Difficulties with anger control, anger in, and anger out significantly differentiated PTSD from non-PTSD anxiety disorder samples, whereas difficulties with anger expression, state anger, and trait anger did not. These findings are discussed in the context of future research on the role of anger in PTSD.
This study examined the factor structure of the English version of the Intolerance of Uncertainty Scale (IUS; French version: M. H. Freeston, J. Rhéaume, H. Letarte, M. J. Dugas, & R. Ladouceur, 1994; English version: K. Buhr & M. J. Dugas, 2002) using a substantially larger sample than has been used in previous studies. Nonclinical undergraduate students and adults from the community (M age = 23.74 years, SD = 6.36; 73.0% female and 27.0% male) who participated in 16 studies in the Anxiety Disorders Laboratory at Concordia University in Montreal, Canada were randomly assigned to 2 datasets. Exploratory factor analysis with the 1st sample (n = 1,230) identified 2 factors: the beliefs that "uncertainty has negative behavioral and self-referent implications" and that "uncertainty is unfair and spoils everything." This 2-factor structure provided a good fit to the data (Bentler-Bonett normed fit index = .96, comparative fit index = .97, standardized root-mean residual = .05, root-mean-square error of approximation = .07) upon confirmatory factor analysis with the 2nd sample (n = 1,221). Both factors showed similarly high correlations with pathological worry, and Factor 1 showed stronger correlations with generalized anxiety disorder analogue status, trait anxiety, somatic anxiety, and depressive symptomatology.
This paper reports the results of an experiment investigating the effect of induced anger on interpretational bias using the homophone spelling task. Four groups of participants experienced anger, anxiety, happy or neutral mood inductions and then completed the homophone spelling task. Participants who experienced anger and anxiety inductions reported significantly more threat/neutral homophones as threats compared to control participants; moods had an emotion-congruent effect on threat reporting, with negative moods increasing the tendency to report threat/neutral homophones as threats and positive moods increasing the tendency to report positive/neutral homophones as positive. The findings provide evidence that anger potentiates the reporting of threatening interpretations and does so independently of any effect of concurrent levels of state and trait anxiety. The mechanism mediating this effect is unclear, but the results do lend support to those theories of psychopathology--and especially of PTSD--that see a causal role for anger in the maintenance of symptoms.
It is unknown whether anger is a risk factor for the development of posttraumatic stress disorder ( PTSD) symptoms, arises as a consequence of PTSD, or both. Two hypotheses were tested in 180 police recruits: Greater trait anger during training will predict greater PTSD symptoms at one year; greater PTSD symptoms at one year will predict greater state anger at one year. Both hypotheses were confirmed, suggesting that trait anger is a risk factor for PTSD symptoms, but that PTSD symptoms are also associated with an increase of state anger. Increased anger is important not only because of the impact it has on individual distress and physical health, but also because of its potential public health impact.
A new questionnaire on aggression was constructed. Replicated factor analyses yielded 4 scales: Physical Aggression, Verbal Aggression, Anger, and Hostility. Correlational analysis revealed that anger is the bridge between both physical and verbal aggression and hostility. The scales showed internal consistency and stability over time. Men scored slightly higher on Verbal Aggression and Hostility and much higher on Physical Aggression. There was no sex difference for Anger. The various scales correlated differently with various personality traits. Scale scores correlated with peer nominations of the various kinds of aggression. These findings suggest the need to assess not only overall aggression but also its individual components.
We review psychometric and other evidence relevant to mixed anxiety-depression. Properties of anxiety and depression measures, including the convergent and discriminant validity of self- and clinical ratings, and interrater reliability, are examined in patient and normal samples. Results suggest that anxiety and depression can be reliably and validly assessed; moreover, although these disorders share a substantial component of general affective distress, they can be differentiated on the basis of factors specific to each syndrome. We also review evidence for these specific factors, examining the influence of context and scale content on ratings, factor analytic studies, and the role of low positive affect in depression. With these data, we argue for a tripartite structure consisting of general distress, physiological hyperarousal (specific anxiety), and anhedonia (specific depression), and we propose a diagnosis of mixed anxiety-depression.
The present report describes the development of the Penn State Worry Questionnaire to measure the trait of worry. The 16-item instrument emerged from factor analysis of a large number of items and was found to possess high internal consistency and good test-retest reliability. The questionnaire correlates predictably with several psychological measures reasonably related to worry, and does not correlate with other measures more remote to the construct. Responses to the questionnaire are not influenced by social desirability. The measure was found to significantly discriminate college samples (a) who met all, some, or none of the DSM-III-R diagnostic criteria for generalized anxiety disorder and (b) who met criteria for GAD vs posttraumatic stress disorder. Among 34 GAD-diagnosed clinical subjects, the worry questionnaire was found not to correlate with other measures of anxiety or depression, indicating that it is tapping an independent construct with severely anxious individuals, and coping desensitization plus cognitive therapy was found to produce significantly greater reductions in the measure than did a nondirective therapy condition.
The present study examined the relationship between depression and various dimensions of anger using multiple measures of anger and hostility and comparing depressed subjects with both a normal sample and a clinical sample with predominant anger difficulties. Three groups of subjects were obtained: a normal sample of 120 parents of elementary school children, 36 psychiatric inpatients meeting Research Diagnostic Criteria for major depressive episode, and 54 hospitalized veterans meeting Diagnostic Interview Schedule criteria for posttraumatic stress disorder (PTSD). The three groups differed significantly on all measures of anger experience, hostility, anger suppression, and anger expression. The depressed group reported greater levels of hostility and anger experience than the normal group but less than the PTSD group. On measures of anger suppression and expression, the depressed group exhibited more suppression than either the normal or the PTSD group and generally reported levels of anger expression comparable with the normal group's. The PTSD group reported the highest levels of anger expression. Within the depressed group, severity of depression was positively associated with levels of hostility and anger experience but was not related to measures of anger expression and was only partially related to anger suppression. These results are discussed as they relate to the "anger turned in" hypothesis of psychodynamic theories of depression, and directions for future research are noted.
Recent advances in the understanding of worry have led to the development of treatments for generalized anxiety disorder (GAD). The present study tested a GAD treatment that targeted intolerance of uncertainty, erroneous beliefs about worry, poor problem orientation, and cognitive avoidance. Twenty-six primary GAD patients were randomly allocated to a treatment condition (n = 14) or a delayed treatment control condition (n = 12). Self-report, clinician, and significant other ratings assessed GAD and associated symptoms. The results show that the treatment led to statistically and clinically significant change at posttest and that gains were maintained at 6- and 12-month follow-ups. Furthermore, 20 of 26 participants (77%) no longer met GAD diagnostic criteria following treatment. With regard to the treatment's underlying model, the results show that intolerance of uncertainty significantly decreased over treatment and that gains were maintained at both follow-ups. Although nonspecific factors were not significant predictors of treatment outcome, their role in the treatment of GAD requires further investigation.
Despite numerous technical treatments in many venues, analysis of covariance (ANCOVA) remains a widely misused approach to dealing with substantive group differences on potential covariates, particularly in psychopathology research. Published articles reach unfounded conclusions, and some statistics texts neglect the issue. The problem with ANCOVA in such cases is reviewed. In many cases, there is no means of achieving the superficially appealing goal of "correcting" or "controlling for" real group differences on a potential covariate. In hopes of curtailing misuse of ANCOVA and promoting appropriate use, a nontechnical discussion is provided, emphasizing a substantive confound rarely articulated in textbooks and other general presentations, to complement the mathematical critiques already available. Some alternatives are discussed for contexts in which ANCOVA is inappropriate or questionable.