title: Peeking into the black box: mechanisms of action for anger management treatment.
abstract: We investigated potential mechanisms of action for anger symptom reductions, specifically, the roles of anger regulation skills and therapeutic alliance on changes in anger symptoms, following group anger management treatment (AMT) among combat veterans with posttraumatic stress disorder (PTSD). Data were drawn from a published randomized controlled trial of AMT conducted with a racially diverse group of 109 veterans with PTSD and anger symptoms residing in Hawaii. Results of latent growth curve models indicated that gains in calming skills predicted significantly larger reductions in anger symptoms at post-treatment, while the development of cognitive coping and behavioral control skills did not predict greater symptom reductions. Therapeutic alliance had indirect effects on all outcomes mostly via arousal calming skills. Results suggest that generalized symptom reduction may be mediated by development of skills in calming physiological arousal. In addition, arousal reduction skills appeared to enhance one's ability to employ other anger regulation skills.
authors.affiliation: National Center for PTSD, - Pacific Islands Division, Department of Veterans Affairs Pacific Islands Healthcare System, 3375 Koapaka Street, Suite I-560, Honolulu, HI 96819, United States. Electronic address: margaret.mackintosh@va.gov.
authors.forename: Margaret-Anne
authors.initials: MA
authors.lastname: Mackintosh
authors.affiliation: National Center for PTSD, - Pacific Islands Division, Department of Veterans Affairs Pacific Islands Healthcare System, 3375 Koapaka Street, Suite I-560, Honolulu, HI 96819, United States; John Burns School of Medicine, University of Hawaii, 651 Ilalo Street, Honolulu, HI 96813, United States. Electronic address: Leslie.Morland@va.gov.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Morland
authors.affiliation: University of Hawaii at Hilo, 200 W. Kawili Street, Hilo, HI 96720, United States; The Menninger Clinic, 12301 Main Street, Houston, TX 77035, United States. Electronic address: frueh@hawaii.edu.
authors.forename: B Christopher
authors.initials: BC
authors.lastname: Frueh
authors.affiliation: National Center for PTSD, - Dissemination & Training Division, Department of Veterans Affairs Palo Alto Healthcare System, 795 Willow Road (334-PTSD), Menlo Park, CA 94025, United States. Electronic address: carolyn.greene3@va.gov.
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Greene
authors.affiliation: National Center for PTSD, - Dissemination & Training Division, Department of Veterans Affairs Palo Alto Healthcare System, 795 Willow Road (334-PTSD), Menlo Park, CA 94025, United States; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA 94305, United States. Electronic address: craig.rosen@va.gov.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Rosen
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000786:Anger / Q000502:physiology*; D001007:Anxiety / Q000209:etiology; D001143:Arousal / Q000502:physiology; D015928:Cognitive Behavioral Therapy; D003130:Combat Disorders / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology* / Q000628:therapy; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
keywords: Anger; Anger control; Cognitive behavior therapy; Military veterans; Posttraumatic stress disorder