PASA program at Kent School District

ASSESSMENT AND INTERVENTION FOR ADOLESCENTS WITH ANGER AND AGGRESSION DIFFICULTIES IN SCHOOL SETTINGS
EVA L. FEINDLER AND EMILY C. ENGEL Long Island University/C.W. Post Campus
The development, implementation, and evaluation of anger management programs have proliferated over the past decade. The programs aim to moderate the intensity, frequency, and severity of anger expression, and facilitate alternative nonaggressive responses to conflict and frustration.Cognitive-behavioraltheoryhighlightscognitiveprocessessuchasattributions,expectations, interpersonal beliefs, and problem solving as most influential in determining an individual’s response to provocation and identifies anger arousal as a mediator of aggressive behavior. Based on this premise that youth exhibit aggressive behavior due to poor arousal management, social, and problem-solving skills, Feindler and colleagues have developed psychoeducational anger management programs to target these deficits and to teach prosocial, conflict resolution skills. This article will review the development of anger difficulties, suggest tools for screening and outcome assessment, describe the anger management intervention approach, and present an overview of the research supporting implementation in school and community settings. Finally, specific recommendations for implementation are provided. C  2011 Wiley Periodicals, Inc.
During adolescence, youths’ physical aggression, relational aggression, and difficulty interacting with authority may lead to antisocial behavior patterns (Kazdin, 1992; Nock, Kazdin, Hiripi, & Kessler, 2006). This article will focus on physical aggression, or gross motor behavior (e.g., hitting, kicking, throwing things at others) and verbal aggression (e.g., cursing, threatening), and the emotionalandcognitiveprecursors.Cognitive-behavioral theorystatesthatanaversivestimulustriggers physiological arousal and distorted cognitive responses, which results in the affective experience of anger, and can precipitate aggressive behaviors in response to triggers (Feindler & Starr, 2005). Although anger is a common and natural emotion, or internal event, problems associated with theinappropriateexpressionofangerremainamongthemostseriousconcernsofparents,educators, andthementalhealthcommunity.Ifleftuntreated,youthaggressionseemsstableovertime,predicts social adjustment difficulties, and may lead to additional antisocial behaviors. Cognitive-behavioral theory highlights cognitive processes such as attributions, expectations, interpersonal beliefs, and problem solving as most influential in determining an individual’s response to provocation and identifiesangerarousalasamediatorofaggressivebehavior.Intenseandunmodulatedangercanfuel cognitivedistortionsandresultinimpulsiveandaggressiveresponsestowardperceivedprovocations. These responses are often reinforced by short-term reductions in anger, immediate impact in the stimulus situation, and social consequences from peers. Cognitive-behavioral therapy, then, assists clients in regulating intense affective states and modifying cognitive distortions to promote more prosocial behaviors. The antecedents to the development of aggressive behavior patterns are multiple and complex. On an individual level, male gender, Black race, genetic predisposition to hyperactivity and impulsivity, and substance use predict physical aggression (Glick, 2003; Hawkins, 1995; Nock et al., 2006). Additionally, social learning theorists consider aggression to be “learned by observation, imitation, direct experience, and rehearsal” (Goldstein, Glick, & Gibbs, 1998, p. 3). Aggression is often learned in the home and from aggressive peer groups that advocate violence as an appropriate way to manage conflict and elevate one’s social status (Goldstein, Nensen, Daleflod, & Kalt, 2004).
Correspondence to: Eva Feindler, Long Island University, 8 Prospect Ave., Garden City, NY 11530. E-mail: eva.feindler@liu.edu
243
244 Feindler and Engel
Aggressionisassociatedwithspecificsocial,emotional,andcognitivecomponents.Aggressive youthoftendemonstrateunderdevelopedsocialskills,whichcanleadtosocialalienation,withdrawal, andanxiety(Glick,2003).Additionally,theyfrequentlyexhibitaninhibitedabilitytoempathizewith others, due to cognitive processes outlined later in this article. Individuals who behave aggressively often engage in impulsive, automatic processing of overwhelming affective experience (Crick & Dodge, 1994; Feindler & Baker, 2004). External aversive events trigger cognitive and physiological arousal,orthesubjectiveexperienceofanger,whichisassociatedwithincreasedautonomicnervous system activity and cognitive labeling based on the individual’s pre-existing cognitive schemas. Cognitively,aggressiveyouthtendtoperceiveinterpersonalcuesunrealistically,oftenmisperceiving abenignactashostileoraggressive(Crick&Dodge,1994;Trembly&Belchevski,2004).Aggressive youth possess underdeveloped social problem-solving abilities, and instead use antisocial belief systems to justify their aggressive responses to perceived injustices (Glick, 2003). In addition to the aforementioned difficulties, aggressive youth demonstrate an arrestation of moral reasoning development;ameta-analysisfoundthatyouthwhoengageindelinquentbehaviorfunctionatlower levelsofmoralreasoningthantheirnondelinquentcounterparts(Glick,2003;Kohlberg,1981,1984; Nelson, Smith, & Dodd, 1990).
Assessment of Anger in Adolescents Prior to implementation of an anger management program, a comprehensive clinical assessment designed to conceptualize the youth’s anger disorder must be completed. An examination of the psychological profile and behavioral history of the aggressive adolescent should indicate that deficiencies in arousal management, impulse control (or the ability to delay behavioral responses to aversive stimuli), and prosocial responses to interpersonal provocation exist. Other factors to consider on interview and screening include level of cognitive functioning, emotional maturity, group readiness, and motivation for treatment and are discussed fully elsewhere (see Feindler & Baker, 2004). Severalstructuredassessmentmethodsareavailablethatmayfurtherdelineatetheadolescent’s anger management difficulties. A number of easy-to-administer self-report inventories can help to evaluate treatment effectiveness using pretest and posttest assessment including the 41-item Adolescent Anger Rating Scale (Burney, 2001), the 29-item Aggression Questionnaire (Buss & Perry, 1992), the 30-item Children’s Inventory of Anger (Nelson & Finch, 2000), the 54-item How I Think Questionnaire (Gibbs, Barriga, & Potter, 2001), the 20-item Normative Beliefs About Aggression Scale (Huseman & Guerra, 1997), and finally the 54-item Multidimensional School Anger Inventory (Smith, Furlong, Bates, & Laughlin, 1998). Given likely response bias and social desirabilityelementsinherentinself-reportassessments,clinicalinvestigatorsareencouragedtouse additionaldatacollectionmethods,suchasdirectobservation;ratingsbyparents,teachers,andstaff; analogue role play methods; and self-monitoring. For a detailed review of assessment methods and issues, see Feindler (1990), Feindler and Baker (2004), and Smith, Furlong, & Boman (2006). In addition to more traditional paper-and-pencil assessments, the use of the Hassle Log, a self-monitoring tool, is encouraged. This data sheet (see Appendix 1) is a flexible method for the quantificationofanumberofvariablesassociatedwithboththeantecedentandconsequentconditions surrounding anger provocation and aggressive behavior. Although the accuracy, reliability, and validity of this self-recording tool have not been examined, the Hassle Log is an important clinical and educational adjunct to the anger management intervention. The Hassle Log functions as (a) a teaching tool to help determine individual sequences to triggers, setting events, responses, and selfevaluation;(b)scriptsforroleplays(therecordingofsituationaleventsprovidesrealisticscenariosfor role play enactments during sessions); (c) a self-recording tool that serves as an alternative response
Psychology in the Schools DOI: 10.1002/pits
Assessment and Intervention for Adolescents 245
to provocation; (d) a way to teach self-observation and self-evaluative skills; and (e) a prompt for self-reinforcement for anger well managed and a generalization strategy for the introduction of treatment in naturalistic settings. The Hassle Log can be altered to fit any client population or treatment context and serves as an early compliance probe to assess an adolescent’s likelihood of following treatment recommendations/homework assignments. We suggest continued Hassle Log completionacrossthedurationofinterventionandexaminationofchangesinrecordingsacrosstime as a method of individualized outcome assessment.
Anger Management Interventions Cognitive behavioral anger management training (AMT) is based on the hypothesis that aggressive behavior is elicited by an aversive “trigger” stimulus that is followed by both physiological arousal and distorted cognitive responses, which result in the emotional experience of anger. To prevent an aggressive reaction to a triggered stimulus, it is necessary for adolescents to learn to match the intensity of the response to the realistic aversiveness of the stimulus and to process the interpersonal exchange so that they can exhibit a more prosocial response. The typical anger managementtreatmentprotocolfocusesonthethreecomponentsoftheangerexperience(physiological, cognitive, and behavioral) and is designed to help students develop self-control skills in each of these areas. AMT can be administered individually and in group settings. Although both contexts include the same principle elements of AMT, each has its own benefits (i.e., individual AMT offers the opportunity for more thorough, individualized work, whereas group AMT offers the opportunity for group modeling and vicarious reinforcement of prosocial behaviors). Although role plays during group sessions more often approximate naturalistic conflict situations engendering anger and aggression, working with group members who are known to each other outside of the group session has potential liabilities in terms of confidentiality and spillover of group issues. Designation of group members should be a careful process with an eye to clinical as well as administrative issues. Tomanagethephysiologicalcomponent,theangermanagementprotocolfirstdirectstheclient to identify the experience of anger, to label the various intensities of the emotion, and to recognize the early warning signs, such as a flushed feeling or quickened heart rate. The therapist validates the experience of anger as a normal and frequently occurring emotion having an intensity range that is under the adolescent’s control. Clients are then asked to identify and track common triggers of their anger using the Hassle Log. Charting daily occurrences of anger (whether handled well or not) helps to identify idiosyncratic patterns of anger loss and control and to increase awareness of external triggers and internal physiological and cognitive reactions. Finally, clients are taught arousalmanagementskillssuchasdeepbreathing,imagery,andrelaxationtoreducetheaccumulated physical tension and to increase the probability that they will think through the interpersonal event in a more rational fashion. Thecognitivecomponenttargetsboththecognitivedeficienciesanddistortionsthatarecharacteristic of persons who respond aggressively and impulsively to perceived provocation. Aggressive youth lack specific problem-solving skills. They generate few possible solutions to interpersonal problems and seem unable to generate future consequences for their aggressive behavior. Furthermore, their assumptions, expectations, beliefs, and attributions are distorted in distinct ways that actually increase their anger experience. In particular, triggering stimuli are perceived to be intentional acts on the part of others—direct insults that are meant to be hostile. They believe that responding aggressively is optimal in terms of outcome, ego protection, and perceived power in the eyes of others. Expectations to behave aggressively and beliefs that others expect them to be aggressive dominate. Then they do not take responsibility for their actions and may blame others
Psychology in the Schools DOI: 10.1002/pits
246 Feindler and Engel
for the provocation. These cognitive distortions combine to confirm that aggression is completely justified because it is seen as the only way to resolve a conflict. Cognitive restructuring strategies are used to help adolescents identify their distorted thinking styles and to encourage them to substitute a series of self-instructions that will enable them to solveproblemseffectively.Strategiesthatassistinexaminingtheirrationalandnarrowfocusoftheir cognitionshelpthemtodevelopalternativecausalattributionsandanonaggressiveperspective.They areencouragedtoengageinself-coachingofattributionsthatprotecttheirself-esteemwhileallowing them to de-escalate conflict and create mental distance from the trigger. This type of cognitive work is difficult for aggressive and impulsive adolescents, but it is the most critical element of any anger management intervention. Altering these internal processes is essential to help youth better manage their anger experience, rethink their possible responses to provocation, and select a more prosocial behavioral response.
Case Example: The following material from a case study detailed elsewhere (Feindler, 1995) reflects the cognitive component of an individualized treatment for a 13–year-old girl:
Erica’s assessment results indicated that her anger arousal was fueled by misperceptions of social cues, hostile attributions concerning peers’ intentions to pick on her, and ruminations about responding aggressively to “get back” at others. Specifically, Erica seemed to filter out positive aspects of social situations and focused on seemingly hostile cues that she used to assume that others did not like her and wanted to hurtandrejecther.OnepeerinteractionexampledocumentedinherHassleLoginvolvedErica’sapproach toward a group of girls standing near her locker. She recorded the following faulty assumptions: (a) “they are probably talking about me,” (b)”they are probably making plans without me,” and (c) “I hate them and don’t trust them.” As she approached, two girls turned toward her, but Erica focused on a third girl who seemed to have “made a face and rolled her eyes.” This led to Erica’s mounting anger, and she felt justified as she made a sarcastic “diss” of her outfit and a screaming match ensued. Thecognitivesessionswereorganizedaroundthesemisperceptionsofsocialcues,faultynegativeassumptions, and beliefs that justified Erica’s own anger and response. Using a series of self-talk prompts, Erica wasinstructedto(a)focusonsomethingpositiveinthegroup(shedecidedtoattendfullytothepersonshe liked most in the group), (b) assume that the girls wanted to interact with her unless they specifically said otherwise (Erica chose to prompt herself to smile back at whomever smiled first, and she used the phrase “no news is good news” to stay positive), (c) figure out nonpersonal reasons why one peer might not be so responsive to her (Erica seemed to enjoy the assumption that snotty girls most likely were PMSing!). Thesealternative,morepositivecognitionsweremodeledforEricaandpracticedduringroleplayswiththe therapist.Otherhypotheticalpeersituationswithsimilarthemeswerediscussed,andEricageneratedadditionalalternativeattributions.Furthermore,wheneverEricadidmakeahostileinterpretationorconclusion concerning another’s intentions (“She’s always trying to make me look bad”), she was asked to provide actualevidencefortheconclusion.Thuscognitiverestructuring,self-talkpromptsforfocusedandpositive responses, and disputing irrational beliefs combined to help Erica better navigate her social challenges.
The final component of the anger reaction is behavioral. Once adolescents are able to manage their physiological arousal and cognitive process, they still need to respond to the situation and achieve some level of social competence. Withdrawal patterns and verbal and nonverbal aggression are the most typical responses to interpersonal conflicts and perceived provocation. Training in solving problems, being assertive, and learning to communicate to resolve conflict is needed. The probability that they can exhibit these skills effectively is enhanced by successful management of emotional arousal. Arousal management and cognitive restructuring should precede the behavioral skills training.
Psychology in the Schools DOI: 10.1002/pits
Assessment and Intervention for Adolescents 247
AMT incorporates a modeling technique of role play with actual scenarios generated from completed HassleLogs.The roleplays arearranged fortheyouth sothat theyaregradually exposed to greater levels of provocation and conflict as their skills grow. Each treatment session includes a variety of graded homework assignments designed so that the adolescents can practice their newly acquired skills and generalize them to the natural environment. Many of the cognitive restructuring strategiesaretransformedintogames,towhichtheadolescentsseemtobequitereceptive.Roleplay with coaching helps them to practice these improved cognitive responses. They are able to learn how to solve problems and to develop nonhostile attributions in response to hypothetical conflict situations. Repeated practice once the “package” of skills has been taught is necessary, not only to reinforce the newly acquired responses, but also to help the adolescent make appropriate social judgmentsinresponsetothetriggeringevent,tomaximizeasuccessfuloutcome.Appendix2presents an overview of the usual 10-session AMT protocol for adolescents (see Feindler & Weisner, 2006). Recently,anewangermanagement protocol,TAME(TeenAngerManagementEducation)has been developed for implementation in both clinical and educational settings (Feindler & Gerber, 2008).Thisenhancedangermanagementprogramusesaself-regulatorycopingskillsapproachwith specialemphasisonthecognitivecomponentsofanger.Adolescentsaretaughttorecognize,moderate,regulate,andpreventangeranditsoftenaccompanyingaggressivecomponentandtoimplement problem-solving actions in response to interpersonal provocation. In addition, elements of dialectical behavior therapy (DBT) emotional regulation strategies and interpersonal effectiveness skills (Linehan,1993)areincludedtoenhanceadolescents’abilitytobuildawarenessofemotionalarousal andincreaseprosocialbehavioroptionsinthefaceofinterpersonalconflict.Behaviorchange,inspecific terms of reduced physiological arousal, aggressive responding, and negative anger-sustaining attributions and self-statements, is the desired outcome of the intervention program (Feindler & Gerber, 2008). Although not yet empirically validated, TAME is a 10-session psychoeducational group protocol easily adapted to implementation in a school or residential treatment setting. A complementary program, which includes anger management as one of three modules, is the aggression replacement training (ART) approach (Goldstein et al., 1998). The first module of ART involves “skill streaming,” which is designed to teach a broad curriculum of prosocial behavior. The second component consists of anger control training, which empowers the individual to modify his or her own anger. The final section is moral reasoning training, which is aimed to help motivatetheindividualtousetheskillsfromtheothercomponents.ResearchdemonstratesthatART produces significant increases in constructive social behaviors and moral reasoning and decreases in impulsivity and antisocial behavior (Feindler & Weisner, 2006; Goldstein et al., 1998).
Social Skills Training Objectives Fifty prosocial skills are taught to the group members. The skills fall into one of six categories or behaviors: beginning (e.g., basic conversation skills), advanced (e.g., apologizing and asking for help), dealing with feelings (e.g., expressing affection and dealing with fear), alternatives to aggression(e.g.,respondingtoteasingandnegotiating),handlingstress(e.g.,dealingwithbeingleft out or being accused), and planning skills (e.g., goal setting and decision making).
Anger Control Training Objectives These objectives include identifying both internal and external triggers that provoke an anger response and identifying physiological cues that signal feelings of anger. Self-statements help the individual remain in control of emotional arousal. Other skills, such as deep breathing and imagery, are also taught to aid in remaining in control. Finally, group members are taught to self-evaluate their performance and reward themselves for remaining in control or learning from their mistakes.
Psychology in the Schools DOI: 10.1002/pits
248 Feindler and Engel
Moral Reasoning Objectives These objectives are designed to raise an individual’s beliefs in fairness, justice, and concern for the needs and rights of others. Members are exposed to a moral dilemma designed to arouse cognitive conflict with the expectation that its resolution will advance the member’s level of moral reasoning.Avalues-orientedcomponentencouragestheindividualtoactinamoresociallydesirable manner. Aswithotherangermanagementprograms,theARTsmall-groupsessionsareheldweekly,and each skill is modeled and rehearsed through role-playing activities. Group leaders provide praise, instruction, and feedback to group members. ART is presented comprehensively in manual format (Goldstein et al., 1998) and can be implemented by a wide variety of educators and mental health professionals. A training video to accompany the manual is also available (see Amendola, Feindler, McGinnis, & Oliver, 2003).
Research on Anger Coping Programs Versions of ART have been implemented in a variety of contexts and with a variety of populations, including school districts, community centers, mental health centers, inpatient facilities, residential treatment centers, and correctional facilities (Goldstein et al., 1998). Jones (1990) and Nodarse (1998) conducted the only two studies of ART treatment effectiveness within a school setting. In 1990, Jones compared three treatment groups of aggressive male high school students in Brisbane, Australia: ART, moral education, and a no-treatment control (as cited in Goldstein et al., 1998). Jones found that participants in the ART group exhibited a greater reduction in aggressive behaviors and impulsivity and an increase in coping, social skills, and self-esteem as compared to control groups. Additional information such as sample size, participant demographics, and specific measures was unavailable and necessitates caution in interpretation. In 1998, Nodarse conducted an evaluation of ART implemented in the Ruth Owens Kruse Educational Center in Miami, Florida. Participants included 50 male and female adolescents, ages 12–14 years, with emotional handicaps; −5 of the participants were assigned to the experimental group, and 25 served as the control group. All participants received individual therapy, crisis management, adventure group therapy, and educational services, and the experimental group also received ART three times a week for 10 weeks. Overt aggression and social skills were assessed by the Behavior Scale for Children– Teacher Report Scale (raters were not blind to study conditions) and Self Report Scale prior to and following the intervention. Nodarse found that participation in ART was associated with statistically significant reductions in aggression and improvements in social skills and higher stage thinking. ART effectiveness research has progressed substantially since its creation by Goldstein and colleagues more than two decades ago. It has been implemented in at least 45 states, six Canadian provinces,andnumerousforeigncountries,andisusedwithavarietyofanger-disorderedpopulations (Glick, 2006). ART has gradually gained support as a treatment effective in increasing prosocial behavior and moral reasoning abilities and reducing impulsivity and antisocial behavior (Goldstein et al., 2004). Effectiveness research strongly suggests that ART is effective in teaching social skills, improving anger management skills, and reducing self-reported anger and recidivism rates among juvenile delinquents (Goldstein et al., 2004). Sukhodolsky, Kassinove, and Gorman (2004) published a meta-analysis examining the effectivenessofangercontroltreatmentsforchildrenandadolescents.Theauthorsanalyzed21published and 19 unpublished evaluations of cognitive-behavioral therapy for anger-disordered youth, and
Psychology in the Schools DOI: 10.1002/pits
Assessment and Intervention for Adolescents 249
calculated effect sizes based on various components of these anger management approaches—-kills development, affective education, problem solving, and multimodal interventions. Participant mean age per study ranged from 7 to 17.2 years (total sample M =12.5 years, SD=2.64). The mean effect size of the treatment sample was Cohen’s d =0.67, signifying a moderate effect(Sukhodolskyetal.,2004).Thiseffectwascommensuratetotheeffectsizesfoundinanalyses of psychotherapy with children. Skills development and eclectic treatments demonstrated greater effectiveness(d =0.79and0.74,respectively)thanaffectiveeducation(d =0.36).Problemsolving did not differ from the other treatment components, but also reflected a moderate effect size (d = 0.67). The difference between skill development/multimodal interventions and purely affective interventions suggests that more behaviorally oriented approaches may be more effective with children and adolescents. Finally, the researchers found that the overall treatment effect size for 15- to 17-year-olds (d =0.74) was significantly larger than that for 7- to 10-year-olds (d =0.54). This finding indicates that older children/adolescents with anger disorders may benefit more from cognitive-behavioral therapy (CBT) than their younger counterparts, possibly due to their more advanced cognitive and social abilities. In 2006, Smith, Larson, and Nuckles published a summary of anger management programs for anger-disordered youth in school settings. A PsycINFO literature review produced 28 treatment evaluations targeting anger disorders in youth. Of the 28 studies, 5 included elementary-age students below Grade 4, 16 included students in Grades 4–8, and 5 included high school students. Interventions were broken down into coping skills therapies, problem-solving therapies, and cognitive-restructuring models. Coping skills therapies such as that proposed by Feindler, Marriott, and Iwata (1984) taught adolescents to identify and regulate their anger arousal and to use alternatives to aggression through the development of assertiveness skills.Other therapies, like those of Deffenbacher, Lynch, Oetting, and Kemper (1996) and Lo, Loe, and Cartledge (2002) emphasized social skills training (as cited in Smith et al., 2006). Problem-solving approaches were used by Feindler and colleagues (1984) in the intervention noted earlier in text as well as in Lochman and colleagues (1995), Hemphill and Littlefield(2001),andSmith,Siegel,O’Connor,andThomas(1994),althoughthelatterinterventions focused on elementary-age students (as cited in Smith et al., 2006). Finally, cognitive-restructuring models were used by Hains (1994) and Hains and Szyjakowski (1990) with high-school students withangerdisordersandmooddifficulties(ascitedinSmithetal.,2006).Theytaughtadolescentsto identify, examine, and challenge maladaptive cognitions associated with emotional arousal. Smith and colleagues (2006) found that 19 of the 28 studies at least minimally addressed issues related to generalization and maintenance of acquired skills through the use of self-monitoring logs, journals, and relevant role plays based on students’ actual experience. Despite the quantity of anger management interventions that have been published, few have been subject to systematic effectiveness research. Furthermore, few studies have examined generalization and maintenance of behavior change at follow-up, and many studies suffer from assessment and methodological flaws (Feindler & Baker, 2004). Specifically, few studies include randomized assignment or control groups. In addition to methodological issues, much remains unknown regarding the effectiveness of anger management treatments. As Sukhodolsky and colleagues (2004) commented,“littleisknownabout[CBT’s]mechanismsofchange,moderatorsofoutcomes,andexportabilityfromclinicalresearchtoclinicalpractice”(p.264).Variablessuchascontextoftreatment (i.e., schools, residential, secure-care institution), corollary interventions (i.e., behavioral management systems; individual, group, or family therapy), student identification, intervention duration, staff training, and treatment fidelity may affect the treatment of anger disorders in children and adolescents.
Psychology in the Schools DOI: 10.1002/pits
250 Feindler and Engel
Suggestions for Program Implementation in School Settings Given that chronically high levels of anger and hostility constitute risk factors for aggression and violence at school, AMT seems ideal as a part of school violence prevention programming. To maximize treatment outcomes vis-`a-vis maintenance and generalizability of anger management skills, however, there are a number of issues that need to be addressed prior to implementation. In general, preparation of the school environment prior to the start of an anger management program is essential. Securing central and building administrative support, as well as providing teacher and staff training in the principles of anger management, provides the infrastructure needed to ensure program success and generalization of newly acquired skills. Feindler and Weisner (2006) summarized a number of issues unique to school settings in Appendix 3. Clearly, identification of students in need of AMT and who will benefit from either individual or group intervention in the school setting requires careful consideration of assessment targets and methods. There is no doubt much variety in both the diversity of the student body and the youths’ specific skills deficits and, as such, anger management interventions may need to be individually tailored for a particular setting. Youth who evidence frequent emotion dysregulation, those who have poor problem solving and conflict negotiation skills, and those who have distorted beliefs and attribution biases might benefit from differing aspects of the anger management protocol. Only careful assessment at referral/screening and continued data collection throughout treatment will help to establish which components work best with which students. We would strongly suggest a multimethod assessment package including pre- and post-self-report measures relevant to the anger management objectives, self-monitoring throughout the intervention, and ratings by teachers and parents in addition to any archival data already collected in the school environment (detentions, suspensions, etc.) School environments provide the opportunity to teach aggression replacement skills to all students, thus impacting relational aggression as well as youth who might be victims or bystanders of interpersonal aggression. This may serve a prevention function as well. Finally, AMT will have the greatest impact if there is a parent education component as well, becauseeachstudentreturnshometoanothercontextinwhichaggressivebehaviormaybeexhibited andreinforced.Angermanagementmaybeausefuladjuncttoothertherapeuticinterventionsalready in place for the target youth and may help to improve interpersonal interactions among teachers and students overall. With careful supervision and adherence to one of the anger management protocols available,itmaybethatspecialeducationteachers,guidancecounselors,and/orschoolpsychologists could be program trainers. Much research has yet to be done on the aspects of anger management intervention unique to the school environment, but so far the promising results in clinical context provide good initial support.
APPENDIX 1: Hassle Log Name: Date: Time: Where were you? Home School Outside Car/Bus Other What Happened: Teased Told to do something Someone stole from me Someone started a fight with me I did something wrong Other Who was that somebody? Friend Sibling Another Student Parent Teacher Another Adult Therapist/Counselor Other What did you do: Hit back Ran Away Yelled Cried Ignored Broke Something Was Restrained Told Adult Walked away calmly Talked it out Told Friend
Psychology in the Schools DOI: 10.1002/pits
Assessment and Intervention for Adolescents 251
How did you handle yourself: Poorly Not so Well OK Good Great How Angry were you: Burning Mad Really Angry Moderately Angry Mildly Angry Nor angry at all Notes:
APPENDIX 2: AMT Protocol Pre-session: Intake and screening of youth referred for AMT. Treatment readiness to be examined; assessments conducted. Introduce Hassle Log. Session 1: Orientation to group AMT; rationale for program; affect education and positive-negative aspect of anger; concepts of arousal management; deep breathing and brief relaxation techniques; review hassle logs. Session 2: Self-assessment of idiosyncratic anger episodes and aggressive behavior pattern. ABC sequential analysis and discussion of anger triggers, emotional and behavioral reactions, and consequences. Session 3: Identification and refuting of aggressive beliefs, reattribution training, understanding the role of cognitive distortions. Session4:Assertivenesstraining,prosocialresponsetointerpersonalconflictandfrustration;coping with criticism, moral reasoning, and empathic responding. Session 5: Self-instruction training, delay of responding tactics, coping self-statements. Session6:Continuedcognitiverestructuringandinternalizationofself-instructions,rationaldecision making in choice of response to provocation. Session7:Thinkingaheadprocess,anticipatoryandconsequential cognitions,linkingcognitiveand arousal management strategies. Session 8: Self-evaluation processes, metacognitions and objective stance, positive reinforcement, coping statements, and constructive criticism.