P.I. Dr. Fernandez and Ph.D. student Brandon Perez will train about five undergraduate
students in the recruitment procedures. Participants will be recruited by sending electronic
announcements and IRB-approved recruitment materials to 1) counseling and psychotherapy
clinics, 2) anger management support groups, and 3) social media platforms. Materials will
contain study and contact information (study email address and Google Voice number) for
potential participants to contact study staff. Interested participants will sign consent
forms and be screened for eligibility via an electronic version of the consent form and a
brief screening instrument, both presented using an online App (created on Thunkable) for
administration of questionnaires. After successfully completing screening, participants will
enter their phone number and email address. Participants who do not satisfy screening
criteria will be notified accordingly.
Consent and Screening: Participants will first go through the informed consent procedure,
where they will be told about the purpose of the study, expectations for them as
participants, etc. Informed consent is expected to take approximately 10 minutes.
Participants will then be asked to complete a screening questionnaire which is expected to
take no more than 3 minutes. These procedures are done via the earlier-mentioned Smart Phone
Application. Eligible participants will be randomly assigned to one of two groups: (i) a
treatment group receiving Cognitive Behavioral Affective Therapy (CBAT), or (ii) a comparison
group receiving Emotional Education (EE). Each group will receive separate links to videos
(specific to the content of that group) and pre-recorded by Dr. Fernandez. There will be two
videos per week, each lasting about 50 minutes (no more than 8 hours total) over the course
of 4 weeks. At 1-month follow-up, each group will be required to view/listen to a final
50-minute videorecording that recaps the specific content for that group.
Questionnaires and other measures: Anger will be screened using the 10-item trait scale of
the STAXI-2. At pre-treatment, post-treatment, and follow-up, anger will be assessed using
two psychometric instruments, the Anger Parameters Scale and the Anger Expressions Scale.
During each of these three phases, anger will also be measured via self-monitoring with
reference to a graphical display. These measurement techniques have been effectively used and
described in our previous studies.
Online Sessions: The video for session 1 will deal with orientation and self-monitoring.
Participants will practice self-monitoring their anger during that first week of orientation.
If a participant has no anger on a given day, no monitoring is necessary. Following this
week, the comparison group participants will continue to self-monitor their anger for 4 weeks
during which they will view/listen to videos on the general topic of emotions (including
anger, fear, sadness, as well as positive emotions such as joy). CBAT participants will
continue to self-monitor their anger for 4 weeks during which they will view/listen to videos
on anger regulation techniques. These videos will cover anger prevention, anger intervention,
and anger postvention consecutively. During the prevention phase, an individually tailored
behavior contract against anger will be signed by each participant that allows them to reward
themselves for adhering to anger reduction goals. Contracts such as these are commonly used
in behavior modification. Not legally binding they are formal agreements made collaboratively
between provider and participant. They are designed to build motivation and commitment to
change. Specifically, both parties agree on the desired or adaptive behaviors, the points to
be awarded for such behaviors, and the points to be deducted in the case of maladaptive
behaviors. The net number of points is then regularly reviewed by both parties and any
appropriate rewards are then "given." In CBAT, rewards are typically watching a favorite
movie, dining out at a favorite restaurant, etc. Participants will work with investigators
over email to draft and electronically sign their contracts. Research Assistants will review
participant progress on their contracts during their regular check-in phone calls. While
there is no feasible way to ensure total adherence to the contract - either with in-person or
online CBAT training - the phone calls are useful in encouraging participation and
self-monitoring. For EE, participants will receive self-monitoring training with an emphasis
on the definition of emotion, and types of emotions. Instead of specific skills for
regulating anger or other emotions, a range of emotions (e.g., fear, anxiety, sorrow, grief,
melancholy, guilt, embarrassment, self-consciousness, pride, contempt, jealousy, surprise,
and happiness) will be illustrated with sources from art, literature and the humanities in
general. While the comparison group will not receive any skills training for anger
regulation, emotional education will receive educational information on negative emotions
(such as anger) and positive emotions too.
CBAT participants will also engage in anger prevention techniques such as behavioral
rehearsal of anger-provoking situations and stimulus control for discriminating and avoiding
situations that are likely to culminate in anger. Intervention techniques include use of
thought-stopping, distraction, reappraisal, and replacing maladaptive cognition with coping
statements. The postvention phase will train participants in dealing with residual anger
through expressive writing and verbal disclosure. Gestalt therapy empty chair dialogue will
be used for overcoming unresolved anger. Finally, affective strategies of humor and
forgiveness will also be broached.
After the final session (in week 5), participants in both groups will complete the same set
of questionnaires previously administered before treatment. This set of questionnaires is
expected to take no more than 20 minutes. Participants will then have a 3-week interim
waiting period, during which time no action is required on their part, but one intended to
serve as a time for participants to reflect and implement techniques that they have learned.
This is followed by 1 week of daily anger self-monitoring. Finally, a follow-up session
(30-50 minutes) will be held with both groups after this self-monitoring period.
Phone Calls and Knowledge Checks: To ensure that participants comprehend the online videos,
RAs will check in with participants twice a week. This also serves to ensure that there are
no difficulties with their participation in the study and to verify that the participants are
not in any emotional distress. Each semi-weekly phone calls is expected to last approximately
10 minutes, for a total time of 160 minutes over the duration of the study (1 week
pre-treatment, 4 weeks of CBAT or EE; and 1 week post-treatment).
Total participant time commitment during the duration of the study is approximately 12 hours.