Review of Cognitive-Behavioral Therapy for Anger and Aggression in Children, by Denis G. Sukhodolsky and Lawrence Scahill

Abstract

[Author Affiliation]Joyce Sprafkin. Department of Psychiatry and Behavioral Science, Stony Brook University School of Medicine, Stony Brook, New York.ISBN: 978.1.46.250632.3. New York, NY, The Guilford Press, 2012, 184 pages.Address correspondence to: Joyce Sprafkin, PhD, Department of Psychiatry and Behavioral Science, Stony Brook University School of Medicine, Stony Brook, NY 11794, E-mail: Joyce.Sprafkin@stonybrookmedicine.eduIs it important for child psychiatrists to learn cognitive-behavioral therapy (CBT) strategies in the current climate of efficient service delivery? With our system of care reaching only 20% of children who need mental health services, can we afford to have child psychiatrists engage in nonpharmacologic interventions?Books such as Cognitive-Behavioral Therapy for Anger and Aggression in Children make it possible for child psychiatrists to incorporate CBT strategies into their practices for youth with anger management problems. Disruptive behaviors, including aggression and defiance, are among the most frequent reasons for outpatient mental health referral, and physical aggression is a frequent reason for psychiatric hospitalization. This book fills an important gap in the literature. Although there have been anger management programs for youths in groups (Feindler and Ecton 1986; Nelson and Finch 1996; Lochman et al. 2008), until now there were none for use in individual therapy. This program is for 8-16-year-old youth with significant problems with anger, aggression, and noncompliance. Each of 10 chapters outlines and describes an individual therapy session, each with a set of goals and alternative activities to meet each goal. The clinician is encouraged to select the activities that are most suitable for the developmental level and interests of the individual child. The suggested activities include carefully prepared worksheets and attractive illustrations to present the concepts. There are also three additional chapters that describe the three parent sessions that are part of the program.The anger management program set forth is divided into three major modules, each of which parallels one of three major theoretical models of aggressive behavior. The first module is based on the emotional arousal model which suggests that physiological arousal and the intensity of angry feelings are related to overt aggression. Accordingly, the first session provides psychoeducation about anger and explores the situations that trigger anger for the individual child (which often includes being teased or bothered by a peer, told to do something by a parent while the child is engaged in an enjoyable activity, or being treated unfairly by a teacher), responses that often make the situation worse; that is, increase anger and/or result in a negative outcome (some form of physical or verbal aggression), and simple strategies to reduce angry feelings (i.e., engaging in a distracting activity or calming physical arousal by deep breathing). Session 2 emphasizes the importance of monitoring one's anger intensity by using a Feeling Thermometer and taking steps to prevent anger from getting out of control. Past situations are examined in order to come to the realization that intense anger clouds one's thinking and often results in negative outcomes. The Stop and Think technique is introduced, which is a visualization strategy intended to interrupt behavior (imagining a big stop sign or perhaps more effectively, imagining oneself sitting in the back seat of a police car). Additional calming strategies are introduced, including verbal reminders to calm oneself (Take a deep breath or Take it easy) and relaxation techniques. Session 3 expands on the concept of emotion regulation, introduces strategies to prevent anger-provoking situations from occurring, and further refines the recognition of one's own anger cues.The second module is based on the social-cognitive model of aggression, which explains aggressive behavior as the product of cognitive deficits and distortions on the part of the aggressor. …