State-Trait Anger Expression Inventory Research Articles

Web-Based Coping Skills Training and Coach Support for Women Living With a Partner With an Alcohol Use Disorder: Randomized Controlled Trial.

Individuals living with a partner with an alcohol use disorder (AUD) can experience significant psychological distress and use health care more than those without a partner with an AUD. However, the prevailing treatment system's focus on the partner and personal barriers limit these individuals from getting help for themselves. Preliminary work on a self-directed, web-based coping skills training program, Stop Spinning My Wheels (SSMW), shows promise in broadening available treatments for this population. In this study, we conducted a robust evaluation of SSMW primary outcomes. The study aims to test whether women with a partner with an AUD assigned to SSMW experienced a greater reduction in negative affect (depression and anger) (1) than a usual web care (UWC) control and (2) with brief phone coach support (SSMW+coach) rather than without (SSMW only) and (3) whether baseline negative affect moderated treatment effects. Women (mean age 45.7, SD 10.8 years; Black: 17/456, 3.7%; White: 408/456, 89.5%) were randomized to SSMW only, SSMW+coach, or UWC. Depression (Beck Depression Inventory-II) and anger (State-Trait Anger Expression Inventory 2-State Anger) were assessed at baseline, 12-week posttest, and 6- and 12-month follow-ups. Participants in all conditions decreased in depression from baseline to posttest and from baseline to follow-up; SSMW-only and SSMW+coach participants decreased in anger, but UWC participants did not. Compared to UWC participants, SSMW-only participants experienced greater anger reduction (P=.03), and SSMW+coach participants experienced a greater reduction in depression (P<.001) from baseline to posttest. However, from baseline to follow-up, only a greater, but not statistically significant (P=.052), reduction in anger occurred in SSMW+coach compared to UWC. Although the SSMW conditions did not differ from each other in negative affect outcomes (P=.06-.57), SSMW+coach had higher program engagement and satisfaction (all P<.004). Baseline negative affect did not moderate effects, although remission from baseline clinically relevant depressive symptoms (Beck Depression Inventory≥14) was higher in SSMW only (33/67, 49%; odds ratio 2.13, 95% CI 1.05-4.30; P=.03) and SSMW+coach (46/74, 62%; odds ratio 3.60, 95% CI 1.79-7.23; P<.001) than in UWC (21/67, 31%); remission rates did not differ between the SSMW conditions (P=.12). The results partially supported the hypotheses. The SSMW conditions had earlier effects than UWC, but positive change in UWC mitigated the hypothesized long-term SSMW-UWC differences. The results highlight the importance of incorporating active controls in web-based clinical trials. Although SSMW+coach showed benefits over SSMW only on engagement and satisfaction measures and in the number needed to treat (5.6 for SSMW only; 3.2 for SSMW+coach), the SSMW conditions were comparable and superior to UWC on depressive symptom remission levels. Overall, SSMW with or without a coach can reduce clinically meaningful distress and add to available treatment options for this large, underserved group. ClinicalTrials.gov NCT02984241; https://www.clinicaltrials.gov/study/NCT02984241.

Testing a Novel Trauma-Informed Treatment for Anger and Aggression Following Military-Related Betrayal: Design and Methodology of a Clinical Trial.

Difficulty controlling anger is a common postdeployment problem in military personnel. Chronic and unregulated anger can lead to inappropriate aggression and is associated with behavioral health, legal, employment, and relationship problems for military service members. Military-related betrayal (e.g., military sexual assault, insider attacks) is experienced by over a quarter of combat service members and is associated with chronic anger and aggression. The high level of physical risk involved in military deployments make interconnectedness and trust in the military organization of utmost importance for survival during missions. While this has many protective functions, it also creates a vulnerability to experiencing military-related betrayal. Betrayal is related to chronic anger and aggression. Individuals with betrayal-related injuries express overgeneralized anger, irritability, blaming others, expectations of injustice, inability to forgive others, and ruminations of revenge. Current approaches to treating anger and aggression in military populations are inadequate. Standard anger treatment is not trauma-informed and does not consider the unique cultural context of anger and aggression in military populations, therefore is not well suited for anger stemming from military-related betrayal. While trauma-informed interventions targeting anger for military personnel exist, anger outcomes are mixed, and aggression and interpersonal functioning outcomes are poor. Also, these anger interventions are designed for patients with posttraumatic stress disorder. However, not all military-related betrayal meets the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-5 definition of trauma, though it may still lead to chronic anger and aggression. As a result, these patients lack access to treatment that appropriately targets the function of their anger and aggression. This manuscript describes rationale, design, and methodology of a pilot clinical trial examining Countering Chronic Anger and Aggression Related to Trauma and Transgressions (CART). CART is a transdiagnostic, transgression-focused intervention for military personnel who have experienced military-related betrayal, targeting chronic anger and aggression, and improving interpersonal relationships. The pilot study will use an interrupted timeseries design, where participants are randomized to a 2-, 3-, or 4-week minimal contact waitlist before starting treatment. This design maximizes the sample size so that all participants receive the treatment and act as their own control, while maintaining a robust design via stepped randomization. This trial aims to (1) test the acceptability and feasibility of CART, (2) test whether CART reduces anger and aggression in military personnel with a history of military-related betrayal, and (3) test whether CART improves interpersonal functioning. The primary feasibility outcome will be the successful recruitment, enrollment, and initiation of 40 participants. Primary outcome measures include the Client Satisfaction Survey-8, the State Trait Anger Expression Inventory-2, Overt Aggression Scale-Modified, and the Inventory of Interpersonal Problems-Short Version. If outcomes show feasibility, acceptability, and initial effectiveness, CART will demonstrate a culturally relevant treatment for chronic anger, the most frequent postdeployment problem, in a sample of active duty service members who have suffered a military betrayal. The DoD will also have an evidence-based treatment option focusing on interpersonal functioning, including relationships within the military and within families.

Training to Reconnect With Emotional Awareness Therapy: A Randomized Controlled Trial in Participants With Traumatic Brain Injury

ObjectiveTo examine the efficacy of an intervention, Training to Reconnect with Emotional Awareness Therapy (TREAT) at improving alexithymia, emotion dysregulation, anxiety, depression, anger, and global positive and negative affect in participants with traumatic brain injury (TBI). DesignRandomized, waitlist control (WLC) trial with 3-month follow-up. SettingOutpatient brain injury rehabilitation center. ParticipantsAdult participants, who were on average 11.37 years postcomplicated mild-to-severe TBI and also had elevated alexithymia (n=44), who were randomized to immediate treatment (TREAT; n=20) or WLC (WLC=24). InterventionsEight sessions, structured training program that teaches emotional awareness and discrete labeling of emotions. Main Outcome MeasuresToronto Alexithymia Scale-20, Levels of Emotional Awareness Scale, Difficulty with Emotion Regulation Scale, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9; State-Trait Anger Expression Inventory (STAXI), Positive and Negative Affect Schedule (PANAS); and Patient Global Impression of Change. ResultsThirty-four participants completed the study per protocol. Compared with WLC participants (n=16) who had not yet received the intervention, TREAT participants (n=18) had significantly less alexithymia, emotion dysregulation, anxiety, and depression (all P’s<.05) within approximately 1 week of completing the intervention. Before/after results from the pooled sample (n=34) showed significant improvements, immediately and 3 months after the intervention, on all outcomes except the STAXI and the Positive Affect subscale of the PANAS. On the Patient Global Impression of Change, a noticeable change in global emotional function and quality of life was reported by 80%. Intent-to-treat analyses (n=38) revealed similar results to the per protocol sample. ConclusionsFindings support the efficacy of TREAT for reducing alexithymia and emotion dysregulation in individuals with chronic TBI. Although outcomes were also promising for anxiety and depression, more research using attention-control designs are warranted to control for the attention received during treatment.

The relationship between trauma, stress, and premenstrual symptoms: the role of attributional style and trait anger

ABSTRACT Aims The aim of this study was to examine potential mediators of the relationship between traumatic experiences, perceived stress, and the subjective, retrospectively measured, intensity of symptoms of premenstrual disorders. It was hypothesised that pessimistic attributional style and trait anger mediate the said relationship. Methods The study sample comprised 150 non-clinical subjects (aged 18–31; M = 21.82; SD = 2.19). Study variables were assessed with self-report questionnaires: the Premenstrual Symptoms Screening Tool (PSST); the Traumatic Experiences Checklist (TEC); the Perceived Stress Scale-4 Short Form (PSS-4); the Attributional Style Questionnaire (ASQ); and the State-Trait Anger Expression Inventory-2 (STAXI-2 – trait anger subscale). Correlation and mediation analyses were performed. Results The symptoms of premenstrual disorders were significantly and positively associated with both trait anger and pessimistic attributional style, as well as with trauma and stress. The correlations were moderate to strong, ranging from rho = 0.57 (pessimistic attributional style and trauma) to rho = 0.85 (stress and premenstrual symptoms). Both anger and pessimistic attributional style partially mediated the relationship between trauma and premenstrual symptoms and between stress and premenstrual symptoms. Conclusion Although the design of the study does not allow to infer causality, it demonstrates strong, positive relationship between the symptoms of premenstrual disorders, trauma, stress, attributional style, and anger. The results of mediation analyses may point to some practical implications (e.g. for psychotherapeutic interventions) but further studies employing prospective methods are needed.

The Mental Health Outcomes and Cost Estimates of Korean Medicine for Anxiety Disorder Patients.

Korean medicine (KM) is used to treat anxiety disorders, but there is limited research on its effects. This study aimed to examine the associations between improved QoL and reduced clinical symptoms and KM in patients with anxiety disorders. The medical records of patients with anxiety who were treated with KM (acupuncture, psychotherapy, Chuna therapy, aromatherapy, or herbal medicine) for at least 4 weeks were retrospectively analyzed. Clinical, QoL, and cost outcomes were measured at baseline and at weeks 4 and 12 (Anxiety: State-Trait Anxiety Inventory [STAI X-1 (state), X-2 (trait)], Beck Anxiety Inventory [BAI]; anger: State-Trait Anger Expression Inventory State [STAXI-S (state), T (trait)], Anger Expression Inventory [AXI-K-I (anger-in), AXI-K-O (anger-out), AXI-K-C (anger-control); depression: Beck Depression Inventory-II [BDI II], QoL: QoL-related instruments Euro Quality of Life 5 Dimensions utility score [EQ-5D], Euro QoL Visual Analog Scale [EQ-VAS]). The total costs for each item were calculated in terms of NHIS-covered costs and patients' out-of-pocket costs from the perspective of the healthcare system. The medical records of 67 patients were evaluated. The KM treatments were found to be associated with decreased anxiety (STAI X-1; STAI X-2; BAI, p < 0.0001), depression (BDI-II, p < 0.0001), and anger (AKI-K-I; AKI-K-O, p < 0.05) and increased QoL (EQ-5D; EQ-VAS, p < 0.0001). An average of USD 1360 was paid for the KM treatments for 4 weeks. The study findings suggested that KM may improve clinical symptoms and QoL outcomes in patients with anxiety disorders.

COVID-19: Sociodemographic determinants of selected mental health problems among adults in South-South Nigeria

During the outbreak of highly infectious COVID-19, the Nigerian Ministry of Health primarily emphasized preventive strategies such as personal hygiene, social distancing, and self-isolation. However, there was a notable lack of information addressing mental well-being and coping mechanisms from both the Nigerian government and other relevant agencies. Notably, social distancing and self-isolation are well-documented triggers for mental health problems. Our study aimed to identify the socio-demographic correlates of mental health problems among adults in South-South Nigeria during the COVID-19 lockdown restrictions. This cross-sectional descriptive survey involved 1240 respondents from this region who completed online questionnaires designed using the Kobo Toolbox. The questionnaire covered sociodemographic information and included standardized assessments for generalized anxiety disorder (GAD), anger disorder, and depression disorder. Specifically, the GAD-7 assessed GAD, Spielberger&amp;rsquo;s State-Trait Anger Expression Inventory-2 assessed anger disorder, and the beck depression inventory assessed depression disorder. Our results revealed that 37% of respondents experienced mild depression, 29% reported mild anxiety, and 27% experienced minimal anger. Significant associations were found between depression and factors such as marital status, age, and education level (p &lt; 0.001). Similarly, anger expression was significantly associated with family size, monthly income, age, and marital status (p &lt; 0.001). Anxiety also exhibited significant associations with sociodemographic characteristics (p &lt; 0.001) in the study. In conclusion, our study highlights that sex, educational level, income, and marital status are important sociodemographic determinants of mental health outcomes.

Validity of the Korean Version of the Brief Irritability Test in Psychiatric Patients.

This study aimed to investigate the validity and reliability of the Korean version of the Brief Irritability Test (BITe) and adapt it for Korean patients with psychiatric disorders. A total of 296 patients at the Department of Psychiatry of Hanyang University Guri Hospital completed the BITe, Korean Beck Depression Inventory-II, Korean Beck Anxiety Inventory, the Korean version of the State-Trait Anger Expression Inventory, and Barratt Impulsiveness Scale-11. Construct validity was confirmed through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Reliability testing included assessments of internal consistency (Cronbach's α) and item-total correlations. Convergent validity was examined through correlational analyses with variables such as anxiety, depression, anger, and impulsivity. First, the scale had good internal consistency with a Cronbach's α of 0.88. Second, EFA indicated a single dimensionality of the BITe, and CFA demonstrated a reasonable fit for the single-factor model (comparative fit index=0.97, Tucker-Lewis Index=0.95, normed fit index=0.97, goodness-of-fit index=0.96, root mean square error of approximation=0.12, standardized root mean residual=0.03). Finally, the convergent validity analysis revealed a significant positive correlation with depression, anxiety, and anger, except for anger control, which is a sub-variable of anger. The results showed that the Korean version of the BITe had good psychometric properties, and might serve as a valuable tool for assessing irritability in Korean patients with psychiatric disorders.

Effectiveness of Combined Treatment of Transcranial Direct Current Stimulation and Treatment as Usual on Depression, Anxiety and Anger in Adolescents with Bipolar Disorder

Objectives: Bipolar disorder (BD) is a prevalent psychological disorder associated with depressive symptoms. Transcranial direct current stimulation (tDCS) is a portable and non-invasive technique for brain stimulation. The present study was conducted to determine the effectiveness of the combined treatment of tDCS and routine medication on the symptoms of depression, anxiety, and anger in BD adolescents. Methods: In this double-blind randomized clinical trial study, forty adolescents with BD referred to the outpatient clinic of child and psychiatry of Golestan Ahvaz Teaching Hospital were included. Eligible patients aged 12 - 18 years were randomly divided into 2 groups receiving routine medications plus active tDCS (intervention group) or routine medications plus sham tDCS (control group). Transcranial direct current stimulation intervention with an intensity of 2 mA was applied to the dorsolateral prefrontal cortex in two sessions for 20 minutes each day, for 5 consecutive days. Data were collected at baseline, one week, and one month after the start of the intervention using the Hamilton Depression Rating Scale (HDRS-21), Hamilton Anxiety Rating Scale (HDRS), and State-Trait Anger Expression Inventory. Results: Based on our findings, age and gender were not considerably different between the two groups (P = 0.592, P = 0.1, respectively). In both groups, scores of depression (control: 12.25 ± 3.97, intervention: 0.75 ± 1.44, mean [SD]), anxiety (13.55 ± 2.58, 25.0 ± 0.55), and anger (52.65 ± 8.27, 47.25 ± 4.86) improved significantly one month after treatment (P &lt; 0.0001). After one month of treatment, the severity of bipolar symptoms in the intervention group (slightly: 10%, moderately: 50%, and markedly: 40%) improved significantly compared to the control group (slightly: 15%, moderately: 10%, and markedly: 0%) (P &lt; 0.0001). The improvement rate of HDRS in the intervention group was 81.29% and 95.24% at one week and one month after treatment, while these values were 8.41% and 23.04% in the control group, respectively (P &lt; 0.0001). All patients tolerated the treatment well without serious side effects. There was no significant difference between the side effects observed in both groups (P = 0.185). Conclusions: The combination of tDCS with routine medications can reduce depressive symptoms and improve bipolar symptoms. Therefore, tDCS add-on could be an effective, safe, and tolerable intervention for bipolar depression.

Evaluation of alexithymia, anger and anxiety depression levels in smokers

ABSTRACT Objective Smokingis a major mental health concern due to its addictive nature and its status asthe leading preventable cause of premature death worldwide. This study aimed toexamine the levels of alexithymia, anger, anxiety, and depression in smokerscompared to nonsmokers. Materials and Methods Thiscase-control study involved 176 smokers from a Smoking Cessation Clinic and 175age- and gender-matched nonsmokers. Participants completed assessments usingthe Toronto Alexithymia Scale (TAS-20), State-Trait Anger Expression Inventory(STAXI), and Hospital Anxiety and Depression Scale (HADS). Nicotine dependencein smokers was measured using the Fagerström Nicotine Dependency Test.Statistical analysis was performed using SPSS 22.0. Findings Significantdifferences were observed between smokers and nonsmokers in TAS, TAS-1, TAS-2,HADS-A, and HADS-D scores. Smokers exhibited higher levels of alexithymia, anger expression, and anxiety, while nonsmokers demonstrated better angercontrol. Additionally, addiction levels in smokers were associated withvariations in TAS, TAS-1, TAS-2, TAS-3, STAXI scores (SA, AC, AI, AO), andHADS-A, highlighting a complex interplay between addiction, psychologicalfactors, and smoking habits. Result This study establishes a link between smoking status, addictionlevels, and elevated alexithymia, anger, anxiety, and depression. The findingsunderscore the psychological impact of smoking, contributing valuable insightsfor mental health interventions in individuals with smoking habits.

Contribuições de um Grupo Reflexivo em Homens Autores de Violência Contra Mulheres

Abstract In Brazil, reflective practice groups and groups for the liability of men who commit violence against women represent a public policy with good results in reducing violence between intimate partners. This study aimed to assess the contributions of a reflective practice group on feelings such as empathy, aggressiveness and anger in men who commit violent crimes against women. Using the Empathy Scale - ACME, the Aggression Tendency Assessment Scale - EATA, the State-Trait Anger Expression Inventory 2 - STAXI 2 and a sociodemographic questionnaire, a quantitative study was carried out with 80 men divided into a reflective practice group and a control group. It was found that the members of the reflective group showed a decrease in mean aggressiveness and an increase in mean empathy compared with the control group. It is suggested that empathy, aggressiveness and anger be integrated into interventions using active methodologies.

Decreased oxytocin plasma levels and oxytocin receptor expression associated with aggressive behavior in aggressive-impulsive disorders

IntroductionThis study aims to enhance the understanding of the association between the phenotypic and endophenotypic characteristics of impulsive-aggressive disorders, through the study of plasma oxytocin (OXT) and oxytocin receptor (OXTR) levels in patients with borderline personality disorder (BPD) and patients with eating disorders (ED), as well as to examine the relationship of OXT system with aggressive behavior in these disorders. Methods68 patients with BPD, 67 patients with ED and 57 healthy control subjects were examined for plasma oxytocin levels and protein expression of OXTR in blood mononuclear cells. Aggressive behavior was assessed using the State-Trait Anger Expression Inventory (STAXI-2). Other self and hetero-aggressive behaviors were also evaluated through interviews. ResultsBPD and ED patients exhibited significantly lower plasma oxytocin levels than control subjects. Furthermore, BPD patients demonstrated significantly reduced expression of OXTR compared to controls. Plasma oxytocin levels negatively correlated with verbal aggression, while OXTR expression was inversely associated with the STAXI trait subscale. ConclusionsThe findings validate the existence of oxytocin system dysfunction in impulsive-aggressive disorders. They also support the link between low OXT levels in plasma and OXTR expression and the impulsive-aggressive behavior that characterizes these patients in both state and trait situations.

Effects of individual characteristics on risky cycling behaviour, mediated by cycling anger experience and expression among Brussels and Flemish adult cyclists: Testing a mediated model

IntroductionAlthough risky cycling behaviour (RCB) has been systematically linked with trip-related factors, no previous research has simultaneously investigated the influence of cycling frequency, car use frequency and trait anger on it. Further, the idea that cycling anger experiences and expressions might mediate the relations between these constructs represents an interesting causal chain to explore. ObjectivesThe primary aim was to assess the relations between trait anger, cycling frequency and car use frequency as predictor variables, mediated by cycling anger experience and cycling anger expression on RCB among adult cyclists, while controlling for the effects of age and gender. A secondary aim was to evaluate the impact of the COVID-19 pandemic on cycling anger experience and cycling anger expression on RCB, by means of a descriptive comparison of two surveys gathered before and during the second COVID-19 lockdown. MethodsA total of 1,346 participants in 2019 (‘before COVID-19 pandemic’) and 1,241 participants in 2020 (‘during lockdown’) filled in an online questionnaire. The questionnaire consisted of a Risky Cycling Behaviour (RCB) variable from the Cycling Behaviour Questionnaire (CBQ), the Cycling Anger Scale (CAS), the Cycling Anger Expression Inventory (CAX) and the Trait subscale of the State-Trait Anger Expression Inventory-2 (STAXI-2). Because different participant samples were included in the 2019 and 2020 survey (independent observations), a two-group mediation model with cycling anger experience and expression as mediators was fitted. ResultsThe results from the 2019 and the 2020 cohort are relatively similar with significant direct effects between trait anger and RCB. At both periods, an indirect effect between trait anger and RCB was present through CAX. As compared to men, women tend to report less anger expression (CAX) while cycling in traffic, but experience (CAS) more anger. A small negative association indicated that older participants tended to report less RCB than younger participants. Both in 2019 and 2020, cycling frequency and car frequency showed no or only small direct and indirect effects on RCB. When comparing the 2019 with the 2020 cohorts, we found a stronger direct effect of trait anger on risky cycling behaviour in 2020 and a stronger indirect effect of trait anger on RCB, through anger expression (CAX). ConclusionsThese results underline the importance to teach cyclists to deal with their anger while cycling. Technics such as relaxation coping skills or a combination of relaxation and cognitive skills (mindfulness) were shown to be effective in cyclists and drivers of motor vehicles.

The mediating role of attachment and anger: exploring the impact of maternal early-life maltreatment on child abuse potential.

Maternal early-life maltreatment (ELM) increases the risk of subsequent child maltreatment, but the underlying mechanisms of these intergenerational effects remain largely unknown. Identifying these mechanisms is crucial for developing preventive interventions that can break the cycle of abuse. Notably, previous research has shown that ELM often results in attachment insecurity and altered anger characteristics. Therefore, this study determines whether these characteristics mediate the relationship between maternal history of ELM and child abuse potential. The study sample included 254 mothers, of whom 149 had experienced ELM to at least a moderate degree. Maternal ELM was assessed using the Childhood Experience of Care and Abuse (CECA) interview. Attachment insecurity, trait anger and anger expression, and maternal abuse potential were assessed using the Vulnerable Attachment Questionnaire (VASQ), State-Trait Anger Expression Inventory (STAXI), and Child Abuse Potential Inventory (CAPI), respectively. The severity of maternal ELM predicted higher child abuse potential, with attachment insecurity and anger suppression mediating this effect. Specifically, higher levels of maternal ELM were associated with greater attachment insecurity and increased anger suppression, resulting in a higher child abuse potential. Although higher levels of trait anger were directly associated with higher child abuse potential, this parameter did not mediate the relationship with ELM. In addition, no significant associations were observed between outwardly expressed anger and ELM or child abuse potential. All analyses were adjusted for maternal mental disorders, years of education, and relationship status. Attachment insecurity and anger suppression may serve as pathways linking the maternal history of ELM to the risk of child abuse, even when considering maternal psychopathology. Overall, our findings indicate that interventions aimed at strengthening attachment and improving anger suppression may be beneficial for all mothers with ELM history and high child abuse potential, not just those who suffer from mental illness.

A - 172 STEP-Home Intervention Improves Inhibitory and Anger Control, Reintegration, and Neurobehavioral Symptoms in Post-9/11 Veterans with TBI and Other Common Comorbidities.

Post-9/11U.S. Veterans are clinically complex with multiple co-occurring health conditions contributing to morbidity/mortality and decreased quality of life. TBI diagnosis can worsen these outcomes. STEP-Home is a cognitive-behavioral transdiagnostic intervention for TBI and common comorbidities. This study determines if STEP-Home improves anger control, frontal system function, civilian readjustment, neurobehavioral symptoms, and work/life functioning in post-9/11 Veterans. TBI may influence Veterans' ability to learn core skills and, thus, impact response to treatment. Treatment outcomes for Veterans with and without TBI will be explored. 56 (39M/17F; mean age = 39.9) post-9/11 Veterans with high rates of psychiatric comorbidity, with and without TBI received 12weeks of the STEP-Home cognitive-behavioral intervention. Assessments at baseline, posttreatment (12weeks), and follow-up (12weeks posttreatment) included: State-Trait Anger Expression Inventory 2 (STAXI-2); Military to Civilian Questionnaire (M2CQ); Post-Deployment Readjustment Inventory (PDRI); Frontal Systems Behavioral Scale (FrSBe); Neurobehavioral Symptom Inventory (NSI); World Health Disability Scale (WHODAS); PTSD Checklist (PCL-5); Depression Anxiety and Stress Scale (DASS-21). STEP-Home significantly improved anger expression (STAXI-2 p = 0.0320), inhibitory control (FrSBe p = 0.0001), and reintegration status (MC2Q p = 0.0001; PDRI p = 0.0097) posttreatment. Similar improvements were seen in neurobehavioral symptoms, work/life functioning, PTSD, depression, and stress (p's < 0.01). Treatment gains were maintained at follow-up (p's < 0.001). Treatment response did not differ by TBI status. STEP-Home teaches Veterans cognitive-behavioral skills to improve anger and impulse control, executive functioning, reintegration, and work/life functioning. Treatment gains were comparable for Veterans with and without TBI. This is critical given TBI prevalence among post-9/11 Veterans and the need for additional palatable treatment options.

Validation of the Korean Adaptation of the State-Trait Anger Expression Inventory-2 (K-STAXI-2)

Background: This study aimed to validate the Korean adaptation of the State-Trait Anger Expression Inventory-2 (K-STAXI-2).Methods: The study included a sample of 307 normal adults and 81 comparable adult patients. The data were analyzed using factor analyses, internal consistency measures, assessments of convergent and discriminant validity, t-tests between groups, and test-retest reliability.Results: (1) Exploratory factor analyses revealed clear-cut factors for anger experience (state anger and trait anger) and anger expression (anger expression-in, anger expression-out, anger control-in, and anger control-out); (2) correlation analyses between K-STAXI-2 and the Emotional Stress Inventory demonstrated convergent and discriminant validity; (3) t-test between the patient group and the normal adults group provided additional construct validity; (4) internal consistencies of the six subscales showed a satisfactory level of reliability (&lt;i&gt;α&lt;/i&gt;=.81 to &lt;i&gt;α&lt;/i&gt;=.94); and (5) test-retest reliability over four weeks showed a satisfactory level of reliability.Conclusions: The results further support the reliability and validity of the K-STAXI-2, suggesting its usefulness in various fields such as medicine, nursing, psychology, addiction, organization, education, and criminal justice.

The Psoriasis Disability Index in Romanian Psoriasis Patients during COVID-19 Pandemic: Contribution of Clinical and Psychological Variables.

Psoriasis is one of the most frequent chronic inflammatory skin diseases and has a negative impact on the interpersonal relationship and psychosocial well-being. The aims of this study were to examine the effects of intensity of pruritus on quality of life and depression, to investigate the relationship between anger, self-esteem, and depression, and to compare patients with early and late onset of psoriasis. As our study was carried out during the COVID-19 pandemic, we aimed also to investigate the safety concerns and anxiety related to COVID-19 in psoriasis patients. This cross-sectional study included 137 patients diagnosed with plaque psoriasis. The patients were classified as early-onset (age < 30 years) and late-onset psoriasis (age ≥ 30 years). Duration of disease, pruritus scores, and socio-demographic characteristics were recorded. Measures included the State-Trait Anger Expression Inventory (STAXI), Rosenberg Self-Esteem Scale, Beck Depression Inventory (BDI-II), Psoriasis Disability Index (PDI), and Fear and anxiety in relationship with COVID-19 Scale were used for determining anger, anger expression style, self-esteem, depression, anxiety, and quality of life. The psoriasis patients had a lower score for self-esteem than the normative data from the Romanian general population. The average scores for state anger and trait anger are similar to the normative data from the Romanian general population, but the scores for anger-in and anger-out are higher. Patients with early onset had higher depression scores and lower quality of life. Self-esteem correlates negatively with depression, anger, severity of disability due to psoriasis, number of affected areas, and duration of disease. Lower level of self-esteem led to increased anger. Reduced self-esteem, increased anger levels, and depression are present in psoriasis patients. The effective treatment of psoriasis must, therefore, consist of a multidisciplinary approach, in which the personalized treatment of the skin condition is as important as the adjuvant therapies that reduce the patients' stress level.

A Cross-Sectional Study on Outcomes of Hospitalization in Patients with Borderline Personality Disorder After Six Months

Background: Borderline Personality Disorder (BPD) is a serious psychiatric disorder that is characterized by unstable affect, mood, behavior, object relations, and self-image. In this study, a 6-month follow-up was performed to evaluate the outcomes of hospitalization in terms of symptoms severity, suicidal attempts, self-harm behaviors, substance use, and anger expression.&#x0D; Methods: This cross-sectional study was performed on 60 patients hospitalized with BPD in Iran Psychiatric Hospital in the first 6 months of 2018. Demographic information of patients was collected at the time of admission. Patients were assessed by initial psychiatric evaluations with the Structured Clinical Interview for DSM-IV [Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-1), Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-2)], the Borderline Evaluation of Severity over Time (BEST), the Spielberger’s state-trait anger expression inventory and Depression Anxiety Stress Scale (DASS). Medical comorbidities, self-harm and suicide ideations and attempts, high-risk behaviors, and substance use disorders were also assessed and recorded. Three months after discharge, the patients were reassessed by BEST questionnaire and after 6 months, they were reassessed using DASS, BEST, SCID-2, and Spielberger’s state-trait anger expression inventory.&#x0D; Results: The repeated measures analysis of changes in quantitative variables including the scores of the severity of symptoms in BEST, DASS, and Spielberger tools showed that the scores of DASS decreased significantly during the study (p=0.020), while no significant change was observed in the scores of Spielberger and BEST inventory.&#x0D; Conclusion: In patients with BPD, hospitalization was correlated with reduced depression, anxiety, and stress 6 months after discharge. Regular follow-ups along with regular patient visits can form an effective therapeutic relationship with the patients and help to improve monitoring of their drug usage, self-harming acts, and suicidal thoughts.

Emotional regulation and body dissatisfaction: the mediating role of anger in young adult women.

Emotion regulation difficulties have an important role in the presence of negative self-image. These problems in the self-regulation of emotion could lead to negative emotional processes (such as anger) that can lead to body dissatisfaction. Therefore, the aim of the present study was to examine emotion regulation difficulties than can negatively impact self-image and to understand if anger acts as mediator in the relationship between emotion regulation and body dissatisfaction. A cross-sectional study was carried out comprising 565 young adult women aged 18-30 years. The participants were administered the Difficulties in Emotion Regulation Scale (DERS), the State-Trait Anger Expression Inventory 2 (STAXI-2), and the Body Dissatisfaction dimension of the Eating Disorder Inventory-2 (EDI-2). The proposed hypotheses were tested by path analysis in MPlus 8.0. The results indicated that anger had a positive significant effect on body dissatisfaction as well as the non-acceptance of emotional responses, the lack of emotional awareness, and the lack of emotional clarity. Of all the dimensions of emotional regulation difficulties, impulse control difficulty was the dimension which had a positive significant indirect effect on body dissatisfaction explained by increased anger. The present study suggests the importance of emotion regulation in the prevention of body dissatisfaction. Impulse control difficulty may be the key emotion regulation emotion in explaining the increments of anger that lead to body dissatisfaction. Among young adults, the promotion of positive body image can be promoted by helping this population to self-regulate their anger impulses.

Bulimia symptoms and anger and aggression among adolescents

BackgroundPrevious research has indicated that anger and aggression may be elevated in adolescents with a bulimia nervosa (BN) diagnosis. However, as yet, little is known about whether bulimia symptoms are linked to anger and aggression in adolescents in the general population. To address this deficit this study aimed to explore the associations between a clinical level of bulimia symptoms (CLBS) and anger, anger rumination and aggression in community-based adolescents, and determine whether gender is important in this context.MethodsThis study was conducted on a representative sample of youth from northwestern Russia (n = 2613, age 13–17 years old, 59.5% female) using self-report scales. A proxy variable for a CLBS was created using the Eating Disorder Diagnostic Scale. Aggression, anger and anger rumination were assessed by the Trait Anger Scale of the State Trait Anger Expression Inventory, the Anger Rumination Scale, and scales created to assess physically and verbally aggressive behavior. Multivariate analysis of covariance was used to examine the associations between the study variables.ResultsA CLBS was more prevalent in girls than in boys (13.4% vs. 3.5%). The association with anger and aggression was stronger in both genders with a CLBS, compared to those adolescents without a CLBS. In the CLBS group, boys as compared to girls scored higher on verbal and physical aggression, anger rumination and social aggression. In both the CLBS and Non-CLBS groups higher anger and aggression scores were associated with increasing age.ConclusionsFindings suggest that aggression and anger rumination are elevated in adolescents with BN symptoms, and that the associations between anger, aggression and BN symptoms may be stronger in boys. As previous research has indicated that the presence of aggressive behaviors may affect the prognosis of BN and complicate management of the disorder, clinician screening for these behaviors in adolescents with BN symptoms may facilitate the provision of more effective treatment, especially among boys.

Trait anger and negative interpretation bias in neutral face perception.

Anger is a basic emotion helping people to achieve goals by preparing the body for action and prompting others to change their behavior but is also associated with health issues and risks. Trait anger, the disposition to experience angry feelings, goes along with an attribution of hostile traits to others. Negative distortions in the interpretation of social information have also been observed in anxiety and depression. The present study examined the associations between components of anger and negative interpretation tendencies in the perception of ambiguous and neutral schematic faces controlling for anxiety, depressed mood, and other variables. A sample of 150 young adults performed a computer-based perception of facial expressions task and completed the State-Trait Anger Expression Inventory (STAXI-2) along with other self-report measures and tests. Trait anger and anger expression correlated with the perception of negative affects in neutral but not in ambiguous faces. More specifically, trait anger was linked to the attribution of anger, sadness, and anxiety to neutral faces. Trait anger predicted perceived negative affects in neutral faces when adjusting for anxiety, depression, and state anger. For neutral schematic faces, the present data support an association between trait anger and negatively biased interpretation of facial expression, which is independent of anxiety and depressed mood. The negative interpretation of neutral schematic faces in trait angry individuals seems not only to comprise the attribution of anger but also of negative emotions signaling weakness. Neutral schematic facial expressions might be useful stimuli in the future study of anger-related interpretation biases.