Problems with managing anger can have severe consequences for the afflicted individual and their loved ones. A new study from the Center for Psychiatry Research at Karolinska Institutet in Sweden shows that a four-week course of cognitive behavioral therapy delivered over the internet can help people with anger and aggression. The results have been published in the Journal of Consulting and Clinical Psychology.

The study, which the researchers have chosen to call the "anger study," is the first to compare different internet-mediated emotion regulation strategies against anger. The results are expected to be important for understanding emotion regulation and for the dissemination of evidence-based methods.

Easy to recruit participants

"It is usually very difficult to recruit participants for treatment studies. For the anger study, however, it was very easy, and we had to close the recruitment site after a few weeks due to the high number of applicants. This suggests that there is a pent-up need for the psychological treatment of anger.

"Many people who have problems with anger feel ashamed, and we think the internet format suits this group particularly well because they don't have to wait in a reception room or sit face-to-face with a therapist and talk about their anger," says Johan Bjureberg, assistant professor at the Center for Psychiatry Research at Karolinska Institutet and researcher responsible for the study, which was carried out in collaboration with researchers at Örebro University in Sweden.

The anger study has evaluated the effect of two emotion regulation strategies: mindful emotion awareness; and cognitive reappraisal. Mindful emotion awareness focuses on the ability to notice and accept one's feelings and thoughts without judging or acting on them. Cognitive reappraisal, on the other hand, focuses on the ability to reinterpret thoughts and situations and identify alternative thoughts that do not trigger difficult feelings.

The 234 participants, all with significant anger problems, were randomly assigned to four weeks of either mindful emotion awareness, cognitive reappraisal, or a combination of these two strategies. All treatments were of approximately the same length and were associated with decreased self-reported anger and aggressiveness at the end of the treatment.

Combination therapy most effective

The combined treatment resulted in significantly lower levels of outward anger expression, aggression, and anger rumination, but not anger suppression, compared to mindful emotion awareness or cognitive reappraisal alone. The combination was particularly effective for participants who were experiencing very high levels of anger at the start of the study.

The results strengthen research and theories suggesting that difficulties in regulating emotions and interpreting events and situations can be a major contributing factor to problems in managing anger.

"Our results suggest that a very short treatment of only four weeks administered over the internet with minimal therapist support is effective in reducing anger problems. Our hope is that follow-up studies support this finding and that the treatment can be offered broadly within regular care," explains Johan Bjureberg.