The role of anger in generalized anxiety disorder

Little is known about the role of anger in the context of anxiety disorders, particularly with generalized anxiety disorder (GAD). The aim of study was to examine the relationship between specific dimensions of anger and GAD. Participants (N?=?381) completed a series of questionnaires, including the Generalized Anxiety Disorder Questionnaire (GAD-Q-IV; Newman et al., 2002, Behavior Therapy, 33, 215-233), the State-Trait Anger Expression Inventory (STAXI-2; Spielberger 1999, State-Trait Anger Expression Inventory-2: STAXI-2 professional manual, Odessa, FL: Psychological Assessment Resources) and the Aggression Questionnaire (AQ; Buss & Perry 1992, Journal of Personality and Social Psychology, 63, 452-459). The GAD-Q-IV identifies individuals who meet diagnostic criteria for GAD (i.e. GAD analogues) and those who do not (non-GAD). The STAXI-2 includes subscales for trait anger, externalized anger expression, internalized anger expression, externalized anger control and internalized anger control. The AQ includes subscales for physical aggression, verbal aggression, anger and hostility. The GAD-Q-IV significantly correlated with all STAXI-2 and AQ subscales (r's ranging from .10 to .46). Multivariate analyses of variance revealed that GAD analogues significantly differed from non-GAD participants on the combined STAXI-2 subscales (η(2)?=?.098); high levels of trait anger and internalized anger expression contributed the most to GAD group membership. GAD analogue participants also significantly differed from non-GAD participants on the combined AQ subscales (η(2)?=?.156); high levels of anger (affective component of aggression) and hostility contributed the most to GAD group membership. Within the GAD analogue group, the STAXI-2 and AQ subscales significantly predicted GAD symptom severity (R (2)?=?.124 and .198, respectively). Elevated levels of multiple dimensions of anger characterize individuals who meet diagnostic criteria for GAD.     

Intolerance of Uncertainty Mediates the Relation Between Generalized Anxiety Disorder Symptoms and Anger

Previous research has shown that individuals with generalized anxiety disorder (GAD) report elevated anger compared with nonanxious individuals; however, the pathways linking GAD and anger are currently unknown. We hypothesized that negative beliefs about uncertainty, negative beliefs about worry and perfectionism dimensions mediate the relationship between GAD symptoms and anger variables. We employed multiple mediation with bootstrapping on cross-sectional data from a student sample (N = 233) to test four models assessing potential mediators of the association of GAD symptoms to inward anger expression, outward anger expression, trait anger and hostility, respectively. The belief that uncertainty has negative personal and behavioural implications uniquely mediated the association of GAD symptoms to inward anger expression (confidence interval [CI] = .0034, .1845, P_M = .5444), and the belief that uncertainty is unfair and spoils everything uniquely mediated the association of GAD symptoms to outward anger expression (CI = .0052, .1936, P_M = .4861) and hostility (CI = .0269, .2427, P_M = .3487). Neither negative beliefs about worry nor perfectionism dimensions uniquely mediated the relation of GAD symptoms to anger constructs. We conclude that intolerance of uncertainty may help to explain the positive connection between GAD symptoms and anger, and these findings give impetus to future longitudinal investigations of the role of anger in GAD.     

Preliminary validation of a Chinese version of the State-Trait Anger Expression Inventory-2

The increased globalization of psychology and related fields necessitates the availability of psychometric instruments in a number of languages, countries and cultures. Unfortunately, research on anger and aggression in Chinese populations has suffered from a lack of valid and reliable measurement instruments. Therefore, the State-Trait Anger Expression Inventory-2 (STAXI-2) was translated into Chinese (Chinese STAXI-2). Two samples of Hong Kong Chinese ( N  = 489 and N  = 775) completed the Chinese STAXI-2. Participants in the second sample also completed measures of anger rumination and aggression. Confirmatory factor analysis (CFA) of responses from the first sample resulted in the loss of nine items from the 57 original items due to misspecification. A second CFA, using responses from the second sample, supported the construct validity of the modified scale. Moderate correlations were observed with measures of aggression and anger rumination, and significant differences were found between males and females on three anger expression subscales (Anger Expression-In, Anger Control-Out, and Anger Control-In). The preliminary evidence suggests that the abbreviated inventory may be a useful measure of state and trait anger, and anger expression in some Chinese populations.     

The Relationship between Anger Rumination and Aggression in Typically Developing Children and High-Risk Adolescents

This paper examines anger rumination as a risk factor of aggression in typically developing children and high-risk adolescents. Study 1 developed and evaluated the psychometric properties of a self-report measure of children’s anger rumination (Children’s Anger Rumination Scale; CARS) and its association with teacher- and peer-rated overt and relational aggression in school-aged children (n = 254, M age = 10.62). Findings offered support for the reliability and validity of the CARS as well as support for the hypothesis that children who ruminate to anger exhibit elevated levels of overt and relational aggression. Study 2 examined concurrent and prospective relationships between anger rumination and aggression and the moderating effects of trait anger in a sample of male juvenile offenders (n = 119, M age = 16.74). Latent growth curve analyses revealed that the interaction between trait anger and anger rumination predicted initial levels of aggression (i.e., intercept) and changes in aggression over time (i.e., slope). Juvenile offenders who were high in trait anger and ruminated in response to anger exhibited the highest initial levels of aggression. Contrary to our hypothesis, this group did not exhibit greater increases in aggression over time relative to others, but instead they had stably high levels of aggression at each time point. These findings suggest that cognitive-behavioral treatment strategies for aggression may be improved by educating youths about the contributory role of anger rumination in the development of aggression and providing them with adaptive alternatives to coping with feelings of anger.     

An Exploration of the Relationship Between Spirituality and State and Trait Anger Among Medical Students

There is a dearth of studies exploring spiritual attitudes of medical students from developing countries and its relationship to anger. This study was conducted to assess spiritual attitudes and their relationship with anger in a set of medical students in southern India. In this cross-sectional observational study, medical students who were undergoing clinical rotations were offered participation. Selected demographic data were obtained. The participants were rated using the Spiritual Attitudes Inventory [SAI, which comprises of Duke Religiosity Index, Existential Well-Being Scale (EWBS), Negative Religious Coping and Multidimensional Health Locus of Control scale] and State and Trait Anger Expression Inventory 2. Out of 98 students approached, 82 participated (response rate 83.6 %). The mean age of sample was 20.7 years (±0.9 years) with a slight preponderance of females (54.9 %). SAI scores correlated well significantly with subscale scores. Gender had no difference on the SAI or subscale score. Differences were found between self-reported religion and EWBS scores (Kruskal–Wallis χ ² = 8.891, p = 0.012). Total SAI score had a significant negative correlation with state anger, trait anger and anger expression. High levels of spirituality may be correlated with lower levels of state anger, trait anger and anger expression in medical students.     

Intolerance of uncertainty,causal uncertainty,causal importance,self-concept clarity and their relations to generalized anxiety disorder

Although numerous studies have provided support for the notion that intolerance of uncertainty plays a key role in pathological worry (the hallmark feature of generalized anxiety disorder (GAD)), other uncertainty-related constructs may also have relevance for the understanding of individuals who engage in pathological worry. Three constructs from the social cognition literature, causal uncertainty, causal importance, and self-concept clarity, were examined in the present study to assess the degree to which these explain unique variance in GAD, over and above intolerance of uncertainty. N = 235 participants completed self-report measures of trait worry, GAD symptoms, and uncertainty-relevant constructs. A subgroup was subsequently classified as low in GAD symptoms (n = 69) or high in GAD symptoms (n = 54) based on validated cut scores on measures of trait worry and GAD symptoms. In logistic regressions, only elevated intolerance of uncertainty and lower self-concept clarity emerged as unique correlates of high (vs. low) GAD symptoms. The possible role of self-concept uncertainty in GAD and the utility of integrating social cognition theories and constructs into clinical research on intolerance of uncertainty are discussed.     

The Aggression Questionnaire: a validation study in student samples

The goal of this study was to examine the psychometric properties of the Aggression Questionnaire (AQ) in Spain. The AQ is a 29-item instrument designed to measure the different dimensions of the hostility/anger/aggression construct. It consists of 4 subscales that assess: (a) anger, (b) hostility, (c) verbal aggression, and (d) physical aggression. In Study 1, reliability, construct validity, and convergent validity were evaluated in a group of 384 male and female university students. Test-retest reliability was evaluated using a group of 154 male and female university students. The results of the factor analysis were similar to the scale structure claimed for this instrument. The subscales also showed internal consistency and stability over time. The AQ and its subscales were also compared with the scales and subscales of the Spielberger State-Trait Anger Expression Inventory (STAXI), the Cook-Medley Hostility Scale (Ho), the Buss-Durkee Hostility Inventory (BDHI), and the Jenkins Activity Survey-Form H (JASE-H). The results show that the AQ evaluates some aspects of anger, such as Anger-Trait and Anger-Out, rather than other elements, such as Anger-In or Anger-State. In Study 2, two new male groups were used to evaluate the criterion validity of the AQ: 57 prison inmates and 93 university students, finding that this instrument discriminated between the scores obtained by common offenders and university students.     

Influence of school-level and family-level variables on Chinese college students’ aggression

With the frequent occurrence of campus violence, scholars have devoted increasing attention to college students’ aggression. This study aims to estimate the prevalence of aggression in Chinese university students and identify factors that could influence their aggression. We can thus find methods to reduce the incidence of college students’ aggression in the future. A multi-stage stratified sampling procedure was used to select university students (N = 4565) aged 16–25 years in Harbin. The Aggression Questionnaire, the Adolescent Self-Rating Life Events Checklist and the Social Support Revalued Scale were used to collect data. Females reported lower levels of aggression than males (p < .001). A multiple linear regression analysis was conducted to determine the influence of factors of aggression, and the model was highly significant (R² = .233, Ad R² = .230, p < .01). The results show that the aggression is affected by gender, family-level and school-level variables. Aggression scores are significantly correlated with not only family-level or school-level variables independently, but their combination as well. We find that the risk factors for aggression include a dissatisfying profession, higher levels of study pressure, poor parental relationships, poor interpersonal relationships, the presence of siblings, punishment, health maladjustment, less subjective support, and lower levels of utilization of social support.     

The role of maladaptive anger in self-criticism: A quasi-experimental study on emotional processes

The present study examines the role of emotion in the self-critical process of individuals with anger problems. Self-criticism is a prevalent intra-personal feature which greatly impacts an individual’s emotion. So far, it is unclear, which emotions individuals with maladaptive anger experience when they work through their self-criticism. Using a quasi-experimental design, the present study compared n = 23 anger-prone under-graduate students to n = 22 controls on process indices of contempt, fear, shame, anger and global distress, as well as on their access to underlying need, as participants were working through personalized self-critical content. This was achieved using a single-session enactment from emotion-focused therapy, augmented with a standardized procedure for priming participants to focus on their unmet needs. Findings suggested that this work on self-criticism reduced for both groups distress, fear and shame, as well as increased assertive anger (McNemar tests significant at p = .05). More centrally, anger-prone individuals expressed more self-contempt (t(1, 44) = 3.65; p < .05), and they had more difficulty in accessing their underlying need (χ² = 5.35; p < .05), when compared to controls. These results have implications for clinical work with anger-prone individuals, and clarify key features in the use of enactment interventions when working towards emotional resolution. The present study also demonstrates the use of personalized stimuli in the context of clinically relevant quasi-experimental research on emotional processes.     

How impulsiveness, trait anger, and extracurricular activities might affect aggression in school children

Individual differences in personality traits such as impulsivity and trait anger as well as environmental variables have an impact on aggressiveness. We tested a model incorporating the related variables of impulsiveness, trait anger, and aggression and incorporated the possible mediating influences of leisure-time activities. Regression analyses of data from 1129 pre-adolescents and 1093 adolescents (55.4% females) from a study evaluating the Spanish version of the Buss and Perry aggression questionnaire (AQ; Santisteban, Alvarado, & Recio, 2007) showed a relation between impulsiveness (Barratt Impulsiveness Scale) and aggression (AQ). Trait anger (Spielberger’s State-Trait Anger Expression Inventory), the time spent watching TV and playing video games, and the time spent doing homework (all related to impulsiveness) also are related to physical, as well as verbal aggression (with low to moderate coefficients). Multiple mediation analyses confirm that media violence exposure and homework, respectively, can have aggravating and attenuating effects on self-reported aggression. These results provide key variables for longitudinal studies which could reveal the causal nature of the results found with our cross-sectional design.     

Validation of the Dutch version of the aggression questionnaire in adolescent male offenders

This study examined the construct validity of the Dutch version of Buss and Perry’s Aggression Questionnaire (AQ) in 73 adolescent male offenders aged 12 to 18 years who were participating in a residential rehabilitation program. There was a strong positive association between the Hostility subscale of the AQ and psychological and physical symptoms. The nature of this connection was discussed. It was argued that the Hostility subscale measures some unique aspect of aggression that is not incorporated by the Physical Aggression, Verbal Aggression, or Anger subscales of the AQ. As expected, the AQ scales correlated significantly with trait anger, social desirability, and age. Furthermore, staff ratings of physical violence, verbal aggression, anger, and negative attitude were obtained for each subject. Correlations between the AQ scales and these ratings were low. Possible explanations for this unexpected finding are discussed. Finally, normative and internal structure data are presented. Aggr. Behav. 28:87–96, 2002. © 2002 Wiley‐Liss, Inc.     

Eating behaviors and emotional distress are predicted by treatment and adverse outcome in patients with type 2 diabetes

Depression and anxiety are hightly prevalent among patients with Type 2 Diabetes (T2D), however not commonly related to outcomes, treatment and comorbidities. Eating behaviors could also have an implication. To evaluate the relation between mood and eating behaviors with demographic, physical, treatment, biochemical profiles and chronic comorbidities in T2D we conducted this exploratory cross sectional study in a population from Mexico. Hospital Anxiety and Depression Scale and the Three Factor Eating Questionnaire Revised 21 (TFEQ-R21) were correlated with age, gender, blood pressure, treatment and comorbidities (nephropathy, neuropathy, retinopathy and cardiopathy). Multi-linear regression models and 2^k factorial analyses were conducted. Sixty-one patients (31 male) 55 years old (SD 13) with at least 5 years of T2D were included. Anxiety correlated with depression (r = 0.25, p < 0.05). Gender (women) (std B 0.026, p < 0.001), insulin therapy (std B 0.3, p = 0.11), systolic blood pressure (std B 0.263, p = 0.02) and cardiovascular disease (std B 0.232, p = 0.035) predicted depression. Insulin therapy had a positive effect in cognitive restraint. (std B 0.32, p = 0.001). Age (std B 0.37, p = 0.003) and systolic blood pressure (std B 0.237, p = 0.048) predicted positively emotional eating (not previously published). 2^k factorial analyses proved additive interaction between complications and insulin therapy with depression. This study supports the relation between mood disorders and eating behaviors with demographic, physical, treatment, biochemical profiles and chronic comorbidities in T2D and the additive interaction between factors and mood disorders.     

Are All Hostility Scales Alike? Factor Structure and Covariation Among Measures of Hostility1

Few studies have examined the correlational and structural relationships between measures of hostility that may predict coronary heart disease. Using data from a population-based study (N= 2,682), we examined the factor structure among the five subscales from Siegel's (1986) Multi-dimensional Anger Inventory, the three subscales from Spielberger et al.'s (1985) anger expression scales, a Cook-Medley (Cook & Madley, 1954) hostility subscale that measures cynicism, and items measuring hostility from four scales that assess Type A behavior. Eight separate factors were identified: hostile anger expression, perceived control over the expression of one's anger, frequency of anger, ease of anger provocation, brooding, hostile outlook, cynicism, and sullenness. These results suggest that the structure of hostility measures is more complex than previous factor analyses have suggested. Our findings point to the dangers in assuming that a factor structure can be generalized beyond the data on which it is based to provide theoretical statements about psychological structure. The new scales appear to be valid because they correlate with demographic variables and indicators of social support in the expected directions.     

Vagal influence during worry and cognitive challenge

Abstract

The primary foci of the study were exploration of the linkage between cognitive and autonomic inflexibility of worry and generalized anxiety disorder (GAD) and examination of the effects of an analog cognitive restructuring task on this relationship. Cardiac responses of GAD and non-GAD participants were measured to examine the sympathetic and parasympathetic effects of worry and cognitive challenge. Diagnostic groups of undergraduate students were determined via administration of a structured interview, yielding a GAD group (n=16) and a control group (n=19) of individuals without GAD, depression, or panic disorder diagnoses. Cardiac autonomic responses were acquired via electrocardiogram during rest, worry, and cognitive challenge conditions by an experimenter blind to diagnosis. Metrics were compared between the two groups and across the three conditions. Individuals diagnosed with GAD did not differ significantly from controls on autonomic indices. Worry was associated with significantly decreased parasympathetic influence and increased sympathetic activity. Cognitive challenge did not result in significant increased cardiac responsivity. The results indicate that worry behavior is associated with decreased vagal activity, suggest a linkage between autonomic and cognitive inflexibility, and provide further suggestions for improving protocols to assess the autonomic effects of cognitive therapy techniques.     

Impact of Youth Strengths and Objective Strain on the Experiences of Subjective Strain Among Caregivers of Youth with Behavioral Health Conditions

Caregivers of youth with behavioral health conditions often experience significant and chronic caregiving strain. Caregiving strain is thought to consist of three dimensions: objective strain (observable negative events), subjective internalized strain (negative feelings directed inwardly), and subjective externalized strain (negative feelings directed outwardly). Based on a modified stress process model, the aims of this study were to: (1) examine whether the association between youth emotional-behavioral problem severity (measured with the Child Behavior Checklist/6–18) and subjective internalized and subjective externalized caregiving strain is mediated by objective strain for caregivers, and; (2) identify other predictors of subjective internalized and subjective externalized strain, particularly related to youth emotional-behavioral strengths as measured by the Behavioral and Emotional Rating Scale-Parent Rating Scale. We also explored the extent to which the association between youth emotional-behavioral problem severity and subjective internalized and subjective externalized strain may be moderated by perceived youth emotional-behavioral strengths. One-hundred and eighty-five (N = 185) caregivers of youth served by a community-based system of care participated in structured survey interviews at program enrollment. Regression analyses indicated that objective strain was found to fully mediate the association between youth emotional-behavioral problem severity and subjective externalized strain. Greater youth strengths related to family involvement were also associated with lower subjective externalized strain. Higher caregiver age, lower education, biological parent relationship to youth, greater youth emotional-behavioral problem severity, higher objective strain, and lower youth strengths related to school functioning were associated with higher subjective internalized strain. A significant interaction was found between youth problem severity, youth affective strengths, and subjective internalized strain such that caregivers who reported higher levels of youth affective strengths experienced stronger effects from youth emotional-behavioral problem severity on subjective internalized strain. These findings shed light upon the complex set of circumstances that may lead caregivers of youth with behavioral health conditions to experience subjective internalized and subjective externalized strain.     

Exploration of a Factor Mixture-Based Taxonic-Dimensional Model of Anxiety Sensitivity and Transdiagnostic Psychopathology Vulnerability Among Trauma-Exposed Adults

The aim of this study was to evaluate the associations between a factor mixture-based taxonic-dimensional model of anxiety sensitivity (AS) and posttraumatic stress, panic, generalized anxiety, depression, psychiatric multimorbidity, and quality of life among a young adult sample exposed to traumatic stress (N = 103, n _females = 66, M _age = 23.68 years, SD _age = 9.55). Findings showed support for the conceptual and operational utility of the AS taxonic-dimensional model with respect to concurrent transdiagnostic vulnerability among trauma-exposed adults. Specifically, relative to the low-AS group, the high-AS group demonstrated elevated levels of panic, depressive, and posttraumatic stress symptom severity as well as greater psychiatric multimorbidity and poorer quality of life. Furthermore, past-month MDD, GAD, PTSD, and panic attacks occurred nearly exclusively among the high-AS group. Continuous AS physical and psychological concerns scores were found to be significantly related to levels of panic and posttraumatic stress symptom severity, psychiatric multimorbidity as well as panic attack status only among the high-AS group and not among the low-AS group. Findings are discussed with respect to their implications for the conceptual and operational utility of the FMM-based taxonic-dimensional model of AS, related vulnerability for psychopathology in the context of trauma, and the clinical implications of these findings for assessment and intervention.     

Psychopathy and Functions of Aggression in Emerging Adulthood: Moderation by Anger Rumination and Gender

Psychopathy has been previously identified as a risk factor for aggression (Porter and Woodworth 2006). However, few studies have considered specific relationships with functional subtypes of aggression, or how gender and anger rumination affect these relationships in emerging adulthood. We hypothesized that primary psychopathy would be uniquely related to proactive aggression (PA) and secondary psychopathy to reactive aggression (RA), and that these relationships would be amplified by anger rumination, and potentially influenced further by gender. Undergraduate students (N = 610; 73.3 % female) ages 18–20 completed self-report measures of anger rumination, psychopathy, and aggression, and hypotheses were tested using hierarchical regression. As predicted, anger rumination enhanced the association between secondary psychopathy and RA. It also amplified the relationship between primary psychopathy and PA, but only at very high levels of anger rumination. Gender moderated interactions between primary and secondary psychopathy on aggression. For men, primary psychopathy attenuated the secondary psychopathy – RA relationship, but not for women. These findings fill an important gap in the literature by demonstrating how tendencies to ruminate on anger and psychopathic traits interact to influence functional subtypes of aggression in young men versus women.     

Implicit Coping Styles as a Predictor of Aggression

Research exploring potential antecedents of aggression provides contradictory results, with some data relating adaptive coping styles with high aggression and other studies finding the inverse. Clarification of these relationships could improve intervention and prevention strategies. This study investigated relationships between aggression and 3 coping styles (adaptive, neurotic, and maladaptive) via cross-sectional correlational methodology (N = 355). Data supported both hypotheses: First, the use of less adaptive coping styles predicted higher levels of aggression; second, this relationship held true for both cognitive (anger and hostility) and overt (physical and verbal) expressions of aggression. Results indicate that maladaptive coping significantly predicts aggression. Implications include potential prediction and prevention strategies to reduce the probability of higher risk individuals exhibiting aggression.     

Effective regulation of affect: An action control perspective on emotion regulation

The present review adopts an action control perspective on emotion regulation, contextualising the gap between emotion control goals (e.g., I want to remain calm) and emotional outcomes (e.g., anger, anxiety, and aggression) in terms of the broader literature on goal pursuit. We propose that failure to effectively regulate emotions can result from difficulties with the self-regulatory tasks of (i) identifying the need to regulate, (ii) deciding whether and how to regulate, and (iii) enacting a regulation strategy. Next we review evidence that a technique traditionally associated with regulating behavioural goals (forming implementation intentions or “if-then” planning) can help to overcome these difficulties. Meta-analysis indicated that forming implementation intentions is effective in modifying emotional outcomes, with a large effect relative to no regulation instructions (k = 21, N = 1306 d ₊ = 0.91, 95% CI = 0.61 to 1.20) and a medium-sized effect relative to goal intention instructions (k = 29, N = 1208, d ₊ = 0.53, 95% CI = 0.42 to 0.65). Our conclusion is that research on emotion regulation might benefit from an action control perspective and the interventions that this perspective offers.     

Emotion Beliefs and Cognitive Behavioural Therapy for Social Anxiety Disorder

Despite strong support for the efficacy of cognitive behavioural therapy (CBT) for social anxiety disorder (SAD), little is known about mechanisms of change in treatment. Within the context of a randomized controlled trial of CBT, this study examined patients' beliefs about the fixed versus malleable nature of anxiety—their ‘implicit theories’—as a key variable in CBT for SAD. Compared to waitlist (n = 29; 58% female), CBT (n = 24; 52% female) led to significantly lower levels of fixed beliefs about anxiety (M_baseline = 11.70 vs. M_Post = 7.08, d = 1.27). These implicit beliefs indirectly explained CBT-related changes in social anxiety symptoms (κ² = .28, [95% CI = 0.12, 0.46]). Implicit beliefs also uniquely predicted treatment outcomes when controlling for baseline social anxiety and other kinds of maladaptive beliefs (perceived social costs, perceived social self-efficacy, and maladaptive interpersonal beliefs). Finally, implicit beliefs continued to predict social anxiety symptoms at 12 months post-treatment. These findings suggest that changes in patients' beliefs about their emotions may play an important role in CBT for SAD.