Patrick M. Reilly, Ph.D.
Michael S. Shopshire, Ph.D.
Contents
Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
How To Use This Manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Session 1 Overview of Group Anger Management Treatment. . . . . . . . . . . . . . . . . . . 7
Session 2 Events and Cues: A Conceptual Framework for
Understanding Anger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Session 3 Anger Control Plans: Helping Group Members Develop a
Plan for Controlling Anger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Session 4 The Aggression Cycle: How To Change the Cycle . . . . . . . . . . . . . . . . . . . 27
Session 5 Cognitive Restructuring: The A-B-C-D Model and Thought Stopping . . . . 33
Session 6 Review Session #1: Reinforcing Learned Concepts . . . . . . . . . . . . . . . . . 37
Sessions 7 & 8 Assertiveness Training and the Conflict Resolution Model:
Alternatives for Expressing Anger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Sessions 9 & 10 Anger and the Family: How Past Learning Can
Influence Present Behavior. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Session 11 Review Session #2: Reinforcing Learned Concepts . . . . . . . . . . . . . . . . . 49
Session 12 Closing and Graduation: Closing Exercise and
Awarding of Certificates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Appendix: Authors’ Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Introduction
This manual was designed for use by qualified substance abuse and mental health clinicians
who work with substance abuse and mental health clients with concurrent anger problems.
The manual describes a 12-week cognitive behavioral anger management group treatment.
Each of the 12 90-minute weekly sessions is described in detail with specific instructions for
group leaders, tables and figures that illustrate the key conceptual components of the treatment,
and homework assignments for the group participants. An accompanying Participant
Workbook is available (see Anger Management for Substance Abuse and Mental Health
Clients: Participant Workbook, Reilly, Shopshire, Durazzo, & Campbell, 2002) and should be
used in conjunction with this manual to enable the participants to better learn, practice, and
integrate the treatment strategies presented in the group sessions. This intervention was developed
for studies at the San Francisco Veterans Affairs (SFVA) Medical Center and San
Francisco General Hospital.
Cognitive behavioral therapy (CBT) treatments have been found to be effective, time-limited
treatments for anger problems (Beck & Fernandez, 1998; Deffenbacher, 1996; Trafate, 1995).
Four types of CBT interventions, theoretically unified by principles of social learning theory, are
most often used when treating anger disorders:
• Relaxation interventions, which target emotional and physiological components of anger
• Cognitive interventions, which target cognitive processes such as hostile appraisals and
attributions, irrational beliefs, and inflammatory thinking
• Communication skills interventions, which target deficits in assertiveness and conflict resolution
skills
• Combined interventions, which integrate two or more CBT interventions and target multiple
response domains (Deffenbacher, 1996, 1999).
Meta-analysis studies (Beck & Fernandez, 1998; Edmondson & Conger, 1996; Trafate, 1995)
conclude that there are moderate anger reduction effects for CBT interventions, with average
effect sizes ranging from 0.7 to 1.2 (Deffenbacher, 1999). From these studies, it can be
inferred that the average participant under CBT conditions fared better than 76 percent of control
participants. These results are consistent with other meta-analysis studies examining the
effectiveness of CBT interventions in the treatment of depression (Dobson, 1989) and anxiety
(Van Balkom et al., 1994).
The treatment model described in this manual is a combined CBT approach that employs relaxation,
cognitive, and communication skills interventions.
Michael S. Shopshire, Ph.D.
Contents
Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
How To Use This Manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Session 1 Overview of Group Anger Management Treatment. . . . . . . . . . . . . . . . . . . 7
Session 2 Events and Cues: A Conceptual Framework for
Understanding Anger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Session 3 Anger Control Plans: Helping Group Members Develop a
Plan for Controlling Anger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Session 4 The Aggression Cycle: How To Change the Cycle . . . . . . . . . . . . . . . . . . . 27
Session 5 Cognitive Restructuring: The A-B-C-D Model and Thought Stopping . . . . 33
Session 6 Review Session #1: Reinforcing Learned Concepts . . . . . . . . . . . . . . . . . 37
Sessions 7 & 8 Assertiveness Training and the Conflict Resolution Model:
Alternatives for Expressing Anger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Sessions 9 & 10 Anger and the Family: How Past Learning Can
Influence Present Behavior. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Session 11 Review Session #2: Reinforcing Learned Concepts . . . . . . . . . . . . . . . . . 49
Session 12 Closing and Graduation: Closing Exercise and
Awarding of Certificates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Appendix: Authors’ Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Introduction
This manual was designed for use by qualified substance abuse and mental health clinicians
who work with substance abuse and mental health clients with concurrent anger problems.
The manual describes a 12-week cognitive behavioral anger management group treatment.
Each of the 12 90-minute weekly sessions is described in detail with specific instructions for
group leaders, tables and figures that illustrate the key conceptual components of the treatment,
and homework assignments for the group participants. An accompanying Participant
Workbook is available (see Anger Management for Substance Abuse and Mental Health
Clients: Participant Workbook, Reilly, Shopshire, Durazzo, & Campbell, 2002) and should be
used in conjunction with this manual to enable the participants to better learn, practice, and
integrate the treatment strategies presented in the group sessions. This intervention was developed
for studies at the San Francisco Veterans Affairs (SFVA) Medical Center and San
Francisco General Hospital.
Cognitive behavioral therapy (CBT) treatments have been found to be effective, time-limited
treatments for anger problems (Beck & Fernandez, 1998; Deffenbacher, 1996; Trafate, 1995).
Four types of CBT interventions, theoretically unified by principles of social learning theory, are
most often used when treating anger disorders:
• Relaxation interventions, which target emotional and physiological components of anger
• Cognitive interventions, which target cognitive processes such as hostile appraisals and
attributions, irrational beliefs, and inflammatory thinking
• Communication skills interventions, which target deficits in assertiveness and conflict resolution
skills
• Combined interventions, which integrate two or more CBT interventions and target multiple
response domains (Deffenbacher, 1996, 1999).
Meta-analysis studies (Beck & Fernandez, 1998; Edmondson & Conger, 1996; Trafate, 1995)
conclude that there are moderate anger reduction effects for CBT interventions, with average
effect sizes ranging from 0.7 to 1.2 (Deffenbacher, 1999). From these studies, it can be
inferred that the average participant under CBT conditions fared better than 76 percent of control
participants. These results are consistent with other meta-analysis studies examining the
effectiveness of CBT interventions in the treatment of depression (Dobson, 1989) and anxiety
(Van Balkom et al., 1994).
The treatment model described in this manual is a combined CBT approach that employs relaxation,
cognitive, and communication skills interventions.