Journal of Psychopathology and Behavioral Assessment, Vol 20, No.

3, 1998

Cognitive-Behavioral Self-Regulation of the

Frequency, Duration, and Intensity of Anger
Richard Beck1 and Ephrem Fernandez1,2
Accepted: May 11, 1998

Within a self-regulation format, cognitive, behavioral, and (combined)

cognitive-behavioral techniques were evaluated for effects on the frequency,
duration, and intensity of anger. Twenty-seven subjects randomly assigned to
three groups each received one of the three treatments after a baseline of
self-monitoring and then completed another phase of self-monitoring. Results
revealed a significant reduction in the frequency and duration of anger (but
not anger intensity) under self-intervention, regardless of treatment type. These
effects were preserved for a week following treatment. Thus, self-regulation may
prevent incidents of anger and even cut short the persistence of anger, but once
anger occurs, it tends to register about the same maximum intensity; this peak
intensity is typically reached at the onset of the anger which then wanes at a
decreasing rate over time. Further research is called for to determine the
long-term durability of the treatment gains obtained and the generalizability of
these findings in clinical populations.
KEY WORDS: anger; cognitive-behavioral therapy; self-regulation.

INTRODUCTION

The emotion of anger is pervasive and of great consequence in the

lives of human beings. Surveys of community and college samples have
found that individuals report an average of 7.3 anger episodes and 23.5
episodes of annoyance per week (Averill, 1982, 1983). In 88% of these
instances, anger was directed at another person, and in 75% of instances
1
Department of Psychology, Southern Methodist University, Dallas, Texas,
2
To whom correspondence should be addressed at Department of Psychology, Southern
Methodist University, Dallas, Texas 75275-0442; e-mail: efernand@mail.smu.edu.

217
0882-2689/98/0900-0217$15.00/0 C 1998 Plenum Publishing Corporation
218 Beck and Fernandez

that individual was a loved one. This is often responsible for negative evalu-
ations of self and others, low self-esteem, marital problems, occupational
difficulties, and general interpersonal conflict (Deffenbacher, 1992). The
potential for aggression is also high in such situations. Overall, more than
50% of murder victims knew their assailants, and an estimated 34% of all
murders were preceded by an argument or disagreement of some kind
(United States Department of Justice, 1991). Of course the link between
anger and violence is only probabilistic but these crime statistics point to
the destructive potential of anger. Moreover, anger has also been impli-
cated as a cofactor in physical illness such as coronary heart disease and
hypertension (Harburg, Gleiberman, Russell, & Cooper, 1991) and the ex-
acerbation of chronic pain (Fernandez & Turk, 1995). It is against this back-
drop of medical and psychosocial costs to society that research on the
treatability of anger has become a priority.

COGNITIVE-BEHAVIORAL THERAPY FOR ANGER

Cognitive-behavioral therapy (CBT) appears to be the treatment of

choice for anger. Based on learning theory and information processing
models, it typically involves the use of relaxation, reappraisal or reframing
of events, coping skills such as imagery and distraction, and interpersonal
or social skills training; these techniques are rehearsed for later use in an-
ger-provoking situations and their successful implementation is typically fol-
lowed by contingent reinforcement.
A detailed review of CBT applications for anger is outside the scope
of this paper, although the past two decades of research on this issue have
recently been quantitatively integrated by Beck and Fernandez (1998).
Their meta-analysis revealed that across 1640 subjects distributed across 50
independent studies, CBT had an effect size of 0.70 as compared to no-
treatment controls for anger. This effect was statistically significant, robust,
and relatively homogeneous across studies. Translated into percentiles, it
indicates that CBT-treated subjects were better off than 76% of untreated
subjects with respect to anger reduction.
Despite the general efficacy of CBT techniques for anger, there are
two issues in need of further investigation. Firstly, what components of
treatment contribute most to the reduction in anger? In the past, there has
been a trend to maximize the efficacy potential of treatment by combining
multiple techniques such as relaxation, reappraisal, and problem-solving
into one package. A few studies have examined the individual contributions
of some techniques such as relaxation and reappraisal (e.g., Deffenbacher
& Stark, 1992). The present study, on the other hand, distinguishes among
Self-Regulation of Anger 219

techniques that are strictly cognitive vs. those that are purely behavioral,
and the combination of the two—a distinction that has also been made at
a theoretical level. It is therefore meaningful to compare these three ap-
proaches to intervention in terms of relative efficacy.
The second issue relates to the format within which the treatment tech-
niques are implemented. Past research has typically reported changes in
anger in the context of clinical sessions or else simulation exercises wherein
subjects respond to hypothetical anger-provoking scenarios. It is therefore
unclear whether or not treatment effects observed in such situations gen-
eralize to naturalistic settings. This is compounded by the fact that (unlike
depression and other affective disturbances) anger occurs more episodically
and spontaneously. This makes it an elusive target of intervention in the
clinic or the laboratory. Rather, intervention is most needed in those un-
predictable instances when anger arises in naturalistic situations. Fortu-
nately, this can be achieved if there is a way to assess anger the instant it
occurs and intervene on it there and then. The self-regulation model which
has been in use in both behavior and cognitive therapy provides such an
avenue which has been somewhat overlooked in the treatment of anger.

SELF-REGULATION OF ANGER

That the same principles used to control others' behaviors can be used
to regulate one's own behavior was pointed out by Skinner (1953). Later,
Mahoney specified five steps in self-regulation: goal specification, self-
monitoring, cueing, self-reinforcement, and rehearsal (Mahoney & Arnkoff,
1978). So, after the therapist and client decide on treatment goals and the
client is trained in how to go about attaining them, the client then assumes
responsibility for observing and recording the target behavior, using the
problem behavior as a signal for intervention, practicing the intervention,
and reinforcing himself/herself upon the success of the intervention (Kan-
fer, 1991; Karoly, 1991).
The self-regulation model has been successfully incorporated in the
treatment of several problems such as obesity (e.g., Westover & Lanyon,
1990), smoking (Capafons & Amigo, 1995), diabetes (Wing, Epstein,
Nowalk, & Lamparski, 1986) and irritable bowel syndrome (Blanchard,
Radnitz, Schwartz, & Neff, 1987). Similarly, it may serve as a valuable
framework for the treatment of anger, even though this has not been pre-
viously investigated. The present study explores this possibility by training
subjects in the self-assessment of anger and the self-management of this
emotion using either cognitive, behavioral, or cognitive-behavioral tech-
niques.
220 Beck and Fernandez

Self-monitoring further served as the source of dependent measures

in this study. By training subjects to record changes in the degree of anger
over time, it was possible to derive measures of the frequency, intensity,
and duration of anger. This differentiation among three separate measures
avoids the limitation of a global measure of anger that might obscure the
selective effects of treatment. It is quite possible that one treatment may
be more preventive in nature and alter how often anger occurs without
changing the magnitude of each episode; alternatively, another treatment
may not block anger from occurring altogether, but instead control how
long it persists or how strong it gets.

METHOD

Subjects

A total of 27 students enrolled in two graduate classes in psychology

at Southern Methodist University participated in the study in return for
course credit. They chose this over the alternative of writing an extended
term paper on related issues. The sample comprised 22 females and five
males, 25 EuroAmericans and two Asian Americans. The mean age was
23.7 years, SD = 2.4 years.

Materials

Sheets of paper (8.5 x 5.5 inches in dimension) were used for self-
monitoring. On each sheet was a graph to record the intensity of the anger
episode (Y-axis) as it changed over time (X-axis). The Y-axis was a 10-point
scale, where 1, 5, and 10 were labeled annoyance, anger, and rage, respec-
tively. In addition, separate handouts were prepared with instructions for
implementing each type of intervention. These handouts were page-long
summaries of the instructions that were verbally delivered to subjects as
described in the Procedures section.

Design

Subjects were randomly distributed to form three equally-sized groups,

each containing between one and two males. Each group was trained to
self-manage anger either by cognitive techniques, behavioral techniques, or
a combination of cognitive-behavioral techniques. The treatment conditions
were administered using a reversal design which began with a baseline
Self-Regulation of Anger 221

phase (self-monitoring), an intermediate phase in which the treatment (by

self-management) was superimposed upon self-monitoring, and a conclud-
ing phase in which treatment was withdrawn and there was a return to
self-monitoring. All phases were completed within the early part of the
semester to ensure minimal interruption by exams or holidays.

Procedure

Subjects met with the investigators (both authors of this paper) at

three scheduled times. In the first of these 60- to 90-minute sessions, they
were trained in self-monitoring. A booklet of 20 self-monitoring sheets was
given to each subject for use in the baseline phase spanning the first week
of the study. Additional sheets were made available as needed. Subjects
were instructed to record each episode of anger on a separate sheet. Anger
was defined as a subjective feeling of disapproval of the actions of another
which have negative consequences for the self (Ortony, Clore, & Collins,
1988) and often accompanied by tendencies to retaliate or undo the per-
ceived wrongdoing (Frijda, 1986). (This was further explained with use of
several examples.) As soon as they became aware of the onset of anger,
subjects were to plot the coordinates for the intensity of anger on the 10-
point scale of the vertical axis (1 being annoyance, 5 being anger, and 10
being rage) and the chronological time of the anger on the horizontal axis.
Each subsequent variation in intensity of anger was similarly recorded along
with the corresponding time, until the level of anger reached an asymptote
at 0. This procedure was illustrated with examples until subjects were clear
and confident about how to self-monitor. They were instructed to begin
their baseline self-monitoring of anger the next morning and continue it
throughout the subsequent 3 weeks of the study.
After the week of baseline self-monitoring, each group of subjects met
separately with the investigators for training in self-management of anger.
This procedure was to be conducted concurrently with self-monitoring over
the second week of the study.
The nine subjects in the Cognitive group were trained to introduce
thought-stopping as soon as anger became evident; this entailed the covert
repetition of a word or phrase (e.g., "halt," "time out") in order to interrupt
the escalation of angry feelings. The next step was to proceed with a re-
appraisal of the anger-provoking situation by reframing it within a different
context and replacing each anger-related cognition with more adaptive
countercognitions; all cognitions and countercognitions were to be recorded
on the self-monitoring sheet. Subjects were also trained in the use of im-
agery designed to be incompatible with the experience of anger; this ranged
222 Beck and Fernandez

from neutral imagery to imagery of mirth and humor. Finally, a self-rein-

forcement component was added, so that each successful intervention on
anger was to be rewarded by covert statements of self-praise and relief,
e.g., "I did it."
Subjects in the Behavioral group signed a "Contract Against Anger"
in which they formally stated their commitment to be anger-free during
the second week of the study (self-intervention). The contract stipulated 1
point for each day without anger, and the subtraction of 1 point for each
anger episode; in addition, a bonus of 3 points was to be awarded for a
full week without anger. Subjects specified (in writing) the rewards they
deserved in exchange for 5 points and 10 points, respectively; these rewards
could take the form of special activities or material goods as long as they
did not conflict with the objective of anger management. The rewards
would be redeemed by subjects themselves at the end of the second week.
Even though the contract was not legally binding, it was stressed that sub-
jects were to honor what they had agreed to in consultation with the ex-
perimenters. In addition to the contingency contracting, subjects in the
behavioral condition were trained to relax as soon as they became aware
of their anger. This entailed the use of diaphragmatic breathing. Successful
implementation of this intervention was to be reinforced by covertly re-
peating statements of self-praise and relief.
The cognitive-behavioral group received training in a combination of
the cognitive and behavioral techniques outlined above. In other words,
they signed the contract and learned how to use thought-stopping, imagery,
diaphragmatic breathing, and cognitive reappraisal in the self-management
of anger.
At the end of the second week of the study, all three groups returned
to self-monitoring alone (without intervention) of their anger for a final
week. Subjects were periodically prompted for feedback regarding their
self-monitoring and self-intervention, in order to ensure adherence to the
instructions. Upon completion of their participation, subjects were thanked
and debriefed regarding the design of the study.

Data Analyses

For each subject, the frequency of anger episodes was obtained by

summing the number of graphed plots of anger over a specified time frame;
the duration of each anger episode was simply the time elapsed from re-
corded onset of anger to the offset of anger; the (peak) intensity of anger
in each episode was the highest point reached on the graph.
Self-Regulation of Anger 223

Descriptive statistics were derived for the three parameters of anger.

Additionally, a MANOVA was performed with treatment group as the be-
tween factor and phase of study as the within factor. This was accompanied
by univariate ANOVAs in case of statistically significant effects.

RESULTS

In 95% of recorded episodes, anger peaked upon onset, and declined

progressively thereafter. In other words, anger was much quicker to reach
its peak intensity than to revert to its asymptote at zero. This gave rise
to a characteristic negatively decelerated slope for anger as a function of
time.
Central tendency and dispersion statistics for each of the dependent
measures are presented in Table I. As shown, during the baseline phase of
self-monitoring, participants averaged five episodes of anger, each lasting
an average of one-and-a-half hours during which the mean peak intensity
reached a moderate level of 4.04 on a 10-point scale. These measures de-
clined in phase 2 (self-monitoring plus self-intervention) by 57% for anger
frequency, 56% for anger duration, and 21% for anger intensity. When
subjects reverted to just self-monitoring in phase 3, the measures remained

Table I. Means and Standard Deviations for Frequency, Intensity, and Duration of Anger
by Treatment Type and Phase of Study
No treatment Treatment No treatment
Mean SD Mean SD Mean SD
Frequency
Cognitive group 4.44 3.23 3.22 1.99 2.11 1.05
Behavioral group 5.33 4.00 1.56 1.67 1.22 1.48
Cognitive-behavioral group 5.22 3.23 1.67 1.58 1.20 1.24
Frequency across groups 5.00 3.23 2.15 1.85 1.59 1.28
Duration
Cognitive group 106.65 82.54 46.81 37.28 29.91 33.29
Behavioral group 67.63 45.83 44.94 54.69 34.87 51.27
Cognitive-behavioral group 93.60 76.40 25.75 27.44 25.56 29.33
Duration across groups 89.29 69.37 39.17 40.91 30.11 37.81
Intensity
Cognitive group 4.22 1.43 3.88 1.12 3.49 .89
Behavioral group 3.67 1.68 2.30 2.01 3.28 3.51
Cognitive-behavioral group 4.24 1.28 3.42 2.82 2.93 2.54
Intensity across groups 4.04 1.44 3.20 2.13 3.23 2.46
224 Beck and Fernandez

relatively stable at an average of 1.59 episodes of anger averaging one-half

hour during which mean peak intensity was 3.23.
The 3 (group) x 3 (phase) MANOVA revealed a significant multivari-
ate main effect for phase of study [Wilks' L = .536, F(6, 140) = 8.51,
p < .0001], Conversely, 46% of the variance in the dependent variables
(combined) was accounted for by this independent variable. On the other
hand, there were no significant effects for either the treatment group
[Wilks' L = .96, F(6, 140) =.50,p > .80] or the interaction between treat-
ment and phase [Wilks' L = .89, F(12, 185) =.70, p > .75].
Univariate ANOVAs revealed a significant main effect of treatment
phase on frequency of anger [F(2, 72) = 17.10, p < .0001]. Planned con-
trasts using Fisher's LSD indicated that the significant difference in this
case was between phase 1 and either phase 2 or phase 3. This dramatic
decline is illustrated in Fig 1.

Fig. 1. Mean frequency of anger by treatment type and phase of study (-*-, cognitive
group; -•-, behaviorial group; -A-, CBT group).
Self-Regulation of Anger 225

Another dependent measure to be significantly affected by phase of

treatment was anger duration [F(2, 72) = 10.09, p < .0001]. Planned con-
trasts indicated that after phase 1, the amount of time in anger declined
significantly across phase 2 and phase 3. As illustrated in Fig. 2, phase 2
accounted for the greatest reduction in anger duration, regardless of treat-
ment type.
No significant effects of either independent variable were found on
measures of peak anger intensity. In other words, neither the type of treat-
ment nor the phase of treatment significantly influenced the maximum in-
tensity of anger episodes. As illustrated in Fig. 3, the behavioral treatment
condition showed the most promise in phase 2, but by phase 3, anger in-
tensity approached baseline levels. There were also no significant differ-
ences on any measures as a function of gender.

Fig. 2. Mean duration of anger by treatment type and phase of study (-*-, cogni-
tive group; -•-, behaviorial group; --A--, CBT group).
226 Beck and Fernandez

Fig. 3. Mean intensity of anger by treatment type and phase of study (-^-, cogni-
tive group; -•-, behaviorial group; --A--, CBT group).

DISCUSSION

As a whole, the results indicate that the self-regulation model did sig-
nificantly alleviate anger. The most pronounced changes were observed for
frequency and duration of anger. Intensity of anger was not significantly
altered by intervention. This suggests that the treatment may have had a
preventive effect on the occurrence of anger episodes, as well as an abortive
effect on the persistence of anger over time. But once anger occurred, its
intensity usually peaked at the same level regardless of treatment. Perhaps,
the intensity of anger is dictated by physiological constants, whereas the
frequency and duration of anger are more susceptible to psychological con-
trol.
The peak intensity of anger was usually registered at onset of recording
after which anger abated in a negatively decelerated fashion over time. This
could imply that subjects were quick to anger but relatively slow to recover
from it. It could also be an artifact of rating, in that subjects may have
Self-Regulation of Anger 227

oriented to their anger only when it reached a high intensity at which point
it was salient; once aware of the anger, they were less likely to lose track
of it during self-monitoring.
It is encouraging that the self-regulation model can be used as an ef-
fective approach to the treatment of anger. However, this effect was not
significantly moderated by the specific type of intervention, be it purely
cognitive, strictly behavioral, or a combination of cognitive-behavioral tech-
niques. This may be partly due to the fact that all three approaches shared
the basic components of relaxation and reinforcement, though the relaxa-
tion techniques were dissimilar and the precise reinforcement contingencies
were slightly different. It is possible that a larger sample affording greater
statistical power may have produced bigger between-groups differences.
Nevertheless, the present findings are in keeping with much of the psycho-
therapy outcome literature which has shown that cognitive, behavioral, and
cognitive-behavioral approaches all appear to be effective in the treatment
of a range of medical and psychological problems (Emmelkamp, 1994; Hol-
lon & Beck, 1994). The three approaches have been separated in theory,
but they are really part of the same family of therapies relying on common
principles of learning and behavior change.
It is also evident that the treatment gains were generally preserved for
1 week after cessation of phase 2. However, there was little new improve-
ment on any of the anger measures in the absence of treatment. This may
also be due to a floor effect. At the same time, it is possible that additional
passage of time may have further eroded the treatment gains. Therefore,
extended follow-up would have been more informative; however, this was
not possible in the present study because of the limited duration of the
academic semester during which the study was conducted.
Future research might look at other ways of augmenting the benefits
of cognitive and/or behavioral therapies for anger management. Thus, the
duration and sequencing of techniques can be modified. CBT can also be
expanded to include social modeling which is typically part of Social Skills
Training methods for anger control. Measurement issues might also be ad-
dressed, in particular, the possibility of corroborating self-report data with
collateral data from informants and further enriching it with physiological
measures; however, that would require greater experimental control than
was possible under the naturalistic conditions of the present study. Formal
measures of adherence to treatment are also a consideration although it
should be noted that mere self-report of adherence is not a foolproof ma-
nipulation check of treatment integrity. The time frame for follow-up may
also be extended to ascertain the long-term durability of treatment gains.
Finally, the self-regulation model of anger management may be appropriate
for college samples such as those in this study, but it remains to be shown
228 Beck and Fernandez

if it will be adequate for the management of anger in clinical populations

with chronic anger of destructive proportions.

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