BEHAVIORTHERAPY17, 109--123 (1986)

Group Anger-Control Training for Institutionalized

Psychiatric Male Adolescents
EVA L. FEINDLER
Adelphi University

RANDOLPH B. ECTON

DEBORAH KINGSLEY

DENNIS R. DUBEY
Sagamore Children's Center, Melville, N Y

Cognitive-behavioral techniques for the self-control of anger and aggressive

behavior in institutionalized psychiatric male adolescents were presented during
an eight-week group training program. Compared to a waiting-list control group
and a within-ward control group, results indicate an increase in reflective and
correct responding on the Matching Familiar Figures Test and an increase in self-
control ratings by staff members for treatment subjects. Standardized role-play
assessments also indicated significant increases in the use of appropriate verbal-
izations and a decrease in hostile verbalizations during conflict situations from
pre- to postassessment for treatment subjects. Finally, analyses of an already-
existing contingency-management system revealed significant differences in fre-
quencies and patterns of aggressive behaviors between treatment and control
subjects. Adolescents in the anger-control treatment group evidenced lower rates
of fines and restrictions during treatment and follow-up phases than the control
subjects. Results are discussed in terms of the effectiveness of group anger-control
training for residential adolescent populations.

Children and adolescents w h o display chronic patterns of aggressive

b e h a v i o r d o n o t o f t e n l e a r n t h e r e q u i s i t e skills f o r s o c i a l a d j u s t m e n t in
l a t e r y ear s ( P a t t e r s o n , R e i d , J o n e s , & C o n g e r , 1975) a n d u s u a l l y c o n t i n u e
to exhibit delinquent and antisocial b e h a v i o r s (Dishion, Loeber, Sou-
t h a m e r - L o e b e r , & P a t t e r s o n , 1984). A l t h o u g h a r e c e n t r e v i e w o f b e h a v -
i o r a l a p p r o a c h e s to th e t r e a t m e n t o f a n g e r a n d a g g r e s s i o n i n d i c a t e s a

Portions of this study were presented at the Annual Convention of the Association for
the Advancement of Behavior Therapy, Philadelphia, 1984. Requests for reprints should
be sent to Eva L. Feindler, Department of Psychology, Adelphi University, Chapman Hall,
Room 2, Garden City, Long Island, New York 11530.

10 9 0005-7894/86/0109~012351.00/0
Copyright1986by Associationfor Advancementof BehaviorTherapy
All rightsof reproductionin any formreserved.
110 FEINDLERET AL.

growing technology (Fehrenbach & Thelen, 1982), only a few of the dem-
onstrations cited have focused on adolescent populations. Adolescents
experiencing difficulties in controlling their anger or aggressive behavior
were targets of a reinforcement-based approach with interventions in-
cluding token reinforcement and response cost (Kaufman & O'Leary,
1972; Hobbs & Holt, 1976) and contingency contracting (Weathers &
Liberman, 1975). Manipulations of the consequences of aggressive be-
havior may indeed result in short-term behavior change; however, there
are few reports of the adequate transfer and maintenance of such change
(Kennedy, 1982). Furthermore, the difficulties in obtaining powerful rein-
forcers, in programming cross-setting generalizations, and in incorporat-
ing developmental changes into treatment requirements have limited the
effectiveness of traditional behavior modification programs with aggres-
sive adolescents.
In contrast to contingency-management approaches, skills training is
based on the assumption that aggressive acting-out and delinquent be-
haviors are a result of skills deficits (Freedman, Rosenthal, Donahoe,
Schlundt, & McFall, 1978). Numerous skills training programs have been
developed for aggressive adolescents in order to teach appropriate social
skills (Goldstein, Sherman, Gershaw, Sprafkin, & Glick, 1978; Elder,
Edelstein, & Narick, 1979), assertive behaviors (Dong, Hallberg, & Has-
sard, 1979), and cognitive problem-solving skills (Sarason & Sarason,
1981). These studies suggest that the acquisition of new skills occurs via
behavioral training; however, little evidence has been reported that the
aggressive and disruptive behaviors decrease concurrently. Behaviors
measured in these studies are usually the deficit skills targeted for change,
and little effort is made to obtain data on generalization across behaviors
and/or across settings.
It may be that a different treatment approach, namely one which em-
ploys cognitive and self-control methods, is required to teach anger and
aggression control. The impulsivity and emotional arousal associated with
angry outbursts also needs to be targeted for intervention. Indeed, there
is more evidence of transfer and maintenance of behavior change via self-
control methods (Lochman, Burch, Curry, & Lampron, 1984; Snyder &
White, 1979) which are designed to foster an adolescent's acquisition of
autonomous functioning and which are sensitive to individual differences
in response to pure skills training (Kennedy, 1982).
Although there are numerous examples of the use of cognitive and self-
control methods to modify anger and aggression in children (Goodwin &
Mahoney, 1975; Bornstein, Bellack, & Hersen, 1980; Lochman, Nelson,
& Sims, 1981; Kettlewell & Dausch, 1983; Garrison & Stolberg, 1983;
Henshaw, Henker, & Whalen, 1984), much work needs to be done with
adolescent populations. Initial case studies (McCullough, Huntsinger, &
Nay, 1977; Feindler, 1979), subsequent demonstrations with high school
students exhibiting disruptive classroom behavior (Feindler, Marriott, &
Iwata, 1984; Brigham, Hopper, Hill, DeArmas, & Newson, 1985), delin-
quents (Hamberger & Lohr, 1980; Williams & Akamatsu, 1978), and
 GROUP ANGER-CONTROL TRAINING 1 11

institutionalized delinquents (Snyder & White, 1979) have supported the

efficacy of cognitive and self-control interventions in the reduction of
aggressive and disruptive behaviors. The effective techniques of emotional
arousal control include stress-inoculation procedures, cognitive restruc-
turing, behavioral self-management, relaxation training, and imagery
techniques taught via modeling and role play. Few external contingencies
are applied for behavior change, thereby making these anger-control tech-
niques self-controlled interventions which can be incorporated in already
existing programs (Feindler et al., 1984).
Despite the clinical utility of these methods, methodological difficulties,
such as inadequate control groups, no baseline data collection, sole reli-
ance on cognitive paper-and-pencil evaluation tasks, limited follow-up
data, lack of data on the continuous direct observation of aggressive
behaviors, and reliance on potentially inaccurate staffrecords have limited
the significance of anger-control research. Furthermore, additional exten-
sions to more severe populations who exhibit frequent and intensive
aggression in restricted environments, such as juvenile offenders and psy-
chiatric inpatients, are required to test the efficacy of these arousal tech-
niques. It may be that this type of self-control is a prerequisite to learning
more adaptive prosocial skills for aggressive adolescents.
The present investigation was conducted in order to ameliorate some
of the previous methodological difficulties as well as to evaluate the ef-
fectiveness of cognitive-behavioral techniques in reducing anger and ag-
gressive acting-out behaviors in groups of institutionalized psychiatric
male adolescents.

METHOD
Subjects
Subjects were male adolescents ranging in age from 13 years old to 18
years old. All subjects resided at a psychiatric treatment facility for be-
haviorally and emotionally disturbed youths. Subjects were already grouped
in inpatient units G and H. Separate brief program presentations were
provided to youths on those units who were targeted as needing anger-
control training, based on recommendations and referrals made by treat-
ment coordinators and direct-care staff. These presentations, conducted
by the training team (the second and the third authors), were lhirty minutes
each and consisted of a brief viewing of a negative symbolic-modeling,
videotaped role play which depicted the "wrong way" of controlling one's
anger and aggression and a brief description of what would be required
of those voluntarily choosing to participate in the 12-session group-anger-
control program entitled "The Art of Self-Control" (Feindler & Ecton,
1984).
Following a quasi-experimental, nonequivalent waiting-list control group
format, 21 male adolescents from G (N = 10) and H (N = 11) units vol-
untarily agreed to participate in the group anger-control training program.
Unit G was randomly selected by the facility's director of psychology
112 FEINDLERET AL.

(fourth author) as the first group to receive treatment and Unit H served
as the waiting-list control group. A comparison of the units indicated that
the treatment subjects were somewhat younger in age ()( = 15.4 years;
the range was 13.2 to 17.11 years) and more socially immature in terms
of interpersonal skills than the control subjects on H (X = 16.4 years; the
range was from 14.2 to 18.8 years). Verbal reports from the staff who
made the recommendations and referrals confirmed that all 21 male ad-
olescents needed an adjunct anger-control program. Furthermore, ad-
missions data revealed that the subjects who had volunteered to partic-
ipate had experienced problems controlling their aggressive or explosive
behaviors in academic, home, or residential environments. Unfortu-
nately, because of the general structure of an already existing contingency-
management program which controlled impulsive, acting-out behaviors
with territorial exclusions from all inclusive areas within the hospital's
milieu environment, it was not logistically or clinically possible to have
more experimental precision in terms of random assignment of subjects
to conditions.
Demographic data on all subjects revealed that their mean length of
stay varied depending upon their commitment status. For six treatment
and five control subjects with involuntary status (e.g., referrals from Di-
rector o f Community Services, two physicians, or court remands), the
mean length o f stay was nine months. The remaining subjects had vol-
untary status (e.g., signed consent by parents or guardians) and their
average stay was 14 months. Additional demographic data showed that
nine treatment and five control subjects were white, one control subject
was Hispanic, and one treatment and six control subjects were black. IQ
scores ranged.from 56 to 106, with the mean IQ scores being 83.7 for
treatment subjects and 80.2 for control subjects. Only 4 subjects (three
treatment and 1 control) were classified in the average range of intelligence
whereas the remaining 17 subjects were classified in lower ranges. Sixteen
subjects were classified as having conduct disorders of either the under-
socialized aggressive type (six treatment and four control) or the under-
socialized nonaggressive type (three treatment and three control). The
remaining five subjects had other clinical diagnoses.
In addition to the treatment group (GT) and H waiting-list control
group (WLC), another control group was formed during the eighth week
o f the research program. Eight youths admitted to Unit G, subsequent to
the research initiation, constituted the within-G control group (WGC).
They were used only for continuous data comparison purposes and did
not complete any other assessment measures. Demographic data on these
8 subjects revealed that all subjects had voluntary status and their ages
ranged from 13.11 years to 16.5 years (X = 14.7 years). Five subjects
were white and three subjects were black; IQ scores ranged from 55 to
102, with a mean IQ of 82.7. Diagnostic classifications were similar to
those in the other two groups.
Finally, all control subjects from the WLC and the W G L groups com-
 GROUP ANGER-CONTROL TRAINING 1 13

pleted the anger-control training program following the completion of the

research. However, because the staffhad difficulties recording continuous
data comparisons, data from two subjects from G treatment group and
three subjects from H waiting-list control group were incomplete; there-
fore, these subjects were dropped from this particular data analysis.
Dependent Measures
Three dependent measures, comprising an assessment package, were
used during a three-week pre- and postassessment phase. These measures
were structured videotaping, the Matching Familiar Figures Test (Kagan,
1966), and the Behavioral Rating Scale for Children (Kendall & Wilcox,
1979). Previous researchers of social skills training (Elder et al., 1979;
Bornstein et al., 1980) for aggressive populations had recommended the
use of these instruments. And for the evaluation of a multi-component
anger package, it was important to employ different assessment methods--
e.g., role-play analyses, a cognitive task, and a rating checklist completed
by the person most in contact with the subjects.
Subjects from the GT and WLC groups were videotaped in structured
conflict role-play situations involving a standard (male) confederate and
script reader. The script reader and confederate were members of the
research team and they provided standard prompts. The five standardized
situations presented interpersonal conflict on the hospital ward, in peer
relationships, over personal possessions, with the opposite sex, and in
contacts with the police. (These scripts are available from the authors.)
Videotaping provided the training team with a direct method of recording
11 classes of verbal and nonverbal behavior. The following classes were
targeted: irrelevant/relevant comments, inappropriate or hostile com-
ments or requests, appropriate requests, hands in pocket, gestures, positive
or negative physical contact, eye contact, loudness, and overall global
rating of assertion. Also, for each conflict situation, the duration of the
scene and the duration of the subject's speech was recorded. Operational
definitions for the targeted behaviors listed above were provided by Fred-
eriksen, Jenkins, Foy, and Eisler (1976). For ten randomly selected sub-
jects, discrete responses occurring across five prescenes and five postscenes
were observed and coded by three blind raters who rotated pairs. These
100 pre- and postscenes--representing 50% of the total number of scenes
taped--served as reliability checks. For the remaining subjects a single
blind rater was used. The videotape raters practiced three hours with
sample videotapes and coding sheets. A discussion of disagreements was
structured by the authors. Because the raters did not view the tapes at
the same time, independence was assured.
The Matching Familiar Figures Test (MFFT) is a 12-item, match-to-
sample task that requires the adolescent to choose from an array of six
variants the one picture that is identical to a standard picture. This test
assesses the conceptual tempo dimension of reflection-impulsivity. La-
tency time to first response (in sec) and number of correct responses were
the dependent variables.
114 FEINDLERET AL.

The Behavioral Rating Scale for Children (BRSC) consists of 33 items

which reflect the types of self-control an adolescent possesses as viewed
by the childcare staff member who completes the scale. The staff member
rates the adolescent's behavior by assigning a value of 1 to 7 to each item
(1 = reflecting good self-control and 7 = reflecting poor self-control). The
same staff member completed both pre- and postratings and all staff were
blind to the experimental conditions.
Finally, a time-sampling procedure was used to collect continuous data
from the daily records of the discipline restrictions placed on the targeted
youths for inappropriate acting-out behaviors. These data reflect two cat-
egories of fines placed on subjects for acting-out behaviors. Incidents of
physical aggression towards peers or staffresulted in a bedroom restriction
and property damage, verbal aggression such as threats or arguments,
stealing and/or elopements resulted in a rule-violation fine. These fines
reflect the response-cost component of an already existing residence-wide
contingency-management system. Direct childcare staff on three different
shifts (N = 11) for each unit were responsible for fining the subjects and
recording these data on a continuous daily basis. These data were recorded
by the second author twice a day (at 2:30 p.m. and at 10:30 p.m.), rep-
resenting two time intervals. The a.m. one from 7:30 a.m. to 2:30 p.m.,
and the p.m. one from 2:30 p.m. to 10:30 p.m. Unfortunately, there were
no reliability data available for this unit's contingency-management sys-
tem.

Procedure
Following the completion of the baseline recording of rule violations
and bedroom restrictions and administration of preassessments, subjects
in Ward " G " received group-anger control training modified from Fein-
dler et al. (1984) to be more appropriate to an inpatient psychiatric hos-
pital setting in terms of behavioral rehearsal content and homework as-
signments. During this eight-week training program, subjects received
training in relaxation, self-instructions, use of coping statements, more
assertive social interactions, the evaluation of one's own behavior, the
self-monitoring of anger and conflict experiences, and problem-solving
training. Specific teaching strategies that were used to enhance partici-
pants' skill acquisition were live modeling, behavioral rehearsal and prac-
tice, role playing, negative and positive symbolic modeling using 30 stan-
dardized videotaped role-play situations involving childcare staff and the
training team and role playing utilizing videotape equipment and vid-
eotape feedback. A point system was in effect for in-session compliance,
cooperation, and participation which provided students with end-of-ses-
sion cokes as reinforcers. A brief description of the anger-control training
program follows (a detailed training manual is available from the authors):
Session 1: The introductory session included a discussion of program
rationale, of the rules and the nature of the training program, and a
presentation of the following brief relaxation techniques: deep breaths,
 GROUP ANGER-CONTROL TRAINING 1 15

backward counting, and the pleasant imagery technique. These tech-

niques assisted group members in maintaining a controlled response
to an anger-provoking stimulus. Specifically, they serve to reduce phys-
iological tension, to refocus one's attention away from external pro-
voking stimuli to internal control, and to provide a time delay before
making a choice as to how to respond.
Session 2: Weekly homework assignments were introduced. The daily
"Hassle Sheet," a self-monitoring device, provided each subject with
an accurate picture of how they handled various conflict situations
during the week. An exercise on how to complete a self-assessment of
anger- and aggression-provoking situations was conducted according
to the behavioral concepts of antecedents, actual behavior response,
and consequences. These self-monitoring data sheets were to be com-
pleted for the remainder of the program.
Session 3: Group members were instructed in the identification of those
situational variables (both direct/indirect and covert/overt) that gen-
erally trigger an angry response in them. Training in progressive muscle
relaxation was also conducted.
Session 4 and 5: Adolescent rights and rights of others were discussed,
and the assertion techniques of broken record, fogging, friendly (or
empathic) assertion, and escalating assertion were introduced. Group
members were instructed to use these techniques as alternative re-
sponses to aggression and to deescalate conflict situation while main-
taining one's rights and an appropriate level of self-control. Group
members viewed videotapes of inappropriate and appropriate ways
(negative vs. positive symbolic modeling) of using these various asser-
tion techniques.
Session 6 and 7: Introduced self-instruction training with specific focus
on training group members in the use of reminders (e.g., "keep cool,"
"chillout," "ignore") as statements to guide our behavior or to control
our anger or to remember certain things. Group members were prompt-
ed to generate a list of Reminders that they could use in pressure-type
situations. Videotapes of the inappropriate and appropriate ways of
using this technique were shown.
Session 8 and 9: The Thinking Ahead Procedure, which involves the
use of self-instructions and problem solving to estimate future negative
consequences for an inappropriate response to a conflict situation, was
introduced. The contingency statement: " I f I (misbehavior) now, then
I will (future negative consequence)" was practiced. The importance of
using negative consequences as a reminder not to get involved was
stressed to group members. Group members then viewed the videotape
of the inappropriate and appropriate ways of using this technique.
Session 10: Self-evaluation Process Training was introduced. Basically,
self-evaluation responses are reminders which occur after a conflict
situation and provide immediate feedback on behavior occurring during
a given conflict situation. "Hassle Sheets" from each subject and various
coping statements used by group members before, during, and after
116 FEINDLERET AL.

TABLE 1
ANALYSIS OF COVARIANCE COMPARISONS OF TREATMENT AND WAITING-LIST CONTROL
SUBJECTS SCORES ON DEPENDENT MEASURES AT PRE- AND POSTTESTING

Ancova
Dependent measures Pre k Post X F value
MFFT a (latency time) 12.91"*
T x group ( d f = 9) 12.76 28.66
Control group ( d f = 10) 24.51 17.66
F value (1, 19) 2.84 4.94**
MFFT (# correct) 21.67"*
T x group ( d f = 9) 6.1 8.9
Control group ( d f = 10) 7.0 6.45
F value (1, 19) .68 8.80**
BRSCb (rated by childcare staff) 8.85**
T x group ( d f = 9) 135.1 117.4
Control group ( d f = 10) 115.18 140.6
F value (1, 19) 2.60 4.91"
a Matching Familiar Figures Test (Kagan, 1966).
b Behavioral Rating Scale for Children (Kendall & Wilcox, 1979).
* Significance level at .05.
** Significance level at .01.

b o t h r e s o l v e d a n d u n r e s o l v e d conflict situations were discussed a n d

role-played.
S e s s i o n 1 1 : P r o b l e m - s o l v i n g T r a i n i n g - - g r o u p m e m b e r s were t a u g h t
h o w to decide w h a t is the best self-control t e c h n i q u e to use for a given
conflict utilizing the following p r o b l e m - s o l v i n g sequence.
l) W h a t is the p r o b l e m ?
2) W h a t can I do?
3) W h a t will h a p p e n i f . . . ?
4) W h a t will I d o ?
5) H o w d i d it w o r k ?
S e s s i o n 1 2 : R e v i e w o f the definition a n d p r o c e d u r e s i n v o l v e d in the
seven m a j o r self-control techniques.
U p o n c o m p l e t i o n o f the p r o g r a m , all subjects in the t r e a t m e n t a n d
c o n t r o l c o n d i t i o n s r e c e i v e d the a s s e s s m e n t b a t t e r y a d m i n i s t e r e d at pretest.
F u r t h e r m o r e , d a t a o n fines a n d restrictions were r e c o r d e d for three ad-
ditional weeks for all g r o u p s a n d t h e n the waiting-list c o n t r o l g r o u p b e g a n
the a n g e r - c o n t r o l p r o g r a m .

RESULTS
A n a l y s i s o f c o v a r i a n c e o f the results o f the t r e a t m e n t p r o g r a m reveals
significant differences in several d i m e n s i o n s o f the d e p e n d e n t m e a s u r e s
for the t r e a t m e n t a n d c o n t r o l subjects (refer to T a b l e 1). U s i n g pretest
 GROUP ANGER-CONTROL TRAINING 117

TABLE 2
ANALYSIS OF COVARIANCE COMPARISONS OF SELECTED BEHAVIOR CATEGORIES DURING
STRUCTURED VIDEOTAPING FOR TREATMENT AND WAITING-LIsT CONTROL SUBJECTS AND
PRE- AND POSTTESTING

Behavior categories Ancova

(across scenes) Pre X Post .~ F value

Appropriate requests 8.82**

Tx group (df= 9) 7.2 20.0
Control group (dr = 9) 8.9 7.1
F value (1, 18) .38 7.78*
Inappropriate/hostile comments 6.45*
Tx group (df= 9) 5.3 0.0
Control group (df= 9) 8.9 7.1
F value (1, 18) .38 7.78**
Negative physical contact 8.12**
T x group (df= 9) 5.3 .20
Control group (df = 9) 6.6 4.1
F value (1, 18) .46 9.10"*
Duration of subject speech .07
Tx group (df= 9) 51.2 69.6
• Control group (dr = 9) 98.0 81.6
F value (1, 18) 12.27"* .51
Duration of scene (sec) .02
T x group (df= 9) 205.3 263.5
Control group (df = 9) 307.0 270.6
F value (l, 18) 9.41"* .03
* Significance level at .05.
** Significance level at .01.

s c o r e s as t h e c o v a r i a t e , t h e r e s u l t s f r o m t h e M a t c h i n g F a m i l i a r F i g u r e s
Test indicate that Ward "G" treatment group showed significant increases
in r e f l e c t i v e a n d c o r r e c t r e s p o n d i n g f r o m p r e - t o p o s t a s s e s s m e n t w h e r e a s
t h e W a r d " H " w a i t i n g - l i s t c o n t r o l g r o u p d i d not, F ( 1 , 19) = 4.94 a n d 8.80,
r e s p e c t i v e l y ; p < .01. O n t h e B e h a v i o r R a t i n g Scale f o r C h i l d r e n , c h i l d -
c a r e staff r a t i n g s f r o m p r e - to p o s t a s s e s s m e n t i n d i c a t e s i g n i f i c a n t c h a n g e s ,
F ( 1 , 19) = 4.92; p < .05, i n t h e t r e a t m e n t s u b j e c t s ' s e l f - c o n t r o l c a p a b i l i t i e s
w h e r e a s d e c r e m e n t s w e r e p e r c e i v e d in t h e s e l f - c o n t r o l b e h a v i o r s o f t h e
c o n t r o l subjects.
R e s u l t s f r o m L e v e n : T e s t for E q u a l V a r i a n c e s , c o n d u c t e d o n t h e p a p e r -
pencil measures, were nonsignificant, indicating a homogeneity of vari-
ance. T h e e x a c t r a t i o s were: M F F T C o r r e c t R e s p o n s e ; F ( 3 , 38) = 1.5 l ,
p < .23: M F F T M e a n L a t e n c y ; F ( 3 , 38) = 2.68, p < .06: B R S C ; F ( 3 ,
38) = 1.11, p < .36.
Videotape role plays were rated by three blind raters who had received
e x t e n s i v e t r a i n i n g in t h e use o f b e h a v i o r a l c o d e s a n d f r e q u e n c y r e c o r d i n g .
118 FEINDLERET AL.

TABLE 3
USE OF VERBAL(V) ANDNONVERBAL(NV) ANGER-CONTROLTECHNIQUESBYWARD"G"
TREATMENTGROUPDURINGPOSTTESTROLE-PLAYASSESSMENT
Total frequency Meanfrequency
Technique of techniques per subject

Assertion techniques (V)

Broken record (N = 9a) 133 14.7
Escalating assertion (N = 10) 25 2.5
Empathic assertion (N = 6) 7 1.2
Fogging (N = 7) 7 1.0
Self-instructions
Thinking ahead (V) (N = 2) 9 4.5
Reminders-ignore (NV) (N = 4) 6 1.5
Relaxation technique
Deep breaths (NV) (N = 6) 8 1.3
9~= 3.9 per scene
Indicates number of treatment subjects employingparticular technique during posttest role
plays.

Reliability checks, calculated on the ratings o f 13 targeted categories, were

conducted on 100 scenes for pre- and postassessment o f the structured
videotape role-play situations. Using a percent-agreement score (number
o f agreements + n u m b e r o f agreements, and disagreements x 100) a m e a n
reliability o f 96°/o agreement was achieved. The individual scores for the
13 individual b e h a v i o r categories ranged from 83.3% (hands-in-pocket/
pretest) to 100%. Table 2 presents significant results from analyses o f
covariance conducted on all pre- and postvideotaped role plays for treat-
m e n t and waiting-list control subjects. The frequencies o f appropriate
requests made and the duration o f subject speech and scene length in-
creased for treatment subjects from pre- to postassessment whereas wait-
ing-list control subjects evidenced decreases. Further, the frequencies o f
inappropriate/hostile c o m m e n t s and negative physical contact decreased
for treatment subjects from pre-.to postassessment. Behavioral categories
o f irrelevant/relevant c o m m e n t s , hands-in-pocket, gestures, positive
physical contact, eye contact, loudness and overall assertiveness showed
insignificant changes across subjects from pre- to postassessment.
Finally, Table 3 represents data on the use o f verbal and nonverbal
anger-control techniques by treatment subjects during the posttest role-
play assessment. One blind rater was trained to identify the anger-control
techniques as defined in the treatment m a n u a l and to record their fre-
quency via a simple tally method. All subjects used at least one o f the
trained techniques and there was an k o f 4.1 n u m b e r o f techniques used
across the 50 postscenes for the 10 experimental treatment subjects.
Continuous data on rule violations and b e d r o o m restrictions are pre-
 GROUP ANGER-CONTROL TRAINING 1 19

PREASSESSMENT & ANGER-CONTROL TRAINING POSTASSESSMENT

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WEEKS IN CONDITIONS _- - GT TREATMENT GROUP (N = 8)
- -

e - --e WGC - - WITHIN-CONTROL GROUP (N = 8)

= -- WLC - - WAITING-LIST CONTROL GROUP (N = 8)

FIG. 1 Total frequencies of rule violations for treatment and control groups.

sented in Figures 1 and 2 for the treatment, waiting-list control, and

within-ward control groups. Results from repeated measures analyses o f
variance are presented in Table 4 and the frequency data are presented
graphically in Figures 1 and 2.
There were two separate analyses c o n d u c t e d for each continuous vari-
able (rule violations and b e d r o o m restrictions). The 2 x 3 repeated mea-
sures A N O V A reflects data from the two p r i m a r y groups (treatment and
waiting-list control) across three conditions (baseline, treatment, and fol-
low-up). The 3 x 2 repeated measures A N O V A reflects data from the

BASELINE PREASSESSMENT & ANGER-CONI~OL TRAINING POSTASSESSMENT

tu &
FOLLOW-UP

°i,, I
I
I
I
I I
I I
6
~4
w

,.=, /' i
/..~ i
I Z
z,~ I ./'
I
1 2 3 4 5 6 7 9 10 11 12 13 14 15 16 17 18 19

WEEKS IN CONDITIONS ~ -- GT TREATMENT GROUP (N = 8)

- -

• 4 WGC WITHIN-CONTROL GROUP (N = 8)

- -

= ~, WLC - - WAITING-LIST CONTROL GROUP (N = 8)

FIG. 2 Total frequencies of bedroom restrictions for treatment and control groups.
120 FEINDLER ET AL.

TABLE 4
REPEATED MEASURES ANALYSES OF VARIANCE COMPARISONS ON BEDROOM RESTRICTIONS
AND RULE VIOLATIONS

Significance
F ratio df level
Rule violations
2 x 3 Analysis (GT and WLC groups)
Between groups 4.57 (1, 14) p < .05
Between phases of treatment 10.16 (2, 28) p < .0005
Interaction 3.51 (2, 28) p < .05
3 x 2 Analysis (GT, WLC and WGC groups)
Between groups 5.04 (2, 21) p < .02
Between phases of treatment 19.66 (1, 21) p < .0002
Interaction .10 (2, 21) NS
Bedroom restrictions
2 x 3 Analysis (GT and WLC groups)
Between groups 2.60 (1, 14) NS
Between phases of treatment 4.42 (2, 28) p < .02
Interaction .30 (2, 28) NS
3 x 2 Analysis (GT, WLC and WGC groups)
Between groups 2.40 (2, 21) NS
Between phases of treatment 15.21 (1, 21) p < .0008
Interaction .72 (2, 21) NS

three g r o u p s (treatment, waiting-list control, a n d w i t h i n - G control) across

two c o n d i t i o n s ( t r e a t m e n t a n d follow-up). Results indicate significant
differences b e t w e e n g r o u p s a n d b e t w e e n t r e a t m e n t p h a s e s for b o t h A N -
O V A analyses for rule violations. Further, there was a significant inter-
a c t i o n effect for the 2 x 3 A N O V A , F(2, 28) = 3.51, p < .05, w h i c h in-
dicates that the anger-control t r e a t m e n t resulted in lower rates o f violations
for the e x p e r i m e n t a l subjects w h e r e a s c o n t r o l subjects' rates o f aggressive
b e h a v i o r s increased across time. T h e r e were p a t t e r n s b e t w e e n the groups:
n a m e l y , b o t h c o n t r o l g r o u p s e v i d e n c e d higher rates o f rule v i o l a t i o n s in
c o m p a r i s o n to the t r e a t m e n t group. W h e n the t h i r d g r o u p was a d d e d to
the analyses, the i n t e r a c t i o n effect was w a s h e d out.
F o r b e d r o o m restrictions, the f r e q u e n c y rates were so low t h r o u g h o u t
t h a t d a t a i n t e r p r e t a t i o n is difficult. But for b o t h the 2 x 3 a n d the 3 x 2
A N O V A s for b e d r o o m restrictions, there was a significant effect for phase:
F(2, 28) = 4.42, p < .02 a n d F(2, 21) = .72, p < .0008, respectively.

DISCUSSION
T h e analyses o f the results o f this i n v e s t i g a t i o n i n d i c a t e t h a t the v a r i o u s
c o g n i t i v e - b e h a v i o r a l , self-control p r o c e d u r e s were effective in r e d u c i n g
anger a n d aggressive a c t i n g - o u t b e h a v i o r s in t h o s e i n s t i t u t i o n a l i z e d psy-
 GROUP ANGER-CONTROL TRAINING 121

chiatric male adolescents who participated in the eight-week training pro-

gram. From reviewing the results, it is clear that participation in group
anger-control training resulted in improved performance by treatment
subjects on the MFFT in terms of reduced error rates and increased
response latencies; improved changes in treatment of subjects' self-control
capabilities as perceived by childcare staff; increased use of more appro-
priate verbal and nonverbal anger-control techniques by treatment sub-
jects in dealing with various anger-provoking stimuli; and a decreased
frequency in treatment subjects' on-ward restrictions for physical aggres-
sion and general rule violations. The efficacy of this treatment program
is further substantiated by the decrements in the various performance
areas evidenced by the waiting-list control subjects at postassessment. In
addition, at a booster session conducted two months following the ter-
mination of group training, anger-control skill acquisition had clearly been
maintained as evidenced by the capabilities of treatment subjects to dem-
onstrate the use of various anger-control techniques to new "generaliza-
tion" role plays. Finally, a three year follow-up check indicates that dis-
charge results for treatment subjects and waiting-list control subjects (after
receiving group-anger control treatment) have been positive. Out of the
21 original subjects, 18 were discharged from the psychiatric facility; only
three subjects required further psychiatric hospitalization in an adult fa-
cility or incarceration.
Although the results from this investigation are encouraging, further
replication of substantial treatment effects is needed with more appro-
priate matched control groups. Due to the clinical setting in which this
investigation was conducted, methodological inadequacies, such as non-
random assignment of subjects to experimental conditions, are evident.
More specifically, the reliance on staff recordings of fines given for ag-
gressive subject behavior is not recommended. Certainly, direct obser-
vation data on both the frequency and the topography of aggressive be-
havior occurring in anger-producing situations are required. However,
the low frequency and "private" nature of these behaviors may make it
difficult to achieve this objective. Further, there was no assessment made
of the use of anger-control techniques occurring in the natural setting.
Finally, institutional contingencies dictated that both control groups re-
ceive treatment immediately following the research program, thus pre-
cluding a long-term, follow-up comparison.
In general, an effect for the treatment group was shown; however, the
use of group data may obscure some important clinical questions con-
cerning individual responses to the anger-control training. Also, due to
agency constraints, the research had to be conducted with already existing
subject groups which may have resulted in strongly correlated behavior
patterns. Future investigations using single subject methodology would
help sort out the issue of client-treatment match in terms of the appro-
priate diagnostic classifications and the severity of anger-control disorders.
It may be that this anger-control package is most effective with a particular
type of adolescent. In addition, precisely which components of the treat-
122 FEINDLER ET AL.

m e n t p a c k a g e w e r e m o s t effective i n p r o m o t i n g b e h a v i o r c h a n g e a n d in
which sequence cannot be determined from this investigation. For cost
efficient a n d o p t i m a l t r e a t m e n t d e l i v e r y , r e s e a r c h e r s i n t h e f u t u r e s h o u l d
d i r e c t t h e i r efforts t o w a r d a n a l y z i n g c a r e f u l l y t h e v a r i o u s c o m p o n e n t s o f
this cognitive-behavioral, self-control treatment package and toward ob-
taining data through individual direct observation in order to develop
a n d e v a l u a t e t h e b e s t t r e a t m e n t p a c k a g e for t h e a d o l e s c e n t w h o is e x p e -
riencing anger-control problems.

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RECEIVED:March 27, 1985.

FINAL ACCEPTANCE:October 1, 1985