Contextual Anger Regulation Therapy: A Mindfulness and Acceptance-Based Approach

230 Pages·2013·1.67 MB·English

by  Frank L. Gardner

Contextual Anger Regulation
Therapy
Anger is a natural human emotion that can serve important survival
functions, but the excessive presence of anger and its associated negative
outcomes—such as aggression and violence—can lead to significant inter-
personal, intrapersonal, occupational, legal, familial, societal, and physical
health problems. Unfortunately, clinical anger clients haven’t historically
been helped in truly sustainable ways, and loved ones and society at large
are often left to simply watch as these individuals struggle to overcome
their anger and the noxious behaviors that often emanate from this trou-
bling condition.
Contextual Anger Regulation Therapy gives clinicians the power to
change this. The book presents an exciting nine-module mindfulness and
acceptance-based behavioral treatment program that has been effectively
utilized in formal clinical settings with clinical anger clients, including
those mandated for treatment following both non-domestic and domestic
violence. Treatment success has not only been demonstrated in observable
ways, including significant reductions in violence recidivism and marked
improvements in quality of life; it has also been seen in scientific data
both in the laboratory and with large numbers of mandated clinical anger
clients.
Frank L. Gardner, PhD, ABPP, is professor and director of the PsyD pro-
gram in school and clinical psychology at Kean University in Union, New
Jersey. He has founded two of the premier centers for the treatment and
study of anger and violence in the United States. In addition, he is code-
veloper of the Mindfulness–Acceptance–Commitment (MAC) approach
to performance enhancement and is the founding editor-in-chief of the
Journal of Clinical Sport Psychology (JCSP).
Zella E. Moore, PsyD, is an associate professor of psychology at Manhat-
tan College in New York, where she is dedicated to teaching and mentor-
ing undergraduate psychology students. Zella is also codeveloper of the
Mindfulness–Acceptance–Commitment (MAC) approach to enhancing
human performance and is the founding senior associate editor of the
Journal of Clinical Sport Psychology (JCSP).
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Gardner and Moore Contextual Anger Regulation Therapy:
A Mindfulness and Acceptance-Based
Approach
Contextual Anger
Regulation Therapy
A Mindfulness and Acceptance-
Based Approach
Frank L. Gardner and
Zella E. Moore
First published 2014
by Routledge
711 Third Avenue, New York, NY 10017
Simultaneously published in the UK
by Routledge
27 Church Road, Hove, East Sussex BN3 2FA
© 2014 by Taylor & Francis
Routledge is an imprint of the Taylor & Francis Group, an informa business
The right of Frank L. Gardner and Zella E. Moore to be identified as authors
of this work has been asserted by them in accordance with sections 77 and 78
of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced
or utilized in any form or by any electronic, mechanical, or other means,
now known or hereafter invented, including photocopying and recording,
or in any information storage or retrieval system, without permission in
writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or
registered trademarks, and are used only for identification and
explanation without intent to infringe.
Library of Congress Cataloging in Publication Data
Gardner, Frank L., 1953-
Contextual anger regulation therapy :
a mindfulness and acceptance-based approach /
Frank L. Gardner and Zella E. Moore.
pages cm.—(Practical clinical guidebooks)
Includes bibliographical references and index.
1. Anger—Treatment. 2. Acceptance and commitment therapy.
I. Moore, Zella E., 1975– II. Title.
RC569.5.A53.G37 2013
616.89'1425—dc23
2013008573
ISBN: 978–0–415–87297–3 (hbk)
ISBN: 978–0–415–87298–0 (pbk)
ISBN: 978–0–203–86491–3 (ebk)
Typeset in Sabon
by Swales & Willis Ltd, Exeter, Devon
A professional life has very little meaning without being
embedded in something greater. To my absolutely perfect
wife who has taught me how to live a life and not simply
have one; to my unbelievable new son who fills me with joy
and wonderment every single day, and to my older son who
fills me with immense pride; thank you all for giving me the
energy and desire to make a difference every day. You are all
at the center of what I value.
—Frank
To my unbelievable husband—I am so tremendously blessed
to have you as the love of my life. And to our beautiful new
baby boy—I sit in amazement of my love for you, and prom-
ise to cherish every single moment of your precious life. I love
you both with every inch of my heart.
—Zella
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Contents
List of Tables and Figures x
Preface xi
Acknowledgments xiii
1 Understanding Clinical Anger 1
Anger as a Unique Clinical Problem 2
Clinical Anger and Psychological Comorbidities 4
Diagnostic Issues and Status 5
The Relationship between Anger and Violence 9
History of Theory, Research, and Treatment of
Clinical Anger 14
2 The Anger Avoidance Model (AAM) 20
Biological Diathesis: Temperament 23
General Psychological Diathesis: Etiology 24
Specific Psychological Diathesis 29
Clinical Implications of the Anger Avoidance Model 37
3 Assessment and Case Conceptualization of Clinical Anger 39
Core Features of Anger Assessment 39
AAM as a General Guide for the Assessment Process 43
Obstacles to Assessing Anger and Violence: Context,
Motivation, and Anger Pathology 56
Putting It All Together 58
Anger Conceptualization Using the AAM: The Case
of Joann 59
Diagnostic Considerations 64
Summary and Conclusions 66
Appendix 3.1: AVIS 66
viii Contents
4 Contextual Anger Regulation Therapy: Treatment Overview 69
CART Treatment Goals 71
CART Treatment Modules (1–9) 73
Conclusion 83
5 Contextual Anger Regulation Therapy: Step-by-Step
Treatment Description 85
Module 1: Psychoeducation, Values Identification, and
Motivation Enhancement 85
Module 2: Using the Therapeutic Relationship to
Recognize and Modify Clinically Relevant Behavior 93
Module 3: Developing Mindful Emotion Awareness 98
Module 4: Cognitive Defusion and the Reduction of
Problematic Rule-Governed Behavior 110
Module 5: Understanding Anger and Anger-Avoidance 118
Module 6: Acceptance and Anger Regulation 125
Module 7: Commitment to Values-Based Behavior 133
Module 8: Developing Effective Interpersonal
Problem-Solving Skills 138
Module 9: Integration, Relapse Prevention, and
Treatment Termination 145
Concluding Comments and Treatment Efficacy 149
Appendix 5.1: Decisional Balance Form 156
Appendix 5.2: Between-Session Emotion Monitoring Form 156
Appendix 5.3: Washing a Dish Exercise 157
Appendix 5.4: Brief Centering Exercise 158
Appendix 5.5: Mindfulness of the Breath Exercise 159
Appendix 5.6: Compassion-Focused Mindfulness Exercise 160
Appendix 5.7: Mindfulness Record Form 161
Appendix 5.8: Guidelines for the Use of Anger Exposures 161
Appendix 5.9: Committing to Life Values Exercise Form 162
Appendix 5.10: Interpersonal Problem Solving Form 162
Appendix 5.11: Post-CART Practice Plan Form 163
6 Special Considerations 164
Client–Therapist Issues: Culture, SES/Privilege,
and Gender 164
Treatment Context: Setting, Mandated Offender Status,
and Finite Sessions Available 167
Comorbidities: PTSD, Depression, and Personality
Contents ix
Disorders 169
Family/Couples Engagement in Treatment 172
Individual vs Group Treatment 173
Age Considerations for CART 176
Conclusion 177
7 Case Study 178
Identifying Information 178
Presenting Complaints/Reason for Referral 178
Precipitating Factors and History of the Problem 178
Developmental and Historical Information 180
Assessment Measures 181
Behavioral Observations 182
Diagnostic Formulation 182
Case Formulation 183
Treatment Goals 184
Treatment 184
Final Comments About Nicolette’s CART Treatment 196
References 198
Index 210