Internet Treatment for Anger Works

Summary: A four-week online anger management program helps decrease anger and aggression, and improve emotional regulation in those with aggressive behaviors.

Source: Karolinska Institute

Problems with managing anger can have severe consequences for the afflicted individual and their loved ones.

A new study from the Centre for Psychiatry Research at Karolinska Institutet in Sweden shows that four weeks of therapy delivered over the internet can help people with anger and aggression.

The results have been published in the Journal of Consulting and Clinical Psychology.

The study, which the researchers have chosen to call the “anger study”, is the first to compare different internet-mediated emotion regulation strategies against anger. The results are expected to be important for understanding emotion regulation and for the dissemination of evidence-based methods.

Easy to recruit participants

“It is usually very difficult to recruit participants for treatment studies. For the anger study, however, it was very easy, and we had to close the recruitment site after a few weeks due to the high number of applicants. This suggests that there is a pent-up need for the psychological treatment of anger.

“Many people who have problems with anger feel ashamed, and we think the internet format suits this group particularly well because they don’t have to wait in a reception room or sit face-to-face with a therapist and talk about their anger,” says Johan Bjureberg, assistant professor at the Centre for Psychiatry Research at Karolinska Institutet and researcher responsible for the study, which was carried out in collaboration with researchers at Örebro University in Sweden.

The anger study has evaluated the effect of two emotion regulation strategies: mindful emotion awareness; and cognitive reappraisal. Mindful emotion awareness focuses on the ability to notice and accept one’s feelings and thoughts without judging or acting on them. Cognitive reappraisal, on the other hand, focuses on the ability to reinterpret thoughts and situations and identify alternative thoughts that do not trigger difficult feelings.

The 234 participants, all with significant anger problems, were randomly assigned to four weeks of either mindful emotion awareness, cognitive reappraisal, or a combination of these two strategies. All treatments were of approximately the same length and were associated with decreased self-reported anger and aggressiveness at the end of the treatment.

Combination therapy most effective

The combined treatment resulted in significantly lower levels of outward anger expression, aggression, and anger rumination, but not anger suppression, compared to mindful emotion awareness or cognitive reappraisal alone. The combination was particularly effective for participants who were experiencing very high levels of anger at the start of the study.

This shows an angry man
The results are expected to be important for understanding emotion regulation and for the dissemination of evidence-based methods. Image is in the public domain

The results strengthen research and theories suggesting that difficulties in regulating emotions and interpreting events and situations can be a major contributing factor to problems in managing anger.

“Our results suggest that a very short treatment of only four weeks administered over the internet with minimal therapist support is effective in reducing anger problems. Our hope is that follow-up studies support this finding and that the treatment can be offered broadly within regular care,” explains Johan Bjureberg.

Funding: The study was funded by the Knut and Alice Wallenberg Foundation. There are no reported conflicts of interest.

About this anger management and psychology research news

Author: Press Office
Source: Karolinska Institute
Contact: Press Office – Karolinska Institute
Image: The image is in the public domain

Original Research: Closed access.
Targeting maladaptive anger with brief therapist-supported internet-delivered emotion regulation treatments: A randomized controlled trial” by Johan Bjureberg et al. Journal of Consulting and Clinical Psychology


Targeting maladaptive anger with brief therapist-supported internet-delivered emotion regulation treatments: A randomized controlled trial

Objective: To evaluate the relative impact of three brief therapist-supported internet-delivered emotion regulation treatments for maladaptive anger (mindful emotion awareness [MEA], cognitive reappraisal [CR], and mindful emotion awareness + cognitive reappraisal [MEA + CR]) and to test whether baseline levels of anger pathology moderate treatment outcome.

Method: Treatments were evaluated in a randomized controlled trial. In total, 234 participants (59% female; mean age = 41.1, SD = 11.6) with maladaptive anger were randomized to MEA (n = 78), CR (n = 77), or MEA + CR (n = 79). Self-reported primary and secondary outcomes were followed up at primary endpoint, 3 months after treatment termination (88% retention). Primary outcomes were also assessed weekly during a prolonged baseline phase (4 weeks) and an active treatment phase (4 weeks).

Results: At the primary endpoint, the MEA + CR was superior in terms of anger expression (d = 0.27 95% confidence interval, CI [0.03, 0.51]), aggression (d = 0.43 [0.18, 0.68]), and anger rumination (d = 0.41 [0.18, 0.63]). MEA + CR was particularly effective in reducing anger expression (d = 0.66 [0.21, 1.11]), aggression (d = 0.90 [0.42, 1.39]), and anger rumination (d = 0.80 [0.40, 1.20]) for individuals who reported high values (+1SD) of the outcomes at baseline.

Conclusions: Brief therapist-supported internet-delivered MEA and CR treatments are effective interventions for maladaptive anger. Combining MEA and CR is especially effective in reducing anger expression and aggression, particularly, in individuals who report higher levels of initial anger pathology. The present study highlights the importance of emotion regulation as an important treatment target for reducing maladaptive anger.

Join our Newsletter
I agree to have my personal information transferred to AWeber for Neuroscience Newsletter ( more information )
Sign up to receive our recent neuroscience headlines and summaries sent to your email once a day, totally free.
We hate spam and only use your email to contact you about newsletters. You can cancel your subscription any time.