Christopher I. Eckhardt

The assessment of anger and hostility: a critical review

While the emotion of anger has become an increasingly important part of clinical assessment, the theoretical and psychometric adequacy of the instruments used to assess anger and hostility have long been questioned. In the present review, we first provide definitions of anger and hostility in order to provide a theoretical context from which to evaluate the scope of current measures of these constructs. Second, we review the major self-report scales used to assess anger and hostility in light of these definitions and provide a detailed evaluation of psychometric evidence concerning their reliability and validity. Finally, we offer specific recommendations concerning how anger and hostility assessment instruments can be improved and expanded. In particular, we note the need for (a) an expansion of anger assessment methods beyond traditional endorsement approaches, (b) scales to assess specific domains of anger experience, (c) scales that assess unique content domains of anger experience and expressions, such as spouse-specific or driving-related anger scales, and (d) scales that assess the clinical aspects of the anger construct.

The Effectiveness of Intervention Programs for Perpetrators and Victims of Intimate Partner Violence

In this review, we provide a descriptive and detailed review of intervention programs for intimate partner violence (IPV) perpetrators and survivor-victims. Given the extensive personal, interpersonal, and societal costs associated with IPV, it is essential that services being offered by the criminal justice, mental health, and medical communities have requisite empirical support to justify their implementation. The review involved a detailed summary of all studies published since 1990 using randomized or quasi-experimental designs that compared an active intervention program to a relevant comparison condition. These studies included 20 studies investigating the effectiveness of “traditional” forms of batterer intervention programs (BIPs) aimed at perpetrators of IPV, 10 studies that investigated the effectiveness of alternative formats of BIPs, 16 studies of brief intervention programs for IPV victim-survivors, and 15 studies of more extended intervention programs for IPV victim-survivors. Interventions for perpetrators showed equivocal results regarding their ability to lower the risk of IPV, and available studies had many methodological flaws. More recent investigations of novel programs with alternative content have shown promising results. Among interventions for victim-survivors of IPV, a range of therapeutic approaches have been shown to produce enhancements in emotional functioning, with the strongest support for cognitive-behavioral therapy (CBT) approaches in reducing negative symptomatic effects of IPV. Supportive advocacy in community settings has been shown to reduce the frequency of revictimization relative to no-treatment controls, although rates of revictimization remain alarmingly high in these studies. Brief interventions for victim-survivors have had more complex and less consistently positive effects. Several studies have found significant increases in safety behaviors, but enhanced use of community resources is often not found. It remains unclear whether brief safety interventions produce longer term reduction in IPV revictimization. Discussion summarizes the general state of knowledge on interventions for IPV perpetrators and victim-survivors and important areas for future research.

What Situations Induce Intimate Partner Violence? A Reliability and Validity Study of the Proximal Antecedents to Violent Episodes (PAVE) Scale

The current study investigated the reliability of a new self-report questionnaire assessing stimuli that would likely elicit intimate partner violence. The Proximal Antecedents to Violent Episodes (PAVE) scale is a 30-item, Likert-type measure designed to assess situations that would reportedly precede the use of violence. In Study 1, an exploratory factor analysis on a clinical sample revealed 3 factors: Violence to Control, Violence Out of Jealousy, and Violence Following Verbal Abuse. In Study 2, the factor structure was replicated on a community sample using confirmatory factor analysis. In both studies, different types of batterers, on the basis of A. Holtzworth-Munroe and G. L. Stuarts (1994) typology, scored differently on the 3 factors in ways consistent with theory. Therefore, the PAVE shows promise as a reliable and valid tool to help to understand the context and function of intimate partner violence.

Readiness to change, partner violence subtypes, and treatment outcomes among men in treatment for partner assault

Men court-mandated to attend a batterer’s intervention program (BIP) were evaluated to determine whether pre-BIP readiness to change and the presence of partner violence subtypes predicted BIP completion, criminal recidivism, and postadjudication partner violence 6 months post-BIP. Of the 199 subject sample, 40% did not complete BIP. Four readiness-to-change clusters were found, with most men (76%) reporting change-resistant stages-of-change profiles. The partner violence typology reported by Holtzworth-Munroe et al. (2000) was supported with clustering into four subtypes: family only (FO), low-level antisocial (LLA), borderline/dysphoric (BD), and generally violent/antisocial (GVA). BIP completion was predicted by violence subtype (with BD and GVA more likely to drop out) but not by pre-BIP readiness to change. Men rearrested scored higher on the precontemplative stage of change and were more likely to be in the BD and GVA subtypes. Implications for counseling strategies are discussed.

Effects of Alcohol Intoxication on Anger Experience and Expression among Partner Assaultive Men.

The author investigated the acute effects of alcohol intoxication on anger experience and expression among 46 maritally violent (MV) and 56 maritally nonviolent (NV) men randomly assigned to receive alcohol, placebo, or no alcohol. Participants completed an anger-arousing articulated thoughts in simulated situations (ATSS) paradigm and imagined marital conflict scenarios. Anger experience was operationalized as subjective ratings of anger experienced during ATSS, and anger expression was measured as ATSS anger statements and aggression verbalizations. MV men given alcohol articulated significantly more aggressive verbalizations than all other groups, with high trait anger and increased anger experience predicting more aggressive verbalizations. Thus, alcohol may exert proximal effects on abusive behavior among individuals already prone to respond to conflict with increased anger.

Anger Disturbances Among Perpetrators of Intimate Partner Violence Clinical Characteristics and Outcomes of Court-Mandated Treatment

In the present study, the authors clustered a pretreatment sample of 190 perpetrators of intimate partner violence (IPV) mandated to attend group counseling based on State–Trait Anger Expression Inventory scores and examined whether these profiles were associated with differential outcomes 1 year postadjudication. Cluster analysis revealed 3 groups: (a) high anger–expressive (HA-E, n = 56), (b) moderate anger–inexpressive (MA-IE; n = 13), and (c) low anger (LA; n = 118). HA-E men perpetrated more IPV, reported experiencing and witnessing more abuse during childhood, scored higher on psychopathology measures, and reported more substance problems. HA-E and MA-IE males had higher program attrition and rearrest rates; MA-IE males were more likely to be arrested for assault-related offenses. Thus, although the majority of partner-abusive men do not present with anger-related disturbances, the presence of anger problems may be a marker for an array of traits that may complicate the treatment process.

Intervention programs for perpetrators of intimate partner violence: conclusions from a clinical research perspective.

In this article, the authors consider the empirical status of batterer intervention programs (BIPs) for male perpetrators of intimate partner violence (IPV). Recent reviews have reported only small average effect sizes for BIPs, with the small number of randomized trials showing little benefit of BIP attendance in preventing future abuse. The most widely adopted BIP intervention model has little empirical justification to support this dominance, yet states with standards governing the content of BIPs often mandate this approach as a contingency for state funding. Little data exist concerning the moderators and mediators of BIP effects on IPV recidivism, and a variety of factors threaten to impede future design advancements, including “turf” battles regarding the causes of IPV and limited funding outlets. Given this discouraging summary, the authors argue that research efforts concerning BIP effectiveness should borrow the design strategies and programmatic research efforts that have proven successful in psychotherapy research, in which significant advances have been made with regard to the evaluation and validation of empirically supported treatments for a wide variety of mental health problems. They conclude by calling for a new generation of IPV researchers to work across professional boundaries in a multidisciplinary manner to design the sophisticated evaluation studies that funding agencies would readily support, and that would provide the substantive answers to the many IPV-related public health questions that remain.

Attention allocation and habituation to anger‐related stimuli during a visual search task

A substantial amount of data has accumulated demonstrating that emotionally disordered subjects are prone to bias their attention toward threatening, emotionally relevant stimuli. Little attention has been reserved for the study of cognitive processes involved in anger arousal. In the present study, we investigated whether mood-congruent attentional biases could be demonstrated in subjects of varying levels of trait anger using a visual search task. This task also assessed whether mood-congruent biases diminished with repeated exposure to specific emotion stimuli. To investigate state-trait interaction effects, a naturalistic, anger-inducing insult was administered to half the subjects. There was a positive relation between participants’ level of trait anger and their degree of mood-congruent attentional bias toward anger-related cues only after an insult. As predicted, this effect diminished across blocks of trials. Aggr. Behav. 24:399‐ 409, 1998.

Anger, irrational beliefs, and dysfunctional attitudes in violent dating relationships.

The purpose of the present investigation was to evaluate whether perpetrators of dating violence could be differentiated from their nonviolent counterparts on measures of anger and cognitive distortion, specifically Ellis’s (1994) irrational beliefs and Beck’s (1976) dysfunctional attitudes. Of the 95 male and 152 female undergraduates surveyed, 27% (24 males and 43 females) reported using some form of physical aggression against their current dating partner in the past year. On a self-report measure of anger (State-Trait Anger Expression Inventory), violent individuals reported higher levels of Anger Out and lower levels of Anger Control compared to nonviolent participants. While there were no differences between violent and nonviolent participants’ levels of Trait Anger, the results suggest that violent individuals have difficulty controlling angry feelings when they arise, which may increase the likelihood of externally directed forms of anger expression. No significant group differences emerged on questionnaire measures of irrational beliefs and dysfunctional attitudes. Within the violent sample, there was no differential pattern of correlations between measures of anger and cognition relative to the nonviolent sample. The present data suggest that while trait-based measures of cognitive distortion explain little variance in self-reported acts of dating violence, future research should investigate whether (a) cognitive distortions are present during affect-inducing partner conflict situations, or (b) vary with violence severity.

Partner Assaultive Men and the Stages and Processes of Change

Researchers have recently suggested that the Transtheoretical Model of behavior change (TTM; Prochaska, J. O. DiClemente, C. C., and Norcross, J. C., 1992, Am. Psychol. 47: 1102–1114) might help in understanding the mechanisms through which partner assaultive men attempt to change their abusive behavior. In the present study, we present data from 2 psychometrically sound scales designed to assess the stages and processes of change in a cross-sectional sample of 250 men attending 2 batterers intervention and prevention programs: the University of Rhode Island Change Assessment Scale for Domestic Violence (URICA-DV; Levesque, D. A., Gelles, R. J., and Velicer, W. F., 2000, Cog. Therapy Res. 24: 175–200), which assesses movement through the stages of change, and the Processes of Change Scale (POC), developed by the authors to assess self-reported usage of behavior change processes. Cross-validated cluster analyses indicated a three-cluster solution based upon URICA-DV scores: Immotive, Unprepared Action, and Preparticipation. Results indicated that individuals in more advanced stages of change reported using more behavior change processes, although this did not appear to result from being in treatment for a longer period of time. These data are interpreted in light of recent data indicating relatively small effect sizes for batterers treatment programs and how assessment of the stages and processes of change might assist in matching men to different levels of treatment.