An investigation of anger regulation in two clinical groups: veterans with combat-PTSD and individuals with high trait anger

Two studies were conducted to investigate anger regulation in two clinical groups well documented to experience anger related problems : trauma-exposed combat veterans and adult individuals with high levels of trait-anger. The first study was a path analysis investigation of the effect of trauma-related cognitive factors (negative trauma appraisals, trauma rumination and suppression) on the association between combat-PTSD symptom severity and anger regulation domains of suppression, aggressive expression and control. Negative trauma appraisals about self and the world were found to partially mediate the relationship between PTSD and anger regulation domains, while trauma rumination and suppression did not. A direct relationship was found between combat-PTSD and aggressive anger expression. Implications for the theoretical conceptualisation and treatment of anger dysregulation in combat-PTSD were discussed. While cognitive-behavioural therapy is the most empirically supported treatment for dysregulated anger to date, acceptance-based approaches have recently been proposed. However, few studies have examined the relative effectiveness of cognitive reappraisal and acceptance approaches to anger. The second study was an experimental investigation of the effectiveness of instructed cognitive reappraisal, acceptance and emotional suppression on state-anger in response to provocation, amongst individuals with high trait-anger. This study examined trait-emotion regulation style and elevated PTSD symptoms as moderators of the effect of instructed ER. Immediate and delayed adaptive effects on subjective state-anger, physiological arousal, and anger intrusions were found for all three emotion regulation instructions. Trait-concealing was found to augment the adaptive effects of suppression on physiological arousal, while trait-tolerance enhanced the effect of cognitive reappraisal. PTSD status was not found to be a significant moderator. This research highlighted the importance of targeted assessment and interventions for negative trauma appraisals in the context of anger treatment for combat veterans, and generated support for cognitive reappraisal, acceptance and emotional suppression as effective short-term strategies for coping with provoked state anger amongst individuals with high trait anger.