Effect of Cognitive-Behavioral Treatments for PTSD on Anger

We investigated three questions related to anger and the treatment of chronic posttraumatic stress disorder (PTSD), utilizing data from a previously published study of cognitive behavioral therapies (CBTs) with female assault victims (Foa, Dancu, Hembree, Jaycox, Meadows, & Street, 1999). The questions were: (1) Do CBTs targeted at PTSD result in a concomitant reduction in anger?, (2) If so, how do these treatments compare with one another?, And (3) Do high levels of pretreatment anger predict poorer outcome on measures of PTSD symptom severity, depression, and general anxiety? Data from the State-Trait Anger Expression Inventory at pretreatment and posttreatment assessments were available for 67 participants randomly assigned to receive prolonged exposure (PE; n = 19), stress inoculation training (SIT; n = 18), combined treatment (PE/SIT; n = 17), or waitlist control (WL; n = 13). Compared to WL, treatments significantly lowered levels of state-anger. Comparisons among active treatments indicated significantly lower state-anger for SIT compared to PE/SIT, but PE did not differ from SIT or PE/SIT. Treatment gains were maintained at follow-up. Pretreatment state-anger was correlated with posttreatment PTSD symptom severity and depression, but multiple regression analyses revealed that pretreatment state-anger did not predict posttreatment PTSD symptom severity or depression beyond the corresponding pretreatment levels of PTSD and depression. A sub-group analysis compared treated participants with clinically significant pretreatment elevations in state-anger (n = 9) to the remainder of the treated participants (n = 45). No significant difference in state-anger was found between groups at posttreatment. The high state-anger group reported greater anger than the low state-anger group at follow-up, but the high state-anger group remained significantly less angry at follow-up than at pretreatment. Thus, CBTs for PTSD reduced anger and pretreatment anger did not reduce the efficacy of these treatments for PTSD and associated psychopathology.