Effects of Psychotherapies for Posttraumatic Stress Disorder on Anger: An Exploratory Study

What is it about?

Objective. Psychiatric research has largely neglected anger. “Anger management” is widely employed to tamp it down. Yet understanding and expressing anger often has clinical and interpersonal value. Few data address anger in the context of treating patients with posttraumatic stress disorder (PTSD). The authors hypothesize the clinical utility of anger expression rather than suppression, particularly using Interpersonal Psychotherapy (IPT), which focuses on interpersonal handling of emotions. IPT effects on anger have barely been researched. Methods. Data analyses examined anger items from a randomized, 14-week trial of Prolonged Exposure (PE), IPT, and Relaxation Therapy (RT) for 110 unmedicated patients with PTSD (NCT00739765). Anger variables from the Clinician-Administered PTSD Scale (CAPS), Beck Depression Inventory (BDI), and Inventory of Interpersonal Problems (IIP) were analyzed using limited mixed-effect models. Results. Anger decreased across treatments, with greater reductions in IPT compared to RT on CAPS anger, controlling for overall PTSD improvement (p=0.0347). The PE time×treatment condition interaction approached significance (p=0.082), suggesting less CAPS anger reduction over time for PE than IPT. Relaxation therapy patients reported higher endpoint BDI irritability (p=0.046) and less IIP reduction in anger-related interpersonal difficulties (p=0.017) than IPT patients. Men had consistently higher CAPS anger scores than women (p=0.042). Conclusions. In this exploratory study lacking a primary anger scale, anger levels on several instruments improved across PTSD treatments with improvement in PTSD. The effect was greatest for IPT, which focuses on negative affect and its useful expression, and least for RT, which employs typical “anger management” techniques.

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