Treatment of Chronic Anger and Aggression Following Military-Related Betrayal

Number of eligible referrals that are recruited, enrolled into the study and randomized to treatment

The survey will assess participant acceptability using the CSQ-8, an 8-item self-report measure designed to assess client satisfaction. Each question is answered on a 4-point scale with a possible range of scores between 8-32. A higher score indicates a higher level of overall satisfaction. Mean scores will be used to determine participant satisfaction.

A 17-item measure that assesses frequency of different aggression acts in outpatient settings, including verbal and physical aggression against self, other, and objects. The OAS-M is scored by summing the instances of aggression since the last assessment. The OAS-M had been administered as an interview as well as self-report and will be administered as a self-report in this study, consistent with past aggression research with veterans (Miles, Kent et al., 2020). The score is calculated using a sum total of all instances of aggression. Higher scores indicate a greater frequency of aggressive behaviors.

A 32-item self-report assessment designed to measure interpersonal functioning. Items are scored on a five-point scale from 0 (not at all) to 4 (extremely) in response to the stem: "How much have you been distressed by this problem?" There are 8 factors and a total score. The 8 factors are: hard to be assertive, hard to be sociable, hard to be supportive, too dependent, too caring, too aggressive, hard to be involved and too open. The possible total score ranges from a T-score are 0-100. T-scores that are higher than 60 are above average and T-scores 70 or higher suggest significant interpersonal difficulty.

A 57-item inventory which measures the frequency and intensity of anger as an emotional state. There are 6 scales, 5 subscales, and an Anger Expression Index (total anger expression). The State Anger scale (15 items) measures anger intensity as a momentary emotional state, while the Trait Anger scale (10 items) measures the disposition to experience angry feelings as a personality-like trait over lengthy time periods (i.e., the individual's disposition to become angry or angry temperament). The Anger Expression scale (16 items) and the Anger Control scale (16 items) measure four anger-related trait dimensions. Ratings of items are on a 4-point response scales that measure state anger (intensity) as well as trait anger (frequency). The possible total range is a T-score from 0 to 100. Individuals with anger scores higher than the 75-percentile experience and/ or express angry feelings to a degree that may interfere with optimal functioning.

The 14 modules may be completed within a 7-14 week time period by each participant.

A count of how many of the 14 modules are completed

A 7-item, self-report measures of psychosocial functioning in seven life domains: romantic relationship, relationship with children, family relationships, friendships and socializing, work, training and education, and activities of daily living. In each area on a 7-point scale ranging from 0 = Not at all to 6 = Very much. The B-IPF total score is calculated by summing the scale items completed by the respondent, dividing by the maximum possible score based upon the number of applicable items and multiplying by 100. Higher scores indicate greater psychosocial dysfunction.

A 5-item self report measure that assesses anger frequency, intensity, urge to act aggressively and impact on social functioning over the past 1 month. Respondents are asked how impacted they have been on a five-point Likert scale ranging from 0-5. Items are summed to provide a total severity score (range 5-25). A score of 12 or higher indicates problematic anger.

The CTS-2 poses 39 questions to assess five tactics used when conflict occurs within the relationships of dating, cohabitating, or marital couples. For this study, only the Physical Assault and Psychological Aggression subscales (20 items) of the CTS-2 will be used, broadening the assessment of conflict to query interpersonal conflict among friends, colleagues, and acquaintances as well as the family. The scoring range is: 0-6, Two Subscales: 1) Psychological Aggression: 1-8 2) Physical Assault: 9-20, Special Coding: Sum midpoints of chosen response option: Never-0, Once-1, Twice-2, 3-5 times -4 , 6-10 times-8, 11-20 times-15, greater than 20 times-25. For item scoring range 0-25, Psychological Aggression scoring range 0-200, Physical Assault scoring range 0-300. The higher scores indicate higher levels of Psychological Aggression and Physical Assault.

A 19-item self report measure to assess anger in the context of posttraumatic stress. Participants are asked to rate each item from Not at all true (0) to ;Definitely True(3) both prior to their traumatic event, and within the past two weeks. The scoring range for the items summed to provide a total severity score is 0-57. Items 1-7 = Anger giving a sense of control or energy, Items 8-14 = thought and emotional avoidance relating to anger, Items 15-17 = anger in response to threat, Items 18-19 = anger in response to pity. The higher score means greater anger in the context of PTSD. Higher scores in past two weeks, as compared with pre-trauma scores, indicate more severe trauma-related anger.