Increasingly during the last decade, correctional systems in North America have felt that anger
management programs would benefit their clients. Many offenders are thought to have difficulty dealing
with anger, aggression and hostility. Such difficulties are assumed to have a causal relationship with
offenders' antisocial and criminal behaviour, and with the level of violence in correctional
institutions.
The content of anger management programs has been described in some detail by Novaco(2) and
Ellis.(3) Cognitive-behavioural programs specifically for use with offender populations have been
described by Fink,(4) Kitchner and Kennedy,(5) and Samuel(6) However, with the notable exception of
Novaco's 1978 monograph there has been a dearth of studies evaluating the effect of such programs.
The results of the few evaluation studies published are not always clear. Typically, studies show
short-term treatment success using measures of self report, but show no differences in ratings of
institutional behaviour. Long-term evaluation of the effectiveness of anger management programs is
notably absent from the literature. Yet long-term evaluation is particularly crucial with offender
populations, where it is assumed that anger management programs will have some impact on future criminal
behaviour. These assumptions affect decisions regarding future risk and conditional release programs for
offenders. Parole boards and case management officers have been reluctant to grant or recommend
conditional releases to inmates who have received no appropriate help for anger problems.
The present study evaluates the short- and long-term impact of a cognitive behavioural anger management
program on a group of adult male offenders. Program Description The program consisted of 12 weekly
two-hour sessions in which a combination of educational and experiential material was used to address
three basic issues:
-
Understanding the concept of anger and why and when to control anger. Techniques used included
arousal awareness, anger recognition, basic moral reasoning and concepts of self-interest.
-
Reducing anger cognitively through the use of coping selfstatements, problem-solving exercises, a
sense of proportion and humour, and the basic tenets of rational-emotive therapy.
-
Modifying and improving behavioural coping skills through relaxation training, assertiveness
training and role playing different behavioural responses.
The program emphasized role playing, both to model new behaviours and to allow inmates to practise new
skills. In a group setting, this also allowed clients to receive feedback, in a relatively "safe"
situation, on how their behaviour determined the behaviour of others. Thus, participants were taught to
use assertive behaviours in place of aggressive or under assertive responses when angry feelings were
unavoidable. The program also taught participants to reappraise external events cognitively to reduce
the frequency and intensity of angry feelings.
While the focus and aims of each session were strictly adhered to, the content of the role playing
remained flexible. Appropriate coping skills depend very much on the situation and may best be taught
within the context of the inmate's own problems. These coping skills typically include how to respond to
accusations, how to complain effectively and how to keep out of fights.
The anger management group was jointly run by an experienced clinical psychologist with advanced
training in rational-emotive therapy and a drama teacher from a local university, who was assisted by a
drama student. The latter two were well versed in the analysis of behaviour such as eye contact, body
posture and voice. Dramatic acting involves skills in observing environmental factors that shape
thoughts, feelings and behaviour. Thus, the drama teacher and student had considerable credibility in
teaching clients how to act in different and more appropriate ways. Study Method A study was
carried out on one group of offenders to evaluate the short- and long-term impact of this cognitive
behavioural anger management program. This group was compared with a second group of offenders, who were
referred and assessed as suitable clients for the program, but who did not start or did not complete the
program for various reasons. Initial Assessment Over a period of 24 months, 79 male offenders
incarcerated in Kingston Penitentiary were referred and assessed as suitable clients for an anger
management group program. All were administered an extensive battery of assessments which included the
Ammons Quick Test, the Beck Depression Inventory, the Over controlled Hostility Scale from the Minnesota
Multiphasic Personality Inventory, the IPAT Anxiety Inventory, the Interpersonal Behavior Survey, the
Jones Irrational Beliefs Test and questionnaires relating to physical symptoms of anger and
anger-provoking situations.
A total of 52 offenders attended at least six group sessions (i.e., half of the program) and were
deemed to have received treatment. Another 27 offenders were deemed not to have received treatment,
including 8 who had started the program but dropped out after one or two sessions. The remaining 19
decided not to participate in the program for a variety of reasons, such as work priorities, imminent
transfer to another institution or lack of interest. This comparison group did not differ significantly
from the offenders who completed the program on any of the initial psychometric assessments. Immediate
Postprogram Follow-up Measures Within four weeks of completing the program, all participants were again
given the two anger questionnaires, the Interpersonal Behavior Survey and the Jones Irrational Beliefs
Test.
Attempts to retest non-participants (those who were referred but who did not complete the program) were
largely unsuccessful. There were, therefore, insufficient data to report on this comparison group.
Participants in the last two group programs were also put through three standardized role-playing
tests, both before and after the program. Similar procedures to those described by Novaco(7) were used,
and participants were asked to rate their level of anger immediately after each role-playing situation.
Long-Term Follow-up Measures During a nine-month period, four years after completion of the last
program, an attempt was made to locate all 79 offenders who had been referred to the program. Where
possible, subjects were asked to report how many hours of psychological or other professional treatment
they had received since completing or being referred to the program.
In addition, each offender's case management officer was asked to rate the subject's ability to cope
with problematic emotions (e.g., anger and anxiety) and to cope in various life domains (e.g.,
employment, family and friends). The likelihood of the offender remaining crime-free was also rated.
For those offenders who had been released, Canadian Police Information records and Correctional Service
of Canada records were obtained to learn whether the subject had reoffended, and if 50, the type of
crime and the latency to rearrest (i.e., the length of time that had elapsed between release and
rearrest). Results Table 1 summarizes the differences in preprogram and postprogram scores for the
questionnaires and psychometric tests. The results include only those offenders who completed the anger
management program. As mentioned above, insufficient information was available on the comparison group
of non-participants. Furthermore, the almost 50% reduction in the number of subjects, from the 52 who
had completed the program, resulted from subjects' refusal or unavailability to complete the postprogram
measures.
Table 1
Pre and post program Scores * for Offenders Completing
the Anger
Management Program |
Measure |
Preprogram
Score |
Postprogram
Score |
| Physical Symptoms (N=25) |
44.84 |
30.00 |
| Anger Inventory (N=26) |
148.85 |
121.04 |
| Irrational Beliefs (N=21) |
283.43 |
263.90 |
Interpersonal Behavior Survey (N=27)
GGR (Aggression)
SGR (Assertion)
Conflict Avoidance
Dependency
Shyness
Impression
Management |
12.67
35.52
10.37
9.93
9.96
13.65
|
8.11
42.67
9.89
7.85
6.78
15.92
|
| Role Playing Self Ratings (N=9) |
53.22 |
28.78 |
* All differences in scores are highly significant statistically,
with the exception of
scores on the measure of conflict avoidance |
With one exception, all differences were highly significant, and in the expected and desired direction.
That is, participants performed significantly better on almost ah measures after completion of the
program. The one exception is in conflict avoidance where any change in participants' scores after
treatment could have been construed as undesirable.
Table 2 summarizes the long-term follow-up measures for program participants and non-participants.
Table 2
| Comparison of Follow-up Measures* for Program Participants
and Non-Participants |
| |
Non-Participants |
Participants |
| Case management officer adjustment ratings** |
33.58 (N=19) |
40.09 (N=42) |
| Treatment hours since program |
11.12 (N=17) |
22.28 (N=38) |
| Latancy to rearrest (months)** |
5.55 (N=11) |
22.04 (N=12) |
| Any evidence of recidivism |
No Yes
31.3% 68.8% |
No Yes
44% 56% |
| Conviction for violent crime |
No Yes
31.3% 65.8% |
No Yes
60% 40% |
* Results measured at the time of follow-up
** Difference in scores is statistically significant |
Measures of recidivism were restricted to offenders who had been released. Of the total number of
subjects, 39 had never been released and most of these were serving life sentences. Two of those never
released died in prison during the period of the long-term follow-up. One individual released into the
community also died. None of the deceased were included in the long-term follow-up figures.
Differences between the two groups on measures of recidivism are unclear, making interpretation
difficult. Four out of five measures show a trend in the desired direction. However, the results for
"latency to rearrest" and "treatment hours" should be viewed with caution, since the scores within each
group varied 50 much.
With only two exceptions, offenders in this study had histories of violence. This included a number of
offenders convicted of murder, and murder offenders typically have very low rates of recidivism.
However, of the 41 released offenders, only one had been serving a life sentence for murder; 37
had a history of multiple incarcerations when they were referred to the program. The released subjects
may have therefore been considered a high-risk group for violent reoffending. Thus, it was important to
distinguish between violent reoffending and general recidivism which included breach of parole
conditions and outstanding charges which had not resulted in reincarceration. While program
participation showed no effect on general recidivism, the effect on convictions for further violent
crime did approach significance. Discussion Changes resulting from the program, as measured by
self-report and other psychometric tests administered immediately after the program, can clearly be
demonstrated.
Similar changes in Interpersonal Behavior Survey scores to those reported here have been reported by
Bellemare and McKay.(8) However, such changes may not be entirely trustworthy, as evidenced by the
significant increase in "impression management" in Table 1. Subjects have many reasons for professing a
change in how they feel, and how they would hypothetically behave, after completion of the program. Even
with the best of intentions, improved skills and self-efficacy, the demands of a provocative situation
may overwhelm the subject and elicit ingrained dysfunctional reactions. It would be reassuring to have
more behavioural measures of change.
For several reasons, such behavioural measures are difficult to obtain. In this study, an attempt was
made to use the number of institutional charges as a measure of behaviour. However, charges were so rare
as to render the measure useless. Also, a case manager's rating of an offender's coping skills, some
years after program completion, is somewhat tenuous as a measure of behaviour. Nonetheless, the
difference in ratings between program participants and non-participants is significant and in the
desired direction.
The need for follow-up or maintenance treatment to bring about long-term behavioural control has been
eloquently argued by those involved in sex offender treatment and research (e.g., FORUM, Vol. 3, No. 4,
December 1991, on sex offender program-ming). Maintenance treatment and follow-up are equally essential
for correctional clients with any long-standing pattern of dysfunctional behaviour. Unfortunately, many
offenders, as well as case managers, fail to accept the need for follow-up treatment; they believe the
program somehow cures or fixes the problem. This attitude 15 typified by the offender who, in no
uncertain terms, angrily rejected the suggestion of taking an anger management treatment program. He
said that he had already done anger management and had all the notes in a box somewhere. Unfortunately,
the program content was neither in his head nor in his behavioural repertoire.
The attempt to collect information on further treatment was not entirely successful in this study.
While there was a trend for program participants to continue with more treatment than the comparison
group, further review of the "treatment hours" data suggests that this measure was also related to
recidivism and further incarceration. There was a significant positive correlation between the number of
months of reincarceration and total hours of treatment. Most subjects who were reincarcerated had
further treatment after reincarceration, rather than in the community where it might have been of more
value. Thus, the tendency for offenders to take part in treatment programs only when incarcerated
obscures the role of continued treatment in reducing recidivism. To compound the problem in this study,
some data on continued treatment were missing, and most of the missing cases were subjects who were
released successfully into the community.
A further complication arises from the kind of additional treatment offered to or taken by the subject.
It is reasonable to assume that some treatment may not be compatible with the cognitive-behavioural
orientation of the anger management program, with its emphasis on self-management and responsibility.
Thus, further treatment may have been counter-productive. In this study, inmates supplied their best
guesstimate of the number of hours of professional help they had received. Many subjects were vague and
unsure of what treatment they had received. Information on treatment was rarely included in a subject's
psychological records, and even if it was, it was not always clear how much or what kind of treatment
had been offered.
Like many quasi-experimental studies conducted by clinicians whose attention is divided among competing
priorities and pressures, there are a number of methodological design problems. Offenders are not always
co-operative in completing lengthy questionnaires. Because of other pressures, some offenders were
allowed into the program without completing the preprogram assessment. Others refused to participate in
the program because they did not like filling out the preprogram psychometric tests. Needless to say,
they were not about to comply with a request to redo the same battery of questionnaires. Missing data
were frequently a problem, making numbers too low to perform an adequate analysis.
The movement of offenders within the system is both time consuming and difficult to track. Once past an
offender's warrant expiry date, tracking is virtually impossible unless the offender commits another
offence. This makes any collection of longitudinal measures difficult. Official records are more readily
available but are not always designed to capture the information required. For example, Correctional
Service of Canada summaries give sentence commencement dates for new charges. These dates are rarely the
same as reincarceration dates, which are more pertinent to a measure of latency to rearrest.
Finally, there 15 the problem of whether to include offenders serving life sentences in this type of
study. Long-term program assessment using such traditional measures as recidivism are clearly
inappropriate. The length of time to release is unusually long and recidivism rates are low, regardless
of treatment. Andrews and colleagues(9) argue against treating low-risk and low-need offenders. Many
lifers can be 50 categorized, and yet many demand psychological programs and aim to achieve considerable
personal growth from participating in them. Certainly, such programs are a means of passing time
profitably and may be a means of reaffirming the non-criminal values held by many lifers. Summary For
those offenders in this study who were released during the follow-up period, the rate of overall
recidivism was relatively high (61%). Whether or not the subject had completed the anger management
program had no significant effect on the overall rate. However, if we examine only reconvictions for a
violent crime, program completion had a more noticeable effect (the rate of recidivism was 40%).
Certainly, the length of time in the community before rearrest was significantly longer for those who
had completed the program.
Once again, we are brought back to the question of expectations of change in high-risk violent
offenders. Perhaps any reduction in violent crime and any increase in latency to reoffend should be
considered a success.
This study offers some evidence of the positive impact of completing a cognitive-behavioural anger
management program on violent offenders. The program was based on the now-accepted principles of
effective correctional treatment, which emphasize self-monitoring and responsibility for attitudes and
behaviour.
From both anecdotal evidence provided by the many graduates of cognitive-behavioural programs, such as
the one under consideration, and the limited results of the present study, I remain optimistic about the
value of such programs.
(1)Correspondence may be addressed to Gareth V Hughes, Ph.D., District
Psychologist, Eastern & Northern District Parole Office, Correctional Service of Canada, 920
Princess Street, Suite 203, Kingston, Ontario K7L 1H1.
(2)R. Novaco, Anger Control: The Development and Evaluation of an Experimental Treatment (Lexington,
Mass.: DC. Heath, 1975).
(3)A. Ellis, How to Live With and Without Anger (Toronto: Fitzhenry & Whiteside, 1977).
(4)E. Fink, A Cognitive-Behavioral Group Therapy Program for Problems of Anger and Aggression in
Adult Male Offenders. Doctoral dissertation, Rutgers University, 1980.
(5)E.P. Kirchner and R.E. Kennedy, Leaders' Manual for an Assertive Skills Course in Correctional
Settings (University Park, Pa.: Institute for Research on Human Resources, 1978).
(6)R. Samuel, "ABC of Anger Management," Canada's Mental Health, 31,1 (1983): 21.
(7)Novaco, Anger Control.
(8)F. Bellemare and D. McKay. "An Anger Management Program in a Maximum Security Federal
Penitentiary." Unpublished poster presentation, 1990.
(9)D.A. Andrews, L Zinger, R.D. Hoge, J. Bonta, P. Gendreau and F. T. Cullen, "Does Correctional
Treatment Work? A Clinically Relevant and Psychologically Informed Meta-Analysis," Criminology,
28(1990): 369-404.
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