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

OBJECTIVE: Psychiatric treatment research has too frequently neglected anger. "Anger management" is widely used to tamp anger down. Yet understanding and expressing anger often have clinical and interpersonal value. Few data address anger in the context of treating patients with posttraumatic stress disorder (PTSD). The authors hypothesized 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: Secondary 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 (ClinicalTrials.gov: NCT00739765). Anger-related variables from the Clinician-Administered PTSD Scale (CAPS), Beck Depression Inventory-II (BDI-II), and Inventory of Interpersonal Problems (IIP) were analyzed with limited mixed-effects models. RESULTS: Anger decreased across treatments, with greater reductions in IPT compared with RT on CAPS anger when analyses controlled for overall PTSD improvement (p=0.035). The PE group × time interaction approached significance, suggesting less CAPS anger reduction over time for PE than for IPT. RT (vs. IPT) patients reported higher end-point BDI-II irritability (p=0.046) and less IIP reduction in anger-related interpersonal difficulties (p=0.017). Men had consistently higher CAPS anger scores than women (p=0.042). CONCLUSIONS: In this secondary data 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 uses typical anger management techniques.