Behav.Res. & Therapy,1973, Vol. II, pp.473to 481.Pergamon Press.Printedin England
MOTOR AND COGNITIVE RELAXATION IN THE DESENSITIZATION OF ANGER* CLIFFORD R. O’DONNELL
University of Hawaii, Honoluh_~, Hawaii 96822, U.S.A.
and LEONARD WORELL
University of Kentucky, Lexington, Kentucky, U.S.A. (Received
8 February
1973)
Summary-Three procedures were assessed to determine their effectiveness in reducing anger. The procedures were: desensitization, desensitization with cognitive relaxation, and desensitization with the absence of relaxation training. Anger was aroused by exposing white males, selected for their reports of anger toward blacks, to black racial stimuli. The desensitization group reported reductions in anxiety and disgust relative to a no-treatment control group. Therapist ratings indicated reductions in anger for Ss in both the desensitization and desensitization with cognitive relaxation groups. In addition the latter group reported reductions in anger concurrently with increases in diastolic and systolic blood pressure. Post-hoc analyses indicated that Ss for whom desensitization was most effective reported less anger after the pretreatment anger arousal procedure, greater depth of relaxation during treatment, and were liked more by their therapists. These Ss also reported a greater reduction in ethnocentrism and a trend toward lower overt hostility following treatment.
of this study is to determine the effectiveness of three procedures to reduce anger. Anger was aroused experimentally by exposing white males to provocative black racial stimuli. The anger response generated by this experience is assumed to be the result of a long conditioning history within a subculture in which it is considered to be an appropriate reaction for these white males. It therefore may well be more resistant to change than most other emotional responses, such as anxiety about snakes, etc., that have been studied heretofore. One procedure that has been found effective in reducing anxiety is that of desensitization (Bandura, 1969; Paul, 1969; Rachman, 1967). In relation to anger, however, Wolpe (1969) believes that both anger and muscle relaxation are associated with parasympathetic nervous activity. Therefore, relaxation should not reciprocally inhibit anger. An apparent contradiction of this position is found in a recent study by Rimm et al. (1971) who report the successful application of desensitization to an anger response. One aim here then is to further explore the use of desensitization with anger. The basis of the effectiveness of desensitization and the role of relaxation is not concept.ually clear (Nawas et. al., 1971; Nawas, Welsch and Fishman, 1970). As has been suggested elsewhere (Rachman, 1968; Wolpin and Raines, 1966) it is quite possible that a cognitive component rather than a physical one is the determining agent for change in muscle relaxation. Consequently, we have included a desensitization group which receives cognitive without the typical motor relaxation training as a second procedure. THE CENTRAL. concern
* This study is based on a dissertation submitted by the first author in partial fulfilment of the require ments for the Ph.D. degree at the University of Kentucky. The authors express their appreciation to committee members, William Claiborn, Ronald Doctor, Melvin Lerner and William Tisdall; to the therapists, Joseph Aponte, Paul Martin, Drew Sappington and Robert Welch; and to the assistants, Joanne Alderfer and Madeline Cooke. 473
474
CLIFFORD
R.O'RONNELL
and
LEONARD
WORELL
Additiona~y, in their investigation of the role of relaxation, both Davison (1967) and Rachman (1965) included a group which did not engage in relaxation either before or during the hierarchy presentation. Ss in these groups were yoked to Ss in the desensitization group with respect to both order and duration of the hierarchy items. This procedure presents some problems, however. The fact that these groups showed no significant change can be attributed to either of two factors: (a) the absence of relaxation prior to or during the heirarchy presentation or (b) the yoking requirement. More specifically, in the latter case it is conceivable that Ss anxiety is aroused rather than relaxed since the presentation of the items is neither graded according to individual intensity nor duration of exposure. Previous research has demonstrated that the absence of relaxation in desensitization provides for little or no behavioral change. This study attempts to specify how this may take place. Therefore, the third and final objective here is to determine the effect of the absence of relaxation training by the inclusion of a group which experiences relaxation only during the presentation of the hierarchy but is not yoked to any other group. METHOD All Ss completed a test battery and a behavioral assessment both before and after their participation in one of four conditions. The test battery
Described below are the five instruments included in the test battery together with the reasons for their being administered. The instruments were: (1) the Buss-Durkee Hostility Inventory (factor analytic version- Bendig, 1962) to assess general hostility; (2) an Emotional Rating Scale, consisting of 5-point Likert type scales, to gather self-reports of anger, anxiety and disgust to racial stimuli; (3) the Ethno~ntrism Scale to evaluate ethnocentric attitudes (Adorn0 et al., 1950); (4) the Lie Scale of the Minnesota Multiphase Personality Inventory to screen potential Ss whose scores might be unreliable (Dahlstrom and Welsh, 1960); and finally (5) the Marlowe-Crowne Social Desirability Scale (Crowne and Marlowe, 1960) to determine whether responses may be influenced by a social desirability factor. The foregoing test battery was administered to 70 volunteer male students enrolled in psychology classes at the University of Kentucky. Thirty-two volunteers who scored at or above the mean of the Anger subscale of the Emotional Rating Scale and at or below the 60th T score on the Lie Scale participated as Ss in the experiment. The behavioral assessment
All Ss were seen individually. Each S was asked to listen to a tape recording and to watch a series of slides “designed to arouse your anger”. The tape, comprised of selections from a militant speech by Malcolm X, was heard through earphones. Simultaneously, 24 slides depicting people and events related to racial issues were presented. Each slide was exposed for 15 sec. The slides were projected from an adjoining room through a one-way mirror onto a white projection screen. During this six-minute presentation, an assistant who was unfamiliar with the experimental conditions observed S through a one-way mirror from a second adjoining room and rated motor behaviors believed to be indicative of anger (e.g. clenching fist, shaking head “no”). Following the presentation each S (a) had systolic and diastolic blood pressure readings taken by the assistant, (b) participated in a tape recorded interview
MOTOR AND COGNITIVE
RELAXATION
IN THE DESENSITIZATION
OF ANGER
475
with E, (c) completed an Adjective Check List (Gottschalk et al., 1963), (d) filled out a five point self rating scale for anger, and (e) arranged his first appointment with the therapist to whom he was assigned. An attempt was made to assign subjects to therapists randomly; however, exceptions from this procedure were made in order to arrange mutually convenient times.
Conditions Eight Ss were randomly assigned to each of four conditions. These were: Desensitization with Motor Relaxation (DM), Desensitization with Cognitive Relaxation (DC), No Relaxation (NR), and No Treatment (NT). The DM condition was similar to the “standard” desensitization procedure (Paul, 1966). The sole exceptions were that relaxation instructions were conveyed by a tape recording and the construction of the heirarchy items was such that Ss were asked to select 10 items from a list of 25 (e.g. Black Panthers, interracial dating, etc.) and order them on a 100 point scale with 10 points separating each item. Each S therefore established his own individual ordering of the 10 items. The DC condition was the same as DM except that Ss did not engage in motor behaviors of relaxation. Instructions for the DC Group were identical to those of the DM Group save that Ss in the DC Group were told to relax and listen to the taped relaxation instructions but not to go through the specific exercises described on the tape. Concomitantly, their instructions concerning practice at home were to relax and think of listening to the tape. The NR condition was identical to DM but here Ss did not receive any relaxation training, either motor or cognitive, prior to presentation of the heirarchy. They did obtain the same instructions, however, during the hierarchy presentations. Ss in this group, of course, were not exposed to the tape recorded relaxation instructions. This omission shortended their first session by 20 min and subsequent sessions by 10 min. NT refers to Ss who did not receive any treatment but participated in the pre- and postmeasures. It is worthwhile noting that instructions regarding expectancy for improvement were identical for the DM, DC and NR Groups. Therapists and treatment termination The eight Ss of each treatment condition were evenly divided among four therapists. Each S received five treatment sessions spaced over an 1%day period. These sessions began 2-days after the pretreatment assessment with a minimum delay of 2 days between any two sessions. At the end of the last session all Ss, except those in the NT Group, filled out a five point rating scale which dealt with the depth of relaxation they experienced during the sessions. They were then given the same test battery as before to take home, fill out, and hand in when they returned for the post-treatment assessment. Upon Ss departure, each therapist rated each S assigned to him on a five point scale of likeability, responsiveness, appropriateness of length of treatment, appropriateness of type of treatment, reduction of anger, need for continued treatment of anger, improvement in other areas, need for treatment in other areas, how comfortable he (the therapist) felt working with him, and the depth of relaxation S was able to achieve.
476
CLIFFORD
R. O'DONNELL
and LEONARD
WORELL
Beginning 7 days after the last S completed treatment, all Ss were seen individually by E for a post-treatment assessment identical to the pre-treatment assessment. This involved presentation of the tape recording, slides and the measurements associated with them. Finally, the tape recordings of E’s interviews with each S were rated for anger indicated in verbal content (Gottschalk et al., 1963) by two assistants who were unfamiliar with the experiment. RESULTS The results from the test battery and behavioral assessment are presented by data from the post-treatment measures and the post-hoc analyses. The test battery and behavioral assessment
first, followed
measures
All data derived from pre- and post-measures were analyzed by fixed effects analyses of covariance with the premeasure as covariate and the post-measures as the variate. To assess the individual effect of each treatment, individual comparison F tests (Winer, 1971) were used to evaluate the differences between the means of the treatment groups and the No Treatment Control Group. The adjusted means of the Ss test battery are presented in Table 1. The mean for the DM Group is significantly lower than the NT mean on both the anxiety (F = 5.88, DF = l/27, p < 0.04) and disgust (F = 6.19, DF = l/27, p < 0.03) subscales of the ERS. No other differences between treatment groups and NT reached an acceptable level of significance on the measures in Table 1. However, the means were in the expected direction on all five measures for the DM Group and on four of the five measures for the DC and NR Groups. TABLE1. ADJUSTEDMEANSOF THE TESTBAI-~ERY Post-treatment Measure ERS-anger ERS-anxiety ERS-disgust Hostility inventory Ethnocentrism scale
Pre-treatment mean 36.7 30.6 38.3 20.4 44.3
means
DM
DC
NR
NT
28.1 23.9 30.0 19.8 47.2
29.8 26.2 32.9 23.6 48.3
32.6 30.1 35.0 21.1 54.0
33.1 32.5 37.8 21.2 50.2
The adjusted means for the behavioral assessment measures appear in Table 2. Comparison of the DC and NT Group means showed the DC mean to be lower on the Adjective Check List scored for anger (F = 7.19, DF = l/27, p < 0.02) but higher on both diastolic (F = 3.93, DF = l/27, p < 0.06) and systolic (F = 4.50, DF = l/27, p < 0.05) blood pressure. Here, the means were not in the expected direction on blood pressure; they were, however, on all four of the other measures for Groups DM and NR and three of the four for the DC Group. Post-treatment
measures
The post-treatment ratings made by the therapists and Ss were analyzed separately by fixed effects analyses of variance. To assess the relationship between ratings and reduction of emotion, the ratings were arranged in a 2 x 3 factorial design. Data for the first factor
TABLE 2. h3USTED
MEANS OFTHE. BEHAWOORAL ASSESSMENT
Post-treatment
means
Measure
Pre-treatment mean
DM
DC
NR
NT
Adjective check list Diastolic BP Systolic BP Verbal content rating Motor behavior rating Anger scale
4.0 76.9 i26.9 22.4 3.7 2.9
3.0 76.3 115.9 13.9 1.8 2.2
1.4 79,3 fI8.6 16.2 2.2 2.6
4.6 73.2 117.8 16.7 2.1 2.4
4.8 73.1 110.3 17.6 2.8 2.6
by dividing the Ss in each treatment group into two subgroups, determined by whether their pre-post difference scores on the combined subscales of the ERS were above or below the median. The three treatment groups constituted the three levels of the second factor. Since the NT Croup was not involved in these treatment ratings, Duncans Multiple Range Test was used here to evaluate the differences among the means on the latter measures. It wiil be recalled that two ratings of the depth of relaxation Ss achieved were obtained; one from the therapist and one from the S. The mean scores of these measures appear in Table 3. were obtained
TABLE~.MEANIZE~THOFRE~XA~ON
RATFNGS
Treatment Rater
Improvement
DM
DC
NR
Subject
High Low
5.00 4.00
5.00 4.50
4.25 4.00
Therapist
High Low
4.75 3.50
4.50 4.25
3.50 3.50
Analysis of the Ss relaxation scores yielded significant main effects for improvements F = 9.71, DF = l/18, p c 0.01, and treatment, F = 3.76, S)F = 2/B, p < 0.05. Simiiar trends, albeit non-significant, were found in the analysis of relaxation scores completed by the therapist (improvement, F = 3.19, DF = I/XX, p i: 0.10 and treatment, F = 3.47, DF = 2/18, p < 0.06). The source of the treatment effects was the difference between the mean ratings of the DC and NR Groups. The therapist also rated each S assigned to him on nine other variables. These mean ratings are listed in Table 4, A significant effect for improvement occurred only in the likeability data, F = 4.50, DF = l,QS,p < 0.05; treatment accounted for the other significant effects: reduction of anger, F = 13.19, DF = 2118, p -K 0.01 (DM and DC > NR), responsiveness, F = 18.06, DF = 2/l&, p c 0.01 (DM and DC > NR), appropriateness of the type of treatment, F = 19.65, DF = 2118, p < 0.01 (DM and DC > NR), and comfortability, F = 5.41, DF = 2118, p < 0.03 JDM s NR),
478
CLIFFORD R. O'DONNELL and LEONARD WORELL TABLE4. MEAN RATINGS OF SUBJECTS BY THERAPISTS Treatment Measure
Improvement
DM
DC
NR
Reduction of anger
High Low
4.00 3.75
4.00 3.50
2.50 2.25
Likeability
High Low
4.50 3.50
4.00 3.50
3.75 3.25
Responsiveness
High Low
4.50 3.75
4.25 3.75
2.00 2.00
Appropriateness of length of treatment
High Low
3.25 2.75
3.00 3.25
2.25 2.00
Appropriateness of type of treatment
High Low
4.50 4.00
3.75 3.25
1.75 1.75
Comfortability
High Low
5.00 4.75
3.75 3.50
3.00 2.75
Need for continued treatment for anger
High Low
2.50 3.00
2.50 2.50
2.75 3.50
Improvement in other areas
High Low
2.50 2.00
2.25 2.50
1.75 1.75
Need for continued treatment in other areas
High Low
1.75 3.25
2.50 2.50
2.25 3.25
Post-hoc analyses The Ethnocentrism Scale and the Buss-Durkee Hostility Inventory were included in the study to see if anger reduction might also be reflected in more general measures of prejudice and hostility. As reported before no significant changes occurred on either measure. Inspection of a change scores on the ERS, however, seemed to indicate that marked reductions of anger occurred for some Ss and slight or no reduction for others. Therefore, the Ethnocentrism and Hostility data were arranged in the same 2 x 3 factorial design that was used with the ratings and analyzed by fixed effects analyses of covariance. The adjusted means are presented in Table 5. Treatment by improvement interactions were significant for Ethnocentrism, F = 4.09, DF = 2/17, p < 0.05, and showed a trend for Overt Hostility, F = 2.81, DF = 2/17, p < 0.10. The sources of these effects lie in the differences between the means of the DM High and DM Low Groups. As a result interest was now focused on identifying the possible differences between the High and Low Groups within the DM condition (Mean ERS change scores = -15.2 and - 1.4 respectively). Therefore the prescores and therapist ratings of these groups were analyzed by analyses of variance. Significant effects occurred on the Anger Scale (x = 2.5 for Highs and 3.5 for Lows), F = 6.00, DF = 1/6,p < 0.05, likeability (x = 4.5 for Highs and 4.0 for Lows), F = 6.00, DF = l/6, p -c 0.05, and Ss relaxation ratings (x = 5.0 for Highs and 4.0 for Lows), F = 6.00, DF = l/6, p < 0.05.
MOTOR AND COGNITIVE RELAXATION IN THE D~ENSITIZATiO~
OF ANGER
479
TABLE 5. ADJUSTED MEAN SCORESOF THE ETHNOCENTRISM AND OVERTHOSTILITYSCALES Post-treatment
means*
Treatment
Ethnocentrism
Overt hostility
High
DM DC NR
39.7 56.5 56.2
8.0 10.4 10.5
Low
DM DC NR
61.0 46.5 58.4
10.7 10.7 9.7
Improvement
* The pretreatment means = 47.8 and 9.8 for ethnocentrism and overt hostility respectively.
Finally differences among the mean scores for ficance, F = < 1, nor alter the pattern of results ences in the mean number of items completed in DC = 9.8, NR = 9.1) were not significant, F =
social desirability did not approach signiif used as a covariate. In addition, differthe hierarchy for each group (DM = 9.9, < 1.
DISCUSSION This study was designed to assess the effectiveness of three procedures to reduce anger. Each procedure will be discussed in turn. The results for the DM group indicate that of the eight Ss, four showed marked reduction in anger, one a moderate reduction, and three showed little or no change. Only therapist ratings of anger reduction and ERS scores for anxiety and disgust showed significant overall differences relative to NT (NR). The therapist ratings may be more indicative of their expections than actual observed changes in Ss. The changes on ERS indicate that although the target behavior was anger, Ss demonstrated reliably greater change in anxieiy and disgust. This suggests that emotions other than the targeted one may be changed in desensitization. The results also suggest that DM may be an effective procedure for some Ss and not for others. If this is valid, then the importance of identifying the factors responsible is apparent. Present post-hoc analyses indicate that Ss for whom Dh4 was effective reported less anger after the pretreatment anger arousal procedure, greater depth of relaxation during treatment, and were liked more by their therapists. In addition, they reported a greater reduction in ethnocentrism and a trend toward lower overt hostility followed treatment. This points to the possibility that lower initial anger combined with greater relaxation may result in more effective changes. Lower initial anger may also heIp to explain the success of Rimm et al. (1971) in reducing anger in driving situations. Since their Ss volunteered on the basis that such anger was inappropriate, they may well be more similar to our Ss who reported less anger after the pre-treatment anger arousal procedure. It is also possibfe that anger in driving situations differs from racial anger with respect to length of conditioning and current social reinforcement contingencies. If so, then anger in driving situations may be more similar to racial anxiety and disgust in that these are less likely to be currently positively reinforced than racial anger.
480
CLIFFORD
R.O'DONNELL
and
LEONARD
WORELL
Another aspect which may be important~ne which was not assessed in this studyis the motivation of the Ss for participating in the study. Clearly with test and speech anxieties or anger during driving, the S will directly obtain benefits by anxiety or anger reduction. For anger provoked in white male Ss by racial stimuli, motivation for change is less clear. Some may be uncomfortabIe when such anger is aroused and genuinely wish to reduce it; others may be equally uncomfortable but expect negative reactions from friends, family, or fraternity brothers if they changed ; some others may volunteer to learn techniques to reduce anger but not be interested in anger related to racial stimuli, or finally, still others may volunteer solely for course credit. In addition, although instructions regarding expectations for improvement were equated across groups, no attempt was made to assess individual differences in expectancy. Given the current controversy over the effects of expectation within desensitization, it is possible that these differences may contribute to differential outcome. The DC Group scored significantly lower relative to NT (NR) only on therapist ratings for anger reduction and the Adjective Check List scored for anger. Concurrently, on both diastolic and systolic blood pressure they showed significant increases relative to NT. This type of discrepancy between self report and physiological measures is not uncommon (e.g. Lazarus and Alfert, 1964). It is of interest here, however, that this disparity between measures occurred only for the DC Group. Perhaps the focus on a cognitive form of relaxation, opposed to both cognitive and motor, continued during the post-assessment and resulted in Ss being relatively less aware of physiological reactions. Given this discrepancy and the lack of change on other measures, no firm conclusions can be reached regarding the effectiveness of the DC procedure. Further the results of the relaxation ratings indicate that improvement was related to depth rather than form of relaxation. That is, greater improvement occurred for Ss whose ratings indicated they were more relaxed during treatment across all treatment procedures. It may be then that depth of relaxation is most important for improvement, and that improvement is most IikeIy to be reflected in outcome measures which are similar to the form of relaxation used in treatment. No reliable differences occurred between the NR and NT Groups. This suggests that the ineffectiveness of a no relaxation group demonstrated in previous studies is not likely to be a function of either the yoking requirement or the absence of relaxation during the hierarchy presentation. Rather, training in relaxation prior to the hierarchy presentation appears to be important when relaxation is to be paired with imaginal aversive stimuli. Finally, although it may be possible to equate for expectancy for improvements with naive Ss assigned to a no relaxation group, it appears to be more difficult to do so with their therapists. The therapist ratings suggest a strong bias regarding the efficacy of the three procedures in favor of the DM and DC Groups. Ctearly, if possible expectancy effects are to be controlled, it is necessary to do so for both Ss and therapists.
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MOTOR AND COGNITIVE RELAXATION IN THE DESENSITIZATION OF ANGER
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