DDE Research Article KG, JJ, GL.pdf X @ File | C:/Users/Moonl/OneDrive/Desktop/Research%20Article%20KG,%20JJ,%20GL.pdf Not syncing . .. 5 | DISCUSSION The aims of this study were to examine the effectiveness of a widely used anger management treatment program by: (1) examining anger symptom changes across a diverse group of veterans with mental health concerns; (2) compar- PDF ing outcome measures of anger and PTSD symptoms between veterans with and without diagnoses of PTSD; and (3) examining potentially important modifiers of treatment response. Consistent with anger management studies among PDE nonveterans (Naeem, Clarke, & Kingdon, 2009; Walker et al., 2010) and with the results of Morland et al. (2010), we found a medium-to-large overall effect on the ADS:S across both groups, indicating that the large majority of + participants benefited significantly from the treatment program. Participants' scores improved on overall measures of anger and on all anger subscales, including reactivity and expression of anger, feelings of offense and resentment, and desire for retribution. Older participants with PTSD experienced less symptom improvement than older partic- ipants without PTSD, possibly due to late life changes, such as retirement and bereavement, which can exacerbate the condition (Averill & Beck, 2000). Differences in outcome scores on the ADS:S were not found based on diagnosis, as both the non-PTSD and the PTSD group appear to have benefited from the anger management treatment program. KALKSTEIN ET AL. WILEY- 1427 TABLE 2 Sociodemographic and other variables Variable n % Age 25-40 14 10.4 41-50 26 19.4 51-60 42 31.3 61-70 45 33.6 71-80 7 5.2 Gender Male 127 94.8 Female 7 5.2 Race Caucasian 36 26.9 African American 90 67.2 Hispanic or Latino 7 5.2 Native Hawaiian or Other Pacific Islander 1 0.7 Court mandated Yes 27 20.1 No 107 79.9 Primary mental health diagnosis PTSD 76 56.7 Depression 27 20.1 10:39 AM Type here to search O 9 54OF ~ 10/30/2021DDE Research Article KG, JJ, GL.pdf X @ File | C:/Users/Moonl/OneDrive/Desktop/Research%20Article%20KG,%20JJ,%20GL.pdf Not syncing . .. Court mandated Yes 27 20.1 No 107 79.9 Primary mental health diagnosis PTSD 76 56.7 PDF Depression 27 20.1 IED or impulse control disorder 5.2 PDE Adjustment disorder 3.7 GAD 3.0 + Schizoaffective disorder 2.2 OHHN NW AMY Alcohol dependence 1.5 Bipolar disorder 1.5 Schizophrenia 0.7 Panic disorder 0.7 No diagnosis 4.5 Service connection percentage Not service connected 27 20.1 0-60 23 15.1 70 26 19.4 80 21 15.7 10 7.5 10 27 20.1 Note. GAD = generalized anxiety disorder; IED = intermittent explosive disorder; PTSD = posttraumatic stress disorder. In contrast to Morland et al. (2010), who found overall PCL-M reductions after completion of the anger manage- ment treatment program, no significant change from pre to post was observed in this sample's PTSD group in either average PCL-M total score or within any of the PCL-M subscales. This result was surprising since irritability and anger are specifically queried among the hyperarousal items on the PCL-M. It is possible that our sample differed in demo- 1428 KALKSTEIN ET AL. -WILEY TABLE 3 Mean pre-treatment and post-treatment Anger Disorders Scale-Short Version (ADS:S) scores for group participants (n = 134) Pre-treatment score Post-treatment score p ADS:S Reactivity 22.4 18.2 <.001 ads:s anger vengeance reactivity y="-4.2x" am type here to search o f research article kg jj gl.pdf x file c: not syncing . .. kalkstein et al. table mean pre-treatment and post-treatment disorders scale-short version scores for group participants pdf score p pde ange d=".65" :s subscale pretest posttest figure change in multivariable regression model estimates predictor leader other ptsd percent service connected age stress disorder version. graphic or mental health characteristics from that of morland another potential explanation the lack improvement pcl-m may be absence relevant material samhsa program specifically target- ing ptsd-related anger. hyperarousal symptoms which represent symptom cluster most consistently associated with include problems such as sleep disturbance fatigue exacerbate irritability lower one threshold frustration. importance along vulnerability factors including marital physical illness eating habits exercise unemployment is emphasized program. demonstrating associations between these domains functioning frustration toler- ance could improve groups constituted similarly ours. this emphasis expanded into a self-contained session perhaps replacing two assertiveness classes. additionally content multivantable mover ads:5 b anger-in social activity relationship empathy exercises forgive- ness also added subscales showed less compared reactivity. financial considerations sample nonimprovement on pcl-m. bolton noted their treatment study while they did expect improvements measures assessing targeted by curriculum core symp- wiley- toms because among reasons veterans recognize questionnaires fear consequences compensation benefits should report has decreased sever- ity. losing have been factor current given high numbers receiving finding post ads were positively increases connection percentage. whose contained majority subjects va obtained similar results showing aggression significantly after manage- ment not. information differed variable. those broadened address context cognitive restructuring lesson. focuses irrational interpretations everyday events encourages reconsideration disputing emotional errors. discussion incorporate influence hypervigilance exaggerated startle response well flashback-related misinterpretations its common distortions. finally light avoidance often involve feelings detachment restricted affect focus increasing support improving interpersonal skills seeking out new relationships. identification places situations are emotionally triggering others feel more comfortable helpful planning activity. fi a: eyal i wiley reasons. questionnaires. sever percentage results. ptsd. errors hypervigi lance finally. symptoms. detachment. conflict resolution it particularly important pclm future since significant protective rosenheck. horvath king fairbank keane. adams updates ones we outlined appear supported findings formally incorporating them format provide additional benefit suffering limitation control against measure change. addition higher patients without diagnoses treated led first author. however. above. there no differences outcomes studies considerrandom assignment reduce effects. if possible inclusion women otherwise healthy adults would so effec- tiveness management can evaluated well. regarding educa- tional achievement was collected included potentially sociodemographic studies. using formal screening assess exclusion criteria alcohol substance abuse impairment ensure confounding variables present. designing projects rather than quality briefing about objectives advance. might attrition rate. although rate within range reported medicine national council. dropout necessarily limits generalizability only presents outcome who completed treatment. find volun- tarily left experience represented our findings. marital. social. occupational functioning. effectiveness pro gram clinical markers fully known. attempt possible. family members objective assessments changes rc salomon w http: references irg ti e11 l10 e>