Anger is a common symptom among military populations with posttraumatic stress disorder (PTSD); yet, anger treatment has received relatively little attention in the literature. This discrepancy is surprising given that excessive anger is a key predictor of treatment outcome in PTSD. This study seeks to (a) build a case for the importance of a more explicit approach to understanding and treating anger in our military and veteran populations, (b) summarize the current literature base on treatment factors and treatment outcomes for treating anger and related symptoms among veterans, and (c) offer clinical and research implications and recommendations based on current findings and on the expertise of the authors in completing a large-scale study of anger treatment with veterans.

The relationship between age of onset for conduct disorder (CD) and the externalizing disorder attention-deficit hyperactivity disorder (ADHD) is well researched. However, little is known about associations between age of CD onset and comorbid internalizing disorders. This study examined whether age of CD onset significantly predicted the presence of a comorbid mood or anxiety disorder in a community-based sample of adolescents (n = 147). Results showed each one-year increase in age of CD onset was significantly associated with increased probability of comorbid depression, but not significantly associated with the probability of a comorbid anxiety disorder. Analyses were replicated in subsamples of youth with (n = 77) and without (n = 70) ADHD. The significant positive relationship between age of CD onset and comorbid depression held in youth with ADHD only, while a negative relationship with anxiety emerged as significant in youth without ADHD.

An increased demand for accountability in community mental health systems has resulted in a need for valid, reliable measures of therapeutic practice. The Monthly Treatment and Progress Summary (MTPS), developed through the Hawaii Child and Adolescent Mental Health Division, is a clinician-report measure that describes therapeutic practices, treatment targets, and progress ratings for each treatment case. The current study evaluated the validity of the therapeutic strategies reported on the MTPS by comparing coder- and clinician-reported use of practices. Using 47 audio recordings from 19 youths' therapy sessions, trained observers reliably coded 12 discrete practices. Four of the 12 practices were found to be valid according to clinician-coder agreement (intraclass correlations ≥0.60). The coding system was revised, utilizing extensiveness and experiential scales, and 100 % of practices were valid according to clinician-coder agreement. Practical use of the MTPS, implications for service systems, and future directions for research on the MTPS are discussed.

Veteran and active duty populations evidence higher rates of intimate partner aggression (IPA) than comparable civilian groups, perhaps due in part to their unique service-related experiences. IPA offender treatment programs that take military background into consideration are not widely available, and it is unclear to what extent there is a perceived need for them among clinicians who serve service members and Veterans. Strength at Home (SAH) is a promising 12-session cognitive-behavioral group intervention designed to address IPA perpetration in military populations. While clinical support for SAH is emerging, the extent to which service members and Veterans find it appropriate and helpful is not yet known. Goals of the current study were threefold: (a) assess the perceived need for a military-specific IPA program among Veterans Administration and community domestic violence (DV) program providers; (b) conduct a pilot study to examine the feasibility and preliminary effectiveness of SAH in a sample drawn from a diverse, multicultural community; and (c) conduct focus groups to obtain participant feedback on the SAH protocol. Findings from the provider survey suggested a need for specialty programs to treat military personnel who perpetrate IPA of mildtomoderate severity. Results of the SAH pilot study (n = 6) indicated decreased psychological aggression and increased anger control from baseline to 6-month follow-up. Focus group feedback indicated participants found the program to be helpful and appropriate across a wide variety of ethno-cultural variables. As more service members and Veterans of the Iraq/Afghanistan war era reintegrate into our communities, it will become increasingly important for providers in both private and public sectors of care to understand the unique needs of this treatment population, and to have access to effective IPA treatment programs.

Frequency, level, and rate of improvement on 48 therapist-identified treatment targets were examined for 790 youth in usual care receiving intensive in-home services. Targets related to disruptive behavior, depressive mood, and functional impairment were most common. Overall, targets attained moderate levels of improvement and reached maximum gains in approximately three months. Targets associated with disruptive behavior and depressive mood disorders showed significantly greater improvement than those associated with ADHD. Anxiety-related targets improved quickest and significantly faster than disruptive behavior targets. Outcomes for targets within the same diagnostic group also varied substantially. Practice and implementation implications are discussed.