Cognitive therapy for violence: reaching the parts that anger management doesn't reach

Abstract

In forensic clinical settings, the most popular model for working with violence has been anger management, which uses a cognitive behavioural approach to explain how stimuli may cause anger via a series of information processing biases. There seem to be a variety of cognitions and thinking processes that are either more common or more extreme in individuals who behave violently. Despite concerns about meta-analytic reviews of treatment effectiveness, and reservations about the relevance of anger management for reducing violence and reoffending, its use is widely advocated in prison and secure settings. We have suggested that low self-esteem is central to violence rather than high self-esteem, but that selfesteem may appear high. Combining cognitive behavioural and psychodynamic approaches produces a formulation that can be used for treatment incorporating not only emotional and behavioural work but also reconstruction of core beliefs and dysfunctional assumptions (rules). It is proposed that because important cognitions relating to violence also relate to self-esteem and the protection of (false inflated) low self-esteem in the face of humiliation, any intervention for violence must also account for a fragile inner sense of self-esteem which, it is proposed, has a causal relationship (along with other factors) with violence. The approach presented here includes a number of core therapeutic tasks. A case study is described to demonstrate its application. It offers a structured but flexible and individually tailored approach to working clinically with violence.Anybody can become angry -that is easy; but to be angry with the right person, and to the right degree, and at the right time, and for the right purpose and in the right way -that is not within everybody's power and is not easy. (Aristotle, 384-322 B.C.) 1 This article is published as a companion piece to ''False inflated self-esteem and violence: A systematic review and cognitive model'' by Julian S. Walker and Jenifer A. Bright, which was published inIntroduction: Developing a treatment package Designing a single treatment for violence would be like giving analgesia as the sole treatment for chest pain -it may be a suitable treatment for some, but ineffective or inappropriate for others. The unique development and causes of the problem for an individual are central for deciding the best treatment. With violence there are a vast number of possible causative, exacerbating, and ameliorating factors which may act differently in combination with one another. The best and most effective treatment will depend on which of these factors are involved and which are most important in increasing the risk of violence (Bush, 1995). Regardless of the therapeutic perspective of the treating therapist, there is no substitute for a good formulation that takes account of both aetiological and maintaining factors as a guide to intervention. Walker and Bright (2009) offer a formulation based on fragile false inflated self-esteem, and the current paper offers a guide to its clini...

The evaluation of violent thinking in adult offenders and non‐offenders using the Maudsley Violence Questionnaire

“…The mean scores suggested that Machismo should be the main focus of intervention. The MVQ has been used as a pre‐/post‐measure to test the impact of cognitive therapy for violence (Walker and Bright, ). This case study demonstrated violence reduction after treatment of an offender, and in Machismo thinking, but no change in Acceptance‐type thinking.…”

A systematic review of the association between rape myth acceptance and male-on-female sexual violence

“…Researchers (e.g. Walker & Bright, 2009;Bowes & McMurran, 2013) have emphasised the need to examine the cognitive distortions associated with sexual violence, as these distortions may have predictive validity for recidivism (Helmus et al, 2013), and targeting these variables is thought to enhance the effectiveness of treatment (see: Olver, Nicholaichuk, Kingston, & Wong, 2014).…”

A Randomized Controlled Trial Exploring the Effects of Brief Anger Management on Community-Based Offenders in Malta

“…Although manualized and structured, the sessions allow flexibility to focus on the idiosyncratic variants and needs of the client’s problematic anger. This focus on individual needs is considered one of the hallmarks of good quality interventions (Walker & Bright, 2009). The one-to-one format might mitigate for the brevity of interventions.…”

“…In fact, some studies have reported that some violent offenders had no pathological or problematic levels of anger despite being incarcerated for violence and aggression (Heseltine, Howells, & Day, 2010; Howells, 2004; Watt & Howells, 1999). Therefore, proper assessment and formulation to determine the role of anger in the offending behavior and the person’s overall functioning is essential to ensure that appropriate interventions are delivered to respective clients (Howells, 2004; Novaco, 2011a, 2011b; Walker & Bright, 2009). It is recommended that anger management should only be considered if there are clear triggers for anger; a pattern of dysfunctional cognitive appraisal systems; an element of physiological arousal; an intense feeling of anger; impulsive actions and behavioral reactions related to the angry feeling (Howells, 2004).…”