Controlling Angry Aggression: A Pilot Group Intervention With Personality Disordered Offenders

Abstract

In this paper, we describe the progress of four male, legally-detained personality disordered offenders in a group treatment programme for angry aggression. ''Controlling angry aggression'' is a 15-session, structured, cognitive-behavioural programme that is part of a wider integrated, multidisciplinary treatment programme run within a specialist personality disorder treatment unit. Psychometric tests showed that three of the four patients improved over the course of the treatment programme. Behaviour ratings of staff and patients concurred, allowing confidence in patients' self-report of anger. No change in behaviour was evident over time for any patient, but initial low rates of aggression allowed little room for improvement. Self-monitored anger and aggression scores did vary markedly over time, and since behaviour remains stable despite anger, this indicates that these patients can control their behaviour. One patient did not improve, and reasons for this are examined, concluding with a reminder of the need for rigorous selection of patients for treatment programmes.

A systematic review of structured group interventions with mentally disordered offenders

“…• Problem-solving skills training (seven studies) (Jones and McColl, 1991;Donnelly and Guy, 1998;Donnelly and Scott, 1999;McMurran et al, 1999;McGuire, 2000;Fleck et al, 2001;McMurran et al, 2001b); • Anger/Aggression management (four studies) (Stermac, 1986;Grant, 1999;McMurran et al, 2001c;Hilton and Frankel, 2003); • Deliberate self-harm interventions (two studies) (Low et al, 2001;Evershed et al, 2003); • Other (seven studies) (Rice, 1983;Beck-Sander et al, 1998;Tennant and Hughes, 1998;Moore et al, 2000;Donnelly et al, 2001;Jennings et al, 2002;Hodel and West, 2003).…”

“…The duration of these groups varied considerably between programmes: mean number of sessions 16.6 (range 6-54). The frequency of the programmes also varied between weekly sessions (Jones and McColl, 1991;Donnelly and Guy, 1998;Donnelly and Scott, 1999;McMurran et al, 1999;McGuire, 2000;McMurran et al, 2001a;McMurran et al, 2001c) and bi-weekly sessions (Fleck et al, 2001). Each session ranged from one and a half to two hours with only Jones and McColl (1991) not including this information in their study.…”

“…The duration and frequency of interventions between the studies varied with the mean number of sessions being 11.5 (range 6-15). Three studies carried out the intervention weekly (Grant, 1999;Hilton and Frankel, 2003;McMurran et al, 2001c), whilst Stermac (1986) used bi-weekly sessions.…”

The manualization of a treatment programme for personality disorder

“…The PDU manuals have passed the first stage in this scheme, in that the treatment has been specified and pilot evaluations of specific components have been enabled (e.g. McMurran, Charlesworth, et al, 2001;McMurran, Fyffe, et al, 2001). To fulfil stage two criteria, further attention needs to be paid to developing staff training and methods of monitoring adherence to the programme.…”

“…sessions within the programme to illustrate to patients that the problem-solving approach is applicable to anger problems, as well as the more specific cognitive-behavioural techniques taught on the programme. Controlling Angry Aggression has been piloted with only four patients, three of whom did better on psychometric measures of anger and aggression after treatment (McMurran, Charlesworth et al, 2001). Important to note was that ongoing self-monitoring indicated fluctuations in anger experiences but behaviour was stable over that same period.…”