Using Interpretation Bias Modification to Reduce Anger in Veterans with Posttraumatic Stress Disorder: A Pilot Study

Abstract

Difficulty controlling anger is the most commonly reported reintegration concern among veterans with posttraumatic stress disorder (PTSD). One of the mechanisms associated with problematic anger is a tendency to interpret ambiguous interpersonal situations as hostile, known as the hostile interpretation bias (HIB). A computer-based interpretation bias modification (IBM) intervention has been shown to successfully reduce HIB and anger but has not been tested in veterans with PTSD. The current study was a pilot trial of this IBM intervention modified to address problematic anger among veterans with PTSD. Veterans with PTSD and a high level of anger (N = 7) completed eight sessions of IBM treatment over the course of 4 weeks. Participants completed self-report questionnaires at pre-and posttreatment assessment visits, as well as a treatment acceptability interview at posttreatment. Veterans experienced large reductions in hostile interpretation bias and anger from pre-to posttreatment, ds = 1.03-1.96, although these estimates may be unstable due to the small sample size. The feasibility for recruitment, retention, and treatment completion were high. Questionnaire and interview data demonstrated that most participants were satisfied with the treatment and found it helpful and easy to use. Overall, IBM for anger was feasible and acceptable to veterans with PTSD and was associated with reductions in hostile interpretations and self-reported anger outcomes. Further research examining this approach is warranted. Difficulty controlling anger is the most commonly reported reintegration concern among combat veterans, especially those with posttraumatic stress disorder (PTSD; Sayer et al., 2010). In veterans, problematic anger is associated with numerous psychosocial challenges, including poor social and occupa

Development and refinement of the mobile anger reduction intervention for veterans with posttraumatic stress disorder.

“…To this end, additional training scenarios were developed for a total of 840. Consistent with the previous scenario development (see Dillon et al, 2020), nine PTSD experts reviewed the new scenarios to confirm that the content was relevant to this patient population. An online readability calculator (https://readabilityformulas.com/) was used to confirm that all scenarios were at a sixth-grade reading level or less.…”

“…The computer-based intervention consisted of eight sessions, each with 64 training scenarios, which took 15 min for participants to complete (see Dillon et al, 2020). The MARI application was designed to deliver the intervention more frequently for shorter durations (i.e., 10 min five times weekly for 4 weeks).…”

“…IBM has primarily been delivered via computer and essentially helps participants to adopt more adaptive interpretational styles through repeated practice resolving ambiguous situations in a benign way. Recently, we have modified this intervention for veterans with PTSD and problematic anger (Dillon et al, 2020). In a small sample of veterans with PTSD and a high level of anger ( N = 7), eight 15-min sessions of IBM, delivered via computer, helped reduce hostile interpretations and anger (Cohen’s d effect sizes = 1.03–1.96).…”

Homelessness and Contact with the Criminal Legal System among U.S. Combat Veterans: An Exploration of Potential Mediating Factors

“…Respondents were asked to report the extent to which they have been distressed or bothered by six hostility symptoms in the past month, including (a) having urges to break or smash things, (b) having urges to beat, injure, or harm someone, (c) feeling easily annoyed or irritated, (d) temper outbursts that they could not control, (e) getting into frequent arguments, and (f) shouting or throwing things. Response categories for each item ranged from “0 = not at all ” to “4 = extremely .” Although labeled as hostility, the construct is more aligned with anger, as it measures the thoughts, feelings, and actions characteristic of anger (Dillon et al, 2020). To assess lifetime major depressive disorder (MDD), a dichotomous measure was created based on a modified self-report version of the major depressive disorder module from the DSM -5 version of the MINI Neuropsychiatric Interview (Panza et al, 2022; Sheehan et al, 2016).…”

“…Response categories for each item ranged from "0 = not at all" to "4 = extremely." Although labeled as hostility, the construct is more aligned with anger, as it measures the thoughts, feelings, and actions characteristic of anger (Dillon et al, 2020). To assess lifetime major depressive disorder (MDD), a dichotomous measure was created based on a modified self-report version of the major depressive disorder module from the DSM-5 version of the MINI Neuropsychiatric Interview (Panza et al, 2022;Sheehan et al, 2016).…”