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1. AGGRESSIVE BEHAVIOR Volume 30, pages 174–185 (2004) Anger Management Therapy With Young Male Offenders: An Evaluation of Treatment Outcome Jane L. Irelandn…
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  • 1. AGGRESSIVE BEHAVIOR Volume 30, pages 174–185 (2004) Anger Management Therapy With Young Male Offenders: An Evaluation of Treatment Outcome Jane L. Irelandn Psychological Services, Ashworth Hospital, Liverpool, and the Department of Psychology, University of Central Lancashire, Preston, United Kingdom : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : The aim of the present study was to assess the effectiveness of a brief group-based anger management intervention with young male offenders. Eighty-seven prisoners were assessed as suitable for the intervention. Fifty of these made up the experimental group and 37 the control. Prior to intervention prisoners completed a self-report anger questionnaire (Anger Management Assessment questionnaire: AMA). Prisoners were also assessed by officers on a checklist addressing angry behaviour (Wing Behaviour Checklist: WBC). Both measures were completed approximately two weeks before the date of the intervention and eight weeks after the intervention (and while the control group remained on the waiting list). It was predicted that the experimental group would show significant improvements in both measures following intervention and that no such change would be observed in the control group. This hypothesis was supported, with significant improvements observed in the experimental group and no change observed in the control. Aggr. Behav. 30:174–185, 2004. r 2004 Wiley-Liss, Inc. : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : Key words: anger therapy; young offenders; treatment outcome INTRODUCTION Dealing with anger and aggression in prisons has long been a serious issue. The decision to develop anger management programmes was mainly fuelled by the concerns of prison managers regarding the disruptive and aggressive behaviour of prisoners [Towl, 1994], with Home Office figures for disciplinary offences showing an increasing need to address anger and aggression in prisons [Law, 1997]. Anger management courses were developed mainly by therapists in North America, largely based on the individual clinical treatment developed by Novaco [1975]. These programs have been running in prisons since the late 1980s, with an Note: The views expressed in this paper are those of the author and not those of HM Prison Service. A brief preliminary version of this paper was published in Forensic Update (2000, Forensic Update, 63, pp. 12–16). It is reproduced here with permission. n Correspondence to: Jane L. Ireland, Psychological Services, Ashworth Hospital, Parkbourn, Liverpool, L31 1HW, UK. E-mail: Irelan-j@ashworth.nwest.nhs.uk Received 11 October 2002; Amended version accepted 9 December 2002 Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/ab.20014 r 2004 Wiley-Liss, Inc.
  • 2. Anger Management Therapy With Young Male Offenders 175 initial aim of, ‘‘..addressing anger and aggression in prisoners, and the long term goal of reducing disruptive behaviour’’ [Law, 1997, p. 91]. Such courses can have two main aims: firstly the reduction of violence within the prison, and secondly the reduction of aggressive and criminal behaviour following release [Hughes, 1993; Hunter, 1993]. As stated by Hunter [1993] however, ‘‘Anger management programs designed specifically for use in the prison setting are rare. They are also increasingly in demand but are rarely evaluated’’ [p. 3]. Determining the effectiveness of such courses is crucial, since their use within the prison service is growing [Hunter, 1993]. A survey conducted by Towl and Bailey [1993] in England and Wales showed that anger management programmes were the fourth most common types of groupwork in prisons, accounting for 10 per cent of all groupwork. Research that has addressed the effectiveness of anger management programmes for use with offenders is fairly limited [Novaco et al., 2001]. Measuring the effectiveness of such programmes in prison settings has its own difficulties. Hunter [1993] describes how the prison environment is unique and that, ‘‘subcultural expectations and rigid systems of prisoner management may reduce or mask program effectiveness’’ [p. 4]. One way of overcoming these difficulties is the use of multiple measures to assess program impact [Hunter, 1993], an approach adopted by the majority of studies. Existing research describes three main forms of measurement – self-report psychometric assessment, behavioural checklists, and disciplinary reports [Law, 1997]. There have also been a small number of studies that have attempted to address re-offending rates following course completion [e.g., Hunter, 1993]. Law [1997] reports that previous evaluations have found evidence of self-reported change on psychometric assessments and some evidence that disciplinary offences are reduced within young offender populations. Law [1997] reports that there appears to be less evidence of change with behavioural checklists, citing the study of Shepherd [1994] who found that significant changes were limited to individual items and not overall scores. The majority of the studies reviewed by Law, however, were unpublished studies or dissertations. Only a limited amount of published research has addressed the effectiveness of prison-based anger management courses. A brief description of a selection of these studies follows. In a study completed by Law [1997], the progress of adult male prisoners who completed an eight-session anger management programme was evaluated. There was a treatment group and a control group (which included prisoners awaiting a course). No data was provided on the number of prisoners in each group. The content of this course was similar to the one described in the present study. Measures included self-reports (psychometric assessments), behavioural checklists completed by prisoners, and staff and disciplinary reports. Measures were administered both prior to and following course completion. Regarding self-reports, all results for the experimental group were in a positive direction, indicating that prisoners felt more able to control and suppress angry responses. Significance, however, was limited to only one result on the State Trait Anger Expression Inventory (STAXI), indicating that prisoners were trying to control their anger more after attending the course. There were no significant differences found with behavioural checklists. Disciplinary reports decreased for the experimental group. There were nine in the six weeks before the course and three in the six weeks after. No data on disciplinary offences were collected for the control group. There were no significant differences reported for the control group on either the self-reports or behavioural checklists. Towl and Dexter [1994] evaluated the progress of 50 adult male prisoners following an anger management programme similar to that of Law [1997]. Using the STAXI as a pre- and
  • 3. 176 Ireland post-measure they reported a significant reduction in the intensity of angry feelings experienced by prisoners following the course. The authors stated, however, that this finding could be attributed to very high pre-scores observed in six prisoners, and that for the majority of prisoners there was no significant decrease observed in the post scores. Regarding trait anger scores, a significant decrease in the scores was found following course completion. Hunter [1993] evaluated a ten-week anger management program used with a sample of 55 adult male prisoners (28 were in the treatment group and 27 the control). Measures included personality, anger, and hostility inventories; demographic/offence-related information; and disciplinary infringements before and after treatment. When compared with a control group, the treatment group showed significant change in specific areas. Impulsiveness, depression, and interpersonal problems were significantly lower at the end of the program, as was likelihood to assault (as measured by the Buss-Durkee Hostility Inventory). Verbal assaults recorded against staff were also significantly lower following treatment. Hunter [1993] concluded from this that such programs could be effective in two ways: they can encourage participants to approach conflict in interpersonal relationships more effectively and they can raise awareness regarding anger arousal and how to control it. Only a limited number of studies have addressed the relationship between prison-based anger management programmes and future criminal behaviour. Hughes [1993] evaluated the short and long-term impact of a programme with a group of adult male offenders. The program consisted of 24 hours of treatment over a 12–week period. The content of the program was similar to that described in the present study: 52 offenders were in the treatment group and 27 in the control. Long-term data was collected on approximately 50 per cent of the treatment group. Hughes [1993] reported both long-term and short-term effects. Regarding short-term effects, the treatment group showed significant reductions in a number of measures relating to aggression and anger. Nine members of the treatment group were also asked to take part in three standardised role-playing tests: their level of anger rated immediately after these role plays significantly decreased following course completion. Regarding long-term effects, program participation showed no effect on general recidivism but there was a trend for further violent convictions to be significantly reduced in the treatment group in comparison to the control group (40 per cent were re-convicted for a violent offence in the treatment group compared to 69 per cent in the control). In addition, the length of time in the community before re-arrest was significantly longer for those who had completed the program. The results from this study, however, need to be interpreted with caution: the treatment group described by Hughes [1993] included offenders who had attended ‘at least half of the program and were deemed to have received treatment.’ Thus this group appeared to contain offenders who had received different levels of treatment. In addition, short-term results for the comparison group were not reported since not enough data was collected. Finally, Escamilla [1998] evaluated the impact on a sample of 16 juvenile offenders who completed a six-session group intervention into angry behaviour. In a follow-up they reported that in the first year following completion of the course 25 per cent of the sample were not re-convicted for an offence, 50 per cent had re-offended but were not convicted of an aggressive offence, and 25 per cent were convicted of an aggressive offence. There were no significant differences reported for the non-matched control group. There was no pre-course information collected on the sample as part of the evaluation. There does appear to be some evidence that anger management interventions can be effective in reducing levels of anger, and that they may have some effect on future offending
  • 4. Anger Management Therapy With Young Male Offenders 177 behaviour. Differences in selection criteria for acceptance onto the course, however, and variance in the research designs adopted, coupled with differences observed in course content, style, length, and outcome measures makes any direct comparison between studies difficult. It also limits the number of firm conclusions that can be drawn. The aim of the present study was to assess the effectiveness of a brief group-based anger management intervention with young male offenders. A total of 87 prisoners took part in the study, 50 represented the experimental group and 37 the control. All prisoners were assessed as suitable for the intervention. Prisoners were required to complete a self-report anger questionnaire (Anger Management Assessment questionnaire: AMA) and had their behaviour assessed by prison officers on a checklist assessing angry behaviour (Wing Behaviour Checklist: WBC). Both measures were completed approximately two weeks before the date of the intervention. The same measures were completed eight weeks following intervention (and while the control group were still on the waiting list). It was predicted that the experimental group would show significant improvements in both the AMA and the WBC following the intervention in comparison to pre-scores. It was also predicted that no such change would be observed between pre- and post-measures for the control group. METHOD Description of the Programme The anger management programme used in the present study is based on cognitive- behavioural principles, argued to be among the most effective when dealing with deficits relating to anger management issues [Escamilla, 1998]. The present programme is a version of the national package that was developed in the United Kingdom in the late 1980s, becoming widely used in the 1990s [Clark, unpublished data (Wakefield Prison Anger Management Course Tutors Manual); HM Prison Service, 1992]. The programme described in the present study includes 12 one-hour sessions run over a three-day period. The average number of prisoners attending the course is ten, with two staff facilitators. A total of six facilitators delivered the programme over the period of the study. To ensure treatment integrity, all facilitators received the same level of training prior to completing the course and both followed a treatment manual to ensure consistency of delivery. In addition, all sessions were videotaped and feedback provided to the facilitators on their performance during the course by the treatment manager. The sessions incorporated a range of material; participants were required to complete anger diaries, to contribute to group discussions, to take part in role-plays and group exercises, to watch videos, and to complete pieces of homework. The 12 sessions addressed triggers to anger, consequences of anger loss, and the importance of behaviour, thoughts and feelings. A brief description of what the sessions covered is presented in Appendix 1. Process of Selecting Prisoners were referred to the anger management course by three main routes: by prison officers, other staff, or by self-referral. All referrals were assessed prior to selection. The assessment was standard for all prisoners and included the completion of a
  • 5. 178 Ireland cognitive-behavioural interview, conducted by a psychologist, and a behavioural checklist completed by prison officers. Each of these assessment measures are described below: Cognitive Behavioural Interview. The interview was identical for all referred prisoners. It addressed why they had been referred to the course, how often they lost their temper, and what happened the last time they lost their temper. They were asked to describe what happened before, during and after this temper loss in relation to their behaviours, thoughts and feelings. They were also asked to provide alternative ways of dealing with the situation. The interview concluded with an assessment of their motivation to complete the course, their attitude towards engaging in group-work, and a description of what would be expected of them during the sessions. Wing Behavioural Checklist (WBC). The checklist provided officers with a description of 29 different angry behaviours and asked them to rate the referred prisoner on each one using a scale ranging from ‘0’ (‘Never shows the behaviour’) to ‘2’ (‘Often shows the behaviour’). Officers were told to base their ratings on behaviours observed over the previous week. The behaviours included were taken from anger diaries completed by prisoners and a review of wing file information detailing incidents of anger loss. Examples of behaviours included, ‘Throws items about cell/wing,’ ‘Bangs on cell door,’ ‘Comes to office swearing and shouting,’ and ‘Points finger in conversations.’ The higher the score on the checklists the higher the anger level. The checklists were completed by the prisoners’ ‘personal officer’; on arrival to the prison each prisoner is allocated an officer. These ‘personal officers’ take a lead in the care and management of the prisoner and are the most familiar with their day-to-day behaviour. Prisoners were placed on the course if they showed evidence of angry behaviour, as observed by prison officers and/or they provided evidence of angry behaviour as measured during the interview. In addition, only prisoners who appeared motivated to take part in all aspects of the course were selected. Participants A quasi-experimental two-sample pre and post non-equivalent groups design was adopted, since it was not possible to randomly assign participants to each group [Robson, 1994]1. In order to ensure that all suitable prisoners completed an anger management course, prisoners were allocated based on their date of referral and their release date. Two groups were used, a ‘treatment’ (experimental) and an ‘awaiting treatment’ (control) group, in order to strengthen the experimental design. A matched design between the experimental and control group was not used since it was not possible to randomly assign participants to each group. Without random assignment the threat to internal validity was deemed too great. There are problems in using tests of significance in absence of random-sampling but the issue relates more to how the pattern of results are interpreted as opposed to precluding their use [Robson, 1994]. A brief description of the experimental and control groups follows. Experimental Group. The experimental group included 50 prisoners who had successfully completed all sessions of the anger management course. The mean age of this group was 19 years, 62 per cent were serving a sentence for a violent offence, 30 per cent for an acquisitive offence, 4 per cent for a drug-related offence, and 4 per cent for other offences. 1 Random assignment would mean withholding treatment from those who require it. Thus, it could be said that random assignment is not appropriate on ethical grounds.
  • 6. Anger Management Therapy With Young Male Offenders 179 Control Group. The control group included 37 prisoners who had been assessed as suitable for the course but had not yet completed it2. They represented those who had been placed on a waiting list for the course (i.e., awaiting treatment controls). The mean age of this group was 18 years, 68 per cent were serving a sentence for a violent offence, 24 per cent for an acquisitive offence, 5 per cent for a drug-related offence, and 3 per cent for other offences.3 Comparisons Between the Experimental and Control Groups. Prior to analysis, the experimental and control groups were compared on the variables of age, offence type, and pre scores on the WBC and AMA. There were no significant differences between the groups regarding age, pre-WBC score, or pre-AMA score (t = 61ns). Differences between the groups regarding offence were assessed using Logit analysis. No significant differences were observed with all z values o.40. Thus, it was concluded that the groups were not significantly different from one another in terms of age, offence, and levels of anger reported prior to course completion. In addition, all prisoners from both the control and the experimental groups indicated that they were willing to take part in the course. Pre and Post Measures Pre course information was collected for both groups approximately two weeks before the date of the course. Post course information was collected eight weeks later (after course completion for the experimental group and while the control group were still on the waiting list). The pre course data was collected by the course ‘treatment manager’ and the post course data by a psychological assistant who was not involved with the delivery of the course. Pre course information was obtained via the behavioural checklists (WBC) described previously, and a self-report questionnaire (Anger Management Assessment questionnaire: AMA) that included 53 it
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