Using Group Therapy to Reduce Anger in Middle School Boys Josie Boehlert

Problems Associated with Anger Issues Academic failure Truancy Dropout Peer rejection Tobacco, alcohol and drug use Suicidal behavior Often becomes worse over time (Sutcu, Aydin, & Sorias, 2010)

Reasons Group Therapy Should be Used Access to multiple students (Burt, Patel, & Lewis, 2012) Students’ behaviors are shaped by peer perception – presence of others might affect behavior Support inside and outside of group “Naturally occurring community of reinforcers” Minimize stress of unfamiliar Members might feel more open to share with people that they can relate to (Dwivedi & Gupta, 2000)

Role of School Counselors Support academic achievement Support social development Improve functioning of whole school

Application of CBT Behavior is learned and can be changed Allows member to try out new behaviors Promote understanding of anger as a process Identifies clear goals Helps students identify triggers Provides coping strategies

CBT Techniques Modeling Behavior rehearsal Coaching Homework Feedback Reinforcement Cognitive restructuring

Pre-group Measures

Screening Initial pool from teacher referral Research conduct reports (Burt, Patel, & Lewis, 2012) Observation Brief interview (Dwivedi & Gupta, 2000) Assess potential for change Consider group dynamics Ability to gain parental consent Choose 5-7 students in same grade

Logistical Planning Scheduling – 30 minutes Location Parental permission Create plans Obtain necessary materials

Group Process

Initial Session Explain purpose Positive framing (Burt, Patel, & Lewis, 2012) Informed consent/confidentiality Identify goals Create rules & consequences Pre-intervention questionnaire (Burt, Patel, & Lewis, 2012)

Session 2 Summarize previous session/review goals Introduce topic Psychoeducation: Talk about situations that cause anger Discuss how anger feels for students Activity: Create an “anger-log.” Students may decorate. On first page, include goals and note signs of anger to watch for Assign Homework: Instruct students to pay attention to triggers, physiological reactions, and behaviors and log

Session 3 Review previous session/ review goals Share notes in anger log homework and discuss Psychoeducation: Talk about acceptable reactions to anger Activity: Play the “Anger Solution Game” Assign homework: Students should record their acceptable and unacceptable reactions to anger

Session 4 Review previous session/ review goals Share notes in anger log homework and discuss Focus on strengths Psychoeducation: Coping skills: Thought stopping, breathing exercises, Progressive Muscle Relaxation (PMR) Activity: Engage in PMT and breathing exercise. Discuss. Inform students that they will be responsible for teaching classmates PMR and/or breathing exercise as a final project Homework: Instruct students to use coping strategies in anger situations and log

Session 5 Review previous session/ review goals Share notes in anger log homework and discuss Psychoeducation: Talk about problem solving skills and communication Activity: Role play anger situations Practice breathing and PMR Homework: Log anger reactions and successful use of problem solving skills, communication skills, breathing exercises and PMR

Session 6 Review previous session/ review goals Share notes in anger log homework and discuss Address termination Activity: Remind students that they will be instructing their classmates in PMR or breathing in the coming week Work together to create a script and assign roles Practice presentation Discuss feelings about presentation Homework: Practice presentation Log anger and coping strategies

Presentation Arrange with teacher Introduce purpose to class Introduce students Observe while students teach classmates

Session 7: Termination Review previous session/ review goals Discuss presentation and associated feelings Share notes in anger log homework and discuss Activity: Review goals. Discuss how they have been achieved. Ask students to write the “autobiography” of their futures Address strengths Address feelings associated with termination Give certificate of achievement (Dwivedi & Gupta, 2000)

Post-group Measures/Evaluation Post-intervention questionnaire Compare results to original Record increase in positive responses to anger as reported in students’ logs 6 month follow up (Sutcu, Aydin, & Sorias, 2010)

Possible Issues

Forming: Issues that may arise May be difficult to establish trust if members see counselor as disciplinarian All members have issues with social skills = may be difficult to form bonds Involuntary members may be unwilling to follow rules or engage Make goals of the group clear Set ground rules Deal openly with issues Encourage members to express themselves in constructive ways

Storming: Issues that may arise Members may feel defensive Conflict may arise Members may have conflict with leader Members may become annoyed with a difficult member Counselor should openly address conflict Counselor should teach members constructive ways of expressing feelings Counselor should have another adult that she can call on in the case of physical aggression

Norming/Performing: Issues that may arise Members may show improvement inside of group but not outside Make sure to revisit goals Give practical homework and activities

Issues that may arise in termination Strong feelings Members may not apply new skills outside of group Address termination early Encourage members to express feelings Discuss ways members will apply new skills

Skills that will be needed Group management Assertiveness Crisis management Knowledge of anger and coping strategies Knowledge of CBT Ability to confront Basic skills: listening, summarizing, reflecting, supporting, empathizing, goal setting, linking, blocking, etc.

Therapeutic Factors Trust – Members must build trust or be able to express lack of trust Empathy – members will benefit from empathy received from leader and other members. Members will work on the cultivation of empathy Intimacy – members will benefit from learning that they are like others Hope – CBT provides hope that change is possible Freedom to Experiment – Role play, relaxation

Therapeutic Factors Cont. Cognitive Restructuring – CBT helps spark change. Adopt more constructive beliefs Commitment to Change – Leader should attempt to elicit by stressing goals Self-Disclosure – Members with share with group Confrontation – Members will be encouraged to take responsibility for actions Feedback – Members and leaders will comment on strengths

Ethical/Multicultural Considerations Confidentiality (giving parents info) Attempt to ensure that no students feel isolated Incorporate diversity Protect members from harm Involuntary members - help them understand

References Burt, I., Patel, S. H., & Lewis, S. V. (2012). Anger management leadership groups: A creative intervention for increasing relational and social competencies aith aggressive youth. Journal Of Creativity In Mental Health, 7 (3), doi: / Dwivedi, K., & Gupta, A. (2000). 'Keeping cool': Anger management through group work. Support For Learning, 15(2), 76. Gaines, T., & Barry, L. M. (2008). The effect of a self-monitored relaxation breathing exercise on male adolescent aggressive behavior. Adolescence, 43 (170), Sportsman, E. L., Carlson, J. S., & Guthrie, K. M. (2010). Lesson learned from leading an anger management group using the 'Seeing Red’ curriculum within an elementary school. Journal Of Applied School Psychology, 26(4), doi: / Sütcü, S., Aydın, A., & Sorias, O. (2010). Effectiveness of a cognitive behavioral group therapy program for reducing anger and aggression in adolescents. Turk Psikoloji Dergisi, 25(66),