Effect of cognitive behavioral intervention on responses to anger by middle school students with chronic behavior problems

ABSTRACT Cognitive-behavioral interventions (CBI), used to teach cognitive problem-solving skills, can remediate social deficits in youths who react inappropriately to feelings of anger with aggression or social withdrawal. This study was intended to provide a clearer understanding of CBI effects by using the Anger Control Curriculum on responses to anger by middle school students placed in an alternative school and in programs for students with emotional or behavioral disorders (E/BD). Results indicated that exposure to treatment decreased inappropriate external responses to anger and increased anger control as measured by student self-reports and teacher behavior checklists, while no effect was found for internal responses. Participants maintained some effect at a 4-week follow-up. The authors discuss implications for teachers, curriculum specialists, students, and researchers.

* As student behavioral responses to anger become more of a concern in public schools, program design becomes crucial to ensure school safety and to increase appropriate student social interactions. Chronic student anger can create an unpleasant and dangerous atmosphere in schools, resulting in a deterioration of the educational and social atmosphere. Many student behaviors that are considered discipline problems or a form of violence emanate from inappropriate responses to anger. Unfortunately, educators are often left with few alternatives to mitigate anger that is expressed through aggressive and violent acts. Thus, the reduction of inappropriate responses to anger must be targeted, and students should be offered replacement behaviors that assist them in interacting appropriately with peer and authority figures. Students can be taught methods to control their anger and to express it in constructive ways. Controlling anger involves identifying anger, developing management strategies, and expressing it appropriately (Gootman, 1997).

Inappropriate behavioral responses to feelings of anger in adolescent populations merit the attention of researchers, practitioners, legislators, and community members. At the same time, however, it is critical to differentiate between feelings of anger and appropriate and inappropriate responses. For instance, aggression is a set of primarily interpersonal actions that consist of verbal or physical behaviors that are destructive or injurious to others or objects (Bandura, 1973) and is one behavioral response to feelings of anger (Averill, 1982). Although most adolescents display various levels of aggression, it is only when it becomes exceptionally severe, frequent, or chronic that it indicates some form of psychopathology (Lochman, Curry, Burch, & Lampron, 1984). Excessive levels of aggressive behavior, an inappropriate behavioral response to anger, have been found to be stable over time (Kazdin, 1987; Loeber & Dishion, 1984) and to be predictive of a multitude of negative developmental outcomes. Adolescents who demonstrate deviant levels of aggression have been found to exhibit poor overall school adjustment, higher rates of juvenile delinquency, greater than average rates of school dropout, increased rates of adult criminal activity, and clinical problems (Loeber & Dishion, 1984).

Adolescents who experience problems responding appropriately in social situations (e.g., aggressively) often exhibit deficiencies in their social problem-solving abilities. Lochman and Dodge (1994) noted that highly aggressive adolescents generate fewer productive solutions to their social problems than do their nonaggressive counterparts. That is, they tend to generate more action-oriented solutions such as pushing or fighting (i.e., physically aggressive solutions), as compared to verbal assertion solutions such as talking about a conflict (Asarnow & Callan, 1985; Lochman & Lampron, 1986). In addition, aggressive adolescents often generate fewer bargaining and compromise solutions because they are less capable of accurately perceiving the motives of others. Thus, the solutions they develop are based on considering both the needs of self and others infrequently (Lochman, Wayland, & White, 1993). During the response-decision stage, aggressive adolescents tend to choose aggressive responses for social situations because they believe that such reactions will alleviate aversive behavior from others (Lochman & Dodge, 1994; Perry, Perry, & Rasmussen, 1986) and that their peers will not view their responses negatively (Slaby & Guerra, 1988).

Research on Cognitive-Behavioral Interventions

The cognitive-behavioral intervention model (CBI) represents one way practitioners can provide students with the requisite skills to respond to anger in socially acceptable ways (see, e.g., Etscheidt, 1991; Larson, 1994; Lochman & Curry, 1986) and to interpret social situations accurately (see, e.g., Lochman & Dodge, 1994). Cognitive-behavioral interventions offer strategies for teaching appropriate replacement skills that can be generalized to other settings and over time (see, e.g., Lochman, 1985; Lochman, et. al., 1984; Lochman & Lampron, 1985). They employ the techniques of cognitive behavior therapy to modify various classes of disorders such as anxiety, fears, phobias, aggression, and disorders of conduct. Such an approach provides effective cognitive strategies (i.e., cognitive components) for individuals to modify their underlying cognition. The CBI model engages a relationship between internal cognitive events and overt behavior change through teaching strategies that guide performance and reduce inappropriate behaviors. Through CBI, teachers can provide students with procedures to modify their thoughts and beliefs, thereby promoting self-regulation (Robinson, Smith, Miller, & Brownell, 1999).

Cognitive-behavioral interventions can also target the cognitive distortions that cause adolescents to rely on inappropriate behavioral responses in social situations. Thus, this investigation incorporated components that targeted altering social distortions (e.g., perspective taking, understanding and handling anger) and provided requisite skills (e.g., effective communication skills, cognitive problemsolving skills) to interact with others effectively and appropriately. Although the techniques inherent in CBI are promising in altering behavior of children and youths, closer scrutiny of their efficacy and efficiency is warranted, especially in school settings. We do, however, have insight into the effects of CBI used with children and youths through meta-analyses conducted by Dush, Hirt, and Schroeder (1989) and Robinson and colleagues (1999), as well as a more traditional literature review by Abi koff (1991).

Dush and his colleagues conducted a meta-analysis of 48 studies to measure the observed effects of self-statement modification (SSM), a specific form of cognitive therapy, on childhood behavioral disorders. These researchers selected studies whose participants exhibited disruptive or aggressive behavior, phobias and social anxieties, delinquency, and hyperactivity or impulsivity and included studies whose participants were in school settings, hospitals, residential treatment facilities, and outpatient clinics. Dush and colleagues found that participants exposed to SSM treatments experienced a half standard deviation greater gain, on the average, than the control groups. However, commingled diagnostic categories and some interventions conducted by therapists in clinical and residential treatment facilities demonstrated the need for a more refined selection of studies specific to definitive diagnostic categories with interventions conducted only in school settings.

Robinson and colleagues (1999) used meta-analysis to examine 23 CBI studies that targeted the reduction of hyperactivity/impulsivity and/or aggression in school settings. The mean effect size across all the studies was 0.74, and 89% of the studies had treatment participants who experienced greater gains on both posttest and maintenance measures when exposed to a treatment with a cognitive component. In addition, the researchers noted that their meta-analytic findings indicated that CBI implemented in school settings resulted in treatment effects that were maintained following intervention.

Conversely, Abikoff (1991) examined CBI studies and noted that few investigators reported significant positive results. Not only did Abikoff find that 62% (8 of 13) of the investigators reported no positive effect and that only 15% (2 of 13) suggested treatment generalization, he also identified inherent methodological problems in a number of the studies. Of note is that Abikoff's analysis focused primarily on children identified as having attention deficit hyperactivity disorder, and there was no delineation of how he chose studies for the review.

Purpose of the Study

The purpose of our research was to provide a clearer understanding of the effects of CBI when applied in school settings. Specifically, we wanted to determine the effect of a curriculum that focuses on teaching cognitive problem-solving skills (i.e., cognitive-behavioral intervention) on inappropriate behavioral responses to anger by middle school students. We also wanted to determine whether results can be maintained after instruction and to identify student and teacher perceptions (i.e., social validity) about the curriculum.

Methodology

Setting and Participants

Student participants were sixth, seventh, and eighth graders enrolled in two classes at one special day school (School 1, N = 13) for students who have exhibited chronic behavior problems (e.g., repeated fighting, blatant disrespect for authority, uncontrollable outbursts) and students enrolled in four self-contained programs for students with emotional or behavioral disorders (E/BD) in two general education schools (School 2, N = 15; School 3, N = 13) for a total of six classrooms. All participants were male. Behavior management strategies in each of the classrooms consisted of traditional methods such as suspension, time out, and administrative intervention. None of the six participating teachers used management strategies with cognitive components prior to the introduction of the curriculum. Although the students from the special day school were not identified as having UBD, their presenting problems (i.e., emotional and behavioral problems) were, according to student records, comparable to the students enrolled in the self-contained programs. Table 1 shows the distribution of students by age, race, and grade.

Only students with lQs of 80 or higher were included in the statistical analyses. Researchers have found that students with lQs that reflect cognitive disabilities (i.e., < 80) exhibit no measurable positive effects on specific knowledge or skills when exposed to a program that introduces problem-solving skills (Lauth & Wiedl, 1989). That is, these students are often unable to apply problem-solving skills. The indication is that students with extreme cognitive disabilities would not receive the same benefit of skills for dealing with anger from a program that teaches detailed problem-solving skills.

We used a cluster sampling procedure to assign groups. We randomly assigned one classroom from each school to either treatment or control to ensure that each group comprised participants with similar demographic and behavioral backgrounds. We assigned the first classroom drawn from each school to the treatment group and the second to the control group, resulting in one classroom from each of the schools being assigned to each group.

Instruments

Children's Behavior Checklist

There are different forms of the Children's Behavior Checklist (CBCL) that can be completed by parents, parent surrogates, and teachers for children and adolescents aged 4 to 16. The instruments consist of items delineating a broad range of behavior problems and social competencies (Achenbach, 1991; Achenbach & Edelbrock, 1979, 1983; Evans, 1975). Each of the 118 behavior problem items is scored on a 3-step Likert-type response scale.

Achenbach's (1991) revision resulted in eight predominant scales consisting of the following core syndromes: (I) withdrawn behavior, (II) somatic complaints, (III) anxious/ depressed behavior, (IV) social problems, (V) thought problems, (VI) attention problems, (VII) delinquent behavior, and (VIII) aggressive behavior. In addition, internalizing and externalizing groupings of behavioral/emotional problems were identified by conducting second-order factor analyses of syndromes I to VIII. Scales I, II, and III constitute the internalizing scale (i.e., withdrawn behavior, somatic complaints, anxious/depressed behavior). Social problems, thought problems, and attention problems that did not have consistently high loading on either the internalizing or externalizing scales were considered separately. Scales VII (delinquent behavior) and VIII (aggressive behavior) constitute the externalizing scale. The two optional scales, sex problems and other problems, were not used in our analysis.

The CBCL represents research efforts of over 30 years to develop an objective and standardized descriptive measure of the behavior problems and social competencies of children and adolescents. It was designed for use in clinical and research settings. The most recent revision (Achenbach, 1991) includes items that list a broad range of problems relevant to the mental health of children and adolescents and are easily observed by parents and teachers.

State - Trait Anger Expression Inventory

The State-Trait Anger Expression Inventory (STAXI) is a paper-and-pencil self-report questionnaire that provides a concise measure of the experience and expression of anger (Spielberger, 1988). Individuals rate themselves on 4-point Likert-type scales where 1 = almost never, 2 = sometimes, 3 = often, and 4 = almost always. The scales were designed to assess either the intensity of angry feelings or the frequency with which angry feelings are expressed, suppressed, controlled, or experienced.

As measured by the STAXI, anger is conceptualized as encompassing three major components. Anger-Out represents the expression of anger toward people and the environment, while Anger-In refers to anger directed inward (e.g., suppression of angry feelings). Anger-Control refers to individual differences in controlling the expression of anger (Spielberger, 1988).

The STAXI consists of 44 items that form six scales and two subscales. The six scales consist of the following:

1. State Anger, a 10-item scale (e.g., I am furious, I feel angry) that measures intensity of angry feelings at a specific time.

2. Trait Anger, a 10-item scale (e.g., I am quick tempered, I fly off the handle) that measures differences in perceiving a variety of situations with angry feelings. This scale is divided into two subscales, Angry Temperament and Angry Reaction.

3. Anger-In, an 8-item scale (e.g., I keep things in, I am irritated a great deal more than people are aware of) that measures the frequency of suppression of angry feelings.

4. Anger-Out, an 8-item scale (e.g., I lose my temper) that measures the frequency with which an individual expresses anger toward people or the environment.

5. Anger Control, an 8-item scale (e.g., I control my angry feelings) that measures the frequency with which an individual attempts to control the expression of anger.

6. Anger Expression, which includes scales 3, 4, and 5, providing an index for the frequency of anger expression, regardless of the direction (Spielberger, 1988).

Over the past 15 years, a number of researchers (e.g., Deffenbacher et al., 1996; Deffenbacher & Sabadell, 1992; Stoner, 1988) have reported acceptable levels of reliability and validity for the STAXI. For example, alpha reliabilities for State Anger range from .88 to .95, with the highest reliabilities for college students (Deffenbacher et al., 1996; Spielberger, 1988), and under provoked conditions, the State Anger scale has strong concurrent validity with anger measures such as the Anger Inventory (r = .60; Novaco, 1975) and the Anger Symptom Index (r = .37; Deffenbacher, Demm, & Brandon, 1986). Anger Expression, combining Anger-In, Anger-Out, and Anger Control, has alpha reliabilities ranging from .73 to .84 (Spielberger, 1988). Spielberger and colleagues (1985) reported concurrent validity of the Trait Anger scale with the Buss-Durkee Hostility Inventory (BDHI; Buss & Durkee, 1957). They reported correlations with the BDHI Total Scores ranging from .66 to .73.

Recall Tests

We gave five recall tests, each covering two lessons, to all students in the treatment group. The tests consisted of three or four questions instructing students to list information, define terminology, and pick correct responses. We designed the recall tests to determine whether the students were able to retain content material from the Anger Control Curriculum (ACC). The teachers conducted the test administrations, and a research assistant subsequently entered the data into an analysis program.

Research Procedures

In this investigation, we evaluated two groups using a pretest-posttest, control group design. The treatment group received a cognitivebehavioral intervention (i.e., Anger Control Curriculum) administered over a 10-week period. The first 5 weeks consisted of two lessons each week and Weeks 6 through 10 provided increased practice of the problemsolving skills. Students in the control group did not receive the ACC.

Treatment

Teachers taught the treatment group the 10lesson ACC (50-minute lessons over a 5-week period) for a total of 500 minutes of treatment exposure, along with an additional five practice sessions of approximately 50 minutes each over 5 weeks. They taught two lessons each week during weeks 1 through 5 and one lesson each week during weeks 6 through 10, for a total of 10 weeks of intervention and 750 minutes of treatment exposure. Generally, the format consisted of presentation or review of the rationale, involvement in an exercise (e.g., discussion, role-play, student activity) related to the training content, and final review of each day's progress.

Because many students require instruction to address inappropriate social interaction skills and distortion of social cues, we included the following elements in the ACC:

1. Lessons on understanding and handling anger.

2. Lessons about effective communication.

3. Introduction to relaxation techniques.

4. Presentation of problem-solving skills (e.g., problem identification, choosing among alternative solutions, evaluating the outcome).

5. Modeling of the intervention steps.

6. Practice (e.g., role-playing the use of the overt and covert self-statements) paired with performance feedback from the teachers and students.

As discussed previously, the CBI model engages a relationship between internal cognitive events (e.g., problem-solving ability) and overt behavior change (i.e., behavioral responses) through teaching strategies that guide performance and reduce inappropriate behaviors. In the ACC, we used well-established behavioral-based interventions such as role-play and demonstration (see Sugai & Lewis, 1996), to teach the cognitive processes involved with problem solving.

Each lesson included objectives, an introduction, and training strategies. The objectives described what the participants should master by the end of the lesson, the introduction explained the goals of each lesson, and the training strategies provided methods to achieve lesson goals. Participants' personal experiences were used for some problem situations, and practical solutions were identified that could be used during day-to-day interactions. One of the main goals of the program was to provide students with the tools to identify problem situations in their daily lives, including individual responses to anger, to slowly think through possible solutions, and to implement the best solution based on the evaluation of potential outcomes.

As part of the second lesson, the teachers instructed students to use so-called hassle logs. These logs provided students with a tool to identify situations in which they felt angry and the specific ways that they reacted to provoking events. The teachers used the hassle logs to gather descriptive information about the time and place of an incident, the angerprovoking element, who provoked the participant, the behavioral response, a self-reported level of anger, and the student's reaction to the outcome. The information provided generalization data about the students' use of the problem-solving skills in school and other settings. The teachers could use the illustrative provocations in the students' hassle logs to practice the skills taught during the training.

We designed Lessons 11 through 15 for students to practice the skills they learned in Lessons 1 through 10. A number of researchers (e.g., Lochman, 1985; Perri, Nezu, Patti, & McCann, 1989) have investigated the issue of treatment intensity with different presenting problems (e.g., anger, aggression, obesity, alcoholism) and concluded that programs with increased treatment intensity (i.e., greater number of minutes) will result in greater treatment gains.

Pilot Study

Prior to this study, we conducted a pilot study of the ACC, data-gathering instruments, and the recall tests with 13 students in a self-contained classroom for students with varying exceptional ities (e.g., emotional or behavioral disabilities, learning disabilities) in a general education school. We conducted the pilot study to ensure that our research materials and protocols were appropriate for students with special needs at the middle school level. The pilot teacher taught the ACC over a 3-week period and was asked to complete a questionnaire about each curriculum lesson. The teacher identified perceived strengths and weaknesses and suggested content modifications. Recommended modifications were based on the developmental level of middle school students (e.g., Are the lessons developmentally appropriate?) and content (e.g., Is all information covered?). After reading the comments, the first author debriefed the teacher to obtain a detailed account of any changes nec-' essary to improve the training. Following Week 2, the first author also met with the teacher to clarify lesson format and content, provide directions, and/or gather information about student response to the ACC.

We also used this time with the teacher to pilot a set of interview questions for the social validity part of our study. We used this information to revise the ACC and interview questions as necessary. In addition, we piloted the dependent measures to ensure that they we're appropriate. Two students completed STAXI forms, and the pilot teacher filled out the CBCL on the same two students. All participating students used the hassle logs and completed the exercises in the student workbook. The information gathered was used to modify activities and the hassle log as necessary. The students also completed the recall tests to determine whether middle schoolers with special needs were able to retain the material.

Teachers

All treatment and control teachers were fully certified. The special education teachers were certified to teach students with E/BD. We trained each treatment teacher during an hourlong training session at his or her school site. We gave the teachers the ACC prior to the training so that they could familiarize themselves with the material and have an opportunity to identify questions before the training session. Training consisted of introducing each of the lessons, discussing each of the activities in detail, and answering questions to ensure that the teachers were familiar with the concepts and learning strategies.

Fidelity of Treatment Implementation

Two research assistants (RAs) who were graduate students in education observed 20% (n = 3) of the lessons in each treatment classroom to evaluate treatment fidelity. We instructed the RAs to mark checklists corresponding to the specific lessons they observed. The checklists consisted of five observable behaviors (e.g., lesson activities, presentation materials) from each lesson. Through the observations, the RAs indicated that lesson components were or were not completely delivered to the treatment groups. We randomly selected Lessons 2, 6, and 9 to be observed in all treatment classrooms. Lessons during the observations ranged from 45 to 65 minutes. For the combined three observations conducted with each of the treatment teachers (i.e., nine total observations), reliability percentages were 100. That is, the teachers covered all content material during each week of intervention.

In addition, we debriefed the teachers following each unobserved lesson (i.e., Lessons 1, 3, 4, 5, 7, 8, and 10) to determine to what extent students were exposed to essentially the same content throughout the investigation. The debriefing consisted of asking the teachers whether they conducted specific activities during each lesson and marking the corresponding checklists consisting of five teaching behaviors. The teachers reported that the unobserved lesson presentations ranged from 50 to 65 minutes. All of the teachers stated that they presented all ACC material.

Data Analysis

We used data-collection methods consisting of standardized measures (e.g., self-report instrument, checklists) and recall tests. All students rated themselves on the STAXI (Spielberger, 1988) and the teachers rated them on the CBCL (Achenbach & Edelbrock, 1983) prior to training, immediately after training, and at a 4week follow-up time. The teachers administered the STAXI during class time and completed the CBCL on each of the students. We conducted data analyses to determine whether differences existed between the two groups at pretraining, posttraining, and followup. We conducted data analyses on the lowest-order scales with unique sets of items. For example, we did not use Trait Anger, since it is the sum of Angry Temperament and Angry Reaction.

We conducted tau-tests to identify significant differences between the two groups at posttest and follow-up. To control the overall Type I error rate more effectively, we used the Bonferroni inequality strategy to identify a more conservative alpha level. The equation is as follows: alpha ^sub c^ = alpha/c, where a refers to the overall alpha level and c refers to the number of comparisons (see Kennedy & Bush, 1985; Weinfurt, 1995). For the purposes of this investigation, alpha = .05, and we conducted eight comparisons on the CBCL and six on the STAXI. The resulting alpha levels used for significance testing were xc = .0063 for the CBCL and alpha ^sub c^ = .0083 for the STAXI.

Social Validity

As an additional component of the investigation, we interviewed treatment teachers and students to identify their perceptions about the ACC. It is important that investigators obtain information about the perceptions of individuals such as students, teachers, and parents who will use curricula to learn or teach new skills (e.g., problem solving, self-coping, self-reflection), including levels of satisfaction with curriculum components, goals and objectives, and associated outcomes. Without social validity, it is unlikely that teachers will implement the curricula or that students will use the procedures (see Wolf, 1978).

We employed interviews for detailed insight into program components that were successful, as well as to identify characteristics that may increase the likelihood that students would respond favorably to the lessons and to increase the probability that teachers would implement such a curriculum. At the conclusion of the intervention, we interviewed nine students and four teachers about the ACC. The interviews lasted approximately 30 minutes each, and we conducted them at the teachers' respective school sites.

During the pilot of the ACC, we also pilot tested the teacher and student interview protocols. We deleted or added interview questions based on the responses given by the pilot students and teacher. We deleted questions that failed to prompt responses about reactions to anger or the ACC and added questions emanating from participant responses that identified themes related to anger control. For example, we changed "Describe one of your most recent conflicts" to "Describe a recent situation in which you became angry" on the student protocol. The teacher interview consisted of 16 questions, while the student protocol had 6, with a number of follow-up questions designed to obtain more specific information. We structured the protocols to collect information on (a) students' behavioral responses to anger before and after lesson presentations and (b) student and teacher perceptions about the effectiveness and efficiency of the ACC.

We analyzed the data from the participant interviews using strategies described by Spradley (1979), and we used interview transcriptions to identify common themes through discussion based on the teachers' and students' overall perceptions about the ACC.

Results

Equivalency of Intervention Groups

We conducted several analyses to determine whether there were any preexisting differences between the treatment and control groups. Chi-square analyses revealed no significant differences between groups with respect to age (X^sup 2^ = 3.753, 4, p = .440) or race (X^sup 2^ = 1.263, 2, p = .532). Table 1 shows the age, race, and grade distribution of the treatment and control groups. The t-tests revealed no significant differences between the two groups on the pretest measures from the STAXI, nor on six of eight scales from the CBCL. The treatment group was rated significantly higher than the control group on the anxious/depressed and attention problems scales at p < .05. With the Bonferroni correction, no scales were significantly different at pretest. Tables 2 and 3 present the central tendency and variability of the data on the CBCL and the STAXI collected in this investigation by group and by instrument.

Data Analysis

We conducted contrasts to identify significant differences between the treatment and control groups. First, we used the Bonferroni correction to obtain more conservative alpha levels for the student self-report and the behavior checklist completed by the teachers. The first contrast compared the average posttest performance of the treatment group to the posttest performance of the students in the no-treatment, control group. Results of these analyses indicated a significant difference between treatment group and control group performance on the STAXI scales of State Anger (tau = 2.99, p = .0048), Angry Temperament (tau = 4.72, p = .0001), Angry Reaction (tau = 3.81, p = .0005), Anger-Out (tau = 2.82, p = .0076), and Anger Control (tau = -6.34, p = .0001). Results indicated a significant difference between treatment and control group performance on the CBCL Aggression scale (tau = 5.54, p = .0001 ).

The second group of contrasts compared the average follow-up performance of the treatment group to the follow-up performance of the students in the no-treatment, control group. The analyses indicated a significant difference between treatment and control groups on the Anger Control scale (tau = -3.10, p = .0036). We identified no significant differences for any of the scales from the CBCL or for any of the other scales from the STAXI.

Finally, the teachers administered recall tests to the students at the end of each week of instruction (i.e., Weeks 1 through 5) to determine whether students were able to learn the ACC material. Individual scores ranged from 0 to 100, and average scores per test ranged from 64.3 to 78.6 overall and from 62.5 to 87.5 for the school means. Overall, the students were able to recall approximately 74.3% of the content.

Social Validity

For the most part, the teachers and students responded favorably to the ACC lessons and activities (e.g., role plays), as well as the outcomes. The students and teachers reported that the lessons covered what they considered to be important content and that there was sufficient detail to introduce the students to the concepts of anger, communication, and problem solving.

Perceived Effectiveness

The teachers mainly focused on school behaviors, while the students were more global. That is, the students discussed problem situations that occurred in a number of different settings (e.g., playground, bus, home). The teachers also related that student behavior improved as a result of the ACC and the use of the hassle logs. They noted that their students responded less impulsively in many situations during the 10 weeks of instruction. For instance, one teacher stated that the fights in her classroom decreased during ACC instruction, and another said:

My students took more time to think before they acted. They were less likely to act without thinking about the consequences of their actions. Because of that, their behavior got better after the lesson presentations, especially after the problem-solving part was introduced.

The students tended to be more critical of the perceived effect of the ACC on student behavior. Nonetheless, they stated that important topics were covered that could help them deal with anger more effectively. For instance, one student at the alternative school stated:

The lessons helped me to act better. The things I learned are going to help me get outta here so I can go back to my regular school. When somebody messes with me, I used to just get in his face and tell him to back off. Doing that just got me in trouble because we would get in a fight most of the time. Now I try to ignore them or ask why they are messing with me . . . like when I play basketball and get fouled real hard, I ignore it.

Reported Satisfaction

The students noted both advantages and disadvantages of the ACC as a whole, but all of those interviewed felt that the training was beneficial for students who had problems dealing with anger. On the one hand, the students noted that the ACC helped prepare them to solve their problems without always having to go to an adult, as well as helping them to avoid fighting and getting in trouble because they made an inappropriate choice. Conversely, three of nine students, each from a different classroom, said that the lessons got boring at times and indicated that lessons shorter than 40 to 50 minutes would be better.

The three teachers reported that the lessons offered the students skills to make appropriate behavioral choices. For example, when we asked about the strengths of the ACC, one teacher stated:

I think that the lessons touched on most of what the students would need to know to act appropriately when they get angry. . . . Most of the problems that these students have seem to come from an inability to interact the right way in social situations, so I think it is important that they learn about ways to work and talk with others appropriately.

It should also be noted, however, that teachers were less satisfied with perceived maintenance of effect and reported that the students were not likely to generalize the skills to other settings. The students, on the other hand, reported specific instances of generalization and stated that they were more successful at resolving anger-related problems because of their exposure to ACC content.

Summary and Discussion

Inappropriate responses to anger represent a large segment of the problems faced by school professionals. The solution appears to lie in teaching students how to handle their anger appropriately. Anger-inducing situations (e.g., getting fouled on the basketball court, getting teased, not getting your way, having to do something distasteful) often emanate from social interactions and a student's inability to recognize the intent of others (Hudley, 1994). As educators begin the difficult process of identifying and implementing effective behavior-change strategies, they must consider student developmental levels; efficiency of the intervention; and social acceptance by teachers, students, administrators, and parents. Educators must design curricula that meet two separate student needs: a reduction of inappropriate responses to anger and appropriate replacement behaviors to interact with their peers and authority figures. Cognitive-behavioral interventions represent one choice for practitioners to provide students with the skills they need to respond to anger in socially acceptable ways.

Posttest Results

Posttest data analyses showed significant differences between treatment and control groups for State Anger, Angry Temperament, Angry Reaction, Anger-Out, and Anger Control scales of the STAXI. Similarly, analyses revealed significant differences between the treatment and control groups on the aggression scale of the CBCL.

The identified differences on the State Anger scale suggest that the students exposed to the ACC perceived their present feelings of anger to be less than those in the control group. The results obtained on the Angry Temperament and Angry Reaction scales indicate that the students who received the treatment had lower general levels of angry feelings about a variety of situations when compared to their control group counterparts. We believe that the ACC may provide students with foundational knowledge about perspective taking, understanding anger, and effective communication that can mollify angry feelings before inappropriate behavioral responses occur. Finally, results from the Anger-Out and Anger Control scales suggest that treatment students expressed their anger less frequently and succeeded more frequently at controlling their behavior than control group students. Handling anger, relaxation techniques, effective problem solving, in-class practice opportunities, and use of hassle logs may be the curricular components of the ACC that affected these outcomes. The differences found on the Aggression scale results from the CBCL validated the findings from the Anger Control scale of the STAXI. Similarly, our teacher interviews indicated that students were exhibiting fewer inappropriate aggressive behaviors (both physical and verbal) than before treatment.

Viewed together, the findings suggest that students who have characteristically responded to anger by directing inappropriate responses toward other people (i.e., verbal or physical aggression) or objects in the environment (e.g., destroying property) are capable of containing and controlling their behavior when taught skills to generate more appropriate solutions. Moreover, students can be taught skills to control their initial reactions (e.g., controlling impulsive behavior) to angerprovoking interactions. Treatment group students reported that they perceived anger differently and were actively attempting to control their anger-related behavioral responses and succeeding significantly more often than their control counterparts. Our findings from this investigation are consistent with the results of previous researchers (e.g., Lochman, 1985, 1992; Lochman, Coie, Underwood, & Terry, 1993; Lochman & Curry, 1986; Lochman, et. al., 1984), who concluded that teaching students cognitive-behavioral skills helps them to respond appropriately (e.g., using effective communication and problemsolving skills) when faced with anger-inducing stimuli.

As indicated by pretest scores on the STAXI and CBCL and interview data, many students in the study experienced difficulty avoiding impulsive reactions and accurately processing environmental social cues. Students and teachers related anecdotes about some students' misinterpretation of motives in social situations that would often lead to an out-of-control situation. Response patterns to social cues emanate from processing of environmental events, including all social information. In most situations, adolescents respond based on subconscious processing of the cues. If adolescents are adept at correctly interpreting the social cues from others, they are more likely to respond with socially acceptable behavior and be judged as socially competent. On the other hand, if they experience difficulty in any stage of processing, it is likely that they will respond with inappropriate strategies, including aggressive behavior (Dodge, 1986). Aggressive response patterns by the students were indicated by the teachers and students on the pretests, while posttest findings revealed that the students became more adept at responding appropriately to anger-provoking situations. Thus, the students were responding to anger by using more effective methods.

To enable students to deal with anger more effectively, strategies should be used that provide them with appropriate skills. Specifically, when taught anger control, communication, and problem-solving skills, the students who participated in this study were able to control their externally directed behaviors (i.e., physical and verbal aggression), as indicated by the results on student self-reports (i.e., STAXI) and teacher behavior checklists (i.e., CBCL).

The posttest analyses indicated no significant differences on the Anger-In scale of the STAXI or any of the other scales of the CBCL. While the significant findings indicated that the ACC was effective in altering general levels of anger and external behavioral response patterns, the lack of significant differences for the Internal Behavior scales indicates that the ACC exerted little or no effect on internally directed behaviors (e.g., refusal to talk, keeping anger inside). The findings for the internalizing scales of the STAXI and CBCL, however, were not totally unexpected. The ACC was not specifically directed toward altering internalized response patterns (e.g., an inability to build or maintain relationships, development of physical symptoms or fears, thought problems, attention problems, general pervasive moods of unhappiness), and failed to influence these patterns substantively. The fact that participants in this study came from school populations who traditionally exhibit externally directed behaviors (i.e., students with behavioral disorders and those served in alternative placements) may indicate that few students with internalizing behavioral patterns participated. Therefore, further cognitive-behavioral research should be conducted with students who exhibit internalized behaviors.

Maintenance of Effects

A 4-week follow-up administration of the dependent measures indicated continued, albeit diminishing, effects of the ACC. The treatment group continued to differ significantly from the control group on only the Anger Control scale of the STAXI. Follow-up analyses indicated no significant differences for any of the CBCL scales. On the STAXI, the treatment students were not significantly different at follow-up on the State Anger, Angry Temperament, Angry Reaction, or Anger-Out scales in comparison to the control participants. Thus, maintenance data indicate that students perceived themselves as continuing in their attempts to control their behavior, but levels of angry feelings appeared to regress.

The finding that treatment students continued to differ significantly on a measure of anger control suggests that the ACC's most powerful components might be skill acquisition (e.g., problem solving, relaxation) and practice through role-playing, along with opportunities for embedded instruction through the hassle logs. How long a student's anger control would continue without concomitant lower levels of angry feelings remains unknown.

The literature is replete with examples of failure to achieve maintenance when intervening to increase social competence. Gresham (1998) delineated recommendations for modifying interventions to increase the likelihood that maintenance effects will be achieved. First and foremost, he suggested that planning is an integral component of the process. The ACC included the hassle log, a self-reflection instrument that allows students to address real-life issues of concern. The premise was to rely on situations from student lives to teach the concepts in the ACC. Future research focusing on generalization should include practicing skills in environments in which the students interact (e.g., cafeteria, home, bus, mall). For example, homework assignments may be assigned to provide opportunities to practice skills in alternate settings.

Possible Limitations

As with many investigations, this study was not without possible limitations. First, logistical constraints such as school structure and student placement in classrooms prevented random selection of individual students. We addressed this issue by selecting one classroom from each of the three schools and randomly assigning it to either treatment or control, resulting in one classroom from each school serving in each group. Subsequently, the make-up of the groups was equivalent for race, age, and pretest scores. Second, we recognize that factors such as teacher enthusiasm, subtle modifications to the lessons, and student reactions are difficult to control and could contribute to differences in groups. We did, however, evaluate for treatment fidelity. We conducted observations for three lessons with each treatment teacher. Teachers were debriefed about the remaining lessons regarding content presentation, duration of lessons, and activities conducted. From the observations and debriefings, we concluded that the students received essentially the same exposure to the ACC.

Finally, we acknowledge that observation of student behavior may generate more accurate measures of a variable than self-reports in some cases. Nonetheless, observational data has limitations-for example, difficulty with identifying the behavioral indicators associated with a complex construct such as feelings of anger (see Gall, Borg, & Gall, 1996). Furthermore, criticisms of self-report measures usually center on their misuse, as compared to their use (Gay, 1996). Self-report measures often provide valid information that can shape the direction of future research and assist practitioners with decisions regarding the use of specific interventions and/or programs (see, e.g., research by Bussing, Zima, Belin, & Forness, 1998; Center & Callaway, 1999; Gresham, Lane, MacMillan, & Bocian, 1999; Zabel & Nigro, 1999). If measures are chosen carefully and constructed competently, valid and reliable information can be gathered.

Implications

Students

Students can benefit from a cognitive-behavioral curriculum designed to remediate inappropriate expression of anger. Teaching students problem-solving skills enables them to address anger during unpredictable situations. Students are taught how to think, as compared to what to think. By acquiring skills that can be applied in the presence of various anger-inducing stimuli, students can identify and implement appropriate behavioral responses.

Students who exhibit problems responding appropriately to anger may have deficits in a number of different areas. Thus, it is important to identify domains that may need remediation. For instance, if students are unable to recognize anger in themselves, it is important to introduce anger-related concepts (e.g., physical signs, levels of anger) to increase awareness and propose strategies for decreasing angry feelings (e.g., calming techniques, relaxation methods). Moreover, to respond appropriately with minimal assistance from others, students should be introduced to approaches such as problem solving for addressing novel anger-inducing conditions. For any academic or social program, the ability to problem solve represents one method to achieve the goal of independent functioning. Finally, many students misperceive the intentions of others during social interactions (Dodge, 1986). The cognitive-behavioral curriculum used in this investigation included lessons such as effective communication skills designed to address social perception and interaction deficiencies.

Teachers and Curriculum Specialists

The implications for teachers and curriculum specialists include designing curricula that rely on examples approximating or paralleling actual problems faced by students in school and other settings. Whalen, Henker, and Hinshaw (1985) delineated a comprehensive list of variables associated with establishing the effectiveness of CBI (e.g., specificity or generality of behavioral domains included; degree of involvement of parents, teachers, and peers; quality of purposeful training for maintenance and generalization) that should be considered during the design phase. The current investigation included the use of a hassle log that represents purposeful training for generalization. Increasing opportunities to practice skills in nonthreatening environments improves the probability that skills will be maintained and generalized (Vockell & Mihail, 1993). Thus, maintenance and generalization must be carefully planned for during the design phase of curricula that will facilitate implementation.

Researchers

Robinson and colleagues (1999) suggested the need for systematic and ongoing research to critique CBI techniques and to identify salient components that produce change in student behavior. When focusing on anger-related problems, future researchers could use (a) the same instruments (i.e., STAXI, CBCL) used in this investigation to replicate results and/or (b) the same or similar curriculum components. Replication of research will continue the process of delineating curricular components (e.g., length of treatment, hassle log) necessary for sustaining and generalizing results. Although many investigators have contributed to the CBI research base, few seem to have worked toward creating a systematic body of research, the notable exception being Lochman and his colleagues. They used the Anger Coping Program and the same instrumentation in numerous studies creating a foundational literature base.

To identify salient treatment components, investigators need to describe their research efforts in enough detail for others to make informed decisions about the results and conclusions of a study. Because there are a number of curricular components (e.g., communication skills, hassle log, problemsolving skills) that may have contributed to the changes identified in our treatment students, future investigators should examine further the elements necessary to engender appropriate change.

It is equally important that investigators identify curricular components that facilitate generalization and maintenance of skills. Planning for generalization of skills includes teaching behaviors that are naturally reinforced by adults and peers, using collaborative strategies across teachers and other educators, and including appropriate training techniques (e.g., multiple examples, multiple response options, multiple settings). Thus, researchers must specify appropriate teaching strategies to ensure that educators can carefully plan for generalization by including the relevant components. It should be noted that in this study the 10 lessons with 5 practice sessions may have been insufficient to produce, at followup, the broad results found at posttest.

Investigators need to begin the process of delineating the elements that facilitate maintenance of learned skills. Planning for maintenance of learned skills may include using booster sessions and embedding explicit instruction into the lesson formats of other subjects. For example, a social studies lesson may include topics from a daily newspaper that touch on anger-related incidents and the way they are handled, providing teachers with discussion points about true-to-life situations.

A number of questions regarding maintenance of learned skills need to be answered using rigorous investigative methods. For example, what is the effect of booster or practice lessons taught once a week, once a month, or bimonthly? What level of detail is necessary to design effective booster or practice lessons? What is the effect of using hassle logs (i.e., a self-reflection tool) on the maintenance of learned skills? Future researchers must provide the template for subsequent inquiries and the tools to judge the efficacy of cognitive-behavioral interventions.

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[Author Affiliation]

T. Rowand Robinson

University of Wisconsin-Whitewater

[Author Affiliation]

Stephen W. Smith and M. David Miller University of Florida

[Author Affiliation]

AUTHORS:

[Author Affiliation]

T. ROWAND ROBINSON, Adjunct Professor, University of Wisconsin-Whitewater, Whitewater, WI. STEPHEN W. SMITH, Professor, Department of Special Education, and M. DAVID MILLER, Professor and Chair, Department of Educational Psychology, University of Florida, Gainesville, FL.

[Author Affiliation]

MANUSCRIPT:

[Author Affiliation]

Initial Acceptance: 12/29/01

Final Acceptance: 3/5/01