Cash Richard, Varker Tracey, McHugh Tony, Metcalf Olivia, Howard Alexandra, Lloyd Delyth, Costello Jacqueline, Said David, Forbes David
Department of Psychiatry, Phoenix Australia - Centre for Posttraumatic Mental Health, University of Melbourne, Carlton, Victoria, Australia.
Department of Psychiatry, University of Melbourne, Carlton, Victoria, Australia.
Mil Med. 2018 Sep 1;183(9-10):e286-e290. doi: 10.1093/milmed/usx115.
Problematic anger is a significant clinical issue in military personnel, and is further complicated by comorbid post-traumatic stress disorder (PTSD). Despite increasing numbers of military personnel returning from deployment with anger and aggression difficulties, the treatment of problematic anger has received scant attention. There are currently no interventions that directly target problematic anger in the context of military-related PTSD. The aim of this case series is to examine the effectiveness of an intervention specifically developed for treating problematic anger in current serving military personnel with comorbid PTSD.
Eight Australian Defence Force Army personnel with problematic anger and comorbid PTSD received a manualized 12-session cognitive behaviorally based anger intervention, delivered one-to-one by Australian Defence Force mental health clinicians. Standardized measures of anger, PTSD, depression, and anxiety were administered pre- and post-treatment.
The initial mean severity scores for anger indicated a high degree of pre-treatment problematic anger. Anger scores reduced significantly from pre to post-treatment (d = 1.56), with 88% of participants exhibiting meaningful reduction in anger scores. PTSD symptoms also reduced significantly (d = 0.96), with 63% of participants experiencing a clinically meaningful reduction in PTSD scores. All of those who took part in the therapy completed all therapy sessions.
This brief report provides preliminary evidence that an intervention for problematic anger not only significantly reduces anger levels in military personnel, but can also significantly reduce PTSD symptoms. Given that anger can interfere with PTSD treatment outcomes, prioritizing anger treatment may improve the effectiveness of PTSD interventions.
问题性愤怒是军事人员中的一个重要临床问题,创伤后应激障碍(PTSD)共病使其进一步复杂化。尽管越来越多从部署任务中归来的军事人员存在愤怒和攻击行为方面的困难,但问题性愤怒的治疗却很少受到关注。目前尚无在与军事相关的PTSD背景下直接针对问题性愤怒的干预措施。本病例系列的目的是检验一种专门为治疗患有PTSD共病的现役军事人员的问题性愤怒而开发的干预措施的有效性。
八名患有问题性愤怒和PTSD共病的澳大利亚国防军陆军人员接受了由澳大利亚国防军心理健康临床医生一对一提供的基于认知行为疗法的12节愤怒干预手册化治疗。在治疗前和治疗后实施了愤怒、PTSD、抑郁和焦虑的标准化测量。
愤怒的初始平均严重程度评分表明治疗前存在高度的问题性愤怒。愤怒评分从治疗前到治疗后显著降低(d = 1.56),88%的参与者愤怒评分有显著降低。PTSD症状也显著降低(d = 0.96),63%的参与者PTSD评分有临床意义的降低。所有参与治疗的人都完成了所有治疗课程。
本简要报告提供了初步证据,表明针对问题性愤怒的干预不仅能显著降低军事人员的愤怒水平,还能显著减轻PTSD症状。鉴于愤怒会干扰PTSD的治疗效果,优先治疗愤怒可能会提高PTSD干预措施的有效性。