Evid Based Mental Health: first published as 10.1136/ebmh.1.4.105 on 1 November 1998. Downloaded from 
                     THERAPEUTICS
                     Review: cognitive behavioural therapy is effective
                     for anger problems
                     Beck R,Fernandez E.Cognitive-behavioral therapy in the treatment of anger: a meta-analysis. Cognitive Therapy and Research 1998
                     Feb;22:63–74.
                     Question                                                            clinical adolescents, juvenile delinquents, inmates, and college
                     In people with anger problems, does cognitive behavioural           students. Effect sizes were calculated from self reports of anger,
                     therapy (CBT) reduce anger?                                         dependent measures of anger and aggression, and behavioural
                                                                                         ratings of aggression,andaveragedacrossvariablestoproduce1
                     Data sources                                                        effect size per study. The effect sizes for the 50 studies ranged
                     Studies were identified using PsycINFO and Dissertation             from −0.32to1.57(SD0.43)withalleffectsizesbutonepositive
                     Abstracts (1970–95) with the terms anger control, anger             in value. The grand mean weighted effect size was 0.70 which
                     treatment, and anger management.                                    differed significantly from zero (p<0.001) and means that the
                                                                                         average patient who received CBT fared better than 76% of
                     Study selection                                                     patients who did not receive CBT. This corresponds to a
                     Studies were selected if they included >4 patients,involved CBT     treatment success rate of 67% for CBT compared with 33% for
                     for anger, and reported >1 anger related dependent variable.        patients who received control treatments.
                     Studiesthatusedcognitiveorbehaviouralinterventionsaloneor
                     that aimed only to promote relaxation were excluded.
                     Data extraction                                                     Conclusion
                     Data were extracted on patient characteristics and numbers,         Cognitive behavioural therapy is effective in patients with anger
                     study design, and dependent variables.                              problems.
                     Main results                                                        Source of funding:not stated.
                     50studies (1640 patients) were included. Patient groups studied     For correspondence:Dr E Fernandez,Department of Psychology,Southern Methodist University,Dal-
                     included abusive parents and abusive spouses, schoolchildren,       las, TX 75275–0442,USA.Fax +1 214 768 3910.(email efernand@mail.smu.edu).
                     Commentary
                     The experience of anger is part of every-    anger disorders remain elusive.              lished. Most of the 50 studies included in
                     day living. We consider anger a problem         Practising clinicians who use CBT         the meta-analysis drew participants from                 http://ebmh.bmj.com/
                     especially when it emerges with verbal or    approaches will appreciate Beck and          educational and clinical settings. How-
                     physical aggression, or both. Clinical       Fernandez’s meta-analysis which comple-      ever, only 1 of the studies applied anger
                     knowledge has linked anger to health         ments the wealth of clinical and theoreti-   management to a “clinical adult” sample,
                     problems (eg, essential hypertension),       cal information on CBT currently avail-      1 study used mentally retarded adults, 2
                     psychosocial problems (eg, abusive be-       able. Other clinicians may be encouraged     studies used forensic inpatients, and 7 of
                     haviour), and some clinicians would like     by the empirical data to incorporate CBT     the 50 studies involved clinical adoles-
                     anger to be considered a disorder similar    into their practice. Some clinicians, how-   cents. Studies treating oppositional chil-
                     toanxietyanddepression.Intheforeward         ever, may point to the need for more         dren and adolescents are well repre-                      on September 26, 2022 by guest. Protected by copyright.
                     of a recent book on anger disorders,         diversity in the population encompassed      sented, with half of the studies in the
                     Albert Ellis states “Anger disorders, how-   by the studies in the meta-analysis. Al-     meta-analysis including them.
                     ever, are common and require clear defi-     though CBT is viewed as the state-of-the-               AnthonyBellissimo,MSc,PhD
                     nition, specific diagnosis and effective     art treatment for depression and anxiety                           McMaster University
                     treatment.”1 Beck and Fernandez’s meta-      disorders, it has lagged behind in its                       Hamilton,Ontario,Canada
                     analysis shows that CBT is an effective      applications to anger control.2
                     treatment for the reduction of anger.           The review by Beck and Fernandez           1 Kassinove H, editor. Anger disorders: definition,
                     However, support for CBT in a clinical       correctly concludes that “ecological valid-      diagnosis, and treatment. Washington, DC: Tay-
                     populationisstill limited and the issues of  ity” for the management of anger for the         lor and Francis, 1995:xii-xiii.
                     clear definition and specific diagnosis of   clinical population still needs to be estab-  2 Salkovskis PM, editor. Frontiers of cognitive
                                                                                                                   therapy. New York: Guildford Press, 1996.
                     Evidence-Based Mental Health   November 1998 Vol 1 No 4                                                              Therapeutics 105