To Örebro University

A large body of research identifies therapist expressed empathy as one of the most important predictors of psychotherapy outcome. Deliberate practice (DP) is an effective method to improve skills in many fields. We asked if DP also can be used to enhance the skill of expressing empathy.

Objective: The aim was to compare the efficacy of DP to didactical learning methods (DLM) in enhancing the skill of empathic expression in students.

Method: A repeated measures randomized controlled group design was used. Novice students (N = 36) from psychologist-, medicine-, social work-, and nursing programs received two training sessions of either DP (n = 21) or DLM (n = 15). Participants' skills in empathic expression were assessed with the Measure of Expressed Empathy (MEE) on three occasions: before the first, between, and after the last training session.

Results: Participants in the DP-group showed improved empathic expression, whereas participants in the DLM-group did not.

Conclusions: These findings suggest that DP is an effective training method for therapeutic skills such as empathic expression and holds implications for the future development of educational practices to incorporate active skill training methods.

Despite documented risks associated with excessive anger inhibition, few treatments specifically target maladaptive anger inhibition. Building on a previously evaluated treatment for general anger, this study evaluated the feasibility, acceptability, and preliminary efficacy of a brief (4-week), therapist-supported online emotion-regulation treatment for maladaptive anger inhibition. In total 38 participants (89.5% female; M-age = 43.8, SD = 14.1) with elevated levels of maladaptive anger inhibition were offered treatment, which was evaluated using a pooled interrupted time series design (ITS). Treatment outcomes included measures of anger inhibition, anger rumination, and anger assertion that were assessed during a baseline phase (4 weeks) and a treatment phase (4 weeks). Feasibility was supported by high retention and adherence, and minor adverse events. Moreover, participants reported high treatment credibility and satisfaction, indicating good acceptability of the treatment. Piecewise growth curve analysis for ITS, comparing baseline and treatment phases, revealed significant and large immediate effects on all outcomes: anger inhibition (d = 1.26), anger rumination (d = 0.80), and anger assertion (d = 0.79), with small additional gains observed at 3-month follow-up. Taken together, the findings suggest that this brief online emotion-regulation treatment for maladaptive anger inhibition is feasible, acceptable, potentially effective, warranting further investigation in an RCT. ClinicalTrials.gov identifier: NCT06697587

Non-suicidal self-injury (NSSI) has been tied to several forms of emotional and behavioral dysregulation in adolescence, with less attention paid to regulation of anger. Most assume that anger dysregulation leads to engagement in NSSI, rather than the reverse. However, it is plausible that NSSI compromises adolescents’ abilities to regulate their emotions, including anger, because it may reduce the development of alternative regulatory strategies and intensify negative emotions by reducing tolerance of distress. Using three waves of data from a sample of adolescents in 17 Swedish schools (n = 1,304 M age = 13.68, SD age = .67; 89% of Swedish origin; 58% girls), we examined the directionality of ties between NSSI and three forms of anger dysregulation: dysregulated expressions of anger, anger suppression, and low anger reflection. We also looked for differences in magnitude of paths and gender differences. Random-intercept cross-lagged panel models showed that NSSI predicted changes in all forms of anger dysregulation but found no support for the opposite direction. Gender differences were not evident. Results challenge directionality assumptions and support suggestions that adolescents’ anger regulation degrades when they self-injure.

OBJECTIVE: This study aimed to investigate the interrelations between emotion regulation strategies and different types of anger using network analysis.

METHOD: Data were drawn from a cross-sectional sample of 538 adults (55% females; mean age = 39.8 years, SD = 12.3) seeking treatment for anger. Data were collected between March and November 2019 in Sweden. Participants completed measures of anger problems (anger expression, anger suppression, angry reactions, anger rumination, trait anger, hostility, physical aggression, and verbal aggression) and emotion regulation (cognitive reappraisal, expressive suppression, anger relaxation, and five mindfulness strategies). To determine whether distinct clusters of anger nodes would emerge, exploratory graph analysis was employed. Based on clustering of nodes, we estimated separate networks including all measures of emotion regulation.

RESULTS: Two clusters emerged: one consisting primarily of cognitive components of anger, and another of behavioral. Across networks, anger nodes were strongly interconnected, and anger rumination and anger suppression were especially influential. Several direct links were found between specific emotion regulation strategies and cognitive components of anger, whereas most strategies were only indirectly related to angry behavior. Cognitive reappraisal showed no direct link with any of the anger nodes.

CONCLUSIONS: Our findings reveal potential pathways by which different emotion regulation strategies may influence different types of anger, which could serve as therapeutic targets.

Individuals who experience problems with anger represent a heterogeneous group. Identifying clinically relevant subtypes of anger may advance treatment research. In the current study, latent profile analysis (LPA) was conducted to explore if distinct subtypes of anger could be identified within a sample of individuals seeking treatment for maladaptive anger (N = 538; 55.4% females; mean age = 39.78, SD = 12.28). Furthermore, the utility of the empirical classification was examined based on differences in usage of emotion regulation strategies (cognitive reappraisal, expressive suppression, mindful emotion awareness and relaxation) across subtypes. Four anger profiles were identified in the best-fitted LPA model: Low Anger (n = 153, 28.4%), Anger In (n = 91, 16.9%), Moderate Anger (n = 193, 35.9%) and High Anger (n = 101, 35.5%). Results from the multinominal regression revealed that the use of emotion regulation differed across all profiles. Participants from the High Anger and Anger In profiles exhibited distinct patterns of dysfunctional emotion regulation. The results add to the increasing amount of evidence demonstrating a link between emotion regulation strategies and maladaptive anger. Clinical implications on how to tailor treatments for individuals with maladaptive anger are discussed.