ANGER MANAGEMENT IN THE PENITENTIARY: AN INTERVENTION STUDY

Copyright 2009 Romanian Association for Cognitive Science. All rights reserved. ISSN: 1224-8398 Volume XIII, No. 3 (September), 329-340 ANGER MANAGEMENT IN THE PENITENTIARY: AN INTERVENTION STUDY Ioan BUŞ * ¹, Elena-Cristiana ŞTEFAN¹, George VISU-PETRA² ¹Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania ² Court of Appeal, Cluj-Napoca, Romania ABSTRACT The objective of the present study was to examine the efficiency of an anger management program in the penitentiary. We hypothesized that the prisoner s involvement in the program will result in a lower anger level, that they will be able to express anger in a less violent manner, and that they will acquire better anger management techniques. Moreover, we predicted that the program results will be maintained for at least two months. The results showed that the anger management program implemented in a Romanian maximum security prison was efficient; the results also revealed that the observed improvements were maintained on the short term (for two months). KEYWORDS: anger management, penitentiary, cognitive behavioral techniques. INTRODUCTION The present paper focuses on anger management in prison a very complex environment, confronted with numerous and difficult problems. Often, the social relationships developed in the penitentiary are characterized by hostility, anger and aggression. The detention environment influences the prisoners mainly by limiting their personal space and by imposing a strict daily schedule. The need for personal * Corresponding author: E-mail: ioanbus@psychology.ro

330 I. Buş, E-C. Ştefan, G. Visu-Petra space and territoriality encountered also in normal life, outside the penitentiary is exacerbated in the detention environment by the crowdedness and significantly contributes to the development and manifestation of aggressive behaviors (Ellenberger, 1971, as cited in Florian, 2003). Detention, as a life stressing event, scores very high on the Holmes and Rahe stress scale (Social Readjusting Rating Scale - SRSS): 63 points out of 100, being rated as the fourth most stressful life event. Due to severity of its consequences, the need for interventions focused on emotion management is obvious. Efficient, short term and involving a large number of subjects, trainings were initially based initially on the north American psychotherapeutic tradition mainly on the work of Novaco. In penitentiary, these programs were implemented in the early '80 and their aim was the reduction of disruptive behavior. Unfortunately, the research examining the efficiency of these programs is limited, given the several methodological difficulties that have to be overcome in order to accurately measure anger and aggression levels. DiGiuseppe et al., (1994) define anger as a subjective emotion accompanied by cognitions and physiological patterns. Dahlen (2007) also includes the behavioral component in the equation. In this way, anger is conceptualized as an emotional state, varying from mild irritation to anger and to rage attacks (as the most extreme manifestation). The cognitive component also appears to have a central role in experiencing anger (Beck, 1976). At the cognitive level, anger is associated with biased interpretations, including thoughts and images and biased attribution styles (consisting in a wide range of judgment errors: overgeneralization, labeling etc.). Often, the cognitions associated with injustice are associated with anger (Wickless & Kirsch, 1988) and most of the anger episodes involve perceiving the activating event as predictable, unjust and blameworthy (Averill, 1982). Spielberger et al. (1996) proposed a distinction between anger as a stable personality trait and the tendency to experience anger as a state. Another useful distinction made by the same authors distinguishes anger as an emotional state from the behavior associated with anger. Different definitions have been proposed for the psychological constructs of anger, hostility and aggression; we will use in the present paper the working definition of AHA syndrome proposed by Spielberger et al. (1983): Anger usually refers to an emotional state that consists of feelings that vary from mild irritation or annoyance to intense fury and rage. Although hostility usually involves angry feelings, this concept has a connotation of a complex set of attitudes that motivate aggressive behaviors directed toward destroying objects or injuring other people. While anger and hostility refers to feelings and attitudes, the concept of aggression generally implies destructive or punitive behavior directed to other persons or objects (Spielberger, Jacobs, Russel, & Crane, 1983, p. 16).

I. Buş, E-C. Ştefan, G. Visu-Petra 331 Anger is clearly at the core of the AHA syndrome and different aspects of this emotion are typically emphasized in various definitions of hostility and aggression (Spielberger et al., 1995). Anger management in the penitentiary Anger management programs have started to be used in prisons in the late '80s with the purpose of reducing disruptive behavior (Law, 1997). One of the problems associated with these programs refers to the fact that it is difficult to measure the efficiency of the interventions, the meta-analyses assessing the impact of these interventions being rare (Novaco et al., 2001). Usually there are several types of measures used in order to evaluate the efficiency of the programs implemented in penitentiary: psychometric evaluations (self ratings), behavioral checklists and observations and disciplinary reports made by prison officers (Law, 1997). Law (1997), and Towl and Dexter (1994) for example, used as assessment tools self evaluations (STAXI), behavioral checklists and disciplinary reports taken during several assessment sessions. Hunter (1993) implemented a ten weeks program involving 55 prisoners. The assessment process included personality, anger and hostility tests, behavioral observations and disciplinary reports before, during and after the program ended. Significant differences were observed in impulsivity, depression, interpersonal problems, violence, verbal attacks, and disciplinary repots. Hughes (1993) developed a twelve weeks long (24 hours of therapy) program and assessed both the short term and long term impact of the intervention. The immediate results showed a significant reduction in aggressive manifestations, but more interestingly, in the long run the experimental group ended up receiving fewer convictions for violence; moreover, the results revealed a longer period before re-arrest for this group. The theoretical foundations of these programs rest in the cognitive behavioral tradition. According to this tradition, criminal reasoning, the perpetrators views of the world, solving problems skills, biased interpretations and attitudes etc. all have an important role in the development of criminal behavior. Several studies have showed that the most efficient cognitive behavioral interventions are those who incorporate problem solving skills, interpersonal skills, negotiation and communication skills and conflict solving skills. Aims and hypotheses The objective of the present study was to assess the efficiency of an anger management program implemented in a penitentiary. First, we predicted that the program will be efficient in the reduction of overall anger levels; second, the

332 I. Buş, E-C. Ştefan, G. Visu-Petra participants will be able to express anger through less violent behavior; and third, the improvements will be maintained for at least two months. To our knowledge, there are no published results published in a peer reviewed journal systematically examining the efficiency of an anger management program in a Romanian penitentiary. Given the importance and the potential benefits of this type of intervention, we designed this study taking into account the particular nature of the Romanian prison environment; unfortunately, we were able to implement only a short term follow-up (after two months). In our country, the penitentiary system is characterized by 1) the fact that the prisoners live in common and 2) the accent on reeducation through work. But the most important characteristic of Romanian penitentiary system relevant to our study is the agglomeration of the detention facilities, which in turn generates several aggressive manifestations. METHOD Participants There was a three stage selection method used. In the first stage, we only selected the prisoners classified as aggressive persons. The classification was based on 1) the data available in the personal file of every prisoner, 2) from the department supervising officers and 3) from the type of crime committed (only violent crimes were included). In the second stage, we implemented the education criteria and selected only the persons with at least five grades completed. The third stage consisted in an interview aimed at investigating the frequency of the anger episodes, the motivation for the involvement in the program, the attitude toward group work and the expectancies related to the program activities and outcome. Using these criteria, we selected 60 participants. We obtained valid data only from 53 participants: 27 assigned to the experimental group (ages between 20 to 35 years, m = 25.26) and 26 constituting the control group (ages between 20 to 36 years, m = 25.54). The education level of the persons included in the study varied between 6 and 12 grades. The crime type was distributed as follows: murder (11 prisoners), attempted murder (20 prisoners), violent attacks (16 prisoners), theft (5 prisoners) and fraud (1 prisoner). Disciplinary incidents (for both groups) were distributed in the following manner: attacks on supervisors or officers (4 cases), attacks on other prisoner (9 cases), problematic (aggressive) behavior towards officers or supervisors (10 cases), failing to behave according to prison regulations (7 cases). The control group initially consisted in 30 participants; only 26 remained because four were transferred for disciplinary reasons. The experimental group initially consisted in 30 participants; only 27 remained in the study because of two

I. Buş, E-C. Ştefan, G. Visu-Petra 333 transfers and one medical situation. The participants were randomly distributed in three groups, each group being scheduled for a weekly meeting. The programme was implemented by the penitentiary psychologist and second author, as a cotherapist. Measures In order to have a detailed measure of several anger dimensions the STAXI - State Trait Anger Expression Inventory (Spielberger, 1988) was used. It is an instrument frequently administered in the prison environment (Dalton et al., 1998; Myers & Monaco, 2000; Slaton et al., 2000, apud Williamson et al., 2003). This inventory contains 44 items scored on a 4-point scale (e.g., from almost never to almost always ), grouped in five primary scales and two subscales (see Table 1). Table 1 STAXI subscales definition of components (adapted after Spielberger et al., 1999). Scale SANGER 10 Items TANGER 10 Items AXIN 8 Items AXOUT 8 Items AXCON 8 Items AXEXE 24 Items Anger component definition An emotional state marked by subjective feelings that vary in intensity, from mild annoyance or irritation, to intense fury and rage, accompanied by the activation of the autonomic nervous system. The intensity of S-Anger varies as a function of perceived injustice, being attacked or treated unfairly by others, or frustration resulted from barriers to goal directed behavior. Individual differences in anger proneness, i.e., the tendency to perceive a wide range of situations as annoying or frustrating, and to respond with elevations in S-Anger. High T-Anger individuals experience S-Anger more often, and with greater intensity, than persons low in T-Anger. TANGERT (4 items): individual differences in a general disposition to experience anger with little or no specific provocation TANGERR (4 items): individual differences in the disposition to feel angry when criticized or treated unfairly. Individual differences in the frequency that angry feelings are experienced, but held in or suppressed. Individual differences in the frequency that feelings of anger are expressed in aggressive behavior directed toward other people or objects in the environment. Individual differences in the frequency that an individual attempts to control the outward expression of angry feelings. The measure provides a general index of the frequency that anger is experienced and expressed, irrespective of the direction of expression (expressed inwardly or outwardly).

334 I. Buş, E-C. Ştefan, G. Visu-Petra Additionally, a semi-structured characterization was used in order to describe the anger level and the violent/aggressive behavior of the prisoners. This chart was completed by multiple evaluators: the officers working with the inmates who participated in the anger management program, along with the psychologist, educator and the priest of the unit, all of them being able to provide accurate descriptions of the inmates personalities. The characterization was required to relate to three pre-specified dimensions: 1) Anger level - as perceived by the others (low, medium, high). 2) Anger expression verbal expression toward prison staff and toward other inmates, as well as physical act toward both categories. 3) Disciplinary measures for violent / aggressive behavior their nature and frequency. Finally, a third measure was used, extracted from the prison file of each participant under the heading Disciplinary incidents. This section contains a description of the incident, the nature and the timing of the penalty. There are several types of incidents that could lead to a disciplinary intervention (e.g. not following the internal regulation system, owning forbidden objects, violence toward guards, etc.). Considering the specific nature of our research, we selected only those acts that indicated possible anger outcomes (violent acts, verbal and physical aggression). The anger management program ( I learn to be calm, after a program adapted by Florian, 2003, and after Ireland, 2004) relies on cognitive-behavioral principles, demonstrated to be the most efficient in the anger management intervention (Escamilla, 1998). Its main purpose is to reduce future violent behaviors, especially the ones which have anger as a determining force. The general objective is to create and practice the necessary competences for the reduction in frequency and intensity of the emotional aggressive response in inmates; additionally, pro-social techniques for conflict reduction were taught to the prisoners. The structure of the program is based on 12 sessions, each lasting for two hours, one in every week. The name of these sessions summarizes their content: Introduction and getting to know each other, Losing one s temper and other risk factors, Analyzing crime, Anger and body language, Automated beliefs, rational/irrational beliefs, Cognitive distortions, Anger and its physiology, Relaxation techniques, Behavior styles, Assertiveness, Interpersonal conflict: Resisting to group pressure, Personal intervention plan. The inmates were divided in three participant groups that separately attended these meetings. After the 4 th and the 8 th session, a partial assessment was conducted in the day following the session. Finally, after the 12 th session, a final program assessment was conducted. The assessments targeted the knowledge level, problematic aspects, the strengths and weaknesses of the courses, and the perceived

I. Buş, E-C. Ştefan, G. Visu-Petra 335 utility and personal motivation for the program. The methods being used were mainly derived from cognitive-behavioral and rational-emotive therapy (such as cognitive restructuring, problem solving, assertiveness training, positive reinforcement, punishment, role playing, debate, exposure). At the beginning of the program, an informed consent and a contract were signed by each participant, presenting the reward and penalty system. Different scores were assigned in each session for being present, for the homework, for complying with the rules. Procedure The initial assessment of the participants took place two weeks before the program started and the STAXI inventory was used (paper-and-pencil, group testing, no time limit). The confidentiality of data was stressed out in this session, with an emphasis on the fact that this was a scientific study and that the results will only be used in this purpose. After the test ended, the participants assigned to the experimental group were informed regarding the future activities. At the end of the two weeks and after two months another testing session took place, identical with the initial assessment. In the two weeks before the program started, a assessment based on the Characterization file of participants was made by the penitentiary officers, the psychologist, the educator and the prison priest. This Characterization file was also completed at the end of the program and after two months. Regarding the disciplinary reports, the data base of the penitentiary was consulted; the time period we took into account was two months before the program was presented and two months after the implementation of the program. RESULTS a) The intervention program We first analyzed the results obtained in the initial assessment of the two groups (see Table 1). The data reveals that there are no pre-test differences between the two groups regarding the means obtained for every scale (or subscale) of the STAXI inventory.

336 I. Buş, E-C. Ştefan, G. Visu-Petra Table 2 Descriptive statistics, initial assessment. Scale/ subscale SANGER TANGER TANGERT TANGERR AXIN Group M SD t-test p EXP CTRL EXP CTRL EXP CTRL EXP CTRL EXP CTRL 15.11 15.19 22.63 22.96 8.70 8.69 10.70 10.50 13.00 13.12 AXOUT EXP CTRL 19.11 18.92 AXCON EXP 17.30 CTRL 17.81 AXEXE EXP 30.70 CTRL 29.69 Note: EXP = experimental group, N = 27; CTRL = control group, N = 26. 1.71 2.13 3.34 3.41 1.77 1.49 -.153.879 -.358.722.025.980 1.99 1.86.384.703 2.44 2.94 -.155.877 2.84 2.66 3.76 3.87 3.38 3.65.248.805 -.487.628 1.046.300 Two more testing sessions were conducted, at the end of the program and after two months, using the same STAXI inventory. The results are presented in Table 3, in which repeated measures ANOVA was used to compare the pre-test, post-test, and follow-up STAXI scores within the control group, and within the experimental group. There were no significant differences between the different sessions in the control group. In the experimental group, a significant decrease in the overall anger level, as well as in each anger dimension measured by the STAXI subscales was noted (except the AXIN and AXEXE subscales, which revealed an increase in the post-test and follow-up sessions).

I. Buş, E-C. Ştefan, G. Visu-Petra 337 Table 3 Mean, standard deviation and the comparison (repeated measures ANOVA) between pretest, post-test and the 2 months follow-up of the control and the experimental group. Scale/ subscale SANGER TANGER TANGERT TANGERR AXIN AXOUT AXCON AXEXE Test Experimental Control session F p m SD (2, 52) m SD Pre 15.11 1.71 15.19 2.13 Post 12.67 1.35 86.29*.000 15.12 2.08 Follow-up 11.89 1.21 15.42 2.06 Pre 22,63 3,34 22.96 3.41 Post 20.56 2.63 49.04*.000 22.73 3.16 Follow-up 20.37 2.54 23.08 3.28 Pre 8.70 1.77 8.69 1.49 Post 7.89 1.34 29.42*.000 8.62 1.35 Follow-up 7.78 1.28 8.81 1.09 Pre 10.70 1.99 10.50 1.86 Post 9.44 1.21 26.57*.000 10.31 1.82 Follow-up 9.26 1.16 10.58 1.98 Pre 13.00 2.44 13.12 2.94 Post 14.89 1.80 36.58*.002 13.08 2.56 Follow-up 15.30 1.48 12.69 2.55 Pre 19.11 2.84 18.92 2.66 Post 16.07 1.96 102.39*.000 19.12 2.35 Follow-up 15.70 1.77 19.38 2.46 Pre 17.30 3.76.000 17.81 3.87 Post 15.04 2.39 38.49* 17.85 3.01 Follow-up 14.70 2.19 18.50 3.12 Pre 30.70 3.38 29.69 3.65 Post 32.00 2.35 8.72*.000 30.31 3.23 Follow-up 32.33 2.21 29.58 3.25 F (2, 52) 1.31 (2, 49) 2.19 (2, 49).82 (2, 43) 2.02 (2, 48) 1.24 (2, 46) 1.52 (2, 50) 2.80 (2, 42) 1.49 (2, 42) p.27.12.44.14.29.22.07.23 Post-hoc comparisons using paired t-tests within the experimental group revealed significant differences between pre-test and post-test, and between pre-test and follow-up, respectively, for all STAXI scales and subscales at p <.001 (only for the AXEXE subscale at p <.01). A further smaller, yet significant improvement was noted from post-test to follow-up (p <.05, except for the AXEXE scale, for which the difference was not statistically significant). b) The characterization chart The evaluation of each prisoner using the Characterization chart was made by different agents: a guardian, the psychologist, the teacher, and the priest. Aside from the required quantitative evaluations described above (e.g. anger level), this instrument provided a qualitative assessment as well. At the pre-test, there were no differences between the two groups regarding the overall verbal violence toward the officers; both groups displayed aggressive

338 I. Buş, E-C. Ştefan, G. Visu-Petra behavior, an inappropriate tone of voice, they used insulting nicknames or displayed other offensive verbal and non-verbal manifestations. For the control group, these behaviors remained at the same intensity at the post-test and follow-up; but for the experimental group, the evaluations revealed a decrease in the aggressive manifestations in the post-test and follow-up. In a similar fashion, only in the experimental group did the verbal and physical violence toward other inmates, as well as toward prison stuff decrease from pre-test to post-test and follow-up. c) Disciplinary incidents The third assessment method consisted in disciplinary reports, a method generally considered the most objective one. The time period taken into account was two months before and after the program ended. Table 4 Disciplinary incidents. Disciplinary Experimental Control incident Pre Post Pre Post Hitting prison staff 1-2 2 Hitting another prisoner 3 1 3 2 Problematic (aggressive) behavior towards officers or 4 1 3 2 supervisors Failing to behave according the prison regulations 2 2 1 2 Note: pre = incidents two months before the program post = incidents two months after the program Looking at Table 4, it is noticeable that in the control group the number of disciplinary incidents were maintained (there were 9 incidents in the pre-test and 8 in the post-test). In the experimental group, although initially the number of offenses was similar (10), after the intervention it was considerably reduced (4, qualitatively less severe). GENERAL DISCUSSION Looking at the results of the intervention program, we observed that the participants in the experimental group were more efficient in experiencing a lower level of anger, trait irritability was also lower, they tended to express less aggressive

I. Buş, E-C. Ştefan, G. Visu-Petra 339 behavior and tried harder to control the anger emotions. Moreover, these improvements maintained for two months after the program ended. The obtained results were consistent with other studies in the literature; Law (1997) for example, showed, using the same STAXI inventory, that their program was efficient regarding the anger management, their subject also displaying fewer aggressive behaviors toward prison staff or other inmates. Towl and Dexter (1994) also suggested that this type of program is useful for a lower anger intensity and a lower anger trait. In the present study however, a decrease was observed only in the state anger, but not in the trait anger. Our data showed a reduction in the irritable reactions, a tendency with important implications in the social interactions with prison staff and other prisoners. The results obtained by analyzing the characterization charts also revealed that for the experimental group the program was efficient compared both with pretest data and with the control group data: a general tendency was observed for the experimental group to be evaluated as less aggressive and less problematic in the penitentiary environment. These results are confirmed also by the lower scores observed in the experimental group at the SANGER and TANGER scales. After the intervention, the participants in the experimental group manifested a less aggressive verbal and physical behavior, replacing the usual anger responses with more adaptive assertive reactions (in interactions with both the personae and other prisoners). A reduction was observed also in the amount of verbal warnings (a disciplinary sanction less severe) given to the experimental group. The results obtained in our study are similar with those reported by Ireland (2004): on the short term, the intervention was efficient in reducing both observed and self-reported aggressive behavior. Hunter (1993) and Hughes (1993) reported similar findings: their programs were efficient for reduction in impulsivity, depression and improvements in social interactions. Finally, looking at the official records of disciplinary incidents, we observed that verbal and physical aggressions were reduced in the experimental group (although a larger sample of behaviors should have been longitudinally collected in order to speak about significant modifications). Similar results are reported by Law (1997), who showed that disciplinary reports after the intervention program were three times less frequent in the experimental group (this author do not specify the type of aggressive behavior). To conclude, the results of this intervention study reveal that: 1) the anger intensity reduced after the participation in the program; 2) the program had the effect of changing the aggressive verbal and physical behavior in assertive behavior; 3) the positive outcomes observed after the intervention maintained for two months after the termination of the program. With its inherent limitations and confounds induced by the naturalistic prison setting (this being also its advantage), the present study represents an important contribution in the field, given the relative small number of studies in this domain;

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