Mindfulness for Anger in Veterans With PTSD

Mindfulness Treatment for Anger in Veterans With PTSD

Research has consistently shown that Veterans with PTSD are more likely to experience higher levels of anger and commit aggressive acts compared to Veterans without PTSD. Given the significant negative impact that anger and aggression can have on the lives of Veterans, their families, and society at large, there is a great need to examine novel interventions that could decrease anger and aggression risk with this population. Mindfulness may be one such technique, given its effectiveness in assisting individuals in regulating difficult emotions and in decreasing physiological reactivity, which have both been implicated in PTSD and aggression perpetration. Findings showing that a mindfulness intervention is effective in reducing anger and aggressive behavior would be relevant for Veterans with PTSD experiencing such difficulties and would help prevent the detrimental consequences that can come from anger and aggression among these individuals.

Study Overview

• Status: Completed
• Conditions: Anger; Aggression
• Intervention / Treatment: Behavioral: Mindfulness Based Stress Reduction; Behavioral: Trauma Recovery Education Class

Detailed Description

Military Veterans suffering from posttraumatic stress disorder (PTSD) have been shown to exhibit increases in aggressive urges, difficulties managing anger, and difficulties controlling violent behavior. Dysregulated anger and aggression can create fear and distress in spouses, family members, and friends resulting in strained and deteriorated relationships, and can have a detrimental impact on Veterans' social, occupational and other important areas of functioning. In addition, more severe forms of aggression and violent behavior (i.e., homicide) in the community have been observed among Veterans with PTSD, as recently reported in several news media outlets. The seriousness of this problem is underscored by the high rates of alcohol use observed among Veterans with PTSD which further increases anger and the risk of aggressive behavior.

Current therapeutic interventions may not be effective in reducing anger and aggressive behavior among Veterans with PTSD due to the lack of techniques that directly target symptoms most strongly associated with aggression, particularly hyperarousal and physiological reactivity. Furthermore, existing interventions may not be effective in assisting individuals achieve awareness and insight into their anger states, necessary for the effective management of anger and aggression. Mindfulness is rooted in Eastern meditation practices and has been successfully used to decrease stress, pain, anxiety, and depression. In civilian samples, mindfulness interventions have been found to be effective in reducing anger and aggression. To date, mindfulness for anger and aggression has not been examined in Veterans with PTSD.

The primary objective of the proposed investigation is to conduct a pilot randomized control trial to examine the initial efficacy of an established mindfulness intervention, Mindfulness Based Stress Reduction (MBSR) in decreasing anger and aggression in Veterans with PTSD. The proposed investigation also seeks to examine potential mechanisms of action that account for its effects. Sixty Veterans with PTSD experiencing problems with anger and aggression will be recruited. These individuals will complete a baseline assessment to assess self-reported levels of anger and aggression. They will then be randomly assigned to participate in an online (i.e., virtual) PTSD psychoeducational course or MBSR. After completing treatment, all participants will complete a post-treatment assessment to assess changes in anger and aggression.

At a later date and time, participants will also be asked to attend an in-person laboratory session where they will engage in a trauma-imagery procedure followed by a task designed to assess provoked aggression. In addition to examining whether participation in MBSR decreases self-reported levels of anger and aggression, this study will examine whether MBSR decreases aggression in participants after being exposed to trauma reminders in vivo. Potential mechanisms of action of MBSR and its effects on additional outcomes also will be explored.

• Study Type: Interventional
• Enrollment (Actual): 61
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Connecticut
    • West Haven, Connecticut, United States, 06516-2770
      • VA Connecticut Healthcare System West Haven Campus, West Haven, CT

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Participants must meet current Diagnostic and Statistical Manual of Mental Disorders (5th edition) diagnostic criteria for PTSD (participants with sub-threshold levels of PTSD will also be allowed to participate).
• Participants must also indicate current difficulties with anger and aggression.

Exclusion Criteria:

• Participants with a current diagnosis of psychotic disorder or current substance use disorder with severe symptoms.
• Participants diagnosed with bipolar II disorder without psychotic features and/or individuals diagnosed with bipolar disorder who are well-controlled on medication will be allowed to participate. Individuals with bipolar disorder who do not fall into either of these categories will be excluded.
• Participants also must not have a seizure disorder.
• Participants are allowed to be taking psychotropic medications, however they must be on a stable dose for at least 2 months.
• Participants who do not have a working and active e-mail account and access to a smart phone or computer will be excluded.
• Finally, participants must not currently be receiving concurrent individual therapy or group therapy focused on anger and aggression, must not be currently receiving any evidence-based treatment for PTSD, and must not currently be participating in the modified TREC group offered at the West Haven VA Medical Center.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Mindfulness Based Stress Reduction; Mindfulness Based Stress Reduction (MBSR) is a group-based intervention in which participants are taught different mindfulness meditation practices, including body scan (focusing attention to different areas of the body in sequence), sitting meditation (focusing attention to one's breathing), and Hatha yoga postures (focusing attention to different body sensations during gentle stretching). Participants also are taught how to practice mindfulness while engaging in ordinary activities including walking, standing, and eating. MBSR consists of 8, two-hour weekly sessions and will be delivered in group format. MBSR groups will be delivered virtually.	Behavioral: Mindfulness Based Stress Reduction; Mindfulness Based Stress Reduction (MBSR) is a group-based intervention in which participants are taught different mindfulness meditation practices, including body scan (focusing attention to different areas of the body in sequence), sitting meditation (focusing attention to one's breathing), and Hatha yoga postures (focusing attention to different body sensations during gentle stretching). Participants also are taught how to practice mindfulness while engaging in ordinary activities including walking, standing, and eating. MBSR consists of 8, two-hour weekly sessions and will be delivered in group format. MBSR groups will be delivered virtually.; Other Names: MBSR
Active Comparator: Trauma Recovery Education Class; Trauma Recovery Education Class (TREC): TREC is a group based treatment that focuses on providing information on PTSD and traumatic reactions. TREC provides psycho-education to Veterans on PTSD, including common reactions to trauma and the role of avoidance, common problems associated with PTSD, as well as common barriers to care (e.g., stigma, maladaptive beliefs, fear). Additional content focuses on problem identification and goal setting, discussion of current problems and life issues, and treatment planning. TREC consists of 8, one-hour weekly sessions. TREC groups will be delivered virtually.	Behavioral: Trauma Recovery Education Class; Trauma Recovery Education Class (TREC): TREC is a group based treatment that focuses on providing information on PTSD and traumatic reactions. TREC provides psycho-education to Veterans on PTSD, including common reactions to trauma and the role of avoidance, common problems associated with PTSD, as well as common barriers to care (e.g., stigma, maladaptive beliefs, fear). Additional content focuses on problem identification and goal setting, discussion of current problems and life issues, and treatment planning. TREC consists of 8, one-hour weekly sessions. TREC groups will be delivered virtually.; Other Names: TREC

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
State Anger Scale	Self-report measure of overall state anger using the State-Trait Anger Expression Inventory-2. Score range: 15-60; higher scores indicate greater state anger.	Baseline, after 3 weeks of treatment, after 6 weeks of treatment, within 8 weeks following the completion of either of the two treatments (i.e., post-treatment), and within 5 months after completing the post-treatment assessment
Trait Anger Scale	Self-report measure of trait anger using the State-Trait Anger Expression Inventory-2. Score range: 10-40; higher scores indicate greater trait anger.	Baseline, after 3 weeks of treatment, after 6 weeks of treatment, within 8 weeks following the completion of either of the two treatments (i.e., post-treatment), and within 5 months after completing the post-treatment assessment
Anger Expression In	Self-report measure of anger expression inward using the State-Trait Anger Expression Inventory-2. Score range: 8-32; higher scores indicate greater frequency of experiencing anger but not expressing (i.e., suppressing) anger.	Baseline, after 3 weeks of treatment, after 6 weeks of treatment, within 8 weeks following the completion of either of the two treatments (i.e., post-treatment), and within 5 months after completing the post-treatment assessment
Anger Expression Out	Self-report measure of anger expression outward using the State-Trait Anger Expression Inventory-2. Score range: 8-32; higher scores indicate greater frequency of expressing anger verbally or physically.	Baseline, after 3 weeks of treatment, after 6 weeks of treatment, within 8 weeks following the completion of either of the two treatments (i.e., post-treatment), and within 5 months after completing the post-treatment assessment
Anger Control In	Self-report measure of anger control inward using the State-Trait Anger Expression Inventory-2. Score range: 8-32; higher scores indicate greater frequency of attempting to control anger feelings by calming down or cooling off.	Baseline, after 3 weeks of treatment, after 6 weeks of treatment, within 8 weeks following the completion of either of the two treatments (i.e., post-treatment), and within 5 months after completing the post-treatment assessment
Anger Control Out	Self-report measure of anger control outward using the State-Trait Anger Expression Inventory. Score range: 8-32; higher scores indicate greater frequency of controlling outward expression of angry feelings.	Baseline, after 3 weeks of treatment, after 6 weeks of treatment, within 8 weeks following the completion of either of the two treatments (i.e., post-treatment), and within 5 months after completing the post-treatment assessment
Anger Expression Index	Total Anger score on the STAXI-2. Score range: 0-96; higher scores indicate greater expression of anger.	Baseline, after 3 weeks of treatment, after 6 weeks of treatment, within 8 weeks following the completion of either of the two treatments (i.e., post-treatment), and within 5 months after completing the post-treatment assessment
Buss Perry Total Aggression Score	Self-report measure of total aggression using the Buss-Perry Aggression Questionnaire. Scores range from 29-203; greater scores indicate greater total aggression.	Baseline, after 3 weeks of treatment, after 6 weeks of treatment, within 8 weeks following the completion of either of the two treatments (i.e., post-treatment), and within 5 months after completing the post-treatment assessment
Buss Perry Physical Aggression	self-report measure assessing physical aggression using Buss Perry Aggression Questionnaire. Scores range from 9-63; greater scores indicate greater total physical aggression.	Baseline, after 3 weeks of treatment, after 6 weeks of treatment, within 8 weeks following the completion of either of the two treatments (i.e., post-treatment), and within 5 months after completing the post-treatment assessment
Buss Perry Verbal Aggression Score	self-report measure assessing verbal aggression using Buss Perry Aggression Questionnaire. Scores range from 5-35; greater scores indicate greater total verbal aggression.	Baseline, after 3 weeks of treatment, after 6 weeks of treatment, within 8 weeks following the completion of either of the two treatments (i.e., post-treatment), and within 5 months after completing the post-treatment assessment
Buss Perry Anger Scale	self-report measure of anger using the Buss Perry Aggression Questionnaire. Scores range from 7-49; greater scores indicate greater total anger.	Baseline, after 3 weeks of treatment, after 6 weeks of treatment, within 8 weeks following the completion of either of the two treatments (i.e., post-treatment), and within 5 months after completing the post-treatment assessment
Buss Perry Hostility Scale	self-report measure of hostility using the Buss Perry Aggression Questionnaire. Scores range from 8-56; greater scores indicate greater total hostility.	Baseline, after 3 weeks of treatment, after 6 weeks of treatment, within 8 weeks following the completion of either of the two treatments (i.e., post-treatment), and within 5 months after completing the post-treatment assessment
Provoked Aggression Subscale 1	An experimental lab-based paradigm designed to assess provoked aggression, the Taylor Reaction Time Task. This subscale determines whether participants' aggression increased, decreased, or remained the same across four blocks of trials (six trials within each block). Scores range from 0-11 within each trial, with higher scores indicating worse outcome. Each of the six trials within each block are averaged together.	within 8 weeks following the completion of either of the two treatments
Provoked Aggression Subscale 2	An experimental lab-based paradigm designed to assess provoked aggression, the Taylor Reaction Time Task. This subscale determines participants' initial levels of aggression. Participants can choose from the following response options: 0, 1, 2, 3, 4, 5, 6, 7,8, 9, 10 or 20, with higher scores indicating greater initial levels of aggression.	within 8 weeks following the completion of either of the two treatments

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
heart rate	physiological assessment implemented while participants are exposed to trauma narratives	within 4 weeks following the completion of either of the two treatments
skin-conductance levels	physiological assessment implemented while participants are exposed to trauma narratives	within 4 weeks following the completion of either of the two treatments

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Skin Conductance Levels	Changes in skin conductance levels during the trauma narrative portion of the lab session.	within 8 weeks following the completion of either of the two treatments
Heart Rate	Changes in heart rate during the trauma narrative portion of the lab session.	within 8 weeks following the completion of either of the two treatments

Collaborators and Investigators

• Sponsor: VA Office of Research and Development
• Investigators: Principal Investigator: Lorig Kachadourian, PhD MA, VA Connecticut Healthcare System West Haven Campus, West Haven, CT

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2017
• Primary Completion (Actual): January 31, 2023
• Study Completion (Actual): January 31, 2023

Study Registration Dates

• First Submitted: July 22, 2016
• First Submitted That Met QC Criteria: August 24, 2016
• First Posted (Estimated): August 30, 2016

Study Record Updates

• Last Update Posted (Actual): May 1, 2026
• Last Update Submitted That Met QC Criteria: April 28, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: aggression; anger
• Additional Relevant MeSH Terms: Aberrant Motor Behavior in Dementia; Behavioral Symptoms; Behavior; Social Behavior; Aggression; Behavior Therapy; Psychotherapy; Behavioral Disciplines and Activities; Cognitive Behavioral Therapy; Mindfulness; Mindfulness-Based Stress Reduction
• Other Study ID Numbers: CLNA-006-15F

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No