Imaginal exposure for anger reduction in adult outpatients: a pilot study

Although exposure procedures have been widely accepted in the treatment of anxiety disorders, they have rarely been applied to the treatment of anger. The present paper describes an initial attempt to apply an imaginal exposure strategy to adult outpatients (n = 6) referred for anger management. This investigation reflects an empirical clinical practice approach rather than a controlled outcome study. Thus, this paper provides a clinical description of the imaginal exposure program, pre-to-posttest effectiveness data, an exploration of habituation patterns for each participant, and 15-month follow-up data from several patients. In considering the impact of the intervention, statistically significant change was found on most anger variables, the majority of patients met a criteria for clinically significant improvement on important indices of anger, and treatment effect sizes were large and compared favorably to previously studied interventions. Process data revealed a consistent habituation effect, across patients and anger stimuli, in response to repeated exposure practice. Participants' satisfaction was also positive. Finally, statistically significant and clinically meaningful change was evident at 15-months following the intervention. Data from the current pilot project are encouraging and hopefully will stimulate more methodologically rigorous clinical trials.