Review and Case Study: Rumination-Focused Cognitive Behavioral Therapy (CBT) for Anger and Anger Rumination

Anger is a common emotion; however, when it is too frequent, too intense, or too prolonged or when it triggers excessive aggression or violence, it becomes a clinical problem. Anger rumination has shown to mediate the link between anger and aggression and is a prevalent clinical problem repeating the activation of aggressive cognitions, increasing anger arousal and the priming and scripting of aggressive behavior.

Rumination-focused cognitive behavioral therapy (Rf-CBT) is a promising treatment of anger rumination to reduce anger and prevent aggression. The chapter presents a case study of Rf-CBT with a patient diagnosed with schizotypal personality disorder (SPD) and suffering from problematic anger and anger rumination. Applying the Rf-CBT theory to anger, anger rumination is triggered when people are angry about perceived insults or frustrations, and the desired mental state is to feel otherwise (e.g., calm or at peace). An individual will continue to ruminate when failing to make progress toward the desired goal and will terminate anger rumination when the goal is either attained or abandoned. Rf-CBT is a principle-driven treatment designed to teach patients to interrupt the mental habit of rumination by identifying triggers of rumination, controlling exposure to these triggers, and acquiring new habits of alternative responses to those cues.

Results of the case study showed Rf-CBT to be a possibly promising approach to reduce anger rumination, anger, and aggression; however, larger studies than a single-case study are necessary to investigate the usefulness of Rf-CBT for anger problems. Using imagery techniques to interrupt anger rumination and thus reduce arousal may be an auspicious strategy, which is in line with advise from meta-analyses for anger treatment to emphasize focus on reducing anger arousal.