Structura interventie de grup CBT pentru condusul agresiv

I.Relaxation Coping Skills (RCS) RCS followed procedures described by Deffenbacher et al. (2000).

Sessions 1 and 2

The first two sessions provide a self-managed relaxation treatment rationale (i.e. the individual would
become aware of anger arousal and apply relaxation to calm down) and training in progressive
relaxation and four specific relaxation coping skills: (a) relaxation without tensing (i.e. focusing on and
releasing muscle tension without tensing muscles); (b) breathing cued relaxation (i.e. relaxing more on
each of three to five slow deep breaths); (c) cue-controlled relaxation (i.e. relaxing more to the slow
repetition of the word ‘relax’ or a similar word or phrase such as ‘calm control’); and (d) relaxation
imagery (i.e. visualizing a personal relaxation image).

In the first portion of each of the first two sessions, clients also identify situations that elicit anger (e.g.
having another driver cut them off or give them the finger).

Homework for the first two sessions involve practicing relaxation, specifying in detail a description of
one of the angering situations discussed in the first two sessions, and self-monitoring driving anger.

Session three

The third session initiate active training in the application of relaxation skills for anger management.

After discussing homework and clarifying the scene, the therapist initiates a brief period of relaxation
without tension.

When all of them are relaxed, the therapist instructs clients to visualize the anger scene (i.e. being stuck
in heavy traffic) and experience and attend to anger arousal.

After experiencing anger arousal for approximately 30 seconds, the therapist terminates visualization of
the scene and provides instructions for two of the four relaxation coping skills.

When all clients signal relaxation, the procedure is repeated with a different combination of relaxation
coping skills. This process is repeated as time allows, usually with four to six repetitions.

Homework is the same as prior sessions, except clients specific concrete details of two scenes for the
coming session and start applying relaxation coping skills for driving anger reduction.

Sessions 4-8

Procedures for the next five sessions follow this same general pattern with the following modifications.

First, two different scenes are employed in each session and are alternated during visualization. This is
done to provide a broad range of situations in which relaxation is applied and to make sure that clients
have at least one scene per session that elicits anger.

Second, the anger arousing capacity of scenes increases over time such that in the eighth session clients
must cope with their most angering sources of driving anger.
Third, procedures shift from therapist to client control (i.e. shift from therapist retrieval of relaxation in
Sessions 3 and 4 to client self-initiation of relaxation while continuing to visualize anger scene in
Sessions 6–8).

Since generalization to other sources of distress was not found by Deffenbacher et al. (2000),
application of relaxation skills to other sources of anger and distress is introduced, encouraged, and
discussed from Session 5 on. Maintenance strategies are also discussed in Session 8.

II. Cognitive-Relaxation Coping Skills (CRCS) CRCS (Deffenbacher et al., 2000) was modified to address
the issues outlined in the introduction.

Sessions 1 and 2

The first two sessions are the same as RCS except for the cognitive-relaxation coping skills rationale (i.e.
becoming aware of and reducing anger by both applying relaxation and rethinking/taking a different
perspective on sources of anger and frustration) and for the monitoring of cognitive processes being
added to self-monitoring homework.

Session three

Starting with third session, cognitive change is initiated. Instead of introducing a specific cognitive
distortion each session as done by Deffenbacher et al. (2000), all anger engendering ways of thinking
about the scenes are discussed, and cognitive counters are developed for each. Cognitive restructuring
uses frequent Socratic questions (e.g. ‘What’s another way of thinking about that situation?’ ‘What are
all the reasons that might account for why the person behaved that way?’ ‘Where’s your evidence for
thinking that they are doing that just to piss you off?’) and behavioral experiments and tryouts (e.g. ‘Can
we identify a situation in which you can check that out?’ ‘Would you be willing to interview 10 people in
your dorm about why they do that?’) to address cognitive distortions and biased information processing.

These processes allow cognitive strategies to be more closely tailored to the specific driving situations
addressed in each session. For example, the types of anger engendering thoughts and their anger
lowering alternatives for dealing with other drivers yelling at them may differ substantially from those
relevant to driving in heavy traffic.

Early in the third session, participants spend about 15 min developing anger lowering thoughts for the
scene for that session (i.e. being stuck in heavy traffic). Alternative cognitive responses are recorded by
the therapist and integrated with relaxation rehearsal described previously for RCS.

After the relaxation is reinstated following visualizing the anger scene, but before going to the next
rehearsal, the therapist instructs clients to think about the heavy traffic situation in less angry ways and
then read two to four of the anger reducing cognitive responses generated earlier. This process is
repeated as time allows, generally leading to three to four repetitions.

Session 4 - 8

Sessions 4–8 follow the pattern of progression outlined for RCS (i.e. identical scenes of increasing anger
arousing capacity, and a shift from therapist to client control), but add cognitive coping skill
development and application. That is, two scenes are discussed in the first half of the session and anger
lowering cognitions are elucidated. Then, two to four of the anger lowering thoughts are rehearsed
along with relaxation in the procedures outlined for RCS (i.e. clients rehearse relaxation and new
cognitive responses prior to going to the next rehearsal).

Across sessions, clients take increasing responsibility for initiating cognitive change strategies that work
best for them.

Homework paralleled RCS, but CRCS clients also develop a written list of personal cognitive counters for
the situations addressed in that session and engage in in vivo cognitive and relaxation coping skill
application.

Inductively, over sessions clients develop an increased repertoire of cognitive coping skills for
addressing anger while driving. Also, application of cognitive coping skills to other sources of anger and
distress are added after Session 5, and maintenance is discussed in Session 8.