Trial of Emotion Regulation for Inappropriate Anger Expression
Condition: Inappropriate Anger Expression
Study type: Interventional

Summary: 
      The overall aim of the project is to develop three internet-delivered cognitive behavior
      therapies for inappropriate anger expression to test the isolated and combined effects of two
      types of regulation strategies, emotional awareness and cognitive reappraisal. Treatments
      will be evaluated in a stratified single blind parallel randomized block design, along with a
      pooled interrupted time series design. Self-recruited adults with elevated levels of anger
      will be stratified based on baseline level of anger. The particular aims are to examine:

        1. the overall and separate effects of emotional awareness training, cognitive reappraisal
           training, and emotional awareness and cognitive reappraisal training on anger and
           aggression;

        2. whether treatment effects are differentially moderated by baseline levels of emotional
           awareness, cognitive reappraisal, anger expression-out, anger expression-out, anger
           control-in, and trait anger;

        3. whether the treatment effects are mediated by changes in emotional awareness, cognitive
           reappraisal, and anger control-in.
    

Detailed description: 
      1. Following the intention-to-treat principle, all primary data models will include all
           individuals as randomized. 3-month follow-up will be considered as the primary
           end-point. We will analyze both (1) overall treatment effect of all treatments (active
           treatment phase and 3-month follow-up compared to baseline) and (2) the relative
           efficacy for the emotional awareness training, cognitive reappraisal training, and
           emotional awareness and cognitive reappraisal training, respectively. We expect that,
           compared to a prolonged baseline phase, all treatments will result in greater
           improvements in on both primary and secondary outcomes. Further, we predict that the
           combined intervention will produce, on average, the strongest effects on primary and
           secondary outcomes relative to the separate interventions. We expect that cognitive
           reappraisal training will result in greater improvements relative to emotional awareness
           as a standalone treatment.

        2. Growth models that include the interaction terms between experimental conditions
           (contrast coded) and baseline levels of moderator variables (as continuous measures)
           will be utilized to examine moderated treatment effects. Significant interactions will
           be examined following recommendations for probing interactions in growth models.

        3. Weekly measurements of mediators will be analyzed with state-of-the-art methods for
           longitudinal mediation analysis, and we aim to to examine associations among process and
           outcome variables both within and between individuals as a function of condition and
           treatment phase.
    

Intervention name(s): Internet-delivered emotional awareness training; Internet-delivered Cognitive reappraisal training; Internet-delivered awareness and reappraisal training
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Emotional awareness training is delivered via an internet platform during 4 weeks and includes therapist contact several times per week via the platform.; Cognitive reappraisal training is delivered via an internet platform during 4 weeks and includes therapist contact several times per week via the platform.; Emotional awareness and cognitive reappraisal training is delivered via an internet platform during 4 weeks and includes therapist contact several times per week via the platform.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment