Howells Et Al 2005

Question 1

What is the aim of Howells 2005?

Answer 1

To determine whether anger management is more effective in treating offenders than no treatment at all in producing change.
To investigate whether improvement in treatment can be predicted from pre treatment offender characteristics(particularly pre treatment level of need and offender readiness for treatment).

Question 2

How many participants in Howells 2005 and who were they?

Answer 2

Initially 418 males aged 18-62
But only 285 made it to complete the post treatment assessment.
Control group were from same pool of ppts but were on the waiting list(offered the programme after).
All referrals from prison and community corrections based anger management programs in south and Western Australia overall. At high risk of reoffending.
From a range of ethnic backgrounds.
73% had not don’t AM before, 20% had, 4% more than one and 3% attempted.

Question 3

Describe the anger management programme used in Howells 2005

Answer 3

10 sessions.
Each were 2 hours long.
Run by trained facilitator.
Manual based on Novaco’s framework and developed in New Zealand.

Content:
Structured exercises focussed on skills (identify provocations, relaxation, cognitive restructuring, assertion and relapse training)

Question 4

What measures did Howells 2005 use?

Answer 4

Questionnaires were given pre and post treatment:

• Self report measures- spielberger state trait anger expression inventory (STAXI) for state and trait anxiety and novaco anger scale (NAS-PI) for intensity of anger. Both have reliability and validity.
• modified watt anger knowledge scale (WAKS) for knowledge of techniques for dealing.
• modified overt aggression scale (MAOS) for types of aggression.
• anger stages of change questionnaire (SCQ) for treatment readiness.
• serin treatment readiness scale (STRS).

Gave applicable response regarding anger and management on a five point scale.

Question 5

Procedure of Howells 2005

Answer 5

All pots given measures to complete pre and post treatment, with follow ups for selected ppts at 2 and 6 months.
Group format but done individually.
One experimental ppt and one facilitator completed a checklist for each session.
High programme integrity found.
2 correctional officers or one member of staff completed a staff rating scale for aggression for each ppt.
Databases were accessed to collect data on number and severity of incidents and charges for 6 months after programme.

Question 6

What did the mean scores for all measures pre and post show?

Answer 6

Small improvement on all key outcome measures over time. With treatment group showing slightly better improvement on most outcomes.

Question 7

What did the ANOVA statistical test show?

Answer 7

All but one showed relative improvement but was not statistically significant.

Question 8

Did prisoners who received AM show a significantly greater improvement in anger knowledge?

Answer 8

Yes
Mean change for treatment group was 1.8
Mean change for control was 0.95

Question 9

What showed a significant linear trend at the 2 month follow up?

Answer 9

Anger control
Angry conditions
Anger arousal
Angry behaviour
Total novaco anger score

Question 10

When looking at trait anger, anger in, anger knowledge and self rated MOAS. What happens to the effect gained during treatment?

Answer 10

It continues to about two months after treatment from which no further improvement occurs but the gains are maintained.

Question 11

What happens to anger knowledge?

Answer 11

Consistent long term improvement but the level of improvement diminishes with time.

Question 12

What did the correlations if the STRA readiness scores and change in outcome scores show?

Answer 12

Significant difference between control and treatment groups.

Question 13

What was the correlation for treatment group between treatment readiness and change in most anger outcome measures?

Answer 13

Negative

Question 14

Strengths of Howells 2005

Answer 14

• linear trends for general measures. The positive changes were maintained.
• knowledge of which individuals benefit most is crucial to make referral cost effective. Readiness is a predictor of improvement as those motivated show most change.
• total sample was large. Reliable conclusions.

Question 15

Weaknesses of Howells 2005

Answer 15

• impact of AM was small. Therefore no clinical significance. Helped improve knowledge but not necessarily anger.
• changes were modest so not easy to know if improvements were maintained. Interpretation is cautious.
• not supported but previous data and meta analysis.
• low motivation had a low impact so need to extend length and revise content eg dowden et al 1999