Development and Evaluation of a School-based Anger Management Program (SAMP) for Adolescents

Young-Joo Park; Ho-Sihn Ryu; Keum-Sun Han; Jung Hye Kwon; HanKyeom Kim; Yoon Jung Cho; Hyun-Cheol Kang; Suk-Hee Cheon; Ji-Won Yoon

doi:10.4040/jkan.2009.39.1.145

Journal List > J Korean Acad Nurs > v.39(1) > 1002513

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Park, Ryu, Han, Kwon, Kim, Cho, Kang, Cheon, and Yoon: Development and Evaluation of a School-based Anger Management Program (SAMP) for Adolescents

Original Article

J Korean Acad Nurs 2009;39(1):145-156.

Published online: 17 February 2009

DOI: https://doi.org/10.4040/jkan.2009.39.1.145

Development and Evaluation of a School-based Anger Management Program (SAMP) for Adolescents

Young-Joo Park¹, Ho-Sihn Ryu¹, Keum-Sun Han¹, Jung Hye Kwon², HanKyeom Kim³, Yoon Jung Cho⁴, Hyun-Cheol Kang⁵, Suk-Hee Cheon⁶, Ji-Won Yoon^7,

¹Professor, College of Nursing, Korea University

²Professor, Department of Psychology, Korea University

³Professor, Department of Pathology, Korea University

⁴Professor, Department of Laboratory Medicine, Korea University, Seoul

⁵Associate Professor, Department of Informational Statistics, Hoseo University, Cheonan

⁶Full-time Instructor, Department of Nursing, Sangji University, Wonju

⁷Part-time Instructor, College of Nursing, Korea University, Seoul, Korea

Address reprint requests to : Yoon, Ji-Won, College of Nursing, Korea University, 126-1 Anam-dong 5-ga, Seongbuk-gu, Seoul 136-705, Korea, Tel: 82-2-3290-4910 Fax: 82-2-927-4676 E-mail: dumom@hanmail.net

Received 17 October 2008 Revised 17 October 2008 Accepted 31 January 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

This study was done to develop a school-based anger management program (SAMP) of 4 sessions and examine its effects on the anger, anger expression, psychosomatic responses, psychosocial responses, and immunologic responses in adolescents.

Methods:

A quasi-experimental study using a nonequivalent control group, pre-post design with repeated measures was used. Chi-square test, t-test, paired t-test, and Fisher’s exact test were used to analyze the data.

Results:

There were no differences between the experimental and control groups in outcome variables except for lymphocytes. However, following additional analyses, statistically significant differences by time point were observed for pain sensitivity, T cell, Helper T (Th) cell, Suppressor (Ts) cell and Natural Killer (NK) cell post-treatment, entrapment and psychosomatic symptoms at the 4-week follow-up, and resilience at the 10-week follow-up for the experimental group.

Conclusion:

Although some modifications in contents and administration will be required to increase the effectiveness of the program for anger management, SAMP can be used to promote anger management ability in adolescents.

Keywords: Anger, Adolescent, School

REFERENCES

Adelson J.., Doehrman M. J.1980. The psychodynamic approach to adolescence. Adelson J., editorHandbook of Adolescency psychology. p. 99–116. New York, NY: Wiley.

Beck R.., Fernandedz E.1998. Cognitive-behavioral therapy in the treatment of anger: A meta-analysis. Cognitive Therapy and Research. 22:63–74.

Berk L. S.., Felten D. L.., Tan S. A.., Bittman B. B.., Westengard J.2001. Modulation of neuroimmune parameters during the eustress of humor-associated mirthful laughter. Alternative Therapies in Health & Medicine. 7:62–76.

Boergers J.., Spirito A.., Donaldson D.1998. Reasons for adolescent suicide attempts: Associations with psychological functioning. Journal of the American Academy of Child & Adolescent Psychiatry. 37:1287–1293.

Bruehl S.., Burns J. W.., Chung O. Y.., Ward P.., Johnson B.2002. Anger and pain sensitivity in chronic low back pain patients and pain-free controls: The role of endogenous opioids. Pain. 99:223–233.

Choi C. J.2006. The effects of meditation programs in the reduction of school life maladjustment and anger of junior high school students. Unpublished master’s thesis. Chungang University;Seoul:

Chon K. K.., Hahn D. U.., Lee J. O.., Spielberg C. D.1997. Korean adaptation of the state-trait anger expression inventory: anger and blood pressure. Korean Journal of Health Psychology. 2:60–78.

Chon K. K.., Lee M. K.1992. Preliminary development of Korean version of CES-D. Korean Journal of Clinical Psychology. 11:65–75.

Crockenberg S. B.1981. Infant irritability, mother responsiveness, and social support influences on the security of infant-moth-erattachment. Child Development. 52:857–865.

Gilbert P.., Allan S.1998. The role of defeat and entrapment (arrested flight) in depression: An exploration of an evolutionary view. Psychological Medicine. 28:585–598.

Gilbert P.., Gilbert J.., Irons C.2004. Life events, entrapments and arrested anger in depression. Journal of Affective Disorders. 79:149–160.

Hong Y. S.2004. The effects of the stress and psychosocial resources for adolescent suicidal behaviors. Unpublished doctoral dissertation. Yonsei University;Seoul:

Ishihara S.., Makita S.., Imai M.., Hashimoto T.., Nohara R.2003. Relationship between natural killer activity and anger expression in patients with coronary heart disease. Heart and Vessels. 18:85–92.

Ju J. Y.2005. The study on the relationship among anger expression mode, depression, and aggression in high school students. Unpublished master’s thesis. Seoul Women’s University;Seoul:

Kadner K. D.1989. Resilience. Responding to adversity. Journal of Psychological Nursing and Mental Health Services. 27(7):20–59.

Kim H. S.., Kim H. S.1999. Development of instrument for measuring personality factor related to juvenile delinquency. Journal of Korean Academy of Psychiatric and Mental Health Nursing. 8:190–201.

Lazarus R. S.., Kranner A. D.., Folkman S.1980. An etiological assessment of emotion. Plutchik R., Kellerman H., editorsEmotion: Theory, research and experience. 1:198–201. New York, NY: Academic Press.

Lutgendorf S. K.., Sood A. K.., Anderson B.., McGinn S.., Maiseri H.., Dao M., et al2005. Social support, psychological distress, and natural killer cell activity in ovarian cancer. Journal of Clinical Oncology. 23:7105–7113.

Na S. I.., Ma S. J.2005. Discriminating variables between vocational high school students and academic high school students. Journal of Agricultural Education and Human Resource Development. 37:61–80.

Park E. S.., Park Y. J.., Ryu H. S.., Han K. S.., Hwang R. I.., Im Y. J., et al2006. A nationwide survey on current conditions of school health education. Journal of Korean Academy of Nursing. 36:381–388.

Park H. S.2004. The effect of emotion expression technique and cognitive relaxation by anger expression. Unpublished master’s thesis. Pusan University;Busan:

Park Y. J.., Baik S. I.., Shin H. J.., Yoon J. W.., Cheon S. H.., Moon S. H.2006. Anger, cardiovascular health and depression in middle-aged Korean men: The mediating effect of social support. Journal of Korean Academy of Nursing. 36:863–871.

Park Y. J.., Han K. S.., Shin H. J.., Kang H. C.., Chun S. H.., Moon S. H., et al2004. Prediction on the negative outcomes of anger in female adolescents. Journal of Korean Academy of Nursing. 34:172–181.

Piko B.2001. Gender differences and similarities in adolescents’ ways of coping. The Psychological Record. 51:223–235.

Seo S. G.2002. Cognitive factors related to anger and their therapeu-ticimplications. Unpublished doctoral dissertation. Seoul Nation-alUniversity;Seoul:

Spielberg C. D.1988. Professional manual for the State-Trait Anger Expression Inventory (STAXI). Tampa, FL: Psychological Assessment Resources, Inc..

Suh J. Y.2002. A study on the influence of parental divorce on children’s adaptation: Focusing on resilience. Unpublished master’s thesis. Yonsei University;Seoul:

Suk M. H.2001. Effects of guided imagery on psychological resources and stress responses of adolescents. Unpublished doctoral dissertation. Yonsei University;Seoul:

Williams J. E.., Paton C. C.., Siegler I. C.., Eigenbrodt M. L.., Nieto F. J.., Tyroler H. A.2000. Anger proneness coronary heart disease risk: Perspective analysis from the atherosclerosis risk in communities(ARIC) study. Circulation. 101:2034–2039.

Yarcheski A.., Mahon N. E.., Yarcheski T. J.2002. Anger in early adolescent boys and girls with health manifestations. Nursing Research. 51:229–236.

Figure 1.

Research design.

Exp.=experimental group; Cont.=control group; X=SAMP (school-based anger management program); O1=general characteristics, anger, anger expression psychosomatic response (psychosomatic symptom, pain sensitivity), psychosocial response, immunologic response; O2= anger, anger expression psychosomatic response (psychosomatic symptom, pain sensitivity), psychosocial response, immunologic response; O3, O4=anger, anger expression, psychosomatic response (psychosomatic symptom), psychosocial response.

Table 1.

General Characteristics and Homogeneity between Experimental and Control Group (N=55)

Variables	Exp. (n=32)		Cont. (n=23)		²/t	p
Variables	n (%)	M±SD	n (%)	M±SD	²/t	p
Age		15.8±0.42		16.1±0.94	−1.61*	.11
Number of siblings		2.6±1.77		2.7±2.13	−0.28*	.78
Parental economic status (1,000 won) (n=32)					0.25 �	1.00
Below 1,000	6 (28.5)		3 (27.3)
1,000-3,000	13 (61.9)		7 (36.6)
Above 3,000	2 (9.5)		1 (9.1)
Live with (n=54)					0.12	.72
Both parents	19 (61.3)		13 (56.5)
Single parent or no parents	12 (38.7)		10 (43.5)
Educational level of Father (n=43)					0.01	1.00
Below high school	8 (32.0)		6 (33.3)
High school or above	17 (68.0)		12 (66.7)
Educational level of Mother (n=44)					0.54	.53
Below high school	10 (38.5)		5 (27.8)
High school or above	16 (61.5)		13 (72.2)
Smoking					2.17	.14
Yes	13 (40.7)		5 (21.7)
No	19 (59.3)		18 (78.3)
Drinking					1.95	.16
Yes	11 (34.5)		4 (17.4)
No	21 (65.6)		19 (82.6)
Height		166.5±29.10		166.34±34.69	0.02*	.98
Weight		69.0±17.48		64.8±17.64	0.88*	.38

*t-test; ^�Fisher’s exact test.

Exp.=experimental group; Cont.=control group.

Table 2.

Homogeneity of Outcome Variables between Experimental and Control Group (N=55)

Variables	Exp. (n=32)	Cont. (n=23)	t	p
Variables	M±SD	M±SD	t	p
Trait anger	23.1±4.32	20.8±4.82	1.77	.08
State anger	13.5±4.38	13.8±4.83	−0.24	.81
Anger expression	32.9±9.66	31.1±7.71	0.71	.48
Anger-in	17.4±3.33	17.2±3.23	0.15	.88
Anger-out	16.8±4.47	15.6±3.63	1.02	.31
Anger-control	17.9±5.12	18.5±5.65	−0.35	.73
Psychosomatic response
Psychosomatic symptoms	27.0±8.29	29.8±8.73	−1.18	.24
Pain sensitivity	5.5±1.58	4.2±0.79	3.85	.00**
Psychosocial response
Depression	37.4±9.14	41.1±13.29	−1.20	.24
Entrapment	42.4±12.85	41.2±18.47	0.27	.79
Outer entrapment	27.1±8.35	25.5±10.99	0.57	.57
Inner entrapment	15.3±5.27	15.7±7.55	−0.22	.83
Resilience	43.8±7.77	45.5±8.05	−0.77	.45
Social competence	21.8±3.73	23.0±4.17	−1.03	.31
Autonomy and sense of self	14.3±2.95	15.0±3.32	−0.84	.40
Sense of meaning and purpose	7.8±2.35	7.5±2.47	0.42	.68
Immunologic response
WBC	6,470.3±1,744.50	6,089.6±1,522.10	0.84	.40
Lymphocytes	32.5±7.72	34.7±8.85	−1.08	.28
B cell	14.7±4.18	15.0±4.50	−0.23	.82
T cell	63.6±6.94	66.0±6.44	−1.31	.20
Th cell	28.1±6.83	32.0±5.58	−2.26	.03*
Ts cell	28.8±5.67	28.6±5.78	0.11	.91
NK cell	18.4±8.15	16.6±6.90	0.90	.37

*p<.05; **p<.01; Th cell=helper T cell; Ts cell=suppressor T cell; NK cell=natural killer cell; Exp.=experimental group; Cont.=control group.

Table 3.

Effects of SAMP on Outcome Variables (N=55)

Variables		Time 2			Time 3			Time 4
Variables		M±SD	t	p	M±SD	t	p	M±SD	t	p
Trait anger	Exp.	23.1±3.97	2.09	.04*	21.6±6.28	0.43	.67	21.6±6.60	1.20	.24
	Cont.	20.8±4.17			20.9±5.48			19.7±4.66
State anger	Exp.	12.9±4.60	−1.00	.33	14.5±6.70	−0.10	.92	12.7±5.24	−0.75	.46
	Cont.	14.1±4.34			14.7±7.09			13.7±4.68
Anger expression	Exp.	32.4±6.64	1.12	.27	32.7±7.04	0.85	.40	31.1±8.17	0.20	.84
	Cont.	30.1±7.26			31.0±7.26			30.7±6.66
Anger-control	Exp.	18.0±4.66	−0.93	.36	19.8±5.00	0.86	.39	18.1±5.42	−0.35	.73
	Cont.	19.4±6.15			18.5±5.48			18.6±5.17
Anger-in	Exp.	17.2±3.24	−0.26	.80	18.5±4.47	0.85	.40	16.9±4.56	−0.62	.53
	Cont.	17.4±4.26			17.5±3.84			17.6±3.89
Anger-out	Exp.	16.7±3.82	1.51	.14	17.7±5.00	1.42	.16	16.3±4.35	0.58	.57
	Cont.	15.1±3.42			16.0±3.14			15.7±3.47
Psychosomatic symptoms	Exp.	26.7±11.19	0.27	.79	23.3±11.39	−0.82	.41	24.3±10.41	0.16	.88
	Cont.	25.9±8.86			26.2±12.81			23.9±10.95
Pain sensitivity	Exp.	4.7±1.04	−1.36	.18
	Cont.	5.1±1.15
Depression	Exp.	40.9±9.55	0.29	.78	37.8±9.10	−0.54	.59	36.8±9.83	−0.55	.59
	Cont.	40.0±12.30			39.2±10.98			38.3±8.68
Entrapment	Exp.	37.5±13.42	−1.22	.23	34.3±16.70	−1.04	.30	39.5±17.21	0.51	.61
	Cont.	42.6±17.00			39.5±20.04			37.1±7.11
External entrapment	Exp.	23.9±8.51	−0.84	.40	21.7±10.53	−0.70	.49	24.9±11.32	0.39	.70
	Cont.	26.1±10.52			23.9±12.58			23.7±10.69
Internal entrapment	Exp.	13.6±5.46	−1.66	.10	12.6±6.74	−1.51	.14	14.6±6.56	0.48	.63
	Cont.	16.4±7.00			15.6±7.78			13.7±6.57
Resilience	Exp.	45.0±11.09	−1.10	.92	45.1±11.49	−1.16	.25	47.5±8.25	0.65	.52
	Cont.	45.2±8.96			48.4±7.97			45.9±9.44
Social competence	Exp.	21.8±5.72	−0.88	.38	22.7±5.59	−0.94	.35	23.2±4.82	0.15	.88
	Cont.	23.0±3.64			24.0±4.30			23.0±4.77
Autonomy and sense of self	Exp.	14.4±4.09	−0.47	.64	15.0±4.17	−1.01	.32	15.9±3.12	0.93	.35
	Cont.	14.9±3.82			16.1±3.08			15.1±3.48
Sense of meaning and purpose	Exp.	7.6±2.73	0.38	.71	7.4±2.85	−1.33	.19	8.7±2.63	1.29	.20
	Cont.	7.3±2.51			8.3±2.39			7.7±2.65
WBC	Exp.	6,297.5±1,079.3	3 0.78	.44
	Cont.	6,000.0±1,763.0	0
Lymphocytes	Exp.	31.6±6.84	2.03	.04*
	Cont.	27.5±8.11
B cell	Exp.	14.6±3.96	−1.18	.24
	Cont.	15.9±4.73
T cell	Exp.	67.1±6.76	0.56	.58
	Cont.	66.0±6.78
Th cell	Exp.	31.6±7.06	−0.76	.45
	Cont.	32.9±5.14
Ts cell	Exp.	29.6±5.58	1.19	.24
	Cont.	27.8±5.73
NK cell	Exp.	15.9±7.17	−0.17	.86
	Cont.	16.3±6.87

*p<.05; SAMP=school-based anger management program; Time 2=1 week after Intervention; Time 3=4-week follow-up; Time 4=10-week follow-up; Th cell=helper T cell; Ts cell=suppressor T cell; NK cel=natural killer cell.

Table 4.

Effects of SAMP for the Experimental Group (N=32)

Variables	Time 1-Time 2			Time 1-Time 3			Time 1-Time 4
Variables	M±SD	t	p	M±SD	t	p	M±SD	t	p
Trait anger	0.2±2.74	0.28	.78	1.7±5.98	1.51	.14	1.6±5.73	1.44	.16
State anger	0.7±2.67	1.44	.16	−0.6±5.73	−0.61	.55	0.7±4.24	0.86	.40
Anger expression	1.5±7.56	0.97	.62	0.1±9.00	0.04	.96	1.9±6.85	1.49	.15
Anger-control	−0.5±4.01	−0.62	.53	−2.3±6.60	−1.86	.07	−0.2±4.20	−0.31	.76
Anger-in	0.3±4.25	0.39	.70	−1.2±3.48	−1.82	.08	0.6±4.72	0.73	.47
Anger-out	0.2±3.86	0.28	.34	−0.9±5.02	−1.02	.32	0.6±3.64	0.94	.46
Psychosomatic symptoms	1.0±10.25	0.51	.62	4.3±8.94	2.58	.02*	2.8±8.48	1.80	.08
Pain sensitivity	0.8±1.55	3.02	.00**
Resilience	−1.2±9.93	−0.57	.58	−3.2±9.84	−1.70	.10	−1.9±7.86	−1.22	.23
Social competence	−2.0±5.49	0.10	.92	−0.8±6.21	−0.69	.49	−0.9±5.30	−0.93	.36
Autonomy and sense of self	0.1±4.11	0.14	.89	−1.2±4.17	−1.45	.15	−1.2±2.90	−2.13	.04*
Sense of meaning and purpose	0.2±2.82	0.46	.65	0.2±2.40	0.46	.65	−0.7±2.63	−1.41	.17
Depression	−3.6±7.27	−2.62	.01*	−0.4±7.91	−0.23	.82	0.3±10.91	0.15	.88
Entrapment	4.8±13.34	1.99	.06	8.0±15.63	2.85	.00**	2.1±15.56	0.75	.46
External entrapment	3.1±8.38	2.04	.05	5.2±10.67	2.71	.01*	1.6±11.15	0.77	.45
Internal entrapment	1.7±5.97	1.63	.11	2.7±5.74	2.68	.01*	0.7±5.76	0.62	.54
WBC	172.8±1,738.8	0.56	.58
Lymphocytes	0.9±7.75	0.62	.54
B cell	0.2±2.49	0.40	.69
T cell	−3.5±3.73	−5.28	<.0001**
Th cell	−3.5±3.11	−6.31	<.0001**
Ts cell	−0.9±1.57	−3.15	.00**
NK cell	2.5±4.20	3.38	.00**

*p<.05; **p<.01; SAMP=school-based anger management program; Time 1=1 week before Intervention; Time 2=1 week after Intervention; Time 3=4-week follow-up; Time 4=10-week follow-up; Th cell=helper T cell; Ts cell=suppressor T cell; NK cell=natural killer cell.

TOOLS

Similar articles