Assessing the Down-Regulation of Maladaptive Anger During Imagery-Enhanced Cognitive Restructuring for Hostility: A Randomized Controlled Trial

The down-regulation of maladaptive emotions during psychotherapy is frequently assessed via self-report, but the additional assessment of physiological arousal may provide unique insights. Maladaptive anger, as experienced by hostile individuals, can have debilitating intra- and interpersonal consequences. In a recent randomized controlled trial (RCT), it was shown that enhancing cognitive restructuring (CR) with mental imagery increases its efficacy in reducing maladaptive anger-triggering hostile beliefs, but not self-reported anger. The present secondary data analysis examines physiological data collected during the RCT to investigate whether imagery-enhanced cognitive restructuring (I-CR) facilitated the down-regulation of maladaptive anger-related arousal. A sample high in trait hostility (N = 87, 72% female, 28% male) was randomized over one session of I-CR (n = 34), traditional CR (n = 32), or an active control group (AC, n = 21). Blood pressure and heart rate were assessed pre- and postintervention, and pre- and poststressor one week after the intervention. The results showed that I-CR reduced postintervention systolic blood pressure to a larger degree than CR and AC. Diastolic blood pressure was reduced more strongly by I-CR compared to AC, but not to CR. No between-group differences in postintervention heart rate were found, nor in response to the stressor for all three measures. Limitations of this study include that the sample was rather small, non-treatment seeking, and mostly female. In conclusion, physiological down-regulation emerged immediately postintervention and was distinctive for I-CR and systolic blood pressure. Adding mental imagery to CR thus facilitates the down-regulation of maladaptive anger-related arousal. Public Health Significance Statement The present study illustrates the utility of assessing both bodily arousal and self-report to measure emotional change during psychotherapy. Incorporating mental imagery during cognitive restructuring of hostile beliefs helps in lowering maladaptive anger-related bodily arousal, but not self-reported anger. 在意象增强的敌意认知重构过程中评估适应不良愤怒的下调：一项随机对照试验心理治疗过程中，适应不良情绪的下调经常发生 通过自我报告进行评估，但对生理唤醒的额外评估可能会提供独特的见解。 敌对个体所经历的适应不良的愤怒可以 具有削弱人际和人际关系的后果。 最近的随机对照 试验 (RCT)表明用心理图象增强认知重构 (CR) 可以增加其在减少由不适应性愤怒引发的敌对信念的功效，但不是自我报告的愤怒。 本文进行的二级数据分析研究了收集到的在 RCT 期间调查图像增强认知重构 (I-CR) 促进了不良愤怒相关唤醒的下调的生理数据 。一个有着高敌意特质（N = 87，72% 女性，28% 男性）的样本被随机分配到一次 ICR（n = 34）、传统 CR（n = 32）， 或活跃控制组（AC，n = 21）中。 血压和心率被在干预前和干预后以及应激前和应激后在干预后一周进行了测量。