Programs that Work
Cognitive Relaxation Coping Skills
Healthy and Safe Children
Children and youth not engaging in violent behavior or displaying serious conduct problems
Children not experiencing anxiety or mood disorders, such as depression
Age of Child
Middle Childhood (9-12)
Type of Setting
Type of Service
Health Care Services
Type of Outcome Addressed
Evidence Level (What does this mean?)
The Cognitive Relaxation Coping Skills (CRCS) program targets heightened cognitive, emotional, and physiological sensations, with a goal of increasing children's ability to control their emotions. Students are taught methods for relaxation and for attitude change and how to use those skills to control their feelings of anger. The premise of the program is that as students apply these skills and learn how to relax, or if they avoid becoming angry in the first place, they are better able to deal effectively with frustrating situations.
Students in grades 6 through 8 who have expressed a high degree of anger
The CRCS program was evaluated in a single study over three years in the 1990s (Deffenbacher et al., 1996). In the first year, all seventh- and eighth-graders in a middle school in Oregon were screened on the Trait Anger Scale (TAS), a self-report measure that asks students to rate how angry they generally feel, e.g., being "hotheaded" or becoming angered by being criticized in front of others. High trait anger is a personality trait that reflects a tendency to experience frequent and intense episodes of anger. In the second year, all sixth- and seventh-graders in the same school were screened on the TAS (eighth-graders were not assessed because they were part of the prior year’s sample). In the third year, all eighth-graders in a junior high in Colorado were screened on the TAS. A total of 694 students were screened over the three-year period.
The 178 students who scored in the upper quartile on the TAS were asked for parental permission to participate in the study. Of the 178 potential participants, 11 left the school or were unavailable before the project started, four moved or could not be assessed at follow-up, eight parents refused to consent, and 35 parents did not return the consent form. The final participating sample consisted of 120 high-anger students who were randomly assigned to CRCS (39 students), to an alternative Social Skills Training (SST) program (40 students), or to a no-treatment control group (41 students). The SST group used a curriculum that emphasized social-communication skills as a way to reduce anger, while the no-treatment control students did not receive special programming or special attention. Fifty-three percent of the sample was male, 78 percent was Caucasian, 19 percent was Latino, 2 percent was Asian, and 1 percent was Native-American. Sixteen percent of the students was in the sixth grade, 32 percent was in the seventh grade, and 53 percent was in the eighth grade.
Prior to implementation of the treatment programs, students were assessed on a variety of measures to determine their level of anger. Along with the TAS, students completed the Anger Rating Scale (which measured general reactions of anger, such as losing one’s temper or wanting to hit someone); the Anger Situation Rating (in which students described the three situations that had made them the angriest and rated the degree of anger created by each situation); and the Anger-In, Anger-Out, and Anger-Control Scales (which assessed students’ styles of dealing with anger--suppressing feelings of anger, outwardly negative expressions of anger, or calm, controlled, and socially appropriate behaviors). In addition, students’ anxiety levels were assessed on two scales--the Trait Anxiety Inventory (in which students rated how anxious they generally feel, e.g., nervous and restless, and the degree to which they feel like a failure), and the Anxiety Rating Scale, which measures general anxiety and worry.
Symptoms of depression were assessed according to the Depression Rating Scale, which asked students whether they felt sad, low, or lonely, for example. General deviant behavior was assessed by asking students how typical it was for them to steal, lie, or cheat, while school deviance was measured by asking students whether any one of seven problems (disciplined by a teacher, disciplined by the principal, suspension, tardy, detention, truant, or getting into a fight at school) had occurred in the past two months. Finally, alcohol use was assessed by asking students how many times in the past month they had used alcohol and how many times they had gotten drunk.
Three groups, each consisting of 12 to 14 students, were in each treatment condition. Groups met for nine 45-minute sessions during regular school hours. Attendance rates were high, with students attending eight of nine sessions on average.
A follow-up assessment took place approximately eight weeks post-treatment. The content of the posttest assessment was identical to the content of the pretest assessment except that students re-rated the same three Anger Situations that they described at pretest, instead of describing new anger situations.
Analysis of pretest scores indicated that there were no significant differences between the two schools; therefore, data for analysis were collapsed across schools. Comparisons of pretest scores also indicated no significant differences among the three treatment groups.
Key Evaluation Findings
The study by Deffenbacher et al. (1996) reported the following:
- Analyses of the anger measures revealed significant positive treatment effects on all anger instruments, with the exception of the Anger Control scale. Significant positive effects for the treatment groups were found on the Trait Anger Scale, the Anger Rating Scale, the Anger Situation Rating, the Anger-In Scale, and the Anger-Out Scale. A consistent pattern of between-group differences was found for the anger measures; in all cases, the CRCS and SST groups differed significantly from the control group but did not differ significantly from one another.
- On the Anxiety Rating Scale, the CRCS and SST groups also scored significantly better than the control group and did not differ from one another.
- On the Trait Anxiety Inventory, CRCS participants reported significantly less trait anxiety than control students, whereas the SST group fell between the CRCS and control groups and did not differ significantly (in a statistical sense) from either group.
- Similarly, for depression, CRCS participants reported significantly less depression than control students, while the SST group did not differ significantly from either group.
- Similarly, for general deviance, CRCS participants reported significantly less general deviance than members of the control group, while SST participants were not significantly different from either group.
- Similarly, for the measure of deviance at school, CRCS students reported significantly less school deviance problems than either SST or control students, who did not differ from one another.
- No significant treatment effect was found for the alcohol-use variables, although it should be noted that students' use of alcohol pretest and posttest was low, making it more difficult to show treatment effects.
Public and private elementary and middle schools
None at this time
The CRCS program originally was developed by Deffenbacher and colleagues and had targeted late adolescents and adults. For the current study, the program was adapted for middle-school students. To ensure treatment adherence, interventions were based on written outlines that specified the activities for each session and were discussed in detail with program implementers prior to and after each session.
The CRCS program includes nine 45-minutes sessions. The content of the sessions is as follows:
- A portion of the first session is devoted to developing a list of anger-provoking situations and how students had previously reacted angrily to those situations. The remainder of the first session and the second session are devoted to progressive relaxation training and to the development of specific relaxation coping skills, including cue-controlled relaxation, breathing-cued relaxation, and relaxation without tension. Homework includes anger self-monitoring and practice of relaxation skills.
- The third and fourth sessions focus on how cognitive processes influence anger and how changing those processes can lessen anger. Students are asked to imagine a provocative situation and to become as angry as possible in reaction to the situation. Students report on the thoughts they are having that are eliciting the angry feelings. Students are then asked to visualize the situation again, while trying to remain as calm as possible. Students then report back on their thoughts, which are contrasted with the thoughts they were having in the first part of the exercise. Homework includes self-monitoring of cognitive processes and practicing relaxation skills.
- The first half of each of the last five sessions is spent introducing a specific provocative situation identified in the first session and discussing specific cognitive changes that reduce feelings of anger. These discussions are made to be lively and interactive and include role-playing with the group leader. The second half of each session is spent rehearsing cognitive-adjustment exercises and relaxation-based coping skills. Students visualize an angering event, experience anger arousal, and then rehearse specific cognitive-adjustment exercises and relaxation-based coping strategies.
- At the end of the sixth session, the cognitive strategies are translated into ten basic strategies (e.g., self-instruction to "stop," to "think calmly," to use "no put-downs or name calling," or to "problem-solve"), and a list of those strategies is distributed to the participants. Homework includes self-monitoring and applying cognitive-adjustment exercises and relaxation-based coping skills to anger and other distressing feelings, such as test anxiety.
In the program, as it was evaluated, the sessions were led by either a master’s-degree-level school psychologist with more than ten years of experience providing psychological services in schools, or by an advanced doctoral student with several years of experience providing psychological services to youth.
Issues to Consider
This program received a "promising" rating. Significant treatment effects were found for reducing children’s levels of anger, depression, anxiety, and delinquent behavior. While the evaluation had certain strengths, such as the use of a randomized controlled design and a relatively large sample size, it also suffered from several weaknesses. One was that the program developer also served as the program evaluator. In addition, the study did not incorporate any long-term follow-up, so it is unknown whether the observed CRCS benefits lasted beyond eight weeks after program completion. Furthermore, the assessments relied only on student self-reports, rather than also including parent, teacher, or peer ratings. Finally, the program has been evaluated in only two schools, which have a predominantly white population, limiting the generalizability of findings to other populations.
It is important to note that the positive findings of the CRCS evaluation are relevant only for high-anger youth. The study sample consisted of children who scored in the upper quartile on the Trait Anger Scale, based on distributions in the participating schools. While study results suggest that the program is successful at reducing levels of anger, anxiety, depression, and delinquent behavior, the program is targeted toward youth displaying high levels anger at baseline, and the program may not be as effective in other populations.
Furthermore, while Deffenbacher and his colleagues reported outcomes for both anxiety and depression, they did not discuss the clinical significance of children's pretest scores on the measures of anxiety and depression. It is unknown whether students had clinically significant levels of anxiety or depression to begin with; thus, the observed significant decrease in the scores on these measures may not be meaningful from a practical sense.
It is also worth noting that while youth who participated in the CRCS treatment group improved relative to students who received no such services, the outcomes of the SST program group had improved as much as those for the CRCS group on many measures. The Promising Practices Network plans to review the SST program in the near future.
Oregon and Colorado
Dr. Jerry L. Deffenbacher
Department of Psychology
Colorado State University
Fort Collins, CO 80523
Tel: (970) 491-6871
None at this time