Online emotion regulation treatment for maladaptive anger inhibition – an open-label pilot with a pooled interrupted time series design

Despite documented risks associated with excessive anger inhibition, few treatments specifically target maladaptive anger inhibition. Building on a previously evaluated treatment for general anger, this study evaluated the feasibility, acceptability, and preliminary efficacy of a brief (4-week), therapist-supported online emotion-regulation treatment for maladaptive anger inhibition. In total 38 participants (89.5% female; M-age = 43.8, SD = 14.1) with elevated levels of maladaptive anger inhibition were offered treatment, which was evaluated using a pooled interrupted time series design (ITS). Treatment outcomes included measures of anger inhibition, anger rumination, and anger assertion that were assessed during a baseline phase (4 weeks) and a treatment phase (4 weeks). Feasibility was supported by high retention and adherence, and minor adverse events. Moreover, participants reported high treatment credibility and satisfaction, indicating good acceptability of the treatment. Piecewise growth curve analysis for ITS, comparing baseline and treatment phases, revealed significant and large immediate effects on all outcomes: anger inhibition (d = 1.26), anger rumination (d = 0.80), and anger assertion (d = 0.79), with small additional gains observed at 3-month follow-up. Taken together, the findings suggest that this brief online emotion-regulation treatment for maladaptive anger inhibition is feasible, acceptable, potentially effective, warranting further investigation in an RCT. ClinicalTrials.gov identifier: NCT06697587.