Behav. Res. & Therapy, 1973, Vol. II, pp. 473 to 481. Pergamon Press.

Printed in England
MOTOR AND COGNITIVE RELAXATION IN THE
DESENSITIZATION OF ANGER*
CLIFFORD R. ODONNELL
University of Hawaii, Honoluh_~, Hawaii 96822, U.S.A.
and
LEONARD WORELL
University of Kentucky, Lexington, Kentucky, U.S.A.
(Received 8 February 1973)
Summary-Three procedures were assessed to determine their effectiveness in reducing anger. The proce-
dures were: desensitization, desensitization with cognitive relaxation, and desensitization with the absence
of relaxation training. Anger was aroused by exposing white males, selected for their reports of anger
toward blacks, to black racial stimuli. The desensitization group reported reductions in anxiety and disgust
relative to a no-treatment control group. Therapist ratings indicated reductions in anger for Ss in both the
desensitization and desensitization with cognitive relaxation groups. In addition the latter group reported
reductions in anger concurrently with increases in diastolic and systolic blood pressure. Post-hoc analyses
indicated that Ss for whom desensitization was most effective reported less anger after the pretreatment anger
arousal procedure, greater depth of relaxation during treatment, and were liked more by their therapists.
These Ss also reported a greater reduction in ethnocentrism and a trend toward lower overt hostility follow-
ing treatment.
THE CENTRAL. concern of this study is to determine the effectiveness of three procedures to
reduce anger. Anger was aroused experimentally by exposing white males to provocative
black racial stimuli. The anger response generated by this experience is assumed to be the
result of a long conditioning history within a subculture in which it is considered to be an
appropriate reaction for these white males. It therefore may well be more resistant to change
than most other emotional responses, such as anxiety about snakes, etc., that have been
studied heretofore.
One procedure that has been found effective in reducing anxiety is that of desensitization
(Bandura, 1969; Paul, 1969; Rachman, 1967). In relation to anger, however, Wolpe (1969)
believes that both anger and muscle relaxation are associated with parasympathetic nervous
activity. Therefore, relaxation should not reciprocally inhibit anger. An apparent contradic-
tion of this position is found in a recent study by Rimm et al. (1971) who report the successful
application of desensitization to an anger response. One aim here then is to further explore
the use of desensitization with anger.
The basis of the effectiveness of desensitization and the role of relaxation is not concept.-
ually clear (Nawas et. al., 1971; Nawas, Welsch and Fishman, 1970). As has
been suggested elsewhere (Rachman, 1968; Wolpin and Raines, 1966) it is quite
possible that a cognitive component rather than a physical one is the determining agent for
change in muscle relaxation. Consequently, we have included a desensitization group which
receives cognitive without the typical motor relaxation training as a second procedure.
* This study is based on a dissertation submitted by the first author in partial fulfilment of the require
ments for the Ph.D. degree at the University of Kentucky. The authors express their appreciation to com-
mittee members, William Claiborn, Ronald Doctor, Melvin Lerner and William Tisdall; to the therapists,
Joseph Aponte, Paul Martin, Drew Sappington and Robert Welch; and to the assistants, Joanne Alderfer
and Madeline Cooke.
473
474 CLIFFORD R.O'RONNELL and LEONARD WORELL
Additiona~y, in their investigation of the role of relaxation, both Davison (1967) and
Rachman (1965) included a group which did not engage in relaxation either before or during
the hierarchy presentation. Ss in these groups were yoked to Ss in the desensitization group
with respect to both order and duration of the hierarchy items. This procedure presents
some problems, however. The fact that these groups showed no significant change can be
attributed to either of two factors: (a) the absence of relaxation prior to or during the heir-
archy presentation or (b) the yoking requirement. More specifically, in the latter case it is
conceivable that Ss anxiety is aroused rather than relaxed since the presentation of the items
is neither graded according to individual intensity nor duration of exposure. Previous
research has demonstrated that the absence of relaxation in desensitization provides for
little or no behavioral change. This study attempts to specify how this may take place.
Therefore, the third and final objective here is to determine the effect of the absence of
relaxation training by the inclusion of a group which experiences relaxation only during
the presentation of the hierarchy but is not yoked to any other group.
METHOD
All Ss completed a test battery and a behavioral assessment both before and after their
participation in one of four conditions.
The test battery
Described below are the five instruments included in the test battery together with the
reasons for their being administered. The instruments were: (1) the Buss-Durkee Hostility
Inventory (factor analytic version- Bendig, 1962) to assess general hostility; (2) an Emo-
tional Rating Scale, consisting of 5-point Likert type scales, to gather self-reports of anger,
anxiety and disgust to racial stimuli; (3) the Ethno~ntrism Scale to evaluate ethnocentric
attitudes (Adorn0 et al., 1950); (4) the Lie Scale of the Minnesota Multiphase Personality
Inventory to screen potential Ss whose scores might be unreliable (Dahlstrom and Welsh,
1960); and finally (5) the Marlowe-Crowne Social Desirability Scale (Crowne and Marlowe,
1960) to determine whether responses may be influenced by a social desirability factor.
The foregoing test battery was administered to 70 volunteer male students enrolled in
psychology classes at the University of Kentucky. Thirty-two volunteers who scored at or
above the mean of the Anger subscale of the Emotional Rating Scale and at or below the
60th T score on the Lie Scale participated as Ss in the experiment.
The behavioral assessment
All Ss were seen individually. Each S was asked to listen to a tape recording and to
watch a series of slides designed to arouse your anger. The tape, comprised of selections
from a militant speech by Malcolm X, was heard through earphones. Simultaneously,
24 slides depicting people and events related to racial issues were presented. Each slide was
exposed for 15 sec.
The slides were projected from an adjoining room through a one-way mirror onto a white
projection screen. During this six-minute presentation, an assistant who was unfamiliar
with the experimental conditions observed S through a one-way mirror from a second
adjoining room and rated motor behaviors believed to be indicative of anger (e.g. clenching
fist, shaking head no). Following the presentation each S (a) had systolic and diastolic
blood pressure readings taken by the assistant, (b) participated in a tape recorded interview
MOTOR AND COGNITIVE RELAXATION IN THE DESENSITIZATION OF ANGER 475
with E, (c) completed an Adjective Check List (Gottschalk et al., 1963), (d) filled
out a five point self rating scale for anger, and (e) arranged his first appointment
with the therapist to whom he was assigned. An attempt was made to assign subjects to
therapists randomly; however, exceptions from this procedure were made in order to
arrange mutually convenient times.
Conditions
Eight Ss were randomly assigned to each of four conditions. These were: Desensitization
with Motor Relaxation (DM), Desensitization with Cognitive Relaxation (DC), No Relaxa-
tion (NR), and No Treatment (NT).
The DM condition was similar to the standard desensitization procedure (Paul, 1966).
The sole exceptions were that relaxation instructions were conveyed by a tape recording
and the construction of the heirarchy items was such that Ss were asked to select 10 items
from a list of 25 (e.g. Black Panthers, interracial dating, etc.) and order them on a 100 point
scale with 10 points separating each item. Each S therefore established his own individual
ordering of the 10 items.
The DC condition was the same as DM except that Ss did not engage in motor behaviors
of relaxation. Instructions for the DC Group were identical to those of the DM Group
save that Ss in the DC Group were told to relax and listen to the taped relaxation instruc-
tions but not to go through the specific exercises described on the tape. Concomitantly,
their instructions concerning practice at home were to relax and think of listening to the tape.
The NR condition was identical to DM but here Ss did not receive any relaxation training,
either motor or cognitive, prior to presentation of the heirarchy. They did obtain the same
instructions, however, during the hierarchy presentations. Ss in this group, of course, were
not exposed to the tape recorded relaxation instructions. This omission shortended their
first session by 20 min and subsequent sessions by 10 min.
NT refers to Ss who did not receive any treatment but participated in the pre- and post-
measures.
It is worthwhile noting that instructions regarding expectancy for improvement were
identical for the DM, DC and NR Groups.
Therapists and treatment termination
The eight Ss of each treatment condition were evenly divided among four therapists.
Each S received five treatment sessions spaced over an 1%day period. These sessions began
2-days after the pretreatment assessment with a minimum delay of 2 days between any two
sessions.
At the end of the last session all Ss, except those in the NT Group, filled out a five point
rating scale which dealt with the depth of relaxation they experienced during the sessions.
They were then given the same test battery as before to take home, fill out, and hand in
when they returned for the post-treatment assessment. Upon Ss departure, each therapist
rated each S assigned to him on a five point scale of likeability, responsiveness, appro-
priateness of length of treatment, appropriateness of type of treatment, reduction of anger,
need for continued treatment of anger, improvement in other areas, need for treatment in
other areas, how comfortable he (the therapist) felt working with him, and the depth of
relaxation S was able to achieve.
476 CLIFFORD R. O'DONNELL and LEONARD WORELL
Beginning 7 days after the last S completed treatment, all Ss were seen individually by
E for a post-treatment assessment identical to the pre-treatment assessment. This involved
presentation of the tape recording, slides and the measurements associated with them.
Finally, the tape recordings of Es interviews with each S were rated for anger indicated in
verbal content (Gottschalk et al., 1963) by two assistants who were unfamiliar with the
experiment.
RESULTS
The results from the test battery and behavioral assessment are presented first, followed
by data from the post-treatment measures and the post-hoc analyses.
The test battery and behavioral assessment measures
All data derived from pre- and post-measures were analyzed by fixed effects analyses of
covariance with the premeasure as covariate and the post-measures as the variate. To assess
the individual effect of each treatment, individual comparison F tests (Winer, 1971) were
used to evaluate the differences between the means of the treatment groups and the No
Treatment Control Group.
The adjusted means of the Ss test battery are presented in Table 1. The mean for the DM
Group is significantly lower than the NT mean on both the anxiety (F = 5.88, DF = l/27,
p < 0.04) and disgust (F = 6.19, DF = l/27, p < 0.03) subscales of the ERS. No other
differences between treatment groups and NT reached an acceptable level of significance
on the measures in Table 1. However, the means were in the expected direction on all five
measures for the DM Group and on four of the five measures for the DC and NR Groups.
TABLE 1. ADJUSTED MEANS OF THE TEST BAI-~ERY
Measure
Pre-treatment
mean DM
Post-treatment means
DC NR NT
ERS-anger 36.7 28.1 29.8 32.6 33.1
ERS-anxiety 30.6 23.9 26.2 30.1 32.5
ERS-disgust 38.3 30.0 32.9 35.0 37.8
Hostility inventory 20.4 19.8 23.6 21.1 21.2
Ethnocentrism scale 44.3 47.2 48.3 54.0 50.2
The adjusted means for the behavioral assessment measures appear in Table 2. Compari-
son of the DC and NT Group means showed the DC mean to be lower on the Adjective
Check List scored for anger (F = 7.19, DF = l/27, p < 0.02) but higher on both diastolic
(F = 3.93, DF = l/27, p < 0.06) and systolic (F = 4.50, DF = l/27, p < 0.05) blood
pressure. Here, the means were not in the expected direction on blood pressure; they were,
however, on all four of the other measures for Groups DM and NR and three of the four
for the DC Group.
Post-treatment measures
The post-treatment ratings made by the therapists and Ss were analyzed separately by
fixed effects analyses of variance. To assess the relationship between ratings and reduction
of emotion, the ratings were arranged in a 2 x 3 factorial design. Data for the first factor
TABLE 2. h3USTED MEANS OFTHE. BEHAWOORAL ASSESSMENT
Measure
Pre-treatment
mean DM
Post-treatment means
DC NR NT
Adjective check list 4.0 3.0 1.4 4.6 4.8
Diastolic BP 76.9 76.3 79,3 73.2 73.1
Systolic BP i26.9 115.9 fI8.6 117.8 110.3
Verbal content rating 22.4 13.9 16.2 16.7 17.6
Motor behavior rating 3.7 1.8 2.2 2.1 2.8
Anger scale 2.9 2.2 2.6 2.4 2.6
were obtained by dividing the Ss in each treatment group into two subgroups, determined by
whether their pre-post difference scores on the combined subscales of the ERS were above
or below the median. The three treatment groups constituted the three levels of the second
factor. Since the NT Croup was not involved in these treatment ratings, Duncans Multiple
Range Test was used here to evaluate the differences among the means on the latter measures.
It wiil be recalled that two ratings of the depth of relaxation Ss achieved were obtained;
one from the therapist and one from the S. The mean scores of these measures appear in
Table 3.
TABLE~.MEANIZE~THOFRE~XA~ON RATFNGS
Treatment
Rater Improvement DM DC NR
Subject High 5.00 5.00 4.25
Low 4.00 4.50 4.00
Therapist High 4.75 4.50 3.50
Low 3.50 4.25 3.50
Analysis of the Ss relaxation scores yielded significant main effects for improvements
F = 9.71, DF = l/18, p c 0.01, and treatment, F = 3.76, S)F = 2/B, p < 0.05. Simiiar
trends, albeit non-significant, were found in the analysis of relaxation scores completed
by the therapist (improvement, F = 3.19, DF = I/XX, p i: 0.10 and treatment, F = 3.47,
DF = 2/18, p < 0.06). The source of the treatment effects was the difference between the
mean ratings of the DC and NR Groups.
The therapist also rated each S assigned to him on nine other variables. These mean
ratings are listed in Table 4, A significant effect for improvement occurred only in the like-
ability data, F = 4.50, DF = l,QS,p < 0.05; treatment accounted for the other significant
effects: reduction of anger, F = 13.19, DF = 2118, p -K 0.01 (DM and DC > NR),
responsiveness, F = 18.06, DF = 2/l&, p c 0.01 (DM and DC > NR), appropriateness
of the type of treatment, F = 19.65, DF = 2118, p < 0.01 (DM and DC > NR), and
comfortability, F = 5.41, DF = 2118, p < 0.03 JDM s NR),
478 CLIFFORD R. O'DONNELL and LEONARD WORELL
TABLE 4. MEAN RATINGS OF SUBJECTS BY THERAPISTS
Treatment
Measure Improvement DM DC NR
Reduction of anger High 4.00
Low 3.75
Likeability High 4.50
Low 3.50
Responsiveness High 4.50
Low 3.75
Appropriateness of
length of treatment
Appropriateness of
type of treatment
Comfortability
High
Low
High
Low
High
Low
3.25
2.75
4.50
4.00
5.00
4.75
Need for continued High
treatment for anger Low
Improvement in High
other areas Low
Need for continued High
treatment in other areas Low
2.50
3.00
2.50
2.00
1.75
3.25
4.00 2.50
3.50 2.25
4.00 3.75
3.50 3.25
4.25 2.00
3.75 2.00
3.00 2.25
3.25 2.00
3.75 1.75
3.25 1.75
3.75 3.00
3.50 2.75
2.50 2.75
2.50 3.50
2.25 1.75
2.50 1.75
2.50 2.25
2.50 3.25
Post-hoc analyses
The Ethnocentrism Scale and the Buss-Durkee Hostility Inventory were included in the
study to see if anger reduction might also be reflected in more general measures of prejudice
and hostility. As reported before no significant changes occurred on either measure. Inspec-
tion of a change scores on the ERS, however, seemed to indicate that marked reductions
of anger occurred for some Ss and slight or no reduction for others. Therefore, the Ethno-
centrism and Hostility data were arranged in the same 2 x 3 factorial design that was used
with the ratings and analyzed by fixed effects analyses of covariance. The adjusted means
are presented in Table 5.
Treatment by improvement interactions were significant for Ethnocentrism, F = 4.09,
DF = 2/17, p < 0.05, and showed a trend for Overt Hostility, F = 2.81, DF = 2/17,
p < 0.10. The sources of these effects lie in the differences between the means of the DM
High and DM Low Groups.
As a result interest was now focused on identifying the possible differences between the
High and Low Groups within the DM condition (Mean ERS change scores = -15.2
and - 1.4 respectively). Therefore the prescores and therapist ratings of these groups were
analyzed by analyses of variance. Significant effects occurred on the Anger Scale (x = 2.5
for Highs and 3.5 for Lows), F = 6.00, DF = 1/6,p < 0.05, likeability (x = 4.5 for Highs
and 4.0 for Lows), F = 6.00, DF = l/6, p -c 0.05, and Ss relaxation ratings (x = 5.0 for
Highs and 4.0 for Lows), F = 6.00, DF = l/6, p < 0.05.
MOTOR AND COGNITIVE RELAXATION IN THE D~ENSITIZATiO~ OF ANGER 479
TABLE 5. ADJUSTED MEAN SCORES OF THE ETHNOCENTRISM AND
OVERT HOSTILITY SCALES
Post-treatment means*
Improvement
High
Low
Overt
Treatment Ethnocentrism hostility
DM 39.7 8.0
DC 56.5 10.4
NR 56.2 10.5
DM 61.0 10.7
DC 46.5 10.7
NR 58.4 9.7
* The pretreatment means = 47.8 and 9.8 for ethnocentrism and
overt hostility respectively.
Finally differences among the mean scores for social desirability did not approach signi-
ficance, F = < 1, nor alter the pattern of results if used as a covariate. In addition, differ-
ences in the mean number of items completed in the hierarchy for each group (DM = 9.9,
DC = 9.8, NR = 9.1) were not significant, F = < 1.
DISCUSSION
This study was designed to assess the effectiveness of three procedures to reduce anger.
Each procedure will be discussed in turn. The results for the DM group indicate that of the
eight Ss, four showed marked reduction in anger, one a moderate reduction, and three
showed little or no change. Only therapist ratings of anger reduction and ERS scores for
anxiety and disgust showed significant overall differences relative to NT (NR). The therapist
ratings may be more indicative of their expections than actual observed changes in Ss. The
changes on ERS indicate that although the target behavior was anger, Ss demonstrated
reliably greater change in anxieiy and disgust. This suggests that emotions other than the
targeted one may be changed in desensitization.
The results also suggest that DM may be an effective procedure for some Ss and not for
others. If this is valid, then the importance of identifying the factors responsible is apparent.
Present post-hoc analyses indicate that Ss for whom Dh4 was effective reported less anger
after the pretreatment anger arousal procedure, greater depth of relaxation during treatment,
and were liked more by their therapists. In addition, they reported a greater reduction in
ethnocentrism and a trend toward lower overt hostility followed treatment. This points to
the possibility that lower initial anger combined with greater relaxation may result in more
effective changes.
Lower initial anger may also heIp to explain the success of Rimm et al. (1971) in reducing
anger in driving situations. Since their Ss volunteered on the basis that such anger was
inappropriate, they may well be more similar to our Ss who reported less anger after the
pre-treatment anger arousal procedure. It is also possibfe that anger in driving situations
differs from racial anger with respect to length of conditioning and current social reinforce-
ment contingencies. If so, then anger in driving situations may be more similar to racial
anxiety and disgust in that these are less likely to be currently positively reinforced than
racial anger.
480 CLIFFORD R.O'DONNELL and LEONARD WORELL
Another aspect which may be important~ne which was not assessed in this study-
is the motivation of the Ss for participating in the study. Clearly with test and speech
anxieties or anger during driving, the S will directly obtain benefits by anxiety or anger
reduction. For anger provoked in white male Ss by racial stimuli, motivation for change is
less clear. Some may be uncomfortabIe when such anger is aroused and genuinely wish to
reduce it; others may be equally uncomfortable but expect negative reactions from friends,
family, or fraternity brothers if they changed ; some others may volunteer to learn tech-
niques to reduce anger but not be interested in anger related to racial stimuli, or finally,
still others may volunteer solely for course credit. In addition, although instructions regard-
ing expectations for improvement were equated across groups, no attempt was made to
assess individual differences in expectancy. Given the current controversy over the effects
of expectation within desensitization, it is possible that these differences may contribute
to differential outcome.
The DC Group scored significantly lower relative to NT (NR) only on therapist ratings
for anger reduction and the Adjective Check List scored for anger. Concurrently, on both
diastolic and systolic blood pressure they showed significant increases relative to NT. This
type of discrepancy between self report and physiological measures is not uncommon (e.g.
Lazarus and Alfert, 1964). It is of interest here, however, that this disparity between measures
occurred only for the DC Group. Perhaps the focus on a cognitive form of relaxation,
opposed to both cognitive and motor, continued during the post-assessment and resulted in
Ss being relatively less aware of physiological reactions. Given this discrepancy and the
lack of change on other measures, no firm conclusions can be reached regarding the effective-
ness of the DC procedure. Further the results of the relaxation ratings indicate that improve-
ment was related to depth rather than form of relaxation. That is, greater improvement
occurred for Ss whose ratings indicated they were more relaxed during treatment across all
treatment procedures. It may be then that depth of relaxation is most important for
improvement, and that improvement is most IikeIy to be reflected in outcome measures
which are similar to the form of relaxation used in treatment.
No reliable differences occurred between the NR and NT Groups. This suggests that the
ineffectiveness of a no relaxation group demonstrated in previous studies is not likely to be
a function of either the yoking requirement or the absence of relaxation during the hierarchy
presentation. Rather, training in relaxation prior to the hierarchy presentation appears
to be important when relaxation is to be paired with imaginal aversive stimuli.
Finally, although it may be possible to equate for expectancy for improvements with
naive Ss assigned to a no relaxation group, it appears to be more difficult to do so with
their therapists. The therapist ratings suggest a strong bias regarding the efficacy of the
three procedures in favor of the DM and DC Groups. Ctearly, if possible expectancy effects
are to be controlled, it is necessary to do so for both Ss and therapists.
REFERENCES
ADORNO T. W., FRANKEL-BRUNSWICK E., LEVINSON D. J. and SANFORD R. N. (1950) The Authoritarian
Personality. Harper, New York.
BANDURA A. (1960) Principles of Behaviar Modi$cation. Holt, Rinehart & Winston, New York.
BENDIG A. W. (1962) Factor analytic scales of covert and overt hostility. J. consult. Psycho/. 26, 200.
CROWNE D. P. and MARLOWE D. (1960) A new scale of social desirability independent of psychopathology.
.J. cunsuit. Psychof. 24,349-354.
DAHIXROM W. G. and WELSCH G. S. (1960) An MMPI Handbook: A Guide to use in Clinical Practice and
Research. University of Minnesota Press, Minneapolis.
MOTOR AND COGNITIVE RELAXATION IN THE DESENSITIZATION OF ANGER 481
DAVISON G. C. (1967) Systematic desensitization as a counterconditioning process. J. ubnorm. Psychol. 72,
91-99.
GOTTSCHALK L. A., GLESER G. C. and SPRINGER K. J. (1963) Three hostility scales applicable to verbal
samples. Arch. Gen. Psychiut. 9, 254-279.
LAZARUS R. S. and ALFERT E. (1964) The short-circuiting of threat. J. abnorm. sot. Psycho!. 69, 195-205.
NAWAS M. M., MEALY W. J. and FISHMAN S. T. (1971) Systematic desensitization as counterconditioning:
A retest with adequate controls. Behavior Therapy 2, 345-356.
NAWAS M. M., WELSCH W. V. and FISHMAN S. T. (1970) The comparative effectiveness of pairing aversive
imagery with relaxation, neutral tasks and muscular tension in reducing snake phobia. Behav. Res. &
Therapy 8, 63-68.
PAUL G. L. (1969) Outcome of systematic desensitization. II: Controlled investigations of individual treat-
ment, technique variations, and current status. In: C. M. FRANKS (Ed.) Behavior Therapy: Appraisal
and Status. McGraw-Hill, New York, 105-159.
PAUL G. L. (1966) I nsight Versus Desensitization in Psychotherapy: An Experiment in Anxiety-Reduction.
Stanford University Press, Stanford.
RACHMAN S. (1965) Studies in desensitization: I. The separate effects of relaxation and desensitization.
Behav. Res. & Therapy 3, 245-252.
RACHMAN S. (1967) Systematic desensitization. Pyschol. Bull. 2, 93-103.
RACHMAN S. (1968) The role of muscular relaxation in desensitization therapy. Behav. Res. & Therapy 6,
159-166.
RIMM D. C., DE GROOT J. C., BOORD P., HEIMAN J. and DILLOW P. V. (1971) Systematic desensitization of an
anger response. Behav. Res. & Therapy 9, 273-280.
WINER B. J. (1971) Statistical Principles in Experimental Design. McGraw-Hill, New York.
WOLPE J. (1969) The Practice ofBehavior Therapy. Pergamon Press, New York.
WOLPIN M. and RAINES J. (1966) Visual imagery, expected roles and extinction as possible factors in reducing
fear and avoidance behavior. Behav. Res. & Therapy 4, 25-38.