Date of Submission


Degree Type


Degree Name

Doctor of Psychology (PsyD)



Department Chair

Robert A. DiTomasso, Ph.D., ABPP

First Advisor

Robert A. DiTomasso, Ph.D., ABPP, Chairperson

Second Advisor

Stephanie Felgoise, Ph.D., ABPP

Third Advisor

Harry J. Morris, D.O., M.P.H.


The hypotheses that when cognitive-behavior interventions for anger-management are introduced to an essential hypertension (EH) patient with clinically significant levels of anger in an eight-session therapy protocol, blood pressure (BP) measures will decrease, coping mechanisms will be enhanced, and behavior associated with anger will be transformed from the inhibition of it or the aggressive expression of it to a more rational and reasoned communications approach, demonstrated by scores falling between the 25th and 75th percentile on the State-Trait Anger Inventory-2 [STAXI-2] (Spielberger, 1999) were supported in this case study. The research findings were that a male, EH patient improved his ability to express anger appropriately after receiving a protocol designed to treat " anger-in" and "anger-out," and that his BP measures decreased both during the protocol and in the poststudy period. The self monitored mean blood pressure readings decreased from 121.58 systolic blood pressure (SBP) and 69.66 diastolic blood pressure (DBP) at baseline to a SBP of 109.78 and a DBP of 65.66 at poststudy. His total scale score on the STAXI-2 decreased from the 90th percentile at baseline to the 25th percentile at poststudy and his total scale score on the Multidimensional Anger Inventory (MAl) [Siegal, 1986] decreased from above the 85th percentile to below the 15th percentile. The 14-week study involved a two-week baseline period, an eight-session anger-management protocol, and a four-week post-treatment period. Psychophysiological, standardized, subjective and qualitative assessments were employed. The standardized tests used in the study were: the STAXI-2 (Spielberger, 1999), the MAl (Siegel, 1986), the Mahan and DiTomasso Anger Scale [MAD-AS] (Mahan, 2001), and the Social-Problem Solving Inventory-Revised [SPSI-R] (D'Zurilla, Nezu, & Maydeu-Olivares, 1996). Qualitative and subjective measures included the Anger Events Inventory, developed by the investigator, for self-monitoring and significant-other monitoring, and the Subjective Anxiety Scale (Wolpe, 1973). Blood pressure (BP) measures were taken three times a week during the length of the study by the subject using a digital BP machine (McGrady, Olson, & Kroon, 1995; National Institutes of Health, National Heart, Lung, and Blood Institute, 1997) and BP levels were measured by the physician's assistant at the end of each session. The treatment protocol combined cognitive-behavioral techniques for anger-management: relaxation exercises, role-play and exposure techniques, assertiveness and communications skills, relapse prevention methods, homework, and reinforcement. The results indicated that cognitive-behavioral, anger-management techniques, when individually administered to an EH patient who attained high anger indexes, were associated with lowered BP, lowered arousal, decreased anger, and increased problem solving.