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.