The relationship between trait anger and reactive aggressive behavior in middle school students: the mediating role and intervention of hostile attribution bias.

BACKGROUND: The reactive aggressive behavior in individuals typically shows a rapid growth trend as individuals enter adolescence, and peaks during middle-school period. According to the Comprehensive Cognitive Model of Trait Anger, trait anger and hostile attribution bias play important roles in the development of reactive aggressive behavior. Based on this, current study explored the relationship between trait anger and reactive aggressive behavior in middle school students, as well as the mediating role of hostile attribution bias and interventions. METHODS: The current study consisted of three sub-studies. Study 1 recruited 87 middle school students with an average age of 12.367 ± 0.889 years, investigated the relationship between trait anger and reactive aggressive behavior, as well as the mediating role of trait hostile attribution bias. Study 2 recruited 62 middle school students with an average age of 13.376 ± 0.963 years, investigated the relationship between trait anger and reactive aggressive behavior, as well as the mediating role of state hostile attribution bias. Study 3 recruited 80 middle school students with an average age of 13.392 ± 0.977 years, implemented an intervention targeting trait hostile attribution bias in middle school students with high trait anger to reduce their reactive aggressive behavior. In current study, data management was performed using SPSS 22.0. Descriptive statistics, independent samples t-test, paired samples t-test, repeated measures analysis of variance (ANOVA), and path analysis were used for statistical analysis. FINDINGS: The results of Study 1 showed that trait anger predicted reactive aggressive behavior through trait hostile attribution bias. The results of Study 2 indicated that trait and state hostile attribution bias played mediating role intermediary, and trait hostile attribution bias had a stronger mediating effect than state hostile attribution bias. The results of Study 3 suggested that the intervention effectively decreased trait hostile attribution bias and reactive aggressive behavior. CONCLUSIONS: Trait anger can predict the reactive aggressive behavior of junior high school students, with trait hostility attribution bias and state hostility attribution bias mediating this relationship. Intervening in the hostility attribution bias of high-anger junior high school students can effectively reduce their reactive aggressive behavior.

Anger is more strongly associated with alcohol and tobacco use and use disorders compared to other substances in American adults.

Background: Anger is elevated in substance use disorders (SUDs) and related to problematic use. However, it is unclear whether anger is elevated in individuals who use substances, is only heightened among those with SUDs, and whether anger is more strongly tied to use of certain substances or SUDs.Objectives: We examine the association between anger, general substance use and SUDs.Methods: Data is N = 28,753 (55% female) respondents from the NESARC-III. Participants endorsing anger and indicating negative functional impact were deemed to have experienced significant anger.Results: Logistic regression examining the relative strength of associations between anger, substance use and SUDs (alcohol, opioid, stimulant, tobacco and cannabis) indicated that having a SUD was associated with anger beyond use alone. Alcohol (adjusted odds ratio [AOR] = 1.45; 95% CI 1.32-1.6) and tobacco (AOR = 1.38; 95% CI 1.27-1.51) use displayed the strongest odds of experiencing anger above and beyond other substances in the model. Similarly, alcohol (AOR = 1.45; 95% CI 1.31-1.62) and tobacco (AOR = 1.46; 95% CI 1.3-1.64]) use disorders had the greatest odds of anger relative to other SUDs. These results were significant after controlling for mood, anxiety disorders, and PTSD and no sex differences were observed.Conclusion: These results indicate that SUDs, particularly alcohol and tobacco use and disorders, are positively associated with experiencing anger beyond just substance use. Research must identify the mechanism driving this association to enhance treatments that target anger.

The relationship between trauma, stress, and premenstrual symptoms: the role of attributional style and trait anger.

AIMS: The aim of this study was to examine potential mediators of the relationship between traumatic experiences, perceived stress, and the subjective, retrospectively measured, intensity of symptoms of premenstrual disorders. It was hypothesised that pessimistic attributional style and trait anger mediate the said relationship. METHODS: The study sample comprised 150 non-clinical subjects (aged 18-31; M = 21.82; SD = 2.19). Study variables were assessed with self-report questionnaires: the Premenstrual Symptoms Screening Tool (PSST); the Traumatic Experiences Checklist (TEC); the Perceived Stress Scale-4 Short Form (PSS-4); the Attributional Style Questionnaire (ASQ); and the State-Trait Anger Expression Inventory-2 (STAXI-2 - trait anger subscale). Correlation and mediation analyses were performed. RESULTS: The symptoms of premenstrual disorders were significantly and positively associated with both trait anger and pessimistic attributional style, as well as with trauma and stress. The correlations were moderate to strong, ranging from rho = 0.57 (pessimistic attributional style and trauma) to rho = 0.85 (stress and premenstrual symptoms). Both anger and pessimistic attributional style partially mediated the relationship between trauma and premenstrual symptoms and between stress and premenstrual symptoms. CONCLUSION: Although the design of the study does not allow to infer causality, it demonstrates strong, positive relationship between the symptoms of premenstrual disorders, trauma, stress, attributional style, and anger. The results of mediation analyses may point to some practical implications (e.g. for psychotherapeutic interventions) but further studies employing prospective methods are needed.

Aggressiveness in Driving: A View From the Spanish Driver's Perception.

Aggressiveness is a concerning issue due to its contribution to road crashes. This study aims to provide an overview on how Spanish drivers perceive aggressive driving, analyzing how this perception is linked to sociodemographic features. Thus, a cross-sectional study was designed, where 1,079 Spanish drivers took part in a telephone survey on aggressiveness' importance, influence on traffic accidents, and frequency of performance. For data processing, Exploratory Data Analysis and Unifactorial Variance Analysis were conducted. The results showed that the perception of aggressive driving has a high valuation and a high-perceived risk, with differences for sex, age, and driving experience. The findings suggest that some groups perceive more aggressiveness than others, meaning it is necessary to develop measures to reduce biases through a gender perspective.

The Role of Anger Cognitions and Anger Rumination in Predicting Externalizing and Internalizing Problems in Adolescence.

This study aims to examine the relative contribution of anger cognitions and anger rumination in predicting externalizing and internalizing problems among 180 adolescents (aged 11-18 years) using correlational and linear regression analysis. Our findings showed that anger rumination predicted both externalizing (aggressive behaviors) and internalizing problems (anxious, depressive, and somatic symptoms). In contrast, biased anger cognitions did not appear to meaningfully predict either externalizing or internalizing symptoms, with the only exception of the hostile verbal labels and catastrophic cognitive attributions, a factor that was significantly associated with both rule-breaking behaviors (ß = .339, p < .01) and aggressive behaviors (ß = .238, p < .05). Anger rumination accounted for a higher rate of variance of psychopathology compared with anger cognitions and should be addressed in interventions for either externalizing or internalizing symptoms in adolescence.

The impact of stressful life events on centralized pain and pain intensity: A combined model examining the mediating roles of anger and perceived injustice among racially minoritized adults with chronic pain.

Stressful life events are highly associated with chronic pain. Yet, research is needed to identify the psychological mechanisms that link life adversity and pain, especially studies that test comprehensive models, recruit racially diverse samples, and measure varied pain-related symptoms. This study examined the relationship between stressful life events and pain in a racially diverse sample and tested the potential mediating roles of both anger and perceived injustice. Both centralized pain symptoms and pain intensity were outcomes. Analyses consisted of two cross-sectional, mediation models among 673 adults with self-reported chronic pain who were racially diverse (Black: n = 258; Latine: n = 254; Asian American: n = 161). Results indicated a positive relationship between stressful life events and centralized pain symptoms (b = 2.53, p <.001) and pain intensity (b = 0.20, p <.001). In parallel mediation analyses, anger (b = 0.91, 95% CI = 0.67, 1.17) and perceived injustice (b = 0.86, 95% CI = 0.64, 1.11) acted as partial mediators on centralized pain symptoms. Also, anger (b = 0.05, 95% CI = 0.03, 0.08) and perceived injustice (b = 0.11, 95% CI = 0.08, 0.14) acted as full mediators on pain intensity. The combined psychosocial variables accounted for 51% of centralized pain symptoms and 26% of pain intensity. Findings suggest that psychosocial factors are significantly associated to pain outcomes. Future research is needed to investigate exposure to adversity in life, anger, and perceived injustice together as psychosocial mechanisms of pain symptoms. PERSPECTIVE: Among racially minoritized adults with chronic pain, this article presents empirical evidence that stressful life events, anger, and perceived injustice are associated with centralized pain symptoms and pain intensity. This could guide psychological intervention to focus on anger and perceived injustice especially when addressing centralized pain.

How movies move us - movie preferences are linked to differences in neuronal emotion processing of fear and anger: an fMRI study.

Introduction: As a source of audio-visual stimulation, movies expose people to various emotions. Interestingly, several genres are characterized by negative emotional content. Albeit theoretical approaches exist, little is known about preferences for specific movie genres and the neuronal processing of negative emotions. Methods: We investigated associations between movie genre preference and limbic and reward-related brain reactivity to close this gap by employing an fMRI paradigm with negative emotional faces in 257 healthy participants. We compared the functional activity of the amygdala and the nucleus accumbens (NAcc) between individuals with a preference for a particular movie genre and those without such preference. Results and discussion: Amygdala activation was relatively higher in individuals with action movie preference (p TFCE-FWE = 0.013). Comedy genre preference was associated with increased amygdala (p TFCE-FWE = 0.038) and NAcc activity (p TFCE-FWE = 0.011). In contrast, crime/thriller preference (amygdala: p TFCE-FWE ≤ 0.010, NAcc: p TFCE-FWE = 0.036), as well as documentary preference, was linked to the decreased amygdala (p TFCE-FWE = 0.012) and NAcc activity (p TFCE-FWE = 0.015). The study revealed associations between participants' genre preferences and brain reactivity to negative affective stimuli. Interestingly, preferences for genres with similar emotion profiles (action, crime/thriller) were associated with oppositely directed neural activity. Potential links between brain reactivity and susceptibility to different movie-related gratifications are discussed.

Serial Cascade Effects of Relative Deprivation and Anger Rumination on the Development of Social Aggression Over 2.5 Years in Emerging Adults.

Although the mechanisms of development of aggression have been focused on day by day, the complicated effects of distal and proximal factors on the development of social aggression in emerging adults have not been uncovered. A serial cascade model of aggression was proposed to address this issue. A longitudinal investigation over 2.5 years was conducted to test this model by exploring the serial cascade effects of relative deprivation (a representative of distal factors) and anger rumination (a representative of proximal factors) on the development of social aggression. A total of 1113 Chinese university students (Mage = 18.95 ± 0.96, 63.10% female) from six universities in five areas participated in this study. The results suggest that developmental trajectories and longitudinal changes in anger rumination mediate the relationship between developmental trajectories and longitudinal changes in relative deprivation and social aggression, and developmental trajectories and changes in relative deprivation mediate the longitudinal relationship between anger rumination and social aggression. These findings support the serial cascade effects of distal and proximal factors on the development of aggression and expand upon the general aggression model (GAM).

The transition from physical sibling abuse to bullying perpetration through trait anger: A longitudinal study.

OBJECTIVES: Experiencing physical sibling abuse is a form of family violence that is common but understudied. While it is often perceived as a normative aspect of sibling relationships, there are apparent behavioral consequences. The current study aims to advance the literature by utilizing the displaced aggression model and I3 theory to longitudinally examine trait anger as a pathway linking physical sibling abuse to bullying perpetration. METHODS: Using data from the Bullying, Sexual, and Dating Violence Trajectories from Early to Late Adolescence in the Midwestern United States, 2008-2013, adolescents (n = 851, M = 14.8 years) completed questionnaires at baseline and were reassessed 6 months later. RESULTS: Results suggested that when adolescents experience physical sibling abuse, they are more likely to engage in bullying perpetration. Mediation analyses indicated that as adolescents were physically abused by a sibling at home, they were more likely to report higher levels of trait anger, which subsequently increased their risk of engaging in bullying perpetration. CONCLUSION: These results suggest that experiencing physical sibling abuse has long-term detrimental consequences, including elicitation of trait anger, subsequently predicting bullying perpetration.

The significant others' responses to trauma scale (SORTS): applying factor analysis and item response theory to a measure of PTSD symptom accommodation.

Background: Symptom accommodation by family members (FMs) of individuals with posttraumatic stress disorder (PTSD) includes FMs' participation in patients' avoidance/safety behaviours and constraining self-expression to minimise conflict, potentially maintaining patients' symptoms. The Significant Others' Responses to Trauma Scale (SORTS) is the only existing measure of accommodation in PTSD but has not been rigorously psychometrically tested.Objective: We aimed to conduct further psychometric analyses to determine the factor structure and overall performance of the SORTS. Method: We conducted exploratory and confirmatory factor analyses using a sample of N = 715 FMs (85.7% female, 62.1% White, 86.7% romantic partners of individuals with elevated PTSD symptoms).Results: After dropping cross-loading items, results indicated good fit for a higher-order model of accommodation with two factors: an anger-related accommodation factor encompassed items related largely to minimising conflict, and an anxiety-related accommodation factor encompassed items related primarily to changes to the FM's activities. Accommodation was positively related to PTSD severity and negatively related to relationship satisfaction, although the factors showed somewhat distinct associations. Item Response Theory analyses indicated that the scale provided good information and robust coverage of different accommodation levels.Conclusions: SORTS data should be analysed as both a single score as well as two factors to explore the factors' potential differential performance across treatment and relationship outcomes.

We examined the Significant Others' Responses to Trauma Scale (SORTS), a measure of symptom accommodation in PTSD, among a large sample of family members.As measured by the SORTS, accommodation in PTSD could be broken down into two aspects: anger-related accommodation and anxiety-related accommodation.Accommodation was positively related to PTSD severity and negatively related to relationship satisfaction.

Trends of fear and anger on YouTube during the initial stage of the COVID-19 outbreak in South Korea.

BACKGROUND: The COVID-19 pandemic has been the most widespread and threatening health crisis experienced by the Korean society. Faced with an unprecedented threat to survival, society has been gripped by social fear and anger, questioning the culpability of this pandemic. This study explored the correlation between social cognitions and negative emotions and their changes in response to the severe events stemming from the COVID-19 pandemic in South Korea. METHODS: The analysis was based on a cognitive-emotional model that links fear and anger to the social causes that trigger them and used discursive content from comments posted on YouTube's COVID-19-related videos. A total of 182,915 comments from 1,200 videos were collected between January and December 2020. We performed data analyses and visualizations using R, Netminer 4.0, and Gephi software and calculated Pearson's correlation coefficients between emotions. RESULTS: YouTube videos were analyzed for keywords indicating cognitive assessments of major events related to COVID-19 and keywords indicating negative emotions. Eight topics were identified through topic modeling: causes and risks, perceptions of China, media and information, infection prevention rules, economic activity, school and infection, political leaders, and religion, politics, and infection. The correlation coefficient between fear and anger was 0.462 (p < .001), indicating a moderate linear relationship between the two emotions. Fear was the highest from January to March in the first year of the COVID-19 outbreak, while anger occurred before and after the outbreak, with fluctuations in both emotions during this period. CONCLUSIONS: This study confirmed that social cognitions and negative emotions are intertwined in response to major events related to the COVID-19 pandemic, with each emotion varying individually rather than being ambiguously mixed. These findings could aid in developing social cognition-emotion-based public health strategies through education and communication during future pandemic outbreaks.

The mediator role of mindfulness in the relationship between the listening skills and anger management skills of emergency health care professionals.

BACKGROUND: Effective communication plays a crucial role in establishing strong relationships and providing essential support in clinical situations. This study was conducted to investigate the mediator role of mindfulness in the relationship between the listening skills and anger management skills of healthcare professionals working in the emergency department (ED). METHOD: This was a cross-sectional study, which was conducted with 230 emergency department healthcare professionals (EHCPs) working in adult EDs in Turkey. Sociodemographic Characteristics Data Collection Form, Mindful Attention Awareness Scale (MAAS), Listening Skills Assessment Scale (LSAS), and Anger Management Scale (AMS) were used for data collection. Descriptive statistics included frequency and percentage; t test and ANOVA test were used for statistical analyses, as was "Process Macro 3.5 Model 4", which was used to study the effect of mediator variables. RESULTS: The participants had a mean MAAS score of 57.71 ± 12.38, a mean LSAS score of 45.36 ± 6.23, and a mean AMS score of 17.93 ± 3.39. There were significant positive correlations between LSAS and MAAS (r = 0.197, p < 0.001), between AMS and MAAS (r = 0.233p < 0.001), and between AMS and LSAS r = 0.24p < 0.001). In addition, the process model analysis results supported that MAAS had a partial mediator role in the correlation between LSAS and AMS, and that its indirect effects were predicted by LSAS and AMS. It was determined that 5.75 % of total change on AMS was predicted by LSAS (F = 13.918; p < 0.001). CONCLUSION: The results of this study indicate that as the mindfulness level of EHCPs increases, their listening and anger management skills increased. Therefore, reinforcing mindfulness by integrating mindfulness interventions into in-service training and applying strategies that promote EHCPs' listening skills and anger management skills would make it possible to provide quality health care with employees who are more efficient in conflict management and enjoy a higher level of satisfaction.

Exploring driving anger-caused impairment of takeover performance among professional taxi drivers during partially automated driving.

Partially automated systems are expected to reduce road crashes related to human error, even amongst professional drivers. Consequently, the applications of these systems into the taxi industry would potentially improve transportation safety. However, taxi drivers are prone to experiencing driving anger, which may subsequently affect their takeover performance. In this research, we explored how driving anger emotion affects taxi drivers' driving performance in various takeover scenarios, namely Mandatory Automation-Initiated transition (MAIT), Mandatory Driver-Initiated transition (MDIT), and Optional Driver-Initiated transition (ODIT). Forty-seven taxi drivers participated in this 2·3 mixed design simulator experiment (between-subjects: anger vs. calmness; within-subjects: MAIT vs. MDIT vs. ODIT). Compared to calmness, driving anger emotion led to a narrower field of attention (e.g., smaller standard deviations of horizontal fixation points position) and worse hazard perception (e.g., longer saccade latency, smaller amplitude of skin conductance responses), which resulted in longer takeover time and inferior vehicle control stability (e.g., higher standard deviations of lateral position) in MAIT and MDIT scenarios. Angry taxi drivers were more likely to deactivate vehicle automation and take over the vehicle in a more aggressive manner (e.g., higher maximal resulting acceleration, refusing to yield to other road users) in ODIT scenarios. The findings will contribute to addressing the safety concerns related to driving anger among professional taxi drivers and promote the widespread acceptance and integration of partially automated systems within the taxi industry.

Mediation analyses of longitudinal data investigating temporal associations between inflated sense of responsibility, obsessive-compulsive symptoms, and anger suppression.

OBJECTIVE: Cognitive theories emphasize the central role of anger and anger suppression in obsessive-compulsive disorder (OCD). According to these theories, anger suppression is seen as a consequence of OCD, whereas cognitive beliefs, such as an inflated sense of responsibility, are seen as antecedent factors. To extend the findings from cross-sectional studies, the current study investigated the temporal associations between OCD symptoms, an inflated sense of responsibility, and anger suppression. Consistent with cognitive considerations, we hypothesized that OCD symptoms mediate the association between feelings of responsibility and anger suppression. These associations were also explored in patients presenting particularly high checking-related symptoms. Further, the stability of effects beyond controlling for depressive symptoms and medication intake was explored. METHODS: A total of N = 48 patients with OCD (50% female, M = 32.46 [SD = 10.63] years of age) completed measures on obsessive beliefs, OCD symptoms, and anger suppression at three assessment points: before and after a metacognitive intervention as well as at a follow-up 6 months later. Mediation models investigating symptom associations at these three timepoints were conducted. Exploratory analyses investigating these associations in individuals presenting high checking-related symptoms (n = 20) and testing the stability of effects beyond controlling for depressive symptoms and medication intake were conducted. RESULTS: The sense of responsibility did not significantly predict the level of anger suppression. A temporal association between OCD symptoms (as assessed with the self-report measure) and anger suppression could be evidenced, which was stable beyond controlling for depressive symptoms and medication intake. Against the expectations based on cognitive theories, the sense of responsibility did not predict OCD symptoms. No mediating effect of OCD symptoms was found. CONCLUSION: In line with cognitive viewpoints, the present study shows that higher OCD symptoms predict higher levels of anger suppression in a longitudinal design, thereby contributing to the suppression of anger. This effect seems to be independent from depressive symptoms and medication intake. The effect of sense of responsibility on OCD symptoms was less clear and could only be found in the subgroup of patients with OCD and checking-related symptoms, who generally presented higher levels of responsibility. Overall, this is the first study demonstrating temporal associations between OCD symptoms and anger suppression. Acknowledging that anger and anger suppression may be a consequence of OCD symptoms and may also affect aspects of psychotherapy, which can ultimately inform future adjustments to psychotherapeutic treatment.

Influence of meaningfulness of work and leadership characteristics on customer-directed counterproductive work behavior resulting from customer mistreatment.

This study explored the impact of customer mistreatment on counterproductive work behavior (CWB) and the moderating role of supervisor responses (self-sacrificial and self-serving leadership) to clarify why customer-directed CWB occurs and how it can be reduced. A sample of 392 customer-facing employees in the USA completed measures assessing the meaningfulness of work and self-sacrificial and self-serving leadership experiences. The meaningfulness of work moderated the relationship between customer mistreatment and employee anger, and a three-way interaction was found between employee anger and self-sacrificial and self-serving leadership on customer-directed CWB. Implications for managing customer mistreatment and fostering meaningful work to promote employee well-being are discussed.

Paranoia and Social Anxiety: Predicting Aggressive Behavior.

Aggression is a transdiagnostic behavior that is associated with poor clinical outcomes. As such, it is important to understand factors that contribute to various manifestations of aggressive behavior. Recent research has revealed a subtype of individuals with social anxiety disorder (SAD) who tend to display relatively high amounts of aggression and experience more severe social anxiety and dysfunction compared to individuals in the prototypical SAD group. The current study used a status threat manipulation along with behavioral indices of aggression to examine the impact of paranoia and social anxiety symptom severity on aggression in a sample of undergraduates with social anxiety (N = 220). Analyses indicated that paranoia uniquely predicted indirect aggression whereas an interaction between social status threat, paranoia, and social anxiety severity uniquely predicted direct aggression. These findings suggest that paranoia may be a particularly important contributor to aggression among individuals with social anxiety.

Understanding anger with New Zealand-born Samoan youth: A Samoan qualitative exploration.

OBJECTIVE: Understanding New Zealand-Samoan young people's experiences and definitions of anger. METHODS: Focus group talanoa (discussions) with 12 New Zealand-born Samoan young people guided by 'Teu le Va' methodology. We used a culturally informed thematic analysis approach. RESULTS: Participants defined anger as a 'bottled up' emotion and emphasised understanding cultural contexts that normalised covert and passive ways of expressing anger. Other key themes around anger we identified included experiencing multiple layers of racism and disconnection in westernised social spaces and pressures to juggle traditional Samoan and western identities. Participants also explored gendered expressions of anger. Communicating anger was important, but not in ways that harm communal values. CONCLUSIONS: Culturally appropriate qualitative research helps understand complex cultural determinants of mental health and wellbeing and suicidal behaviour. IMPLICATIONS FOR PUBLIC HEALTH: We must recognise the positive, polycultural capital of a generation that navigates many cultural spaces, including their emotional expressions. Anger should be understood in relation to cultural and societal pressures. Improved understanding of the cultural context of anger can inform systemic responses during crises in mental health and prevention of suicidality.

Internalizing and externalizing behaviors in children and adolescents with Wilson's disease in the context of quality of life.

Patients with Wilson's disease (WD) are at increased risk of poor quality of life (QoL) and social-emotional outcomes. The above data has been well established in the adult population. What are the predictors of QoL in children and adolescents with WD are unknown. Our study examined whether subjective feelings about QoL are related to the psychosocial functioning in paediatric patients. A cross-sectional study among 50 children with WD, aged 7-18 years. Participants completed the KINDL QoL questionnaire and the Child Behavior Checklist assessing internalizing and externalizing behaviors. Internalizing and externalizing behaviors and their interaction are significant in predicting the QoL of children with WD. Internalizing behaviors are significant predictor of the QoL ß = -0.328 (p < 0.05). The effect of internalizing behavior on the QoL varies with the level of externalizing behavior ß = -0.344* (p < 0.05). Simple effects analysis indicates that the highest QoL for children with WD is in the group characterized by both low levels of internalizing and medium levels of externalizing behaviors, t = -3.052 (df = 46) and p < 0.01, or high levels of externalizing behaviors, t = -2.725 (df = 46) p < 0.01. The interaction between internalizing behaviors explained an additional 7.5% of the variance in scores on the QoL scale. Overall, the final regression model explained 14.9% of the scores on the QoL scale. Monitoring internalizing and externalizing behaviors will allow a better understanding of the course of treatment. In chronic disease, the QoL is an aspect that determines the doctor-patient relationship and often determines the course of the therapeutic process.

Case Report: Nonverbal approaches in the treatment of a patient with fibromyalgia with anger rooted in adverse childhood experiences.

Introduction: In psychotherapy, it is important to establish and deepen a therapeutic trusting relationship, but patients who have experienced extreme adversity in childhood tend to have difficulty in building such a relationship. This paper reports a case of fibromyalgia with adverse childhood experiences (ACEs) in which a nonverbal approach was successful in building a trusting relationship. Case and methods: The patient is a woman in her late 40s. She had strong anger rooted in ACEs, including neglect by her father, a feeling of unfair parenting by her mother compared to her younger brother, overcontrol of her life by her mother, and sexual abuse by her uncle. She was filled with strong interpersonal distrust and anger, and the experience of an unsuccessful surgery compounded her distrust of medical care. The therapist initially had severe difficulty in verbal interaction with the patient. When conducting "drawing" therapy, she ignored the therapist's comments and completely blacked out the drawing paper. However, the patient-therapist relationship gradually changed, and verbal interaction became possible through the use of nonverbal approaches such as framing her drawing paper and "Towel Baby Holding." Results: The therapist was able to understand the patient's emotions through these nonverbal approaches and to communicate with the patient that she understood her feelings. This approach was also successful in the patient's understanding of her own pathology. The patient became able to honestly express her feelings in words, which eventually enabled her to be introduced to mindfulness therapy, leading to a favorable treatment course. Conclusion: For patients with ACEs, a nonverbal approach helps build a therapeutic relationship and plays an important role in understanding the patient.

Mindfulness decreases driving anger expression: The mediating effect of driving anger and anger rumination.

Mindfulness is a state of being fully attentive to the current moment and is an experiential way of living in daily life. As a personal trait, mindfulness has been proven to enhance various negative emotions and behaviors. However, in the field of driving, there is still a lack of research on the mechanisms of mindfulness on anger expression behavior, specifically aggressive driving. Therefore, the purpose of this study is to reveal the impact of mindfulness on drivers' aggressive driving behaviors and the mediating effect of driving anger and anger rumination. A total of 350 (208 males and 142 females) participants in China voluntarily completed a series of questionnaires, including the Mindful Attention and Awareness Scale (MAAS), the Driving Anger Scale (DAS), the Anger Rumination Scale (ARS) and the Driving Anger Expression Inventory (DAX). The hierarchical multiple regression analysis and pathway analysis results showed that mindfulness negatively predicted driving anger, anger rumination and driving anger expression. Moreover, driving anger and anger rumination mediated the relationship between mindfulness and driving anger expression, accounting for 9.51% and 18.74% of the total effect, respectively. The chain-mediated effect of driving anger and anger rumination accounted for 8.00% of the total effect. This study has revealed some of the internal mechanisms through which mindfulness reduces aggressive driving. It fills a part of the gap in understanding the protective role of mindfulness in the driving domain. Furthermore, it suggests mindfulness interventions for drivers, which may have the potential to enhance overall road safety.