Anger-Aggression-Violence Assessment (AAVA)


The Anger-Aggression-Violence-Assessment (AAVA) is an evidence based self-report assessment instrument or test that focuses on anger-aggression and violence, which are conceptualized as an emotional triad. More specifically, triad theory postulates shades (or intensities) of anger-aggression and violence exist as points on a continuum of emotional reactivity. This triad theory is based on the theorem that “as anger increases, it can evolve into aggression, which in turn can intensify and evolve into violence.

Continuum

Anger-Aggression-Violence


An emotionally reactive continuum

Obviously, the emotionally reactive continuum theory as stated here is an over-simplification nevertheless it does help conceptualize the Anger-Aggression-Violence Assessment (AAVA) tests purpose and use. The AAVA is designed for both clinical practice (patients) and criminal justice (offenders) risk assessment. Furthermore, probation and parole departments have welcomed the use of risk assessments

The Anger-Aggression-Violence Assessment (AAVA) instrument or test has seven domains (scales) which include:

Anger-Aggression-Violence Assessment (AAVA) Domain (Scale) Descriptions.


Truthfulness Domain

Truthfulness Scale: Self-report tests are subject to the danger of respondents not telling the truth. An important advance in psychological testing is the Truthfulness Scale, which measures client (patient/offender) honesty while they are completing their test. It would be naïve to believe all people taking tests always answer questions truthfully. Truthfulness scales identify self-protective and guarded people who attempt to deny, minimize or conceal information. This scale also identifies functionally illiterate individuals. Truthfulness Scales are of special importance in court-related, criminal justice (probation, incarceration, parole), and clinical (counseling, treatment) settings. The Truthfulness Scale is particularly important when assessing violent individuals.

Alcohol Domain

Alcohol Scale: Measures alcohol use and the severity of abuse. Alcohol refers to beer, wine and other liquor. An elevated (low problem) Alcohol Scale score is indicative of an emerging problem. An elevated Alcohol Scale score in the high problem range is indicative of an established problem. An Alcohol Scale score in the severe problem range identifies serious and established drinking problems.

Drug Domain

Drug Scale: Measures illicit (non-prescription) and licit (prescription) drug use and as warranted – abuse. Drugs refer to prescription and non-prescription drugs, such as marijuana, cocaine, crack, ice, amphetamines, barbiturates, heroin, etc. An elevated Drug Scale score (low problem) is indicative of an emerging problem. An elevated Drug Scale score in the high problem range is indicative of an established problem. A Drug Scale score in the severe problem range identifies serious and established drug problems.

Stress (Coping) Management Domain

Stress Management Scale: Measures how well the individual copes with stress. It is now known that long term stress is linked to mental and emotional problems. Thus, an elevated (problem or severe problem) Stress Management Scale score in conjunction with other elevated scale scores, helps explain the individual’s situation. For example, when a person doesn’t handle stress well, other existing problems are often exacerbated.

Stress (coping) Management Domain

Stress Management Scale: An elevated (problem risk range) Stress Management Scale score can exacerbate emotional and mental health symptoms. When a Stress Management Scale score is in the severe problem range, it is likely that the individual has a diagnosable mental health problem. The Stress Management Scale score can be interpreted independently or in conjunction with other elevated scale scores.

Anger-Aggression-Violence Assessment


Anger

Anger is a normal emotion that everybody experiences. Sometimes anger can enhance a person’s well-being and functioning. However, anger can become overwhelming or uncontrollable and lead to aggressive and violent behavior. Anger has been defined as a person's response to perceived threats against an individual or group (Lazarus, 1991). Anger can also evolve from hostility (Spielbeger, et al., 1985) or cynicism (Martin Watson & Wan, 2000). Intense or uncontrolled anger (rage) can affect one’s relationships, jobs and daily life.

Because anger varies from person to person, and the situation they are in at any given time, it is difficult to describe a typical angry response (Avenill, 1983). Consequently, theoreticians have published contradictory lists of different types of anger. When experiencing extreme anger (e.g., rage) the loss of rationality often results in violence and legal issues.

Strong emotions often bring about physical changes in ones’ body, and anger is not an exception. Anger symptoms include, but aren’t limited to, increased blood pressure, headaches, heart palpitations, fatigue, etc. Unresolved anger often leads to anxiety, whose symptoms typically include rapid breathing, muscle tension and nausea. And long term anger can lead to depression. Depression and anger often co-occur. Breaking the anger-depression cycle may require professional help. Substance (alcohol/drug) abuse has also been linked to anger and angry outbursts. When anger interferes with a person’s relationships, daily activities, work and quality of life, that person should seek professional help for their anger-related problems. Treatment options include outpatient counseling, individual or group counseling and medically prescribed medication. Prescription medication should be used prudently to avoid side effects and possible addiction.

Anger management is frequently recommended for people who engage in angry, aggressive and even violent behavior. A high anger range Triad Scale score identifies anger management candidates. The purpose of anger management is to teach the basics (techniques and strategies) necessary to express one’s emotions in safe, healthy and satisfying ways. Most anger-management programs increase participant’s anger awareness, along with anger management (relaxation, desensitization, cognitive awareness, assertive training, etc.); acceptance of change (reframing, cognitive restructuring, forgiveness, etc.) and ability to learn relapse prevention skills.

Some therapists maintain you can’t “cure anger,” but you can manage its intensity and effects. Other therapists don’t agree with the definition of cure and think it's moot, since the intensity and effects of anger (and aggression or violence) can be reduced and positively managed. One of the most researched and popular psychotherapies is Cognitive Behavioral Therapy (CBT), which is structured, relatively short term (10-20 sessions) and lasting.

In many ways anger can be viewed as the emotional commitment of a person’s propensity for aggression. Intense anger is often called aggression. Of course people don’t always become aggressive when angry, and they may become aggressive when not angry. Nevertheless, anger is usually the signal that a person’s bodily systems are adjusting to their aggressive mode. And intense anger is often externalized in the form of aggression or violence.

Anger is conceptually different from aggression (Parrott& Giancola, 2007). And anger does not always result in depression (Berkowitz, 1993). There have also been some mixed results using some tests (test answers) and their relationship with physical aggression. Nevertheless, Anderson and Bushman (1997) reported the test results in their research were positively related to physical aggression and violence. Other research (Giumetti & Markey, 2007) reported weak correlations with behavioral aggression. These findings emphasize that aggression is very complex and is influenced by many factors. These findings raise questions regarding each study's definition of aggression and the specific psychological tests used. Psychological tests, their configuration and domains (scales), let alone their test items vary.

That said, neurobiological research on anger, aggression and violence has made great strides in the last decade. Research indicates that left frontal cortical activation is associated with anger heading to aggression (Beckman and Lieberman, 2010, Hortensius, Schutterr & Harmon-Jones, 2011; Peterson, et al., 2011).

Intense, uncontrolled anger is often called aggression. Anger and aggression are often mentioned together, but they are not synonymous terms. Anger is a normal emotion. Yet, uncontrolled anger (extreme anger) can evolve into aggression. In other words, anger can play a causal role in aggression.

In today’s society anger and aggression are increasingly important areas of concern. They are reflected in threats of violence, relationship issues, social problems and arguments or fights. Exposure to violent media (movies, television, video games, etc.) has been associated with increased aggression (Anderson, et al., 2003). Media violence affects a person’s physical, emotional and verbal behavior.

Aggression

Aggression has been divided into various categories, which has fostered considerable disagreement. There are now numerous types of aggression depending upon the aggressor’s intentions and the situation that caused the aggressive act. These categories, or dichotomous aggressions, are allegedly classifications of aggression that are based upon the intentions of the aggressor and the situation that elicited the aggression.

Traditional discussions of aggression describe a series of dichotomous distinctions between types of aggression. Several aggression dichotomies are set forth below:

Dichotomous Aggression Categories

Aggression refers to behavior that is motivated to harm or injure another or damage property. Some theorists believe all harmful behavior can be classified as aggressive. The term aggression is used broadly to refer to verbal threats, physical assaults and property damage.

Violence has been described asaggression in its most extreme form.” In other words, violence has been characterized as extreme aggression with the intent to injure or harm others. Some theorists argue that aggression is the result of extreme anger.

Proactive aggression refers to people who use aggression to attain a goal. For example, if a person wants something they simply take it. Some people use proactive aggressive to obtain social goals (Dodge, 1991). Other proactive and reactive aggression differences include social cognitive correlations (Hubbard, Dodge, Cilley, Coie and Schwartz, 2006).

Reactive aggression is based upon anger. The primary goal is to harm someone. Reactive aggression is characterized by intense anger and it is emotionally driven. Reactive aggression is associated with interpersonal aggression, whereas proactive aggression is not (Dodge, Lockman, Harnish, Bates & Pettit, 1977). Reactive aggression is a reaction to provocation and is accompanied by anger (Pulickmen, 1996).

Affective aggression is also known as hostile or emotional aggression. It is usually impulsive and driven by anger. The affective aggressor’s primary motive is to harm. Affective aggression occurs in reaction to perceived provocation. “Perceived” means the provocation may be real, imaged or assumed.

Instrumental aggression is goal directed and rationally or logically based. Its primary goal is not harming or injuring another. Instrumental aggression has been called assertiveness.

The above dichotomous aggression categories represent a sample of the many aggression dichotomies that exist. To varying degrees, the dichotomous logic or reasoning has also been applied to anger and violence. The aggression dichotomies are discussed to share their definitional issues, overlapping classifications and seemingly ubiquitous presence in the aggression (anger, violence) research literature. There are numerous types of aggression, which are allegedly classified in terms of the intentions of the aggressor and the situation that elicited the aggression.

Some theorists believe strict dichotomies of anger, aggression and violence could be replaced with a dimensional approach. In other words, anger, aggression and violence could be studied as dimensions. Anderson and Huesmann (2008) dismiss “social-cognition information processing models of aggression" that adopt similar premises about processing information in social problem solving, the social cognition structures involved, the interactive role of emotions as well as cognitions, and the person-situation interaction.

Aggression (anger and violence) are samples as they are influenced by a wide variety of psychological, biological, genetic, cultural and interpersonal factors. And as there are no psychiatric diagnoses for anger, aggression or violence in the Diagnostic and Statistical Manual of Mental Disorders, 5 th Edition (DSM-5), there are no “Anger Disorders,” “Aggressive Behavior Disorders,” or “Violence Disorders” diagnoses. Consequently, anger, aggression and violent behavior are often considered symptoms of a number of DSM-5 disorders like Conduct Disorders, Oppositional Defiant disorders or Intermittent explosive disorders.

Nevertheless, there are a number of mental health illnesses that have been linked to aggression and violence. These include: Antisocial Personality Disorder; Bipolar Disorder; Borderline Personality Disorder; Histrionic Personality Disorder; Intermittent Explosive Disorder; Schizoaffective Disorder; and Substance (alcohol/drug) use. Alcohol consumption and drug abuse have been linked to aggression and violence. A Conduct Disorder diagnosed in early childhood or adolescence usually involves aggression, and when it continues into adulthood is often classified as Antisocial Behavior (Schaffer, Petrs, Laccongo, Poduska & Kellm, 2003).

Violence has been described as extreme aggression. Violence is a multifaceted and complex behavior pattern. It is generally believed that intense anger evolves into aggression, which is characterized by the aggressor’s “intention” to injure or harm another (or others). And violence has been defined as the “physical expression” of anger, aggression or rage. Violence is aggression in its most extreme and unacceptable form.

Differentiating between aggression and violence can be difficult when describing the transition (or overlap) between these two emotions. In other words, when does aggression become violence? Aggression is the intention (commitment to violence) to injure or harm another. In contrast, violence is the physical act (doing or performing violence) itself.

Assessment of violent offenders is a complex and challenging task. Violent offenders are often suspicious, distrustful and resistant or uncooperative. Consequently, they often minimize, deny, disavow and recant earlier admissions. Violent offenders may also present as aggressive, hostile and non-compliant. These violent offenders characteristics underline (emphasize) the importance of the Anger-Aggression-Violence Assessment (AAVA) Truthfulness Scale.

Although most adults are not seriously aggressive or violent, the frequency rates of these acting-out behaviors is nevertheless alarming. Violence and its consequences represent a major public health problem in our society. Assessment, identification and treatment of aggression and violence are challenges for the courts, outpatient clinics, probation department, community treatment based programs and mental health professionals. The links between anger, aggression and violence are increasingly recognized in the psychological research literature. Virtually all probation and correctional systems have some form of an anger management program.

Violence offender assessment has several purposes: 1. Accurately identify problems that warrant intervention or treatment. 2. To prioritize realistic and effective intervention or treatment. 3. When appropriate, to match problem severity with treatment intensity. 4. To establish appropriate intervention (groups or classes) or treatment (counseling or psychotherapy) plans. And 5. Document the client’s (patient or offender) assessment results and recommendations.

Violence is not one behavior pattern, but several. This multifaceted and complex nature of violence has led to a number of classification systems. Behavior scientists have developed many of these classifications by grouping violence categories that have common etiological factors and functions in classification categories. Dichotomies have been developed independently. For example, aggression and violence. One approach classifies violence according to the underlying motivation of the offender. For example, hostile (motivated to harm, injure or damage), and instrumental violence (not motivated to cause harm, but could). In both cases the distinction between these violent acts depend upon the aggressor’s intent – not on the act itself.

At the risk of being redundant, violence has been defined as “behavior involving physical force intended to hurt, damage or seriously harm someone or something.” Violence is characterized as severe aggression (or aggressive) acts) intended to cause harm or damage. Violence classification systems are intended to guide prevention and control efforts. Each type of violence involves different causal mechanisms, which means they require different types of intervention and treatment. For example, Relationship Violence is influenced by interpersonal conflict, more so than the violence involved in an armed robbery by a stranger.

Combining violence risk factors dramatically increase the scope of violence risk. For reference, violence risk factors often include: regular loss of one’s temper, frequent arguments, interpersonal friction, substance (alcohol/drug) abuse, vandalism (property destruction), harming living things (people, animals), frequent threats, family issues, etc. When any one (or cluster) of these behaviors interferes with a person’s normal daily functioning or quality of life that person may have a serious violence problem.

With the increasing recognition of the importance of violence in public health (Brundtland, G.H., 2002) the assessment of violence risk has been the subject of considerable clinical research interest. Clinicians, assessors and mental health professionals use aggression and violence risk assessments in their treatment planning. Furthermore, probation departments' criminal justice systems have valued the use of violence risk assessment to assist in sentencing and establishing levels of supervision decisions. Violence risk assessments now have a role in clinical settings as well as probation departments and criminal justice systems.

Treatment

A variety of intervention programs (e.g., anger management) and treatment options (e.g., Cognitive Behavior Therapy, Applied Behavioral Analysis, etc.) along with medically prescribed medication are available for treating anger, aggression and violence.

Cognitive Behavior Therapy (CBT) is a popular and well researched psychotherapy that is used in the treatment of anger, aggression and violence. CBT is available in individual and group settings. A combination of CBT techniques like cognitive restructuring, relaxation techniques, meditation, deep breathing exercises, etc. have been effective in treating anger, aggression and violent behavior problems. CBT is also effective in treating other DSM-5 disorders like depression, anxiety and substance (alcohol/drug) abuse.

Applied Behavior Analyses (ABA) is another psychotherapy that is used in the treatment of intense anger, aggression and violence. ABA is based on learning theory and principles. ABA teaches a variety of skills (e.g., language skills, interpersonal skills, etc. along with coping strategies like problem solving, anger management, etc.). ABA interventions are carried out in the real world. It has been said that ABA enhances a patient’s quality of life.

Medically prescribed medication is also used in the treatment of aggression and violence. Research on psychotherapy medication in treatment is equivocal. There is some concern about side effects and inadvertent addiction. It’s common to combine psychologically based treatment (counseling or psychotherapy) with medically prescribed medication.

Summary

With increased recognition of the importance of violence (Brundtland, 2002), considerable research has focused on the assessment of violence (Samukler, 2001). Evidence based violence assessment tests have greatly increased since “unstructured clinical opinions” were discredited.

The Anger-Aggression-Violence Assessment (AAVA) is an evidenced based self-report assessment instrument or test. It consists of 135 true-false and multiple choice questions, and takes 30 minutes to complete. All AAVA tests are computer scored. From test data (answers) input, AAVA tests are scored with their 3-page printed reports available within 3 minutes. AAV reports have impressive reliability, validity and accuracy. AAVA research is provided at wwww.BDS-Research.com. The AAVA is appropriate for adult (male and female) assessment in clinical and correctional settings.

Behavior Data Systems, Ltd. believes strongly in the axiom “A specific test for specific patient and offender groups.” The AAVA is focused on the anger-aggression-violence continuum. When acting out is of concern, the AAVA test determines where the client (patient/offender) is categorized or fits (anger-aggression-violence) in the emotional anger-aggression-violence continuum.

The anger-aggression-violence triad represents the theory that “as anger increases in can evolve into aggression, which can intensify and evolve into violence.” Rather than treat these emotional states as if they are strict dichotomies, triad theory postulates that shades (intensities) of anger, aggression and violence exist as points on a linear continuum of emotional reactivity.

Continuum

Anger-Aggression-Violence


An emotionally reactive continuum

The Anger-Aggression-Violence Assessment (AAVA) is a violence risk assessment instrument or test that is readily available (on Windows diskettes, USB flash drives or over the internet).


Citations

Anderson, C. A., & Huesmann, L. R. (2003). Human aggression: A social-cognitive view (pp. 296-323). In M. A. Hogg& J. Cooper (Eds.) The Handbook of Social Psychology, Revised Edition. London: Sage Publications. (2007). Reprinted in M. A. Hogg & J. Cooper (Eds.) (pp. 259-287). The Sage Handbook of Social Psychology, London: Sage Publications.

Anderson, C.A., Lindsay, J.J., Bushman, B.J. (1999). Research in the psychological laboratory: truth or triviality? Current Directions in Psychological Science, 8, 3–9.

Averill, James R. (1983). Studies on anger and aggression: Implications for theories of emotion. American Psychologist, Vol 38(11), Nov., 1145-1160.

Berkman, E.T., Lieberman, M.D. (2010). Approaching the bad and avoiding the good: lateral prefrontal cortical asymmetry distinguishes between action and valence. Journal of Cognitive Neuroscience, 22, 1970–9.

Berkowitz, L. (1993). Aggression: Its Causes, Consequences, and Control. Philadelphia: Temple University Press.

Dodge, K.A. (1991). The structure and function of reactive and proactive aggression. In D.J. Pepler & K.H. Rubin (Eds.), The development and treatment of childhood aggression (pp. 201-218). Hillsdale, NJ: Lawrence Erlbaum.

Dodge. K. A., Lachman, J. E .. Hamish. J.D., & Bates, J. E. ( 1997). Reactive and proactive aggression in school children and psychiatrically impaired chronically assaultive youth. Journal of Abnormal Psychology, 106, 37-51.

Dr Gro Harlem Brundtland, Report: Global Launch of the World Report on Violence and Health, October 2002. Brussels, Belgium

Hortensius, R., Schutter, D., & Harmon-Jones, E. (2012). When anger leads to aggression: Induction of relative left frontal cortical activity with transcranial direct current stimulation increases the anger-aggression relationship. Social Cognitive and Affective Neuroscience, 7, 342–347. doi:10.1093/scan/nsr012

Hubbard, J. A. , Dodge, K. A., Cillessen, A. H. N., Coie, J. D., & Schwartz, D. (2001). The dyadic nature of social information processing in boys' reactive and proactive aggression. Journal of Personality and Social Psychology, 80, 268-280.

Lazarus, R. S. 1991c. Emotion and Adaptation. New York: Oxford Univ. Press. Parrott, D.J., Giancola, P.R. (2007). Addressing “The criterion problem” in the assessment of aggressive behavior: Development of a new taxonomic system. Aggression and Violent Behavior, 12, 280–99.

Martin, R., Watson, D, & Wan, C. K. (2000). A three-factor model of trait anger: Dimensions of affect, behavior, and cognition. Journal of Personality, 68, 869-897.

Peterson, C.K., Gravens, L., Harmon-Jones, E. (2011). Asymmetric frontal cortical activity and negative affective responses to ostracism. Social Cognitive Affective Neuroscience. doi: 10.1093/scan/nsq027.

Pulkinnen L. Proactive and reactive aggression in early adolescence as precursors to anti- and prosocial behavior in young adults. Aggressive Behavior. 1996;22:241–257.

Schaeffer CM 1 , Petras H,Ialongo N,Poduska J, Kellam S. (2003). Modeling growth in boys' aggressive behavior across elementary school: links to later criminal involvement, conduct disorder, and antisocial personality disorder. Dev Psychol. Nov;39(6):1020-35.

Spielberger, C.D., Johnson, E.G., Russell, S.F., Crane, R.S., Jacobs, G.A., & Worden, T.J. (1985). The experience and expression of anger. In M.A. Chesney, & R.H. Rosenman (Eds.), Anger and hostility in cardiovascular and behavioral disorders (pp. 5-29). New York: Hemisphere/McGraw-Hill

Szmukler, G. ( 2001 ) Violence risk prediction in practice. British Journal of Psychiatry , 178 , 84 -85