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Anger Management Back to Course Index

 

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We are taught throughout our lives that anger is bad.When someone feels angry they also frequently feel shame, guilt, hurt or embarrassed.Getting mad is scary… and potentially dangerous.We learn that anger should be avoided. That expectation is not only very difficult, but actually can be unhealthy. Anger is a powerful, natural feeling.At some time or another everyone feels it and we have the right to feel that way.It’s what someone does with the anger that makes the difference.

 

As clinicians it is our goal to help clients learn effective ways to manage their anger.

In this course we will explore:

Anger and Its Causes

Common Approaches to Anger

The Problems with Anger

The Positive Aspects of Anger

Exploring Anger Management

 

Anger and Its Causes

Anger is a natural emotional reaction. It affects the entire body, creating energy. When someone begins to anger adrenaline and other chemicals enter the bloodstream. The heart pumps faster and the blood flows more quickly. The muscles tense. This biological reaction is frequently in preparation for a behavioral response, conscience or not. That behavioral response can be out of protection or aggression.

Anger is an emotional-physiological-cognitive internal state; it is separate from the behavior of aggression it might prompt. Aggression, separate from anger, is action. It is intended to harm. It can be a verbal attack–insults, threats, sarcasm, or a physical punishment.

Just how widespread is hostility? Psychology Today asked, “If you could secretly push a button and thereby eliminate any person with no repercussions to yourself, would you press that button?” 69% of responding males said yes, 56% of women said yes. Emotion usually triumphs over reason.

Much of our learned behavior is learned young in life. By the time we are five years of age, we have learned to be kind and caring or aggressive.

Is anger innate? Certainly most three-year-olds can throw a temper tantrum without any formal training. They learn this reaction usually even without observing a model. Is the behavioral response to anger learned? Why are the abused sometimes abusers? Does having a temper and being aggressive yield payoffs? You bet.

The causes of anger vary from person to person and from situation to situation.

images-3Research has shown that stimulation of certain parts of animals’ brains leads to aggression. Stimulation of other parts stops aggression. Even back in 1966 we learned through Charles Whitman who killed his wife and mother because “I do not consider this world worth living in…”, then climbed a tower on the University of Texas campus and fired his rifle at 38 people. He killed 14 before being killed. An autopsy revealed a large tumor in the limbic system of his brain (where the aggression “centers” are in animal brains).

 

I have personal knowledge of a friend’s family pet of 13 years with no forewarning mauling their 8 year old child causing 93 puncture wounds. After an autopsy it was revealed the animal had a brain tumor.

 

In epileptic patients with implanted electrodes, in rare cases violence follows stimulation of certain parts. Abnormal EEG’s have been found among repeat offenders and aggressive people. So, aggression may sometimes have a physical basis. More recently, scientists have learned to use neuro-imaging to see the living, thinking, feeling human brain at work. Neuro-imaging tools include functional magnetic resonance imaging (fMRI), which uses magnetic fields and radio waves to elicit signals from the brain, and positron emission tomography (PET), which uses low doses of a radioactive tracer to obtain signals from the brain. Both of these technologies have been designed to reveal signals that correlate with human brain activity. These approaches have been used to study the pathways in the brain involved in sensory processes such as vision, and in a variety of cognitive processes.

Other physiological factors seem to be involved. Examples: high testosterone (male sex hormone) is associated with more unfaithfulness, more sex, more divorce, more competitiveness, and anti-social behavior. It is also known that a viral infection, called rabies, causes violent behavior. About 90% of women report being irritable before menstruation. Furthermore, 50% of all crimes by women in prison occurred during their menstrual period or premenstrual period. By chance only 29% of crimes would have occurred during those eight days. Hypoglycemia (low blood sugar) increases during the premenstrual period and it causes irritability.

  • Stress related to work, family, health and money problems can frequently make someone feel anxious and irritable
  • Frustration when someone fails to reach a goal or when they feel as if things are out of their control.
  • Fear can cause anger.Anger is a natural response to threats of violence, or to physical or verbal abuse.
  • Irritation can escalate anger and lower someone’s tolerance.
  • Disappointment can trigger anger when expectations and desires aren’t met.
  • Resentment can cause anger when someone feels hurt, rejected or offended.

Whether anger is learned, due to an issue in the brain, physiological in nature or a combination of these with the inability to control such feelings comes problems.

 

The Problem with Anger


Poorly handled anger can cause many problems. Some individuals try to pretend they aren’t angry. Other people feel as if their anger is out of their control. Ignoring anger or giving up control over it can lead to:

Physical Health Problems

  • Headaches
  • Sleep Problems
  • Digestive Problems
  • High Blood Pressure
  • Heart Problems

Poor Decision Making

  • Anger can make it hard to think clearly.A person may have trouble concentrating or may use poor judgment. This can lead to accidents, injuries and other problems.

Problems with Relationships

 

  • If a person cannot control their anger, they may end up insulting, criticizing or threatening those close to them. They may respond with anger or resentment. Getting angry may also keep them from telling
  • others how they feel.

Low Self-Esteem

  • If someone has difficulty managing anger, they may feel bad about themselves.

Depression

  • Anger that is kept bottled up can affect a person’s thoughts and feelings.

Alcohol or other Drug Problems

  • Alcohol and other drugs dull strong feelings. They can become a crutch to help someone avoid negative consequences of an angry outburst.
  • Uncontrolled anger can lead to aggression as we discussed earlier. The result of uncontrolled
  • anger may include verbal attacks or physical assaults, abuse and other criminal behavior.

 

The Positive Aspects of Anger


With all of this being said, learning to recognize and express anger appropriately can have very positive consequences in a client’s life. Sometimes, anger can gain attention when nothing else will. Anger can be a tool for change. It can serve as a motivator and energizer. It signals to us that “this does not work for me” or “this is not pleasurable or right for me”.

As we provide treatment services to clients, we want to remember that positive aspects of anger do exist. We also want to remember that for our clients to function at an optimum level, becoming un-angry is not the goal. F

inding productive ways to use their anger is the goal of affective anger management.


 

Theoretical Approaches to Anger


Some theorists believe anger just naturally results from frustration. This is called the frustration-aggression hypothesis. As noted earlier there are several physiological reactions that accompany frustration, including higher blood pressure, sweating, and greater energy. At times, particularly when the cost of anger is high, for example getting hurt or fired, most individuals can learn to control their anger but as a basic drive it remains there seeking some expression.


A common approach to dealing with anger is to express it. In the popular movie Pretty Women the leading man expressed that it took 10 months of therapy to learn how to say, “I am angry at my father.” The belief is that clients benefit when given a forum to express their anger in therapy. Individuals must acknowledge their anger, vent their anger and manifest their rage both emotionally and physically. Methods include letting out their anger during individual or group therapy, hitting punching bags when angry, yelling or exhibiting some extreme display of emotional or physical release. The obvious downfall to this technique is that aggression is a habit. The goal in therapy should be to learn effective ways to manage anger without violent physical release. A preferred approach might be creating the venting habit of intense exercise in reaction to anger. People who have a tendency to lose control of their physical behaviors should not practice “punching” as a method of letting it all out. Most clients in therapy for anger issues don’t have difficulty venting their anger; moreover that is what got them to treatment in the first place.

Some in the mental health field argue that aggression is learned in two basic ways:

 

(1) from observing aggressive models and

 

(2) from receiving and/or expecting payoffs following aggression.

 

The payoffs may be in the form of:

 

(a) stopping aggression by others,

(b) getting praise or status or some other goal by being aggressive

(c) getting self-reinforcement and private praise, and

(d) reducing tension.

 

Treatment would include cognitive processes, like rational problem-solving, “trial runs” in fantasy to see what might happen if I did _____ , and the self-control procedures of self-observation, self-evaluation, and self-reinforcement.

Therapy, whatever the theoretical basis should see anger as a normal human emotion. Treatment should help clients eliminate self-defeating behaviors or behaviors that are destructive or harmful to others. A client is entitled to their feelings and they are responsible for their actions.

 

Exploring Anger Management

When focusing on the management of angry feelings an individual can:

 

(a) prevent it, i.e. keep anger from welling up inside, or

(b) control it, i.e. modify our aggressive urges after anger erupts inside.

 

As discussed, although someone can decrease the frequency and volatility with which they feel and express anger, they cannot prevent it entirely. Then it is crucial for them to learn to control it.

 

Potential Signs of Anger Issues

If an individual has an anger problem, he or she may be aware of it but not know what to do. That individual may also not be aware of his or her anger; the nature of anger may lead those experiencing extreme anger to deny they have any responsibility for the problems to which they contribute.

Potential signs of anger issues include:

  • Persistent feelings of frustration toward oneself or others.
  • An inability to enjoy life or the company of others.
  • A hot temper or a tendency to yell or argue with others.
  • Physical signs such as headaches, rapid breathing, or a pounding heart.

 

Anger, as an emotion, begins as an inner twinge. A person can sense something long before it explodes into an emotional tirade.If someone can listen to this twinge, the emotional outburst is frequently not needed.Clients can learn to stop, choose the best outcome and act accordingly. For this to work though a client needs to learn to recognize the signs that they are getting angry before the behaviors escalate beyond control. Two techniques frequently used in treatment include the Warning Signs Checklist and/or Anger Journal listed below.

What are your warning signs?

Check the warning signs you often have when you get angry.

Write in signs that aren’t listed.

___Tense muscles

___Tight fists

___Clenched jaw

___Sweaty palms

___Racing heartbeat

___Fast breathing

___Trembling or feeling shaky

___Feeling warm or flushed

___Upset stomach

___Loud or mean voice


Anger Journal

Date/TimeTriggerWarning SignsAnger RatingResponseHow I felt afterward

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Once a client can get ahead of the anger by recognizing what is coming they can learn techniques and coping strategies to employ to reduce the negative consequences of uncontrolled anger.

Thoughts that create angry feelings frequently begin with should, must or ought statements.These statements can be noted in the Trigger section of the journal.

During my work with clients who were mandated to treatment due to a crime involving violence we would work on the concept of seeing the loss of control when angry as giving their power away.If they could see that allowing another person to control their feelings and “make me lose my temper” then they were allowing the other person to have their power.To stay in control begins to look like maintaining control rather than escalating the argument.

Cognitive Shift

As a parent of two children I have seen a “survival of the fittest” type of mentality in children.It creates a self centered approach to life during this phase. “If I don’t take it there won’t be enough for me”.It is an interesting shift to watch occur when they begin to realize that others have feelings and also want to go down the slide and have a turn.Making that cognitive shift is to correct the error belief system they previously held.To become secure in the rightness of the situation.A client who has anger issues might have faulty belief systems such as, “if I do not yell, nobody will listen”, ” anger is the only way I can protect myself from becoming emotionally hurt”, “because my anger is justified, my behavior should not have consequences”.These beliefs need to be challenged.There is a three-stage process for a client to challenge and change their cognitive errors:

1) Recognize

2) Remove

3) Replace

The first step involves helping our clients to recognize their cognitive errors. This can be done through confrontation, through the process of following conclusions to their erroneous logical extremes, and through the creation of new experiences, which experientially change an individual’s belief.

Once this cognitive error is recognized as false, the most effective way to remove it is by implementing a third strategy, which is to replace those cognitive errors with the new truth.

Another important aspect of effective anger management is to help clients find healthy ways to express their anger.

  • Teaching them to practice skills such as remembering to calm down and think carefully before they speak.
  • Teaching them to name the problem, clearly and calmly explaining why they are angry or what the problem is.
  • Teaching them to use I statements.The use of I statements in describing how they feel helps the listener feel less blamed or criticized.
  • Teaching them to identify solutions focusing on what they would like to change or see happen in the future.
  • Teaching them to use positive self-talk.


Increasing Tolerance or Decreasing Volatilityimages


The goal of therapy is not to teach clients to avoid anger, but rather how to have an increased tolerance for those situations that are going to make them upset.One method for teaching clients to tolerate higher levels of anger is using therapeutic relaxation training exercises. Therapeutic breathing exercises and progressive muscle relaxation exercises can help a person take physical control over the emotions that they experience.

Allowing and fostering clients to be a part of creating their treatment plan gives them control over their progress.In the throes of a control issue this is very important.One of the approaches to give them power is to have them complete an Anger/Rage Safety Plan.They can complete it with steps that will help them personally.Here is an example:

Safety Plan

1.) Take a Deep Breath and Sit Down.

2.) Stop Drinking Alcohol.

3.) Exit by going outside or to another room. Take three deep breaths.

4.) Call _________________________ @ ______-___________. Talk for five minutes.

5.) Write out what is bothering you on a piece of paper.

6.) If you are still feeling angry, go to this place: ___________________________________.

7.) If you are still unable to control your rage, or if you feel like killing yourself or others, call

_________________________ @ _______- ___________ and tell whoever answers that,

I feel like killing myself, or others, and I want help.

 

Outside of the Box Tools to Use With Clients

  • Strategies Sandwiches

These creative sandwiches can be used with younger clients that need to learn better ways to recognize and deal with their anger.  Use paper cut into the shape of bread, tomato, lettuce, etc. to represent the ingredients.  These ingredients represent the things that you talked about trying when the anger starts to overwhelm.

  • Candle and Flower

This strategy distracts and teaches deep breathing.  Bring to session a candle and a flower.  Instruct your client to take a deep breath through their nose as the smell the flower.  When they are breathing in the flower, have them focus on breathing in good, calm feelings.  Instruct them to hold their breath for two seconds then release their breath by slowly blowing out the candle, pretending that they are breathing out the out to control angry feelings.  Repeat.

  • Say what?

Help your client create a flip chart of ways of calming down through verbalizing how they feel and what they need the other person to understand.  It sometimes takes longer than they think to separate their anger from what they are really trying to say.

  • Fuse

Clients who get angry easily can be shown pieces of string, cut to various lengths from very short to long, with an explanation that a person with a very short fuse tends to get angry and explode (yell, scream, fight, get into trouble) more quickly than someone with a longer fuse.

The counselor discusses with the client what happens when they get angry.  How fast they get that out of control feeling, showing the shorter string then asking what would be different if their fuse what longer giving them more time to process and think about the situation.  The counselor would then proceed with teaching how the client’s self-talk leads to the increased anger response and how changing her self-talk can allow for a calmer, more rational response to stimuli that would have previously resulted in an angry outburst. The counselor would keep emphasizing that the client’s more rational, different, self-talk leads to a longer fuse. 

 

  • Pop Bottle to Water Bottle

At times, clients who suffer from angry outbursts can relate to the build-up of anger inside of them like pressure in a shaken pop bottle. Counselors who use this analogy find that when helping clients understand this concept, actually showing them a bottle of pop that is about to explode lends a visual reference point to the client’s anger.

What is the difference between a pop bottle and a water bottle?   One will explode if shaken and then opened and one won’t.  Giving this visual can help a client to understand how anger can bottle up and then get out of control.  Help the client understand that they need to be clear thinking. The counselor then proceeds with teaching the client from a cognitive-behavioral framework to understand his behavior as it relates to his self-talk.

 

Theoretical Approaches to Treating Anger

Uncontrolled anger can affect your client’s relationships, their job, and their health. Rage can take over their life and result in depression, violence, and suicidal feelings.  Clients must get the support they need to develop effective management strategies.  Many theoretical approaches can be employed when working with this population.

Modern therapeutic strategies are targeted and effective, often offering results in as little as six to eight weeks.  Frequently used approaches include:

  • Cognitive-behavioral therapy
  • Improvements in communication skills
  • Focus on problem-solving
  • Avoidance of problematic situations
  • Humor and self-deprecation

 

Cognitive Behavioral Therapy

One of the most common types of psychotherapy is cognitive-behavioral therapy. The purpose of the treatment is to help an angry person recognize the self-defeating negative thoughts that lie behind anger flare-ups. Patients work with mental health professionals to learn how to manage stressful life circumstances more successfully.

The cognitive-behavioral approach has many benefits. Patients learn to:

  • Cope better with difficult life situations
  • Positively resolve conflicts in relationships
  • Deal with grief more effectively
  • Mentally handle emotional stress caused by illness, abuse, or physical trauma
  • Overcome chronic pain, fatigue, and other physical symptoms

Cognitive therapies are structured and may offer quicker results than other approaches. Better yet, the results are lasting, with patients showing significantly decreased relapse rates.

This sort of treatment tends to focus on specific problems and personal triggers. They should learn how to deal with their particular issues using conscious, goal-centered strategies. The specific steps in cognitive behavioral therapy include:

  • Identification of situations or circumstances in their life that lead to trouble
  • Awareness of their thoughts and emotions surrounding anger triggers
  • Acknowledgment of inaccurate, negative thought patterns
  • Relearning healthier, positive thought patterns

Several effective cognitive-behavioral techniques are outlined below:

 

Enhanced Personal Awareness

Angry individuals often do not have a clear sense of their anger. They don’t understand where it comes from or what is happening to them when they are angry. There are many ways you can learn about the elements of anger episodes. These include detailed discussions with your therapist, role-playing anger-causing situations, and self-monitoring (making a record of) anger in day-to-day living. Whatever approach is chosen, the goal is to help you become more aware of the anger in your life, by addressing the following issues:

Where and when does the anger occur? Why does anger occur (what events or situations lead to the anger)? What kinds of memories or images trigger the anger? How do you feel when you become angry (emotionally and physically)? What are you thinking when you are angry? How do you handle the situation that made you angry? Do you always behave the same way? If not, why not? What do others do when you become angry?

Answering such questions will help you become aware of the nature, reasons, and results of anger. The answers will also eventually help you develop a greater sense of self-worth and personal control, and the ability to use anger management and problem-solving skills. Although enhanced personal awareness is rarely all that is needed, it is often very helpful.

Anger Disruption by Avoidance and Removal

These techniques lead to the interruption of anger by removing you, mentally or physically, from the situation. For example, it might be wise to simply get up and leave a situation when anger develops. This might even be negotiated with a spouse, friend, or business associate in advance. It might be wise to delay responding by asking for time to think about angering issues or to gather additional information before responding. It might be wise to seek an alternative mode of response, such as a written or email answer, instead of an immediate spoken one. These techniques may decrease or even prevent anger altogether.

Doing a distracting non-angry activity is also an alternative. One mother, with an anger problem, chose to plan meals and do the laundry instead of arguing and insulting her teenage daughter about homework. Other individuals may count to ten or may provide themselves with a brief, non-damaging physical distraction, such as pressing their fingers together very firmly or leaving to take a shower or work in the garden.

These few examples are simple strategies that can disrupt anger and give the individual some time and distance to calm down, then approach the situation differently, at a later time. As with enhanced self-awareness, these strategies are rarely sufficient alone but are an important part of treatment.

 

Relaxation Coping Skills

Anger is often marked by increased emotional and physical excitement. Relaxation coping skills target this excitement and can help you calm down when angered. You can learn to become aware of the triggers for anger and you can use relaxation to lower it. Relaxation skills include slow deep breathing, slowly repeating a calming word or phrase, picturing a personal relaxation image, or focusing on muscle tension and consciously letting it go. These skills are practiced at home until you can relax quickly. Then, as you become better at using relaxation, it can be used to lower anger within the therapy session. For example, the therapist may ask you to imagine an angering event, experience the anger, and then assist you in the relaxation skills to lower the anger. Throughout a few sessions, as the therapist’s assistance decreases, you can learn to handle increasing levels of anger. If successful in the therapy sessions, you can begin to use relaxation for anger management in daily living, freeing yourself to approach situations more calmly.

 

Attitude and Cognitive Change

When angry, people often make bad situations worse by the way they think about them. For example, angry individuals tend to demand that things should be, ought to be, or have to be, their way—rather than just wanting or preferring them to be a certain way. Often, they call other people insulting, sometimes obscene, names. The problem situation is often seen as awful or catastrophic, rather than simply difficult, frustrating, or truly disappointing. By thinking about bad situations in this way, natural frustrations hurt, and disappointments seem much larger, leading to increases in anger.

Attitude and cognitive change techniques focus on identifying anger-producing thoughts and replacing them with more reasonable ways of thinking. As with relaxation skills, many different techniques may be employed. For example, therapists could use the careful exploration of thinking errors, role-playing, self-monitoring, self-debating strategies, and trying out new behaviors. You and your therapist will work together in session using one or more of these techniques to become aware of, and change, attitudes, and images that increase anger. Then, you practice the new and more reasonable thought patterns (habits) for anger reduction in the real world.

 

Silly Humor

Another cognitive change technique is silly humor. This does not mean that you will be taught to laugh away problems. Instead, the goal is to use silly humor, rather than hostility, as a partial cure. This is particularly helpful with certain types of angering thoughts. For example, adult drivers may make themselves angrier by calling other drivers “asses.” The client might be asked to define this term correctly. This usually leads to a definition of a burro. Then, they might be asked to draw a picture of this definition and to picture this image when they use the term. Rarely is silly humor the primary therapy technique, but it often helps people chuckle at themselves, take a step back, and approach the situation less angrily.

 

Acceptance and Forgiveness

Many things that others do simply can not be helped. For example, children spill drinks; they commonly argue with each other, then pout or shout, and they are always testing the boundaries of “no.” In industry, economic conditions sometimes lead to layoffs. Spouses sometimes forget about issues that are important to their partners.

But thinking that others have intentionally set out to cause problems is almost always wrong. Think that they could have acted differently if they wanted to, ignoring other causes of behavior. Sometimes, for example, spouses or colleagues just didn’t hear what you said, or your friend just forgot. Thinking that the bad behavior of others is always intentional just increases anger and does little to solve problems. Understanding that some behaviors are caused by biology or genetics, normal development, or economic stressors, is more realistic. Acceptance and forgiveness interventions help you to understand these realities. The goal is to improve relations with others while reducing needless and repetitive lecturing and blaming.

 

Skill Enhancement

Some people experience anger because they do not have the necessary skills to negotiate common interpersonal hassles and conflicts. They may fight with a spouse because they don’t know how to communicate well about family budgets; become furious and yell at a child because they don’t know how to handle the child’s misbehavior, or become angry and intimidating when dealing with coworkers because they don’t know how to be assertive. Anger escalates because of insufficient skill at resolving the situation.

Although the needed skills vary greatly from individual to individual, skill training can help you approach negative situations in a calm, direct, problem-solving manner. You and your therapist identify the needed skills and rehearse them during therapy sessions until you are comfortable with them. Then, you work together to transfer these skills from the office into the real world. Over time, you will learn general principles and strategies that can be adapted to many anger-causing situations. This leads to a reduction in anger because the skills stop or lessen conflict and tension with others.

Very few risks are associated with cognitive behavioral therapy, and the benefits are plentiful. The client will likely explore painful feelings and emotions, but they will do it in a safe, guided manner.

Cognitive therapy is considered a short-term approach and generally lasts about 10 to 20 sessions depending upon your specific disorder, the severity of your symptoms, the amount of time you’ve been dealing with anger symptoms, their rate of progress, their current stress levels, and the amount of support they receive from friends and family.

 

Communication Skills

Teaching communication skills is also an effective treatment for anger management.  The way we communicate or the style we use to communicate is often learned from much earlier experiences in our lives when our language skills were newly formed. Most individuals tend to communicate in a way that was adaptive in the environment we grew up, in but problematic in our lives today. For many, our style of communication can leave someone with unmet needs, unexpressed emotions, and damaging effects on individuals around them.

Eric told his counselor that in his family they typically yell at one another to get the point across. Eric recently got in a relationship with a woman who told him that his anger scares her when he gets upset. Eric replied that he was not upset, this was just the way he is used to expressing himself when he gets upset, and this is normal for him.

The reality is that what might be normal for a client’s family of origin may not be the norm in terms of communicating effectively with others.

Eric’s style of communication is aggressive, but he didn’t realize the impact it had on his girlfriend. Eric had to learn about his style of communication as well as other styles of communication to understand the kind of changes he needed to make. By learning to become more assertive, Eric felt better, his needs got met more of the time, and his girlfriend no longer feared him when he did get upset.

It is important to understand that there are many different communication styles, yet only one tends to yield the results we are seeking. Learning to express primary feelings and needs, clearly, calmly, and with good eye contact is what assertive communication is all about.

Good communication skills are an essential ingredient to anger management because poor communication causes untold emotional hurt, misunderstandings, and conflict. Words are powerful, but the message we convey to others is even more powerful and often determines how people respond to others.

 

Prescription and Over-the-Counter Medications

Because anger is a psychological issue, it is possible to treat symptoms with medication. While the goal of treatment programs will be to eventually make the patient self-sufficient, particular medicines can be helpful in the treatment phase.

Antidepressants such as Prozac, Celexa, and Zoloft are commonly prescribed for anger issues. These drugs do not specifically target anger within the body, but they do have a calming effect that can support the control of rage and negative emotions. Epilepsy medicines are sometimes indicated, particularly when a patient’s seizures result in anger reactions.

The client should speak with their doctor about whether or not prescription medicines can help them with their anger issues. They should pay particular attention to potential side effects and any risks of addiction. The purpose of medications is to complement their healing, not to complicate it.

Several over-the-counter medications and supplements can also be used to improve mood and support anger management therapy. These include:

  • Valerian
  • Primal Calm (formerly Proloftin)
  • Benadryl
  • Passionflower
  • Chamomile

Benadryl is an anti-allergy medication that also helps to reduce anxiety. Valerian and Primal Calm are herbal extracts that purportedly promote lowered stress levels and calm feelings. Passionflower and chamomile are usually consumed in either tea or tablet form to support mood and reduce anxiety.

Employing Self-Help Method

Our goal is to help our clients help themselves. The following are some tips that can be used by the client to help avoid and de-escalate potential problems:

(1) Avoid frustrating situations by noting where you got angry in the past.

(2) Reduce your anger by taking time, focusing on other emotions (pleasure, shame, or fear), avoiding weapons of aggression, and attending to other matters.

(3) Respond calmly to an aggressor with empathy or mild, unprovocative comments or with no response at all.

(4) If angry, concentrate on the undesirable consequences of becoming aggressive. Tell yourself: “Why give them the satisfaction of knowing you are upset?” or “It isn’t worth being mad over.”

(5) Reconsider the circumstances and try to understand the motives or viewpoints of the other person.

(6) Train yourself to be empathic with others; be tolerant of human weakness; be forgiving (ask yourself if you haven’t done something as bad); and follow the “great lesson of mankind: to do as we would be done by.”

 

Case Examples

  • Anger and domestic violence: Claude, 43, is referred to therapy for anger issues by a court after being arrested for beating up his girlfriend and her teenage son. Claude feels regret for his actions, which signifies to the therapist that he may be successful in treatment. Therapy quickly reveals that Claude has a tremendous, irrational fear that his girlfriend will leave him. Claude realizes that it is his angry behavior and violence that may lead her to leave, but, with the help of his therapist, he discovers that his fears stem from childhood, when his mother, for reasons Claude denies knowing, left his father to care for Claude and his four siblings. Claude realizes he still feels great anger toward both his parents for this event. Later, in a couple of sessions, he reveals this about himself to his girlfriend, establishing a level of intimacy and trust he has never achieved with anyone else. Claude still finds himself angry more often than he would like, but he becomes able to express his emotions more readily and avoid violence or aggression.

  • Depression manifesting as anger: Linda, 23, seeks treatment for depression and is soon angry with her therapist because her mood does not quickly improve. She is demanding treatment and has poor insight into her actions, blaming others, and their shortcomings for everything wrong in her life. Her therapist reframes her disclosures, focusing not on her complaints but on what Linda wants and needs, but lacks: intimacy, a sense of purpose in her life, and self-forgiveness for past mistakes. The therapist also identifies some biological tendencies toward mood swings. Linda can express her sadness and fear, and she gains insight into the ways she causes herself to be isolated from others by always criticizing or arguing with them. She soon begins to work on communicating more assertively and less aggressively, rediscovers her childhood love of painting and music, enrolls in college, and begins apologizes to friends for her past actions. Her anger, while still sometimes a challenge for her, is under control.

  • Anger and loss of control:  Art feels like Gina could be his soulmate and just wishes she would allow their relationship to improve getting back to how they were when they first got together.  Gina just can’t let her guard down.  “When Art gets angry is so irrational!”  When Art fights with Gina the argument, over the simplest thing, ends up in him turning the utilities off at the house or throwing her clothes into the guest room.  After one argument he drove home leaving Gina and her kids in a hotel in another state.  She says the relationship is over if he can’t get his “out of control” behavior under control.  “We should be able to fight without him resorting to “craziness”.  The counselor can help Art and Gina establish “rules” for arguments including the ability for Art to walk away and calm down and then return after 15 minutes.  Once they began communicating the need to escalate the situation was no longer as necessary for either of them.

images-4In summary, anger and arguments are normal parts of healthy relationships. However, anger that leads to threats or violence, such as hitting or hurting, is not normal or healthy. The goal of anger management is to reduce both the emotional feelings and physiological arousal that anger causes. An individual can’t get rid of, or avoid, the things or the people that enrage them, nor can they change them, but we can help them learn to control their reactions.

 

References

Sood A. Relationships. In: The Mayo Clinic Handbook for Happiness: A 4-Step Plan for Resilient Living. Cambridge, Mass.: Da Capo Press/Lifelong Books; 2015.

Pish S, et al. Anger management program participants gain behavioral changes in interpersonal relationships. Journal of Extension. 2016;55:e1. https://joe.org/joe/2016october/a3.php. Accessed Jan. 18, 2017.

Mehta M, et al., eds. Anger management. In: A Practical Approach to Cognitive Behaviour Therapy for Adolescents. New Dehli, India: Springer India; 2015.

Controlling anger before it controls you. American Psychological Association. http://www.apa.org/topics/anger/control.aspx. Accessed Jan. 18, 2017.

Fabian P, et al. Does exercise reduce aggressive feelings? An experiment examining the influence of movement type and social task conditions on testiness and anger reduction. Perceptual and Motor Skills. 2016;122:971.

McCullough M, et al. Conciliatory gestures promote forgiveness and reduce anger in humans. Proceedings of the National Academy of Sciences of the United States of America. 2014;111:11211.

 

 

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