Best Practice: Anger Management

Anger is a normal and healthy emotion that causes psychological changes to occur, such as intense frustration and irritation. There are also physiological changes that occur, such as an increased heart rate and a raised level of adrenaline. Anger can be beneficial by helping to provide the energy necessary to fight in a threatening situation, or create social actions such as Mothers Against Drunk Driving, the Americans With Disability Act, and the Civil Rights Movement (Peacock, 2000). However, when this emotion escapes the control of an individual, there can be serious repercussions, especially in the work and family environments (American Psychological Association, 2004; Underwood, 1998).

According to Underwood (1998) there are three fundamental psychological needs that must be met in order to be happy: the need to be valued, the need to be in control of your life, and the need to like yourself. Often, when one or more of these needs are threatened, people become angry. Therefore, it is very important to help people with anger management problems fulfill these needs.

Therapeutic Interventions
According to the American Psychological Association (2004), there are three major ways to manage anger: expressing, suppressing, and calming. Expressing angry feelings requires one to be assertive by communicating his/her feelings and needs. In order to effectively express these feelings, it must be done in a manner that does not belittle or intimidate others (APA, 2004).

Anger can be suppressed by not thinking about the angering event or redirecting it towards something positive, such as expressing one’s self through art or working on a favorite hobby. However, a significant danger of ignoring anger is that if it is not redirected in a positive manner, it is possible that it will be turned inward or “bottled up.” If this occurs, physiological maladies, such as hypertension, depression, and an increased risk of cancer may result (Biaggio, 1987). Unexpressed anger can result in passive-aggressive behavior or hostility or an explosive outburst (APA, 2004; Besley, 1999).

Stress management can be used to lower psychological and physiological responses, such as anxiety and blood pressure levels. Such relaxation techniques as progressive muscle relaxation, autogenic training, diaphragmatic breathing, and guided imagery are used to help calm an individual who has excessive anger. These techniques do not necessarily have to be used at the height of anger. Typically, using these exercises of a morning and/or night will be sufficient to lower stress levels for the entire day. However, in order to control anger immediately, one must be able to recognize when he/she is becoming angry. Once an individual recognizes the onset of symptoms that will result in full-blown anger, such as contracted muscles, upset stomach, and negative thoughts, he/she may take steps to calm him/herself by using “time outs.” “Time outs” are used to help calm an angry individual by removing him/herself from the situation for a brief period of time (APA, 2004; Matlack, Jen, and Shape, 2004).

The American Psychological Association (2004) refers to cognitive restructuring as a practice of changing the way one thinks. They suggest that instead of “awfulizing,” such as saying “I’m doomed” or “This is a failure,” one should change his/her self-talk to more positive things like “Its not the end of the world” or “Getting angry will not help me, what other action can I take?”

Avoiding the use of the words “never” and “always” and using “I statements” when talking to others is another helpful cognitive restructuring technique that can be used when communicating. For example, when a person is angry, instead of saying “You never listen to what I say” the person should rephrase the statement to “I feel that you often do not listen to what I say.” When this phrasing is used, there is less of an accusatory tone and more of an expression of the speaker’s feelings (APA, 2004).

Using logic is also a way of defeating anger. It is important to use logic when one thinks “the world is out to get me.” By using logic, one can see that there are most likely few instances where this holds true. One can logically reason why undesired events are occurring and then develop a plan to address them. In addition, it is important to use logic to help prevent desires from turning into demands. For example, when one has many desires that he/she would like fulfilled, it is important for him/her to critically examine how likely the demands are to be fulfilled. Once one has an idea of the likelihood of each desire being fulfilled, he/she is less likely to be surprised about the level of realization of each desire, thus resulting in lower levels of anger (APA, 2004; Biaggio, 1987).

Research has also shown that people with anger problems often have difficulty deciphering the true message behind the words spoken to them (Dodge, 1986; Milich & Dodge, 1984). Effective communication is very important because understanding what others are saying and noticing the undercurrents of the conversation can significantly reduce the amount of anger one may experience. One skill that can aid in the detection of undercurrents of a conversation is empathy. Empathy is the process in which the listener adopts the speaker’s point of view and looks at the situation through the speaker’s eyes. Once the listener has done this, it is more likely that he/she will have a greater understanding and compassion for what the speaker is attempting to communicate (Matlack, Jen, & Shape, 2004; Davis & Boster, 1992).

Assertiveness training, although used more commonly with people who seldom feel angry, is also an option for people with anger management problems. The theory behind putting a person with anger management problems into assertiveness training is that they will learn how to be assertive, instead of aggressive. Assertiveness training can be very effective for this population because it focuses heavily on effective communication skills, which they often lack (APA, 2004; Biaggio, 1987).

Treatment
Besley (1999) suggests that anger management should be taught in school. Once there is a problem with a student’s anger, the teacher can immediately coach the student through his/her anger. Afterwards, individual or group counseling may be used to further explore the student’s anger issues. Unfortunately, this type of anger management coaching is not very prevalent in the school systems. Therefore, the weight of anger management and often many years of anger mismanagement is placed upon the shoulders of the therapist and client’s work.

According to Davis and Boster (1992), the therapist must be able to address the undesirable behavior, as well as accept the individual. Clients who are violent often have limited imaginations and look through an aggressive lens when examining many situations. In order to address such an aggressive lens, a therapist may request the client to keep a journal of perceptions. In this journal, the client will describe situations that brought about aggressive and/or angry thoughts and how he/she reacted. In the next session, the therapist can discuss the journal with the client and help him/her identify triggers, which are specific instances that bring about anger. Triggers may be present in physical or emotional hurts, frustrations, injustices, and annoyances (Peacock, 2000c). After the triggers are identified, steps can be taken to avoid and/or address them.

Processing angry feelings with the client is a very important and effective part of anger management therapy. All too often, anger and accompanying feelings are not frankly discussed in daily life. If the client is allowed to process these feelings with a therapist, the client may develop a greater understanding of how he/she reacts to different situations. Once there is an understanding of why the client reacts in a particular manner, the therapist can then work with the client in order to change the way he/she reacts to the situations. Other techniques such as conflict resolution, negotiation, compromise, and gratification delay can be taught to the client in order to expand his/her life skills (Davis, & Boster, 1992).

“I statements” can be very beneficial when communicating one’s feelings to another person. To go one step further, it may be quite effective to use active listening. Active listening is a technique that is often used by mental health practitioners who reflect feelings and rephrase what the client has just said to them. This same technique could be very beneficial for people who have anger management problems and are engaged in a conversation that is starting to provoke anger. For instance, if a person is becoming angry because he/she is being criticized, he/she can say “I hear you are saying…Is that right?” Using active listening will help the person with anger management problems twofold: first, there will be a greater quality of communication; second, this will give the person who is angry time to think about and empathize with the other person. Once this has occurred, it will be less likely that the person with anger management problems will become angry (Matlack, Jen, & Shape, 2004).

Therapists must be cognizant that clients in anger management have the potential to become violent. However, the therapist needs to walk a fine line between being over cautious and being blind to the potential of violence in the office. Most of the therapists who have been assaulted reported that there were some warning signs before the attack, such as increased agitation of the client. Therapists who are inconsistent in behaviors and consequences and who use techniques that can be perceived as over structured, authoritarian, and inflexible are much more likely to agitate clients to the degree that violence may occur. It is also important to note that many therapists who have been attacked reported a dislike for the client before the attack took place. This could suggest that higher tensions may have been present in the client-therapist relationship (Davis, & Boster, 1992).

Discussion
Using anger suppression techniques can be a double-edged sword. Since anger is a healthy and natural emotion, it may be unhealthy to restrict such an emotion (APA, 2004). While management of all emotions are quite important, suppressing any one of them could detract from the ability to cope with events in one’s life or the ability to process how one is feeling.

Catharsis is also a problematic treatment technique. Although literature in the past has expressed a need to “let one’s anger out,” recent studies have found that catharsis may reinforce violent behavior (Peacock, 2000b). Even though society often encourages catharsis, the associated risk is too great to continue using this technique. This paper has outlined many proven techniques that can be implemented in the absence of catharsis.

It is very important to look beyond the issue of anger when working with a client. The therapist needs to look at the person-in-environment. What else is occurring in the client’s life? In addition, there is a great need to further assess the client’s psychological status. Does he/she have other issues that are hidden under the anger? Often, other emotions are causing anger problems. Occasionally, anger problems may be related to eating disorders, chronic physical illness, brain injury, or mental illness. Once the therapist assesses the entire situation, a detailed treatment plan can be created that will address all of the psychological needs of the client. Often progress in anger management is seen about eight weeks into therapy (Peacock, 2000d).

There is a wide array of anger management techniques available. Likewise, there is a wide array of people. Therefore, it is important to match appropriate techniques with the person. It is important to recognize that different people will prefer different techniques. It is the job of the therapist to use his/her professional judgment to create a tailor made treatment plan for each client.

References
American Psychological Association. (2004). Controlling Anger -- Before It Controls You. Retrieved July 25, 2004, from http://www.apa.org/pubinfo/anger.html
Besley, K. R. (1999). Anger management: immediate intervention by counselor coach. Professional School Counseling, 3(2).
Biaggio, M. (1987). Clinical dimensions of anger management. American Journal of Psychotherapy, XLI(3), 417-427.
Davis, D., & Boster, L. (1992). Cognitive-behavioral-expressive interventions with aggressive and resistant youths. Child Welfare, 71(6).
Dodge, K. A. (1986). A social information processing model of social competence in children. New York: Wiley.
Matlack, Jen, & Shape. (2004). The upside of Anger. Health Source- Consumer Edition, 23(9).
Milich, R., & Dodge, K. A. (1984). Social information processing patterns in child psychiatric populations. Journal of Abnormal Child Psychology, 12, 471-490.
Peacock, J. (2000a). Chapter one: What is anger? Health Source- Consumer Edition.
Peacock, J. (2000b). Chapter two: Anger styles. Health Source- Consumer Edition.
Peacock, J. (2000c). Chapter three: Anger triggers. Health Source- Consumer Edition.
Peacock, J. (2000d). Chapter seven: Brining in the bomb squad. Health Source- Consumer Edition.
Underwood, J. C. (1998). How to manage your anger. Women in Business, 50(1).