How does Anger Management Therapy work?

Anger is often portrayed as "bad", reckless or an unhelpful emotion. However, while anger leads to increased amount of destructive behavior, it also has an important self protective function that can help bring about social change. 

Why do we get angry? 

Simply put, we get angry when we perceive an injustice, we believe we have been wronged, or experience provocation that challenges our values or principles. 

Anger can range in intensity from low level annoyance to fire breathing fury and can also bring about changes in physiology like: 

        1. Increased blood pressure 

        2. Increased heart rate 

        3. Sweating, etc 

                                        

                                            What is the Best therapy for anger? 

    Most amount of research has been focused on Cognitive behavioral therapy like CBT and has been the dominant form of therapy in this area. 

        1. CBT and Anger management 

CBT emphasizes important links between how we feel, the thoughts and beliefs we have, and the behaviors we carry out and is a highly effective treatment for psychiatric and nonclinical groups (Lee & DiGiuseppe, 2018).

    How does it work? 

            CBT anger management interventions typically target the emotional and physiological elements of anger, the cognitive (thinking/behavioral) processes that drive dysfunctional anger, and/or social and communication skills (Deffenbacher et al., 2002)

                                                A.  Relaxation based interventions 

People learn to use relaxation to cope with anger and lower their arousal. Being in a more relaxed frame of mind can help people think through their behaviors and use their skills in conflict management and problem solving. 

                                                B. Stress Inoculation 

During stress inoculation training, individuals rehearse an internal dialogue to walk themselves through how they would deal with an anger-inducing situation.

They may create a repertoire of coping statements or think through how they will challenge negative appraisals of the situation.

Through practicing this self-guiding dialogue, they can begin to approach situations with greater self-control and lower levels of arousal (Deffenbacher et al., 2002).

                                        C. Cognitive Restructuring 

Cognitive restructuring begins as an error-finding mission, where clients are supported to recognize dysfunctional or biased beliefs and thinking processes that lead to anger, such as overly personalizing comments from others or unhelpful beliefs such as “people never listen to me.”

Clients are then supported to develop alternative thinking processes that are more helpful, rational, and aligned with reality (Deffenbacher et al., 2002).

                                        D. Social Skills Intervention 

Social skills interventions aim to reduce destructive and antagonistic behaviors and help people develop stronger communication and conflict management skills.

Some skills the client is supported to develop are listening and assertiveness, thinking about the impact of their behavior on others, and negotiation (Deffenbacher et al., 2002).

Being able to communicate more effectively can reduce anger in itself, and improving skills to deal with anger-inducing situations can stop conflict from spiraling (Deffenbacher et al., 2002).

                      3 Best Interventions & Counseling Tips

There are many ways to help clients notice, express, and manage their anger in more constructive ways. Importantly, anger management therapy is not likely to be appropriate for people with certain conditions, such as neurological disorders, psychosis, personality disorders, or paranoia.

 

                                    1. Retreat, Rethink, Respond 

A typical negative reaction pattern is to react (e.g., shout at someone), retreat (remove yourself from the situation or be removed), and then rethink (go over your actions and what you could have done differently) after the damage is done.

To disrupt this negative cycle, you can help the client work out how they could shift this habitual reaction to first retreat to a mental space, rethink the event, and then respond more thoughtfully (Schimmel & Jacobs, 2011).

                                    

                  2. The 7/11 technique 

Help your client practice these steps when they next feel angry:

- Stop and focus on your breath

- Breathe in for a quick count of 7

- Breathe out for a quick count of 11

- Keep going for at least 1 minute

- Reflect on the consequences of responding from this more relaxed place (Tyrrell, 2018)

             3. Norman Cotterell's 7 steps for Anger 

Step 1: What “should” rule is broken?

Anger is triggered when one of our “should” rules is broken; for example, “They should be honest with me” or “He should return my call.” Acknowledging which rule is broken gives us the choice to accept what’s happened or continue to fight against it.

“Should” rules also hint at what our positive values are, which can be helpful to reflect on. For example, “he should pay for half” could show that you care about fairness and equality (Cotterell, 2021).

The client is then asked to think about what they would like for themselves long term and how they can constructively deal with rule-breaking situations while still acting in line with their values (Cotterell, 2021).

Step 2: What is hurtful or scary about this rule being broken?

Explore why it’s painful that someone breaks your rules. What does that signal to you? Does it confirm negative beliefs you have about others or yourself?

Here, it’s useful to explore the evidence for their beliefs and consider more helpful ways of interpreting the behavior of others (Cotterell, 2021).

Step 3: “Hot thoughts”

Identify thoughts that are very “hot” or emotional and try to change reactive thoughts; for example, change “He’s an idiot” to the more reflective thought, “He made an honest mistake” (Cotterell, 2021).

Step 4: Anger

Learning to manage the arousal associated with anger can be done with classic relaxation practices, such as visualizations and progressive muscle relaxation. Cotterell (2021) suggests you could also explore anger as a source of energy that can be useful when it’s directed toward realizing our values and principles.

When anger results in behaviors that we would judge to be unacceptable or immoral, it can become hypocritical (Cotterell, 2021).

Step 5: Moral Disengagement

Explore any beliefs or justifications for using anger destructively, such as “He started it” or “They were deliberately pushing my buttons.”

These rationalizations essentially make us feel better about doing bad things. Encourage the client to assess the pros and cons of these justifications and what they can gain from having greater patience and empathy for others (Cotterell, 2021).

Step 6: Aggression

This step involves taking a closer look at the problematic behaviors stemming from anger. The client can be asked to empathize with people who make them feel angry or whom they act aggressively toward. This is a perspective-taking exercise to help the client manage their anger, the anger of others, and increase opportunities for constructive communication (Cotterell, 2021).

Step 7: Outcome

In this final stage, you can work with the client to decrease feelings of guilt and to understand that if they experience anger episodes again, they are not a failure. Each time this happens is an opportunity to learn and to disrupt the anger cycle with the strategies and skills they’ve acquired (Cotterell, 2021).