Anger Control Problem

What Is an Anger Control Problem?

People with anger control problems (ACP) often quickly react in aggressive ways when they feel insulted, wronged, or injured, especially when they think they are being treated unfairly.¹ People struggling with this problems often blow up or explode at others. They are also quick to blame other people for their problems, without examining the role they might be playing in the situation.²

Everyone gets angry sometimes. This is normal, and sometimes it’s even necessary and helpful. If a person is being hurt, it might be beneficial to that person’s health and survival to get angry and tell the other person to stop. In other, less threatening situations, some people try to communicate and find compromises, some try to think of nonthreatening responses, and others try to distance themselves from the situation before reacting.³

However, people with ACP often react in a way that is more intense and aggressive than what is needed in the situation. Some of them physically hurt others or themselves. Some take their frustrations out on objects by punching walls or kicking garbage cans. Others argue aggressively. They call others insulting names, give dirty looks, make threatening gestures, or even hold all their anger inside and stew in their own hostility, perhaps while plotting how to take revenge.¹

When someone is struggling with ACP, it’s readily noticed. The person gets angry very easily, frequently, and with great intensity and may remain angry for as long as an entire day.^{1, 4} For example, a man with ACP might get angry with other drivers on the road and yell at them for driving in ways that he thinks are stupid or insulting. He might even display acts of road rage by following other drivers and cutting them off in retaliation. A woman with ACP might get into frequent arguments with store clerks and scream at them for not treating her the way she thinks she deserves to be treated. Another person might frequently yell at coworkers or employees for doing things that he or she thinks are dumb.

ACP frequently disrupts relationships and families. A person’s anger might even lead to physical fights with his or her spouse or partner, the person’s children, or maybe even strangers. In these situations, ACP can be exceptionally violent and dangerous to the individual and others.

During these episodes of anger, the person probably notices excessive physical sensations related to stress. The heart begins to race, the face and ears get hot and flushed, muscles become very tense, breathing gets faster and deeper, the palms get sweaty, and the person feels edgy or nervous.¹ The person might also feel a little sick in the stomach, much like heartburn. These are all symptoms of the sympathetic nervous system response, the fight-or-flight response that prepares the body for emergency situations. Then, when the episode of intense anger has ended, the person with ACP might feel guilty when he or she notices that others who witnessed the situation feel very uneasy or upset.

ARE THERE OTHER PROBLEMS RELATED TO ACP?

ACP is often very damaging for everyone involved. For the person with the problem, excessive anger has been linked to higher job stress, increased blood pressure,⁵ an increased risk for heart disease,^6-10 and an increased potential for suffering.

In a study of people with long-term lower back pain, higher levels of anger were associated with a less frequent tendency to forgive others, greater psychological suffering, and, in some cases, greater physical pain.¹¹ Other researchers have found that people who report high levels of anger also experience greater sensations of physical pain, even if the anger is covered up and not expressed by the person.^12-14

Having high levels of anger can also lead to problems sleeping at night, as well as increased daytime fatigue as a result of not sleeping.¹⁵ It’s also been widely reported that men who commit domestic violence against their spouses and partners consistently have higher levels of anger and hostility when compared with men who don’t commit these acts of violence.¹⁶ Other studies have suggested that excessive anger is often associated with other disorders, such as depression, bipolar disorder, antisocial personality problems, self-focused personality problems, and borderline personality disorder.^17-20

WHO IS AFFECTED BY ACP?

Unfortunately, there are no statistics on how many people are affected by ACP. However, one large study of 1,300 people who were seeking treatment at a mental health clinic found that ACP was just as prevalent as depression and anxiety for that group of people.¹⁷ If this rate holds true for the general population, it would mean that millions of people around the world are affected by ACP.

WHAT CAUSES ACP?

The exact causes of ACP are unknown, but certainly there are biological and social factors that contribute to its development. One theory is that the emotion of anger activates the behavioral activation system within the larger human nervous system.^21-23 When a person is confronted with an anger-inducing situation, the behavioral activation system causes that person either to confront the situation and express the anger, or to escape the situation and suppress the anger. The choice someone makes in that situation is influenced by a combination of social factors and inheritable genetic tendencies to either express or suppress anger.²⁴

Since the 1940s, research has confirmed that people who habitually suppress their anger and otherwise don’t express their feelings increase their risk of developing problems related to high blood pressure.^{25, 26} However, more recent studies have shown that people with ACP who express their anger often have even higher blood pressures.²⁷ Therefore, the problem with ACP appears to be anger itself and not the decision to suppress it or express it. Similarly, in studies of men with classic type A personalities—that is, men who are highly ambitious and hyperaggressive—it is their anger and hostility that puts them at a higher risk for heart disease and heart attacks.^{28, 29}

Anger is a fundamental emotion that is expressed and recognized in every culture around the world.^30-32 However, the way in which a person expresses anger is largely determined by what is considered acceptable by that person’s culture.^33-35 Some cultural groups are more likely to suppress their anger, while other groups are more likely to express their anger.^36-38 Research has shown that children imitate aggressive behaviors they observe in other people, especially when that type of behavior is rewarded.^{39, 40} So if a person grows up in a family, peer group, or culture where excessive anger is frequently displayed or accepted as normal, that person has a greater chance of developing ACP.^41-45

Other factors also influence anger. Those who think other people don’t like them will more quickly blame others for their problems and are therefore more likely to get angry with others.^{46, 47} Many people are easily angered when they’re already experiencing negative feelings caused by hunger, stress, nervousness, sadness, fatigue, illness, or boredom.^{48, 49} A person is also more likely to become angry when the situation is perceived to be unfair, preventable, intentional, and someone else’s fault.^{1, 50}

WHAT TREATMENTS ARE EFFECTIVE FOR ACP?

There are some very successful treatments to help people with ACP reduce but not eliminate their anger.⁵¹ Remember, anger is a fundamental emotion that is often helpful, so it isn’t realistic or desirable to try to completely get rid of one’s anger. Many of these treatments—often referred to as anger management—help people identify the triggers for their anger and then learn how to create distance between the triggers and their angry responses.

Many people feel as though their anger quickly overwhelms them and leaves them little choice but to get angry. Anger management treatment aims to create a gap of time between the moment a person feels angry and the moment when he or she responds, providing the person with time to choose an alternative response.

One of the treatments proven most effective is cognitive behavioral therapy.^52-55 This treatment often uses relaxation skills to help manage angry feelings, thought-processing to help reassess triggering situations, and skills training to learn new types of responses to these situations.^{1, 52}

Other forms of successful treatment include anger management group therapy,⁵⁶ forgiveness therapy,⁵⁷ and mindfulness therapy.^{58, 59} Acceptance and commitment therapy is a form of behavioral therapy that uses mindfulness techniques, and it, too, might be effective for ACP since it has proven to be very effective at treating other problems, such as anxiety.⁶⁰

The antidepressant medications fluoxetine (Prozac) and nefazodone (Serzone) have also shown some effectiveness at treating the anger attacks that accompany depression.^61-63

COGNITIVE BEHAVIORAL THERAPY FOR ANGER CONTROL PROBLEMS

Cognitive behavioral therapy (CBT) is a form of treatment that combines elements of both cognitive therapy and behavior therapy. Cognitive therapy examines the way people’s thoughts about themselves, others, and the world affect their mental health. Behavior therapy investigates the way people’s actions influence their own lives and their interactions with others. By combining the two, CBT examines the way people can change their thoughts and behaviors in order to improve their lives.

The CBT treatment for anger control problems is called cognitive-relaxation coping skills. It is usually composed of six steps:¹

Conduct an assessment and provide education
Develop relaxation skills
Challenge and correct self-defeating thoughts
Practice coping skills in situations that produce anger
Develop problem-solving communication skills
Prevent relapse

1. Conduct an Assessment and Provide Education

The first step in the cognitive behavioral treatment for ACP is to conduct an assessment of the person’s symptoms in order to verify that he or she is struggling with ACP and not some other similar problem. Once people are diagnosed with an anger control problem, it’s important that they understand the basic nature and causes of the problem (as highlighted above). They must learn to identify the situations that trigger their anger, how they experience and express anger, and the consequences of their anger. They must also understand the demands of the treatment for anger control problems, particularly that CBT is an interactive treatment that requires them to do work outside of the therapy session. (Click here for more information about the nature of ACP.)

2. Develop Relaxation Skills

The second step of the treatment for ACP is to learn relaxation skills, because it is very difficult to feel angry when a person is focused on feeling peaceful and relaxed. Plus, people with ACP often experience physical tension in addition to their mental stress. Learning relaxation skills can help relieve both problems, and there are a variety of different techniques that a person can learn. Included here are four of the most important. All of these techniques include focusing on slow, rhythmic abdominal breathing, which often produces a feeling of calmness.

The first relaxation skill that’s taught is progressive muscle relaxation. It involves a seven-second tightening and releasing of specific muscle groups from head to toe, with emphasis on noticing the difference between the tense feeling and the relaxed feeling.

The second relaxation skill is learning how to release muscle tension without first tensing the muscles. This is done by focusing attention on the muscles and visualizing the tension being released.

The third skill is cue-controlled relaxation, in which a person is taught to relax his or her body by saying a relaxing word, such as “peace” or “relax,” with each slow exhalation.

And, finally, the fourth relaxation skill is special-place visualization. This skill teaches the person to envision a place of calmness and comfort in his or her imagination. The person can go to this “mental safe place” whenever he or she is overwhelmed by angry feelings. (Click here for a full description of relaxation techniques.)

3. Challenge and Correct Self-Defeating Thoughts

The third step of the CBT treatment for anger control problems is to learn several cognitive coping skills that challenge and correct self-defeating thoughts. These thoughts are often the cause of angry and anxious feelings. At the most observable level are automatic thoughts. These are critical thoughts that people think and say to themselves that sabotage success and happiness. Two examples of automatic thoughts might be “Everyone’s always trying to take advantage of me” and “Other people are idiots.” A person can be either aware or completely unaware of having a thought like this. However, in both cases the result is that the person feels angry or anxious. (Click here for information on identifying automatic thoughts.)

Often, these anger-producing automatic thoughts are the result of cognitive distortions, or unhelpful thinking styles. For example, overgeneralizing involves making broad negative conclusions about life based on limited situations, such as “Everyone’s always trying to take advantage of me.” Magnifying or catastrophizing involve enlarging the negative aspects of life or expecting the worst to occur; for example, “This situation is going to end very badly.” Labeling is used to automatically categorize people and events in negative and demeaning ways, such as “jerk,” “loser,” and “worthless.” Demanding and commanding thoughts are rules that a person has created for himself or herself and the rest of the world. Examples include beliefs such as “Things should always be done perfectly,” “The world should be perfectly fair,” and “Everyone should love me and treat me with respect.” Cognitive distortions like these are often the triggers for excessive anger. (Click here for information on identifying cognitive distortions.)

Much of the CBT treatment for ACP will be spent identifying and reevaluating these errors in thinking. This can be done with the use of an anger log. The anger log helps those with ACP identify triggering situations, the resulting automatic thoughts and distortions, and their reactions to the situation. Then, most importantly, it helps them identify alternative coping strategies for dealing with the situation in a healthier way. This last step includes making a counterresponse plan for each triggering thought. This might consist of finding exceptions to automatic thoughts and looking for alternative explanations for anger-producing situations. (Click here for instructions on completing an anger log.)

It is also helpful to create reliable coping thoughts that can help the person think of the situation in a different, less angry way. Examples of coping thoughts include “I need to relax before I handle this situation,” “Take a time-out, then deal with it,” and “No one’s perfect; everyone makes mistakes.” (Click here for information on creating coping thoughts.)

As the work on challenging automatic thoughts continues, a person using an anger log might notice common themes among his or her thoughts. These themes often point to deeper, more firmly entrenched core beliefs about one’s self that make a person more vulnerable to ACP. These core beliefs, often called schemas, include thoughts like “I’m a failure,” “I’m worthless,” and “I’m unlovable.” When these core beliefs are encountered, they too need to be challenged and modified using a thought log and other techniques. (Click here for instructions on challenging core beliefs.)

4. Practice Coping Skills in Situations That Produce Anger

The fourth step of the CBT treatment for anger control problems is to practice using both the relaxation skills and the cognitive coping skills in situations that cause anger. At first, the person can practice these skills by imagining situations that typically elicit anger; however, the person should begin using these skills in live anger-producing situations as soon as possible. (Click here for instructions on using coping skills in anger-producing situations.)

5. Develop Problem-Solving Communication Skills

In addition to developing coping skills, it’s helpful to learn problem-solving communication skills, which can prevent anger from developing in the first place. Many people with ACP have difficulty making requests to get their needs met in fair and reasonable ways. Assertive communication skills can be very effective for making these requests. Other people with ACP have difficulty setting limits with others, have trouble effectively listening to others, don’t know how to read others’ body language, have difficulty negotiating, or don’t know how to deal with criticism. Problem-solving communication skills are effective tools for creating better outcomes in all of these situations. (Click here for instructions on developing problem-solving communication skills.)

6. Prevent Relapse

Finally, the last step of the cognitive behavioral treatment for ACP is preventing relapse after treatment is complete. The key to relapse prevention is for the person to continue using the cognitive and behavioral skills learned in treatment and to recognize the early signs of recurring ACP, such as labeling people and situations, in order to take steps to prevent relapse.

MINDFULNESS TECHNIQUES FOR ANGER CONTROL PROBLEMS

Mindfulness is the ability to be aware of thoughts, emotions, physical sensations, and actions—in the present moment—without judging or criticizing oneself or the experience. Many forms of mindfulness and meditation have been practiced by most of the world’s major religions for thousands of years.

Mindfulness skills help a person focus on one thing at a time in the present moment. By doing so, the person is better able to control and soothe overwhelming emotions, thoughts, and feelings. Mindfulness skills also help people learn to identify and separate judgmental thoughts from their daily experiences, which is helpful because it is often these judgmental thoughts that fuel their overwhelming anger. (Click here for instructions on mindfulness techniques.)

ACCEPTANCE AND COMMITMENT THERAPY FOR ANGER CONTROL PROBLEMS

Acceptance and commitment therapy (ACT) incorporates elements of behavior therapy, meditation and mindfulness practices, and scientific research on how humans think and learn.

ACT (pronounced “act”) is based on the principle that many psychological problems are caused by efforts to control, avoid, or get rid of emotions and thoughts that are undesirable. Often, people try to get rid of feelings and thoughts that make them angry or anxious, just as they get rid of other things they don’t want, such as old clothes. However, as ACT points out, feelings and thoughts can’t be controlled. A person can’t throw them out like an unwanted pair of shoes. In fact, the harder a person tries to control his or her thoughts and feelings, the more powerful they often become and the longer they stick around.

The ACT treatment for ACP usually includes eight steps:⁶⁴

Educate about ACP, anger, and ACT
Develop creative hopelessness
Clarify values
Commit to taking action
Develop acceptance
Focus on contact with the present moment
Utilize cognitive defusion
Stay committed to values and actions

1. Educate About ACP, Anger, and ACT

The initial step of the ACT treatment for anger control problems is to educate the person about ACP and the nature of anger. It’s especially important for the person to understand the nature of anger from an ACT point of view. According to this treatment, anger itself is not the cause of ACP. Rather, it’s the person’s avoidance of angry emotions and thoughts that make ACP an overwhelming problem. Starting with the early stages of treatment, it’s also important for people to understand that ACT is an active, participatory treatment designed to help them live a more fulfilling life, not necessarily a “happier” one. (Click here for more information about acceptance and commitment therapy.)

2. Develop Creative Hopelessness

In order to develop what ACT calls “creative hopelessness,” a person must conduct a thorough evaluation of the strategies that he or she has already used to cope with anger. After doing this, the person often recognizes that all of these strategies have been unsuccessful or actually made the problem worse. This is because these strategies are actually attempts to avoid and control feelings of anger, which can never be successful. For example, a man who attempts to control his anger by drinking alcohol actually develops a worse problem, as does a woman who tries to avoid her angry feelings by choosing not to talk to her loved ones about them. But rather than just being hopeless, this stage of treatment is also creative because it allows the person to begin exploring new, more successful ways of coping with anger and other distressing emotions. (Click here for instructions on how to develop creative hopelessness.)

3. Clarify Values

ACT acknowledges that life is often lived on autopilot, without much sense of what a person really cares about. Clarifying and establishing what a person values can often help that person live a more fulfilling life, despite having occasional feelings of anger. Values are the elements of life that give it meaning and importance, like “maintaining a loving relationship with my spouse or partner” or “being an active member of my community.” These values are like compass headings that guide a person through life. They are not destinations at which a person can ever arrive. A person can never stop maintaining a loving relationship and still have a loving relationship. Values are concepts that point a person in the direction of a fulfilling life, and ACT uses many types of values clarification tools to help people identify their values. (Click here for instructions on how to clarify and establish values.)

4. Commit to Taking Action

After a person has determined his or her values, it’s important to establish goals that support those values and then commit to taking actions that fulfill those goals. For example, if a person’s value is to be an active member of her community, she might list a number of different goals to fulfill that value, such as “attend community meetings twice a month.” This is something that can be completed and thereby create a sense of valued living. The ACT treatment for anger control problems includes development of skills and goals that lead to taking committed action. (Click here for instructions on how to commit to taking action.)

5. Develop Acceptance

In ACT, learning to accept anger-producing situations and angry emotions is the alternative to trying to control or avoid them. Acceptance can be hard, but it’s often the only way people can reclaim control of their lives. Many situations cannot be altered, no matter how much a person wishes them to be changed. Accepting this fact is often the first step in re-engaging with life. Accepting what cannot be changed frees a person from struggling against it and allows that person to start taking actions based on what he or she values in life.

In order to cultivate acceptance, people are encouraged to experience the angry emotions that they have been avoiding, to cease fighting things that cannot be altered, and to engage in situations that have been evaded. (Click here for instructions on how to develop acceptance skills.)

6. Focus on Contact with the Present Moment

Focusing on what’s happening in the present moment can help people develop more flexible coping strategies for handling anger. When people dwell on the past, they often become sad, and when they anticipate the future, they often become anxious. In both cases, they miss what’s happening at the present time. Paying attention to what’s happening in the moment gives people more control over the decisions they’re making and allows them to see more possibilities in life. This skill is often developed with present-focused mindfulness skills, such as focusing on the rising and falling of the breath or on physical sensations in the body. (Click here for instructions on how to develop present-focused mindfulness skills.)

7. Utilize Cognitive Defusion

Cognitive defusion is a mindfulness technique that helps people observe their angry thoughts without becoming attached to them. “Defuse” is an invented word that means to unstick or to unfuse one’s self from the words that arise in thoughts. The goal of this stage of treatment is to allow people with ACP to function more freely without judging themselves, their feelings, or their thoughts. Thoughts and emotions often arise haphazardly, so it’s easy to see that ACP could worsen over time if a person were to follow or believe every thought and emotion that arose.

Cognitive defusion is often accomplished using meditation or mindfulness techniques, such as imagining thoughts floating by on a cloud, repeating the words of a thought over and over until they lose meaning, or imagining a thought as something outside of oneself. By observing the process of thinking and feeling, the goal is to create space between the person and his or her experience. This gives the person more control over decisions made based on those thoughts and feelings. (Click here for instructions on how to develop cognitive defusion skills.)

8. Stay Committed to Values and Actions

In order to create a fulfilling life, it’s crucial for people to continue making decisions based on what they value in life, rather than based on the thoughts and feelings they have tried to avoid in the past. (Click here for instructions on how to stay committed to values and actions.)

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