Anger Control Problems

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, an increased risk for heart disease, 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. 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.

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. 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. 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.

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. If this rate holds true for the general population, it would mean that millions of people around the world are affected by ACP.

There are some very successful treatments to help people with ACP reduce but not eliminate their anger. 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. 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.

Other forms of successful treatment include anger management group therapy, forgiveness therapy, and mindfulness therapy. 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.

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

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
2. Develop relaxation skills
3. Challenge and correct self-defeating thoughts
4. Practice coping skills in situations that produce anger
5. Develop problem-solving communication skills
6. Prevent relapse

Step 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.

Step 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.

Step 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.

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.

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.

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.”

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.

Step 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.

Step 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.

Step 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 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.

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:

1. Educate about ACP, anger, and ACT
2. Develop creative hopelessness
3. Clarify values
4. Commit to taking action
5. Develop acceptance
6. Focus on contact with the present moment
7. Utilize cognitive defusion
8. Stay committed to values and actions

Step 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.

Step 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.

Step 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.

Step 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.

Step 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.

Step 6: Focus on Contact with the Present Moment