Anger management

Intro:

Anger management is a psycho-therapeutic program for anger prevention and control. It has been described as deploying anger successfully. Anger is frequently a result of frustration, or of feeling blocked or thwarted from something the subject feels is important. Anger can also be a defensive response to underlying fear or feelings of vulnerability or powerlessness.Anger management programs consider anger to be a motivation caused by an identifiable reason which can be logically analyzed and addressed.

Overview:

The ideal goal of anger management is to control and regulate anger so that it does not result in problems. Anger is an active emotion that calls a person feeling it to respond.  People get into anger issues because both the instigator and instigated lack interpersonal and social skills to maintain self-control.Research on affect and self-regulation shows that it occurs because negative emotional states often impairs impulse control.They can train to respond to their anger as unwanted and unpleasant rather than react to its need. Turning a blind eye or forgiveness is a tool to turn anger off. Getting enough sleep, exercise and good diet are tools which can assist in preventing anger. Professionals who deal with those who have trouble managing anger include occupational therapists, mental health counselors, drug and alcohol counselors, social workers, psychologists and psychiatrists.

History:

The negative effects of anger have been observed throughout history. Advice for countering seemingly uncontrollable rage has been offered by ancient philosophers, pious men, and modern psychologists. In de Ira, Seneca the Younger (4 BC – 65 AD) advised for pre-emptively guarding against confrontational situations, perspective taking, and not inciting anger in anger-prone individuals. Other philosophers echoed Seneca with Galen recommending seeking out a mentor for aid in anger reduction.In the Middle Ages, the people would serve as both examples of self-control and mediators of anger-induced disputes.Examples of intercession for the common people from the wrath of local rulers abound in hagiographies. The story of St. Francis of Assisi and the metaphorical Wolf of Gubbio is one famous instance.

In modern times, the concept of controlling anger has translated into anger management programs based on the research of psychologists. Classical psychotherapy based anger management interventions originated in the 1970s. Success in treating anxiety with cognitive behavioral therapy (CBT) interventions developed by Meichebaum inspired Novaco to modify the stress inoculation training to be suitable for anger management. Stress and anger are sufficiently similar that such a modification was able to create a successful branch of treatment. Both stress and anger are caused by external stimuli, mediated by internal processing, and expressed in either adaptive or maladaptive forms. Meichebaum, and later Novaco, used each aspect of experiencing the relevant emotion as an opportunity for improvement to the patient's overall well-being.

Potential causes for development of problems:

Medical causes

Drug addiction, alcoholism, a mental disability, biochemical changes and PTSD can all lead to a person committing an aggressive act against another person. Not having sufficient skills on how to handle oneself when faced with aggression can lead to very undesirable outcomes. These factors are typically associated with a heightened chance of anger, but there are other, less-known factors that can lead to people acting in a negative way. Prolonged or intense anger and frustration contributes to physical conditions such as headaches, digestive problems, high blood pressure and heart disease. Problems dealing with angry feelings may be linked to psychological disorders such as anxiety or depression. Angry outbursts can be a way of trying to cope with unhappiness or depression.

Migraines: Frequent migraine can be associated with levels of aggression and the need for anger management. A 2013 study examined migraines and its association with anger problems in young children (m = 11.2 years of age). The patients in the study were split into low migraine attack frequency (AF), intermediate AF, high frequency, and chronic migraine AF. The tendency for a participant to inhibit his anger and not lash out was found more in children with higher AF. Children that qualified for low migraine AF actually had more anger expression.

Psychological causes

Psychological factors such as stress, abuse, poor social or familial situations, and poverty can be linked to anger problems. Without proper anger management, individuals may be more prone to violence.They also may have increased stress levels, which can have both mental and physical symptoms if not taken care of sooner rather than later. Thankfully, there are many different methods of treatment that can help an individual control and cope with their anger.

Trauma

A history of trauma can result in increased anger. Anger is not associated with aggression in all individuals with symptoms of PTSD.Sexual trauma is particularly correlated with anger, as well as childhood trauma since more often than not, they either didn't know what was going on and/or didn't have any control over what was going on. It is important to recognize and validate trauma, rather than ignoring it and having their symptoms worsen.

Types of treatment:

Some effective anger management techniques include relaxation techniques, monitored breathing exercises, cognitive restructuring and imagery (e.g. Stosny's Healing imagery Explain oneself emphatically what and why it makes you respond angrily Apply kindness and comion to self Love oneself Solving the co-morbid problems phases), problem solving, improving communication strategies and interpersonal skills (DEAR MAN & GIVE). Below are specific types of anger management treatment approaches ed by empirical studies. Several of the studies examined used self-report, which some psychologists feel could be a limitation for results. People do not want others to think of them as angry individuals, so their answers could be changed to fit how society wants them to behave.

Prevention and Relationship Enhancement

The Prevention and Relationship Enhancement Program (PREP) is a program that was used in a study consisting of Air Force families. The families were assigned to either a traditional multi-couple group format or a self-directed book version focusing on relationship satisfaction and anger management skills. There was a significant main effect for time related to both relationship satisfaction (pretest M = 49.8, SD = 17.6; post-test M = 53.8, SD = 17.6, F(1, 76) = 6.91, p < .01), and anger management skills, (pretest M = 32.2, SD = 4.2; post-test M = 34.6, SD = 4.0, F(1, 74) = 31.79, p < .001).

The self-directed book version did not show as positive of results. Improving a couple's anger management skills can be a vital step in ensuring there are no violent outbreaks throughout the relationship.

Cognitive behavioral therapy

The use of cognitive behavioral therapy (CBT) is frequent in anger management treatment. By trying to get patients to open up about their emotions and feelings and being driven to accomplish a specific task (in this case controlling anger), a person is cognitively motivated to use positive skills towards their behavior.

Studies show using a mix of CBT as well as other therapies on the participants/clients increased the effective usage of the anger management techniques and that they also felt more in control of their own anger. Personal changes like these can lead to less aggression and fewer violent acts. The use of play therapy with this is also found efficient in tackling anger issues among children.

Positive mentalization and personal development

This is a style that is commonly used in elementary schools for students expressing anger outbursts. Researchers who have looked into the reason for young student anger have found that one common reason could be the inability to adjust socially. Students that were selected for this study received a daily one-hour session throughout one week of school. The researchers of the mentalization program educated children through group therapy in positive psychology and tried to do activities that put the child in a happy mood while interacting. At the end of the week, research showed that there was a negative correlation between anger and social adjustment. This process lowered the overall anger levels of the students involved in social adjustment deficits.

Use of personal development (PD) led to higher views of themselves and more positive self-esteem. Aggression has been shown to be a result of poor self-worth as well as thinking that those around us do not care or us, so this PD is vital in helping change a person's self-perception.

Anger journaling

Understanding one's own emotions can be a crucial piece of learning how to deal with anger. Children who wrote down their negative emotions in an "anger diary" actually ended up improving their emotional understanding, which in turn led to less aggression. When it comes to dealing with their emotions, children show the ability to learn best by seeing direct examples of instances that led to certain levels of anger. By seeing the reasons why they got angry, they can in the future try to avoid those actions or be prepared for the feeling they experience if they do find themselves doing something that typically results in them being angry.

Simply logging episodes of anger could also be beneficial. Middle school students with emotional disorders who completed regular “anger logs” showed pronounced improvement of anger management. According to Keller, Bry and Salvador, students who used anger logs “were observed to exhibit significantly more prosocial behaviors toward their teachers and showed a trend toward exhibiting fewer negative behaviors toward peers”.

Reflecting on feelings of anger in writing can be a type of Cognitive Behavioral Intervention (CBI), or a self-strategy used to combat negative thoughts.

Other evidence-based approaches

Anger management interventions are based in cognitive behavioral techniques and follow in a three-step process.First, the client learns to identify situations that can potentially trigger the feeling of anger. A situation that elicits anger is often referred to as an anger cue. If a potential trigger can be avoided, the individual can not only avoid unwanted outbursts, but also avoid internal conflict. Often anger occurs through automatic thought and irrational beliefs, these pose a problem for treatment because the patient may respond too quickly to change the thought or behavior. Wright, Day, & Howells referred to this phenomenon as the "hijacking of the cognitive system by the emotional system".Second, relaxation techniques are taught as appropriate responses to the identified situations. Common techniques include regulating breathing and physically removing themselves from the situation. Finally, role-play is used to practice the application of the learned techniques for future encounters with anger-inducing situations in the individual's life. The result of repetition is an automatic response of learned beneficial techniques.Modifications of each general step result in distinctive programs. Additionally, different fields of psychology will change aspects of the above three-step process, which is primarily based in cognitive-behavioral therapy. Group, family, and relaxation only therapies each contribute to the wider range of available anger management programs.

Relaxation therapy can reduce cognition and motivations to act out, and through relaxation, clients gain coping skills to better manage their anger. This therapy addresses various aspects of anger such as physiological, cognitive, behavioral, and social. These aspects combined are what make relaxation an effective treatment for anger.Mindfulness attempts to teach clients acceptance of bodily sensations and emotions. Mindfulness originated in Eastern spiritual traditions that are practiced through meditation. A two-prong component of mindfulness includes: self-regulation and orientation toward the present moment. The center of this therapy technique is experiencing the present moment in a non-judgmental manner that is reflective of meditation. In practice, clients observe breathing, sitting and walking during meditations. The goal is for clients to understand that his or her thoughts of anger are merely thoughts rather than reality. Mindfulness is also a technique used in the relaxation approach because the technique halts physiological arousal.An example of this is Meditation on the Soles of the Feet (SoF) which has been shown to help persons with mild intellectual disability decrease aggressive behavior by mindfully focusing on the soles of their feet.

Rational emotive behavior therapy explains anger through the client's beliefs and emotion, rather than the event itself. The concept involves clients interpreting events in a rational manner in order to avoid irrational thoughts that lead to anger. Delayed reaction technique is when clients attempt to uncover what is making them angry before acting out on their anger. This allows them to have time to change what is making them angry and increase time before their response; this encourages thought on a more rational level. In addition, clients are also encouraged to avoid demands in an anti-oppressive order to avoid anger.An example of a demand placed on a client may be that, "I have to have this done by my standards". Research is starting to show that the better individuals understand what anger management is and how it can help them personally and in relationships, aggressive actions are less likely to occur.

Anger treatments' success rates can be difficult to estimate because excessive, severe anger is not a recognized disorder in the Diagnostic and Statistical Manual of Mental Disorders. This manual is used as a reference for mental health professionals. Some research does exist on comparing various treatments for anger, but they also describe methodological difficulties in making accurate comparisons. The best practice for anger treatment is to use multiple techniques rather than a single technique. The relaxation approach had the highest success rate as a standalone treatment.The effectiveness of the CBT-based anger management therapies has been evaluated by a number of meta-analyses. In a 1998 meta-analysis with 50 studies and 1640 individuals, measures of anger and aggression were used to compare the effects of the anger management intervention with no treatment. A significant effect for anger management was found with a 67% chance of improvement for individuals having received the anger management as compared to the individuals without the therapy. In addition, a 2009 meta-analysis compared psychological treatments for anger across 96 studies. After an average of 8 sessions, a significant improvement in anger reduction resulted. Overall, the completion of an anger management program is likely to result in long-lasting positive changes in behavior. Successful interventions can result in not only a reduction of the outward display of aggression, but also a decrease in the internal level of anger.

Medication

As anger is a psychological concern, treating with medication is a secondary line of approach. However, if there is a medical reason for an anger response certain psychotropic medications are prescribed by doctors to complement the psychotherapy intervention. Medications include Antidepressants, Anti-psychotics, Anti-seizure and Beta blockers. These drugs specifically do not target anger directly, but they have a calming outcome that can control of rage and negative feeling.

Antidepressants may have a particular role when anger is a manifestation of depression. Anger attacks are found in 40% of those with major depressive disorder with 64–71% of cases responding to an SSRI such as fluoxetine.

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