CLINICAL MANAGEMENT OF ANGER
 

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 ©  LDS Family Services and used by Mental Health Resource Foundation with permission July 2003.
“He that  is slow to anger is better than the mighty; and he that ruleth his spirit than he that taketh a city.”

Proverbs 16:30

Title

OVERVIEW

IMPORTANT CONCEPTS FOR WORKERS
AGENDA
ANGER'S GOOD AND BAD EFFECTS
MANAGING ANGER THROUGH TRACKS, PATTERNS AND CYCLES
ANGER MANAGEMENT INOCULATION TRAINING
STRESS INOCULATION FOR FEAR OR ANXIETY, ANGER, AND PAIN
RELAPSE PREVENTION
BIBLIOGRAPHY

OVERVIEW

PURPOSE

bulletTo present a coherent clinical model for assessing and treating anger.
bulletTo learn how to use anger management training.

OBJECTIVES

To be able to:

bulletDiscuss the nature of anger.
bulletDifferentiate between “bad” anger and “good” anger.
bulletTrack anger; recognize anger patterns and anger cycles.
bulletImplement the Meichenbaum Model to assist in anger management.
bulletApply relapse prevention measures.

IMPORTANT CONCEPTS FOR WORKERS

bulletAnger is a human emotion.
bulletAnger, like all emotions, is not inherently unhealthy.
bulletAnger is often secondary.
bulletAnger may be addictive.
bulletAnger may be related to frustration or the lack of problem-solving skills.
bulletAnger may be suppressed, only to be expressed while under the influence of drugs or alcohol.
bulletSuccessful management of anger can remove significant barriers to individual, family and community progress.

AGENDA

I. Introduction
   
A. Anger Management Training.
    B. Aggressiveness and assertiveness.

II. Differentiate between “good anger” and “bad anger.”
    A. “Good anger”
        1. Anger can give you energy.
        2. Anger can help you talk with others.
        3. Anger can give you information.
        4. Anger can motivate.
    B. “Bad anger”
        1. Anger stops you from thinking, feeling and acting clearly.
        2. Anger occurs more frequently than necessary.
        3. Anger is the energy that directs aggression.

III. Track anger; recognizing anger patterns and anger cycles.
    A. Tracking anger.
    B. Recognizing anger patterns.
    C. Recognizing anger cycles.

IV. Present and Demonstrate the Meichenbaum Model
    A. Cognitive Preparation.
    B. Confronting and coping.
    C. Dealing with temporary difficulties.
    D. Assessing and self-reinforcement.

V. Describe Relapse Prevention
bulletAnger is a common response. It may be overt or covert, expressed openly, misdirected or disguised as depression or aggression.
bulletAnger may be a symptom of an underlying psychological disorder.
bulletAnger may be constructive if it leads to positive change.
bulletAnger is destructive if it leads to violence or aggression.

ANGER'S GOOD AND BAD EFFECTS

Anger, like other emotions, is neutral. It may be uncomfortable or undesirable. However, it is the effects of anger that may be problematic.

Good Effects:

    1. Anger gives energy. If there is danger, anger can provide an extra boost to move you away from a situation.
    2. Anger can motivate individuals to talk. If there is a problem and you are willing to talk about issues, much
good can be done for you and others.
    3. Anger can provide information. Anger indicates that something is wrong.
    4. Anger can motivate individuals to take control of their lives. Self-control is a sign of good mental health.
    5. Anger can signal the need to problem-solve. Taking constructive action to resolve problems makes individuals
feel competent.

Bad Effects:

    1. Anger can stop individuals from thinking, feeling and acting clearly.
    2. Anger has an addictive quality resulting in greater frequency than is needed.
    3. Anger may lead to aggression. Anger can build up and result in violence to self or others. When anger leads to aggression both suicide and homicide become real possibilities.
    4. Anger affects relationships. Anger is incompatible with intimacy, a necessary ingredient in all good relationships.

MANAGING ANGER THROUGH TRACKS, PATTERNS AND CYCLES

Managing anger is not magic, but is a skill. Tracking anger, understanding patterns and cycles can help in managing anger.

Tracking steps include:
    A. Cognitions (knowing what angers you)
    B. Affect (feelings when you become angry)
    C. Behavior (how you act and what you do when angry)

The tracking model

Anger patterns include:
    A. Withdrawal/isolation
    B. Yelling and shouting
    C. Threats
    D. Shoving/slapping/punching
    E. Violence

Anger cycles include:

    A. Pretends to be normal phase
    B. Building up phase
    C. Acting out phase
    D. Downward spiral phase
    E. Pretends to be normal phase

MEICHENBAUM MODEL OF ANGER MANAGEMENT INOCULATION TRAINING

An analogue of biological immunization, Anger Inoculation Training prepares clients to deal with anger by teaching self-control strategies and then exposing the individual to the stressful situations either in vivo or vicariously.

The four phases of Anger Inoculation Training include:

    1. Cognitive Preparation. Clients are provided with an adaptive way to view and understand their negative reactions. Clients are told that they can learn coping skills that will allow them to reconceptualize and deal with such situations without becoming emotionally upset.

    2. Confronting and Coping. The client learns coping skills, primarily restructuring. Clients are taught to monitor their negative, maladaptive thoughts when faced with angry situations and to replace them with coping self-statements. When clients have mastered a number of coping skills, they are ready to be exposed to angry situations where they can use their newly acquired skills.

    3. Dealing with Temporary Difficulties. Temporary difficulties in coping are noted and replaced with other strategies.

    4. Assessing and self-reinforcement. Assessment alternatives are: partially successful coping and successful coping.

STRESS INOCULATION FOR FEAR OR ANXIETY, ANGER, AND PAIN

Examples of Coping Self-Statements
 

STAGE OF COPING

 ANGER

1. Preparing What do I have to do?
This is going to upset me, but I know how to deal with it.
I can manage the situation. I know how to regulate my anger.
Easy does it.
Remember to keep your sense of humor.
2. Confronting & Coping Think of what you want to get out of this.
There is no point in getting mad.
I’m not going to let him (or her) get to me.
Look for the positives.
Don’t assume the worst or jump to conclusions.
3. Dealing with Temporary Difficulties
 
My muscles are starting to feel tight.
Time to relax and slow things down.
I have a right to be annoyed, but let’s keep the lid on.
My anger is a signal of what I need to do.
Time to instruct myself.
Try to reason it out.
Treat each other with respect.
4. and 5. Assessing
Self-Reinforcement
Partially Successful Coping

These are difficult situations and they take time to straighten out.
I’ll get better at this as I get more practice.
Can I laugh about this?
It’s probably not so serious.

Successful Coping

I handled the one pretty well. It worked.
I actually got through that without getting angry.
That wasn’t as hard as I thought.

 

RELAPSE PREVENTION

Relapse prevention is a process for emotional (feelings), cognitive (thoughts) and behavioral (actions) self-management of a problem behavior. The relapse processes happens in the first two parts of the anger cycle (the Pretends To Be Normal Phase and the Build-Up Phase). When individuals work on Relapse Prevention Skills, they are less likely to get to the Acting Out Phase. Instead they get into the Anger Action and Resolution Phases.

Relapse Prevention Procedures

    1. Client and therapist discuss the commitment and make preparation for the individual’s journey to freedom from “Bad Anger.”

    2. Identify High Risk Factors (defined as circumstances, situations, triggering events, thoughts, feelings, and behavior that occur in your life just before you act in an angry manner).

    3. Identify perceived level of self-efficacy (client confidence) in facing each high risk situation.

    4. Educate the client regarding covert set-ups.

    5. Focus on successful coping and partially successful coping and provide reinforcement according.

BIBLIOGRAPHY

Bums, David. (1980) Feeling Good. New York: William Morrow.

Cullen, M. And Freeman-Longo, R.E. (1995) Men to Anger. Vermont: The Safer Society Press.

Lerner, H.G. (1985) The Dance of Anger. New York: Harper & Row.

Meichenbaum, D. (1990) Stress Inoculation Training New York: Pergamon Press.

Nyc, B. (1995) Understanding and Managing Your Anger and Aggression. Washington: BCA Publishing.

Sonkin, D.J. (1990) The Wounded Man: Healing from Childhood Abuse. California: Jeremy P. Tarcher, Inc.

Sonkin, D.J. & Durphy, M. (1989) Learning to Live Without Violence. California: Volcano Press.

‘Weisinger, H. (1985) Anger Workout Book New York: Quill.