Adolescent Anger Management

Description of the Strategy

In a variety of clinical, educational, and residential treatment settings, adolescents exhibiting oppositional defiant and conduct disorders show patterns of irritability and aggressive behavior, including anger outbursts, that result in poor conflict resolution, poor interpersonal skills, and a host of compliance problems. Although behavior modification interventions that use a combination of contingency management and punishment strategies have been successfully implemented to reduce occurrences of aggressive behavior in a controlled setting, these approaches are somewhat limited. Often, when the adolescent returns to the natural environment and is outside the control of the contingencies and the purview of adults, the aggressive behavior returns. Problems with maintenance and generalization of behavior change indicate that aggression management self-control skills are not being learned.

Cognitive behavioral anger management technology, on the other hand, emphasizes the cognitive and physiological components of anger and focuses on teaching arousal reduction skills within that context. It is based on the hypothesis that aggressive behavior is elicited by an aversive “trigger” stimulus that is followed by both physiological arousal and distorted cognitive responses, which result in the emotional experience of anger. Children and adolescents who behave impulsively and aggressively often react to the trigger and fail to solve interpersonal conflict in an appropriate manner. Research has shown that hostile attributions and expectations of negative outcome influence negative behavioral responses to interpersonal interactions. Aggressive youth seem to lack a prosocial reasoning process, and instead engage in distorted thinking that intensifies their perceptions of injustice, fuels their rage, and justifies their use of aggression. They have trouble regulating their emotions and understanding their emotional states, perhaps due to early family experiences or an innate physiological dysynchrony. They seem unable to cope with even mild levels of anger in a constructive way. The irritability or annoyance resulting from minor interpersonal conflict or having a goal blocked often expresses itself in intensified anger and explosive rage.

To prevent an aggressive reaction to a triggering stimulus, it is necessary for adolescents to learn to manage their anger arousal and to process the interpersonal exchange so that they can exhibit a more prosocial response. The anger management treatment protocol focuses on the three components of the anger experience: physiological, cognitive, and behavioral. It is designed to help young people develop self-control skills in each of these areas.

To manage the physiological component, the anger management protocol first directs the client to identify the experience of anger, to label the various intensities of the emotion, and to recognize the early warning signs, such as a flushed feeling or quickened heart rate. The therapist validates the experience of anger as a normal and frequently occurring emotion having an intensity range that is under the adolescent's control. Clients are then asked to identify and track common [Page 654]triggers of their anger using a self-monitoring assessment called a Hassle Log. Charting daily occurrences of anger (whether handled well or not) helps the youth to recognize idiosyncratic patterns of anger loss and control and to increase awareness of external triggers and internal physiological and cognitive reactions. Finally, they are taught arousal management skills such as deep breathing, imagery, and relaxation in order to reduce the accumulated physical tension and to increase the probability that they will think through the interpersonal event in a more rational fashion.

...