Anger Management

Description of the Treatment Strategy

Providing therapy for persons having recurrent anger problems is a challenging clinical enterprise. This turbulent emotion, ubiquitous in everyday life, is a feature of a wide range of clinical disorders. It is commonly observed in various personality, psychosomatic, and conduct disorders; in schizophrenia, [Page 7]bipolar mood disorders, organic brain disorders, and impulse control dysfunctions; and in a variety of conditions resulting from trauma. The central problematic characteristic of anger in the context of such clinical conditions is that it is “dysregulated”; that is, its activation, expression, and effects occur without appropriate controls.

Cognitive-behavioral therapy (CBT) for anger augments clients' self-regulatory capacities. It aims to minimize anger frequency, intensity, and duration and to moderate anger expression. It is an adjunctive treatment for a targeted clinical problem, seeking to remedy the emotional turbulence associated with subjective distress, detrimental effects on personal relationships, health impairments, and the manifold harmful consequences of aggressive behavior. The main components are cognitive restructuring, arousal reduction, and enhancement of behavioral skills. A key feature of its implementation is therapist-guided progressive exposure to provocation, in conjunction with which anger-regulatory coping skills are acquired.

The term anger management has become a rubric for a variety of interventions, as well as becoming common parlance. Therefore, it is useful to distinguish levels of therapeutic intervention for anger, differentiating (a) general clinical care for anger, (b) anger management, and (c) anger treatment. General clinical care for anger identifies it as a clinical need and addresses it through various counseling, psychotherapeutic, and psychopharmacological provisions, including client education, support groups, and eclectic treatments, without a formal intervention structure. In contrast, anger management typically refers to a structured CBT intervention, which originally was applied as an individual therapy but now is often provided in a group mode, largely psychoeducational in format, such as occurs in court-referred or school-based programs and in general public workshops. Such programs typically follow a topical sequence, covering situational activators (“triggers”), how thoughts and beliefs influence anger, self-observation, various relaxation techniques, problem-solving and conflict resolution strategies, and other cognitive and behavioral coping skills, such as calming selfstatements, effective communication, and appropriate assertiveness. There is wide variation in anger management programs, which are now marketed commodities.

Anger treatment, as a cognitive-behavioral therapy, is distinguished from these other levels of intervention by its theoretical grounding, systematization, complexity, and depth of therapeutic approach. It is best provided on an individual basis and may require a preparatory phase to facilitate treatment engagement. Increased depth is associated with thoroughness of assessment, attention to core needs of the clients, greater individual tailoring to client needs, greater specialization in techniques, and the need for clinical coordination and supervision. A specialized form of CBT anger treatment follows a stress inoculation approach, which involves therapist-guided, graded exposure to provocation stimuli to facilitate anger control. This occurs in vitro through imaginal and role play provocations in the clinic, and in vivo through planned testing of coping skills in anger-inducing situations, as established by a hierarchy of provocation scenarios collaboratively constructed by the client and therapist.

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