Anxiety/Anger Management Training

Description of the Strategy

Both anxiety and anger have serious effects on emotional and physical health. High anxiety or stress may reflect disorders such as generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), or phobic disorder. Even in reasonably healthy persons, high stress can interfere with performance, such as public speaking or sport performances. Academic work can suffer when there is test anxiety, and reasonable decision making can be difficult when a person is under stress. In a similar way, high anger can lead to negative behaviors culminating in violence to others, self-injury, and even property breakage or destruction. Child abuse and domestic or workplace violence have become serious concerns of society. Interestingly, both anxiety and anger have negative physical health outcomes: High levels are associated with vulnerability to diseases such as respiratory diseases and heart disease and with higher mortality rates. Anxiety/anger management training (AMT) is a behavioral intervention that has proven effective for diverse anxiety-based disorders as well as for anger management. AMT is unique in being equally applicable to focused anxiety, such as phobias or test/ math/performance anxieties, as well as general anxiety conditions. Similarly, AMT is equally effective in controlling anger that is directional and focused, as well as generalized anger states.

Anxiety/anger management training (AMT) was originally designed in the 1970s as brief behavioral treatment for anxiety, an alternative to exposure or psychotherapy approaches. Unlike exposure, AMT trains the individual in relaxation to eliminate the arousal from the exposure experience. The person therefore has a coping skill to use to directly control the anxiety-arousal state. Basically, relaxation is used to deactivate the emotional arousal. The exposure part of AMT is for the purpose of having the patient experience the emotional arousal in order to practice eliminating the arousal by use of relaxation skills.

AMT also systematically uses steps to increase self-control and self-reliance aspects. Graduated homework assignments assure transferring these skills to real-life settings. The typical AMT session covers six to eight structured sessions, beginning with relaxation training. As the relaxation skill is acquired, AMT sessions then use visualization to recall anxiety/anger, followed by application of relaxation to eliminate the arousal. As the patient demonstrates success, further sessions direct the patient to be able to identify behavioral or cognitive signs that reflect the beginnings of anxiety/anger arousal. The patient is then trained in initiating relaxation when these signs are noted in order to abort the arousal before the anxiety/anger escalates out of control. The total number of sessions depends upon the rate of progress of the [Page 12]patient in acquiring relaxation skills and in the application of relaxation to reduce the anxiety/anger arousal. Initial sessions are characterized by active direction by the therapist, while later sessions involve increased self-direction by the patient in achieving relaxation, experiencing emotional arousal through visualization, and returning to relaxation to reduce and/or eliminate the arousal state.

In 1986, AMT was applied to anger management as the similarities between anxiety and anger were recognized. Both involve emotional arousal, involving physiological changes (e.g., increased sweating during anxiety or increased blood pressure during anger), behavioral changes (e.g., anxious hand clenching or angry verbal outbursts), cognitive changes (e.g., anxious worries or angry thoughts), or subjective feelings (e.g., of panic or blowing up). Both emotions are experienced as powerful impulses that are disruptive and appear out of control. Both emotions may remain ambiguous, as in generalized anxiety or angry outbursts that seem to occur unpredictably. Both can also have a more specific focus: For anxiety, the focus can be specific, such as in phobias; for anger, the focus can also be specific, as in child abuse.

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