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Anger Disorders Treated with Cognitive Behavior Therapy (CBT) at New York Behavioral Health

Description

Anger is typically considered to be a negative feeling.  This means, most people, most of the time, attempt to prevent feeling this way or would like to turn down the intensity, or shorten its length.  But, unlike other negative feelings, e.g., guilt, sadness, and disgust, some people report positive aspects of their anger.  Anger often gives people a sense of righteousness, and is often referred to as a moral emotion.  It is often related to themes (or values) of morality, justice, fairness, and respect.  But, it can also be triggered by other emotional material and have less to do with morality.  At times, an individual may not realize there is a connection between anger and another emotion.  For example, it may feel much better to be angry at a loved one then to feel the hurt associated with rejection.  Early aggression theories proposed that mounting frustration could lead to aggression, and it seems likely anger would mediate this relationship.  A newer theory, Berkowitz’s Neoassociationistic Model, reformulates Dollard and Doob’s Frustration-Aggression Hypothesis.  He proposes negative affect (emotions) all accumulate, and once a threshold is reached, aggression is likely to occur.  This would mean that even anxiety, guilt, and embarrassment could precipitate anger and aggression.  This is somewhat counterintuitive since these emotions are typically associated with withdrawal and escape behavioral tendencies.  This also means that the act of anger/aggression may have less to do with the target than previous aversive interactions or issues.  In these cases, the emotional expression (i.e., the motor behavior associated with the anger episode) may be “misplaced.”  Misplaced anger may be perceived by both the target and the actor as disproportionate to the apparent trigger. 

Anger, like anxiety, may feel uncomfortable, but can be associated with adaptive behaviors or unhealthy consequences, the same way fear, and the related constructs of anxiety and panic are.  For example, anger can alert people that an injustice is being committed, or that someone is taking advantage of him or her.  On a larger scale, it may lead groups of people to organize and motivate them to take action in favor of social change. Examples of this could be Mothers Against Drunk Driving (M.A.D.D.), protestors of a war, or unfair law.  But, like fear, if anger becomes intense, lasts for long periods of time, or leads to unhealthy (risky) behaviors (e.g., domestic violence, child-abuse, drinking, drug use, or road rage), it can become very self-defeating and even lead to medical problems (e.g., heart attacks, strokes, high blood pressure, gastrointestinal problems, binge eating, etc.).

Treatment

Anger can be successfully treated with a number of cognitive-behavioral techniques.  Components of cognitive-behavior therapy have been studied more than other psychotherapies, and have proven to be effective.  In as little as 8-12 weeks, many techniques have shown promising results. Cognitive restructuring, problem solving, relaxation training, communication skills, and combinations of these techniques have reduced both the experience of anger and many of the associated behaviors.

Cognitive-behavior therapy is a form of treatment that focuses on alleviating current symptoms by addressing current causes of the problem(s). Specifically it is based on the theory that emotional problems are the result of the combination of situations and human beings beliefs about these events.  Thoughts about how other people should behave, how mistreated I was when I was younger, the amount of respect I should be given, how frequently people should be polite and fair, etc. 

The common model for conceptualizing this idea is Albert Ellis’ ABC model, where “A” stands for Activating Events, “B” stands for Beliefs, and “C” stands for Consequences.  

Activating events (A’s), are anything real or imagined that activates our belief system (B’s) and results in an emotional consequence (C).  Emotional Consequences (Ce’s), set the stage for behavioral consequences (Cb’s).

If you were bumped by someone with a backpack while walking on the sidewalk, that could be an A.  You may then believe (B), “He should watch where he is going, and at a minimum apologize.”  The combination of this activating event (A) and belief (B), may result in anger, and an emotional consequence (C).  

 

            A                     x                     B                     =                     Ce      

        Activating event                                                    Belief                                                Consequence emotional

  (Inconsiderate behavior)                    (Others should always be considerate)                               (Anger)

Symptoms

Anger symptoms vary and cross many domains.  Symptom domains for anger include physiological, cognitive, and behavioral.  These symptoms may result in detrimental effects in the family, love life, medical profile, or work life of a person.  They may also lead to more risky behaviors resulting in serious physical threat and even legal problems (e.g., assault and battery, reckless driving, drug possession charges).

Physiological symptoms can include rapid heart rate, palpitations, perspiration, shaking muscles, and urges to hit others.  Cognitive symptoms may include difficulties concentrating, remembering, rumination about events, or revenge fantasies.  Behavioral symptoms could be severe, as in the case of physical altercations, reckless driving, alcohol consumption, mild procrastination, or small accidents.

When left untreated there is mounting evidence that these symptoms over time wreak havoc on our physical bodies and lead to medical problems. Surges in blood pressure, frequent activation of the nervous and endocrine systems, and tendencies to neglect self-care put angry individuals at risk for all kinds of problems.  Certain types of anger can predict all-cause-mortality and reliably predict heart disease as well as blood pressure and cholesterol do.

 

Cognitive-Behavioral Therapy (CBT) Worksheets for Anger Management

CBT Relaxation Worksheet

CBT ABC Form

CBT Anger Management Log Worksheet

CBT Dashboard for Anger

CBT Goal Setting Worksheet

CBT Self-Assessment

References

Fuller, J.R., DiGiuseppe, R. , Fountain, T., O’Leary, S., Lang, C. (2010). An open trial of a comprehensive anger treatment program on an outpatient sample anger.

Anger Management Treatment Efficacy Pilot - Extended Report - PDF