Anger Management

There have been a number of incidents over the last couple of months that have led to me writing this blog on Anger Management. Anger is an emotion that comes up regularly in conversations I have with patients- they may be angry with their partners, their work colleagues, their health professionals – and it’s such a negative emotion which can sap an already depleted nervous system of any positivity. As a Women’s Health colleague pointed out- anger can also be a positive emotion when injustices occur and changes must be made to set things right. But why I am raising this issue and posting some anger management strategies is to assist those people where their anger is a negative in their life and they would like to address it with themselves or with someone in close proximity to them.
Social media is full of angry people. The apparent anonymity gives rise to a belligerence in replies that would probably never happen if people were conversing face to face. Facebook rants, Twitter tirades (most unbecoming of a US President methinks) and blog trolling are regular occurrences. Media ‘personalities’ – often white 50 something males – are very angry people and they can be responsible for some of the mob mentality that arises from talk-back radio, whipping up outrage and crushing moderate intelligent thought and conversation on topics.
One of the more public ones recently happened here in Australia, when the Qantas CEO Alan Joyce was giving a speech and a ‘gentleman’ walked up on stage and proceeded to smash a cream pie in his face.

Now to be honest Alan Joyce was never one of my favourite people because over the years he has made what seemed to be like some harsh decisions  about Qantas and staffing and maintenance of their planes which I felt I had an opinion on (based on what, I have no idea) but over recent times I have admired his public position on gay marriage and equal rights in this area, and he has been brave enough to vocalise it despite of his position as a CEO of a major company. Now this is apparently what riled the offender. He got so angry and indignant that he felt he had the right to go right up on stage while Joyce was presenting and push a cream pie in his face. I saw the news the next day and the offender was contrite and apologetic, but I did hear it wasn’t enough and Alan Joyce is going to press assault charges.
Every night on the news, there are also many instances of road rage – where someone upsets the other with a change of lanes or by driving at the speed limit (instead of over it) and next thing, a completely-over-the-top reaction – sometimes aggressively, violent response, with someone being hurt. Similarly horrific, there are regular instances of domestic violence, where wives and children most predominately suffer as a result of uncontrolled anger. So I decided to do some reading on anger management strategies and write a blog on it.
The information in this blog is taken directly from ‘Change Your Thinking’ by Sarah Edelman PhD (2006) without too much summarising because it is so good and it was important to not reduce the message on this increasingly necessary topic- this is a great book with topics including managing depression, overcoming frustration and anxiety strategies. I highly recommend it to you either if you are a patient or a clinician.
Anger is an emotion that we experience when we perceive that something is bad or unfair. In most situations anger is directed at other people or organizations, governments systems or even ourselves. Anger is often accompanied by the perception of threat where part of us feels unsafe.
Anger affects the way we behave. When we feel angry we may lose our patience or act on impulse. We may become aggressive and say things we later regret. Anger drains energy and interferes with our happiness and to have good relationships. Angry people may argue, attack, abuse, hit, blame or withdraw. This behaviour creates more problems than it solves. It can lead to physical violence, destruction of property or abuse of alcohol and drugs. Uncontrolled anger can lose your friends, break up your marriage, cause problems at work and cause you to become a social outcast.
An occasional burst of anger is not always a problem but it must be proportionate to the situation. However, long term, intense or frequent episodes can be a detriment to all aspects of our lives including the ability to feel good and to enjoy good relationships. Long term or frequent anger increases stress to organs of the body and increases blood pressure – thus increasing the risk of hypertension and heart disease.
Researchers have found that anger/ aggressive behaviour can be influenced by brain chemistry or defects within the brain. Negative childhood experiences may also affect the anger response.
Some people rarely express anger. This may be because they are well adjusted and have flexible expectations. On the other hand, lack of expression of anger may carry with it suppressed anger. This may manifest in passive-aggressive behaviour. They may be full of negative comments or subtly undermine others.
There is a belief that ‘letting out your anger’ is better than holding it in. If we are experiencing a brief episode of anger then physical activity – hitting a punching bag, gardening or going for a run – is a good way of release. Evidence shows that people often feel angrier after an explosive response – not less. More importantly, yelling is often hurtful to people we care about. We may feel guilty and remorseful afterwards.
STRATEGIES FOR MANAGING ANGER
Extingush the Fuse – Preventing an Angry Explosion
Although it may not always be possible to avoid getting angry, we can learn strategies to keep our anger in check and prevent it escalating: –

• Learn the internal signals of anger arousal. You may become hot, flushed, your heart may start pounding, your hands may tremble or your jaw may clench. These are your clues to take control. Then use the ‘Stop – Breathe – Leave’ technique: –

Stop
Say the word ‘stop’ in your mind and visualise a stop sign or flashing rail crossing lights. This will short-circuit your automatic response and allow you to choose to respond differently. Go on to…
Breathe
Take in a few deep breaths to lower your anger arousal and distract yourself from the perceived injustice. Then…
Leave
Physically remove yourself from the situation. Leave the room or go for a walk. During the most testing period, this will keep you out of harm’s way or causing harm to others.

• Once you have removed yourself from the situation, this will give you the opportunity to reflect. Ask yourself, ‘What is my goal here?’ Is it to get on with people? To have happy children? Avoid unnecessary stress? Enjoy the evening? Look after my health? Whatever the circumstance, focus on what really matters and recognize that getting angry stops you from achieving what really matters.

Reduce Your Physical Arousal
When we can reduce our level of anger arousal, our anger also receded. Here are some techniques: –

• Exercise

Physical exercise allows us to use up reserves of energy that anger draws upon. Although our level of anger can rise during the actual exercise, it drops substantially afterwards and helps to relax. Vigorous exercise also releases endorphins which increase our sense of well-being. The exercise does not have to be pumping iron or punching a bag, equally effective is vigorous housework or digging the garden.

• Diaphragmatic Breathing

I use belly breathing every day with my patients and myself for that matter. Belly breathing is calming and allows the brain to think more clearly and allows for easier processing of information. Place your hand over you tummy and as you breathe in feel your tummy rise up under your hand and then as you breathe out, your belly drops away.

Breathing gif to work with

• Deep Relaxation

This is a physical state in which all our major muscles are extremely relaxed. As it is difficult to practice deep relaxation while we are angry, this technique is not suitable during an acute stage of anger. Use the methods above in the first instance. Practice deep relaxation as a maintenance tool which, when practised daily, reduces our potential towards becoming angry in the first place.
Dealing with Sustained Anger
Unlike explosive anger which is usually over in a few minutes, more sustained anger which does not fade quickly or after a night’s sleep, requires a long-term approach. Here are some strategies: –

• Problem Solve

Whenever we perceive an injustice has occurred, it is sensible to think about actions we can take to redress it. Sometimes there is nothing we can do about it and we must accept the situation. At other times, we can resolve it through problem-solving. Even if we may not successful, it helps to know we tried our best and there is nothing more we can do about it.
When you find yourself feeling angry about a situation, ask yourself ‘What is the best action I can take to resolve this problem?’ You might be able to present a reasonable case to fight a traffic ticket. You might need to assert yourself to a builder who has left shoddy workmanship. You might discuss with your partner or housemate that you are unhappy that you are doing all the housework and ask they do their fair share. In many cases, taking some constructive action enables the problem to be solved.

• Sometimes It Is Better to Let It Go

Sometimes we find ourselves in situations that are plainly unfair and there is nothing we can do to change them. Or we may recognize that our chances of achieving a fair solution is small and the cost of pursuing it is likely to be high. When we weight the chance of success against the cost of failure, it makes perfectly good sense to let it go. It may be best to practice acceptance. The acceptance affirmation below can be helpful in these situations: –
ACCEPTANCE
NOT HOW IT
– Was
– Might have been
– Should have been.
NOT HOW
– I wanted it to be
– Hoped it would be
– Planned it would be.
I ACCEPT THAT THIS IS HOW IT IS.
Now get on with my life in a positive way.

• Give Yourself Some Stewing Time

At the outset of your anger resulting from a significant injustice, give yourself permission to stew for a while. Perhaps do some exercise, talk about it or even write a letter. As long as you don’t say or do things you’ll later regret, it is OK to experience the anger for that significant injustice for a few hours or days.

• Talk About It (Ventilation)

The very process of talking about something that we feel angry or upset about can help us feel better. Sometimes all we need is to be heard and validated by a sympathetic, caring listener. Psychologists call this process ‘ventilation’. While talking to a third party can be helpful, sometimes speaking directly to the person we feel angry about is best by releasing accumulated anger and resentment and thus to feel better. It is not best to do this during an acute stage of anger when the risk of hostile confrontation is high.

• Write a Letter

Sometime it is difficult to directly speak with the person who makes us angry either because the issue is too upsetting or we do not trust ourselves to remain calm. In this case, it might be better to express our thoughts on paper. This process gives us time to express ourselves coherently. While sending the letter helps the other person understand our position, sometimes just the process of writing helps us rationally evaluate the problem to the point where the letter might not need to be sent.

• Thought Stopping

Thought stopping can be helpful in dealing with recurring ruminations that just won’t go away. Before you begin the process of stopping the unwanted thoughts, you need to prepare a pleasant fantasy that you will use to replace them. This pleasant fantasy might be memories of a good holiday, hugging a grandchild, a moment of past success, a beautiful place, a sexual fantasy, an inspiring person, an activity or hobby. To practise thought stopping, you need to catch yourself in the process of rumination and immediately shout out ‘Stop!’ either aloud or in your mind. Then turn your mind to that pleasant fantasy and focus on it for 30 to 60 seconds. If the unwanted thoughts return repeat as necessary. To be effective, thought stopping needs to be practised consistently for as long as the ruminations continue. At first this will happen many times per day but with practice, the unwanted thoughts will reduce and eventually disappear.
Choose to Let Go of Your Anger
Anger comes from the perception that important rules are being violated. When we feel angry, we tend to blame other people or external events. The truth is other people do not actually make us angry, they merely provide the stimulus. We make ourselves angry through our belief that things should not be this way.
Like all emotions, anger is generated by cognitions. Other people’s actions can anger us but whether or not we get mad depends on how we perceive what is happening in our world. Events that enrage some people, do not phase others.
Anger is different to most other unpleasant emotions in one important way – we instinctively want to hold onto it. If we have sustained anger, we need to ask, ‘do I want to hold on to this anger?’ Choosing to let go of anger may feel like we are letting a culprit off too lightly. Our sense of indignation can be a major obstacle to moving on. We have to ask ourselves – ‘who is suffering?’ Sustained anger can be painful and self-defeating. Anger does not hurt the other person – it hurts us. Even if we are able to make the other person uncomfortable by snubbing or bitching about them, chances are we are still suffering. Anger might be likened to drinking poison and hoping the other person will die. Why would we do it to ourselves?

• The Cost / Benefit Analysis

Wanting to stay angry is one of the biggest obstacles to letting go of it. If we are not convinced we want to let go of the anger, do a cost / benefit analysis of maintaining the rage. Put pen to paper and under the headings of ‘Costs’ and ‘Benefits’ write down your thoughts. A benefit might be, ‘It feels right’ or ‘It gives me something to talk about with friends’.
Costs might be ‘It distracts me from thinking about more important things’, ‘I get churned up in the stomach’, ‘It stops me from getting a good night’s sleep’, ‘It makes me hard to live with’, ‘It is such a waste of time and energy’. After weighing up the costs and the benefits, this process might help us commit to whatever is necessary to let go of the anger.

• Goal Directed Thinking

Anger can be self-defeating because it prevents us from getting the things we really want. These might include maintain a good relationship with our partner, being respected by our colleagues enjoying a night out or simply feeling happy and relaxed. It is not in our interests to feel this way.

• Remember the vital question, ‘Does thinking this way help me to feel good or to achieve my goals?’

Identify and Challenge Anger Producing Cognitions
Anger is rooted in negative thinking. It is fuelled by being preoccupied with what has gone wrong or with assumptions about the bad intentions of others. One way to combat this negative syndrome is to maintain a constructive outlook about yourself and others.
Once we are motivated to work on letting go of our anger, we are ready to take the next step – to identify and challenge the patterns of thinking that makes us feel that way: –

• The Shoulds

Of all the thinking patterns that contribute to human unhappiness, it is the ‘shoulds’ that are the most pervasive and unhelpful. ‘Shoulds’ play a major role in feelings of anger, resentment and bitterness. They reflect our expectations of how people ought to behave. Beliefs like ‘My husband should be able to communicate better’; ‘My friends should be more supportive’; ‘The trains should run on time’; ‘Pet owners should not allow their pets to make a mess of my garden’; ‘The neighbours should keep their music down’ can cause us to feel angry if we hold them as absolute truths rather than preferences. This is because the world does not conform to our rules. Rigid expectations make us anger prone.
This is not to say that we should have no expectations of others or that we should accept unreasonable behaviour without challenging it. At times it is important to take an stand and do what we can to right the wrong.
However, it is important to be flexible and accept that in the real world, people will not always think the way we think.

• The ‘Just World Fallacy’

A common expectation of an anger prone person is that of justice and fair play. The problem is that this expectation does not match what happens in the real world. Injustices exist in every society, every family and every work place. Perhaps we should be taught from kindy that many things in life are simply not fair and often there is nothing we can do about it.
Again, if there is something we can do to resolve an injustice, it is important to try. However sometimes there is nothing we can do about it. We can get angry or we can accept that we live in an imperfect world and focus on the things that are within our control.

• Black and White Thinking

Anger often arises from black and white thinking. This is the tendency to see situations as either good or bad, right or wrong. It is the inability to see shades of grey that makes us prone to anger.

• Injustice May Be Subjective

It is important to appreciate that although we may be strongly attached to our point of view, it is quite possible that it is not completely correct or definitive. Justice is often subjective. What is perceived as fair by one person, is not necessarily fair to another.

• Blaming

Blaming goes hand in hand with anger and resentment. Some people spend all their lives blaming others for their own unhappiness. It fuels our anger and makes it hard to let it go. The blaming habit is strongly tied to our ‘shoulds’ – underlying assumption is that people who break our rules are bad.
As we can rarely punish others or control their behaviour so labelling them as idiots or creeps and demanding they should not be the way they are is a waste of our energy and it only makes us bitter.
We may still take action to resolve a perceived injustice but importantly we need to remember that we live in an imperfect world full of imperfect human beings.
When we can truly accept this we make life easier for ourselves.

• Personalizing

Whenever someone acts unfairly, rudely or aggressively towards us, we might take offence because we perceive their behaviour as a personal attack. At times people will act in ways we do not like. But we don’t have to take it personally. It is not always about us. Consider, ‘Could this have happened to anyone in this situation?’

• Empathy

‘Forgiveness is not an occasional act. It is a permanent attitude.’ M. L. King Jr.

It is easy to feel anger towards people who say or do things we do not like. It is harder to understand them – their thoughts, their motives, their insecurities and their pain. Our anger often disappears when we can see the situation from the other person’s viewpoint.
Anger can turn to compassion. We can develop empathy towards almost any person when we can see their vulnerabilities and how things are for them. We are all trying to live on this planet using the resources we have developed over our lives. Resources are our: – cognitions, problem solving skills, social support, innate sense of security, self-worth and our ability to communicate and get on with other people. These resources are determined by two factors: – our life experiences; and our biology which includes reactivity to stress, intelligence, energy levels, physical strength, memory and our body’s chemicals that determine our psychological predispositions.
Some people are dealt a great hand both biologically and in their life experiences. As a result, they are well equipped to deal with life’s challenges. Others have been dealt a very meagre hand. For them life is a struggle. Their behaviours that appear to be unreasonable, selfish, stupid, neurotic often reflect the person’s limited resources with which to respond to life’s challenges. Understanding how it is for other people and why they behave the way they do does not mean we must like their behaviour. We may loathe it. However, it releases us from blaming and labelling them and enables us to stop taking it personally.
‘The reason to forgive is for your own sake. For our own health. Because beyond that point needed for healing, if we hold on to our anger, we stop growing and our souls begin to shrivel.’ M. S. Peck 

• Behavioural Disputing

Behavioural disputing can be one of the most powerful techniques for letting go of anger or resentment towards someone.
The process is to go against our feelings and to treat perceived adversary in a friendly and reasonable manner – as we would treat a friend – through direct pleasant communication, friendly email or even a card. Changing our behaviour towards this person changes the dynamics between us and thus the way we feel. In most cases, they will respond in kind. We will feel more comfortable in their presence and they in ours. Most people respond positively to a peace offering but if this does not happen, we have lost nothing and we can enjoy the moral high ground, knowing we have behaved in a decent way.

• Coping Statements

Coping statements are useful as reminders of our processes to quell anger when it resurfaces. Some examples are:-

• Everyone behaves according to their own values and rules
• People don’t have to do what I think is right
• The world is not fair
• If it’s beyond my control, let it go
• Stay goal-focused-remember the big picture
• Keep your cool and you’re in control
• He/she is not perfect, and neither am I
• People are just people. They are neither good nor bad.
• Justice is in the eye of the beholder.

 

• Communication

Good communication skills are our most valuable tool for solving problems, redressing injustices and getting on with people. Communicating with others when we feel angry can help us in two ways. Firstly, when we tell someone that they have done (or are currently doing) something that is a problem to us they may choose to change their behaviour. Secondly, the very process of communicating can sometimes make us feel better. Telling someone that we feel angry or upset over something that has happened can allow us to release a lot of anger. This is particularly the case if we speak directly to the person we feel angry with. If we can communicate in a calm, non-threatening manner, people sometimes validate what we say. This means that they express understanding for how we feel or acknowledge that we have the right to feel the way we do. Occasionally, they may even acknowledge that they did the wrong thing or apologize for their behaviour. Granted, this does not always happen, but in situations where it does, it is like salve to our wound. We can forgive and recover from almost any transgression when people are willing to acknowledge they were wrong or say that they are sorry.
Although it is usually appropriate to speak to the person who is directly involved, sometimes we may need to approach a third party who has the power to intervene. This is particularly the case when our initial approach gets us nowhere. So for instance, you might end up speaking to the school principal about the unsatisfactory behaviour of one of your child’s teachers or to the bank manager about the lack of service at your branch or to the foreman about the poor attitude of some of your fellow tradesmen.
Sometimes we may need to communicate in writing. This is usually necessary when we wish to make a formal complaint. We might also communicate in writing if there needs to be a record of our complaint or when we find face-to-face communication too difficult. Taking time to compose our thoughts on paper often results in clearer and more constructive messages. Whatever the circumstances, our case is strengthened with calm, rational communication, whether spoken or written. We are far more likely to get a favourable response when we are perceived as reasonable and conciliatory, as opposed to hostile, accusing or unreasonable.
Of course, even excellent communication skills do not guarantee that we will always get our needs met. Unfortunately, no system of communication in the world can ensure that other people will always do what we want; but constructive communication increases the likelihood of resolving problems and it helps us to keep people on side, enjoying healthy relationships that are based on mutual respect. Given that communication is such an invaluable resource, it is surprising how often we shy away from using it (‘It won’t work … what’s the use?’). Often it is because we feel uncomfortable bringing up an issue that involves a perceived injustice. The situation is already upsetting to us, and the possibility of an unpleasant confrontation may be extremely anxiety-provoking. It might seem easier to rationalize that talking about it will not work anyway. However, it’s important to keep in mind that communication does not necessarily result in conflict. Good communication involves sound judgement, negotiation and diplomacy, and very often leads to a reduction in tension and improved relationships.
IN SUMMARY

• Anger is created by the perception that something is unfair, and is usually accompanied by feelings of threat or vulnerability. While it can sometimes motivate us to behave assertively or to solve a problem, anger has many negative consequences.
• Acute, explosive anger is potentially harmful because it generates destructive behaviours and alienates other less intense but more sustained anger is also self-defeating because it drains our energy, impairs our relationships, makes us unhappy and can adversely affect our health. Different strategies are appropriate for dealing with the different types of anger.
• Unlike other upsetting emotions, people often want to remain angry because they believe it is justified. However, anger hurts us more than the other. An important first step in releasing anger is to recognise the cost of holding onto it, and to make a decision to let it go.
• Several cognitive strategies can help to release anger, including a cost/benefit analysis, goal-directed thinking, thought monitoring and disputing, empathy and coping statements. Accepting that injustice is unavoidable at times, and that ‘justice’ is sometimes subjective, can also help to release anger.
• Behavioural strategies that are useful in the management of anger include problem solving and arousal reduction techniques, such as physical exercise and deep………… In addition, behavioural disputing choosing to behave in a friendly manner towards someone we resent-can be a powerful strategy for releasing anger. Utilizing effective communication can also resolve anger by lowering interpersonal tension.

A fantastic summary of anger management. Every chapter in Sarah Edelman’s book is thorough and most importantly manageable and practical for patients to implement.