The Rational Management of Anger
An outline for therapeutic intervention

Introduction

Anger is one of the most difficult emotions for human beings to change. Rational Emotive Behaviour Therapy (REBT), which focuses on the underlying belief system that creates dysfunctional emotions and behaviours, is able to help people move from hostile, destructive rage to a more constructive type of anger, and maintain their change in the long term.

What causes anger?

First let us dispose of a common misconception. People do not become angry just because they are frustrated. Frustration is a normal reaction to unwanted events and circumstances, and will result when a person fails to get something they want or ends up with something they don’t want. Extreme anger, on the other hand, is what people experience when they fail to get what they think they need or must have. It is an emotional response to a frustrated demand.

Cognitive causes

What does cause anger? People with anger problems often have a simple answer - they believe that other people cause their emotional upsets. But this raises two questions. How can an external event create an internal reaction? And why is it that one person can be disappointed but calm in the face of a circumstance to which another reacts with rage?

Events and circumstance alone do not cause anger. Anger results from how people view what happens to them (Ellis, 1977; Novaco, 1975). There are four types of thinking that typically create dysfunctional anger:

1. Inferential distortions such as mind-reading, fortune-telling, filtering, and emotional reasoning (Burns, 1980) lead people to misinterpret what is happening around and to them.

More important, misinterpretations are followed by self-defeating evaluations (Ellis, 1962):

2. Awfulising and discomfort-intolerance about unwanted events (often called 'cant-stand-it-it-is’). Anger frequently results from anxiety, and violence often represents an attempt to ward off perceived threats. REBT suggests that such threats may be of two types:

• perceived threats to well-being (discomfort anxiety);
• perceived threats to self-image (ego anxiety).

3. Expectations that are held as demands. Demands typically lead to low-frustration tolerance - a key cause of dysfunctional anger:

• moralising about how people 'should’ or 'should not’ behave;
• believing that the world or one’s circumstances 'have’ to or 'need’ to be a certain way.

4. Global rating of other people:

• labelling a person as a 'bitch’, 'bastard’, or some other all-encompassing label makes it easier to be angry with them.

The role of cognitions in creating anger can be illustrated with the 'ABC’ model developed by the founder of REBT, Albert Ellis (Ellis, 1962). Following is an example:

A: Activating event (experience, event, or situation that started things off):

Children playing noisily, could not hear television programme.

B: Beliefs (self-talk that led from 'A’ to 'C’):

Thoughts specific to the situation:

1. I can’t stand their noise.
2. They shouldn’t be so noisy when I am trying to relax.
3. I have to make them behave.

Underlying rules:

4. I can’t stand to feel frustrated.
5. Others should never do things that frustrate or upset me, and when they do, I must get them under control.

C: Consequence (reaction to the 'A’):

Emotions: Felt angry.

Behaviours: Went into lounge, shouted at children and called them abusive names.

Other causal factors

Although anger results primarily from thinking processes, physiological causes (such as tension, agitation, or ill-humour) can exacerbate the emotion, along with behavioural deficits (like unassertiveness and poor problem-solving methods). An effective approach to anger management will take all such factors into account.

Summary of treatment procedure

The overall aim of treatment is to help the client replace hostile dysfunctional anger (directed at people) with moderate, functional anger (directed at solving problems). Treatment involves raising frustration-tolerance through developing the client’s cognitive, physiological, and behavioural coping skills; then providing for the practice of these skills with exposure to regulated doses of stressors that arouse but not overwhelm the client’s defences.

Three treatment phases

Treatment typically progresses along the following lines (though not necessarily in a rigid or linear sequence):

1. Assessment and cognitive preparation.
2. Cognitive change.
3. Reduction of physiological symptoms.
4. Skill acquisition.
5. Application practice.

Assessment & cognitive preparation

In this first stage, the focus is on helping the client:

• Identify their personal anger patterns (typical triggers and usual responses), so they will be able to recognise their anger at an early stage, before it gets out of hand.
• Identify the functions that anger may serve for them.
• Understand that there are different types of anger.
• Understand that the primary cause of their anger is low frustration-tolerance and the underlying system of beliefs and attitudes they hold about themselves, other people, and the world.

Assess causal factors

It is sometimes useful to help the client understand where their learning may have come from. Questions like the following will facilitate this exploration:

• 'How did your father / mother / siblings behave, and how did you know they were angry? Was there any violence or verbal/passive aggression?’
• 'What messages did you get from your parents about the expression of anger - OK or not OK? How did you know it was OK or not OK?’

Don’t, though, fall into the trap of spending too much time on the client’s past – the focus of attention needs to be on the factors that currently cause their anger:

1. The 'A’s (Activating events) – the persons, situations, and states that trigger anger.

• look for such events as rejection, rule-breaking by others, arguments, alcohol, anxiety, and perfectionism.
• check out the gains that the client perceives (possibly subconsciously) may result from becoming angry (e.g. release of tension or frustration, control of other people, and the like).

2. The 'C’s (Consequences they experience - both emotional and behavioural). Look for:

• body signals of tension and arousal: anxiety, muscular tension, stomach-ache, sweating or cold, changes in the depth and speed of breathing, headache, backache, and so on.
• behaviours: getting mean, blaming, sarcasm, forced humour, depression, withdrawing, acting over-nice and trying to please, going quiet, passive-aggressiveness, violence, change in eating or sleeping patterns, etc.

The purpose is to help the client learn to recognise these signs early in an angry episode. Having them keep a diary of A’s & C’s for a few weeks can facilitate this learning.

Finally, introduce the client to the most important causal factor:

3. The 'B’s (Beliefs) - the thoughts and attitudes that are activated by the 'A’s. Help the client to see that 'A’ does not cause 'C’. Events and circumstances activate beliefs - thinking, both conscious and subconscious, then creates the individual’s emotional and behavioural reactions.

Teach the client new views on anger

• Help the client see that there is a difference between (1) anger (an emotion, what one feels inside) and (2) aggression (what one does: verbal and physical actions directed at people or property).
• Explain that anger in itself is not 'evil’, and that it can be destructive or constructive. Deal with any secondary emotional problems about having an anger problem, especially guilt (which only perpetuates anger).
• Help the client see the causes of anger: cognitive, physiological and behavioural.

The purpose here is to help the client see anger in practical terms – that is, in terms of its consequences – rather than view it as a 'moral’ issue; and accept their self, while rejecting their behaviour. It is often useful to help the client see anger as having three different forms (Froggatt, 1993):

1. Passive anger is hostility that is expressed indirectly, often by omission rather than commission. Typical behaviours may include going silent, withdrawing, impatience, being late, 'forgetting’ to do things, or denying sex or physical affection. It can lead to physical illness, relationship difficulties, and failure to seek change.
2. Aggressive hostility, too, can create the above problems, and may also lead to violence and risk taking (as, for example, when a person is steamed up while driving).
3. Constructive anger is very different to the other types. It involves moderate emotions like irritation, annoyance, dissatisfaction, displeasure and disappointment. These are still angry feelings - but will not cause people to lose their heads. Constructive anger is also directed against unwanted events and circumstances - not against people. It leads to problem-solving, not people-harming.

Cognitive change

Now it is time to help the client learn how to identify and change the self-defeating beliefs which create and maintain their anger.

Teach the procedure of self-analysis

Have the client extend the diary they kept earlier from 'A-C’ to 'A-B-C’ – that is, add the 'Beliefs’ component. Then, as soon as they get the idea, move on to having them complete full self-analyses of their angry episodes. Add 'D’ – disputing self-defeating beliefs, 'E’ – developing a new emotional and behavioural goal, and 'F’ – self-help work that the client will complete between sessions. (The self-analysis procedure is described in detail in Froggatt, 1993 & 1997, and there is an example of a completed analysis at the end of this article).

Self-analysis with anger problems will usually involve:

• increasing frustration-tolerance;
• challenging demands directed at other people or the world, especially:
  - the idea that other people or the world 'must’ conform to one’s expectations;
  - the 'need’ to punish others or control their behaviour;
• developing the concept of accepting people, even when their behaviour is rejected.

For a list of beliefs that are typically involved with angry reactions, see A sample of anger-creating irrational beliefs at the end of this article. Disputation of self-defeating beliefs takes some skill - most people need to learn how to do it effectively (see Kopec, Beal & DiGiuseppe, 1994 or Froggatt, 1997). Because of its self-righteous nature, clients with anger problems usually need special help to see how their demands are illogical and self-defeating.

Other cognitive strategies

• Give the client reading (if they have adequate reading skills) to educate them about self-defeating thinking and how it can be changed.
• Help the client develop empathic abilities, using techniques like role-reversal.
• Help the client develop a task-orientated attitude to dealing with problems – that is, changing circumstances (where possible) rather than upsetting themselves.
• Assist the client to increase their motivation to change by listing and weighting the advantages and disadvantages of their anger.

Helping at the physiological level

Physiological treatment aims to reduce tension and ill-humour by working on the symptoms themselves. The client learns how to modify their 'C’s – in other words, to reduce the physical sensations which further fuel their anger. This helps them avoid exacerbating annoyance or irritation into hostility or rage.

Strategies

Strategies that are commonly used include:

• Relaxation training (see Froggatt, 1997).
• Anxiety management (see Froggatt 1993).
• Encouraging the client to maintain a sense of humour – avoid taking oneself or the situation too seriously.
• Moderate alcohol use (and no alcohol at all when angry or upset).

Physiological strategies are 'palliative’ – that is, they ease the symptoms without addressing the causes – but are a useful adjunct to the therapist’s armoury.

Skill acquisition

Teach the client how to use anger adaptively rather than destructively. The client learns to minimise the dysfunctional aspects of their anger, and instead engage in problem-solving behaviour.

Strategies

Time out

'Time-out’ is useful in the early stages of therapy, before the client has learned to deal with the underlying cause of their anger. The client prepares the scene by explaining to their partner what they will do and arranges their co-operation. When the client identifies the early stages of anger, they follow these steps:

1. Share with their partner that they are feeling angry, and say they are going to take time-out.
2. Leave the situation for about one hour. Avoid drinking or driving while angry, instead, do something physical (brisk walk, run, gardening, etc.), and/or do a self-analysis to deal with self-defeating thinking.
3. When the hour is up, return and check in with their partner and offer to talk about what happened.

Assertiveness training

The aim of assertiveness is for the client to achieve their objectives and gain a sense of control without using anger. It involves:

• Effective communication of feelings.
• Asking for what they want and saying 'no’ to what they don’t want.

Suggestions for assertiveness are detailed in Froggatt, 1993 & 1997.

Problem-solving training

Train the client how to use task-oriented, problem-solving strategies. They will then be able to deal with problems straight away rather than bottling up their feelings. As therapist, you help the client gain coping skills by:

1. Teaching techniques;
2. Modelling them;
3. Assisting the client to rehearse the techniques.

A problem-solving model is described in detail in Froggatt, 1993 & 1997.

Application practice

The final step is to help the client apply what they have learned. What follows is a process for helping clients do this in a graduated fashion. As mentioned earlier, therapy does not often proceed in a linear sequence - some stages may be mixed together or approached in a different order to that described. Techniques outlined in this section may be used to facilitate specific learning from earlier stages.

1. Develop a hierarchy

Start by having the client list anger situations they are likely to meet in real life.

2. Exposure via imagery

Progressively using each hierarchy scene, expose the client to manageable doses of anger stimuli, via the use of imagery and role-playing. Use cognitive procedures such as Rational-Emotive Imagery (Maultsby & Ellis, 1974; Froggatt, 1997) and Rational Self-Analysis (Froggatt, 1993 & 1997) to assist the client to identify and dispute the thoughts that create the anger they feel while carrying out the imagery exercise.

3. Exposure in real-life situations

When the client is ready, move them on to using exposure with response-prevention:

• The client deliberately (in a planned way) confronts situations that would normally trigger anger.
• They inhibit their usual response (eg. argumentativeness, defensiveness, demanding of others, etc.) and instead use the new strategies they have learned.

The purpose is to give the client practice at increasing their frustration-tolerance and coping in a non-hostile way with a variety of situations, where the practice is under the their control (see Froggatt 1997 for more information on the technique of controlled exposure).

Rational self-analysis - an example

What follows is an example of a completed rational self-analysis. Note that it is usually most effective to proceed with an analysis in the following order: A, C, B, E, D, F:

A: Activating event (the experience, event, or situation that started things off):

Children playing noisily, could not hear television programme.

C: Consequence (my reaction to the 'A’):

Emotions: felt angry.

Behaviours: went into lounge, shouted at children and called them abusive names.

B: Beliefs (the self-talk that led me from 'A’ to 'C’):

Thoughts specific to the situation:

1. I can’t stand their noise.
2. They shouldn’t be so noisy when I am trying to relax.
3. I have to make them behave.

Underlying rules:

4. I can’t stand to feel frustrated.
5. Others should never do things that frustrate or upset me, and when they do, I must get them under control.

E: the new Effect I want to achieve:

How I would prefer to feel: annoyed rather than hostile.

What I would prefer to do: calmly explain that I like to relax after work, and ask them to play more quietly.

D: Disputation & new beliefs (what I could tell myself to achieve the new Effect I want):

Disputation of thoughts specific to the situation:

1. I don’t like their noise, but I can stand it - it hasn’t killed me yet.
2. I would prefer them to play quietly when I am trying to relax, but what Law of the Universe says that they 'should’?
3. It would be helpful to train them to behave, but I don’t absolutely 'have’ to.

Disputation of underlying rules:

4. I dislike frustration, but I have always stood it!
5. I would prefer others not to do things I find frustrating, but where is it written that they 'must’ not? And, anyway, others don’t frustrate me - I frustrate myself with what I think about their behaviour.

F: Further action (what I will do to avoid the same dysfunctional thinking and reactions in future):

1. Re-read the article on managing anger my counsellor gave me.
2. Talk with my anger management group about better ways to communicate when people do things I dislike.
3. Use 'time-out’ for the next few months to practice increasing my tolerance for the kid’s noise.
4. Do a self-analysis when I take time-out, to chip away at my demanding rules.

References and further reading

Burns, David M. Feeling Good: The new mood therapy. Signet, New American Library, New York, 1980.

Kopec, A.M., Beal, D. & DiGiuseppe, R. Training in RET: Disputational Strategies. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 12:1, 47-60, 1994.

Ellis, Albert. Anger - How to live with and without it. Carol Publishing Group, New York, 1977.

Ellis, Albert. Reason and Emotion in Psychotherapy. Carol Publishing Group, New York, 1962.

Froggatt, Wayne. Choose to be Happy: Your step-by-step guide. HarperCollins, Auckland, 1993.

Froggatt, Wayne. GoodStress: The life that can be yours. HarperCollins, Auckland, 1997.

Maultsby, M.C., & Ellis, A. Technique For Using Rational-Emotive Imagery. Institute For Rational Living, New York, 1974.

Novaco, Raymond. Anger Control. Lexington Books, Lexington, MS, 1975.

Useful resources on the internet

• Brief Introduction to Rational Emotive Behaviour Therapy - http://www.rational.org.nz/prof/docs/intro-REBT.htm
• New Zealand Centre for Rational Emotive Behaviour Therapy - http://www.rational.org.nz

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