When episodes of anger are too frequent, too intense or last for too long
When anger negatively impacts personal relationships
When anger begins to interfere with psychological, social or educational/occupational functioning
When anger interferes with general physical wellbeing
Provide psychoeducation about anger
Initiate monitoring to increase personal awareness about anger triggers
Utilise behavioural anger management strategies
Assess the current state of an individual’s experience of irritability and anger?
Instruct individuals in the use of an anger monitoring chart?
Provide psychoeducation on anger?
Implement basic behavioural anger management strategies?
It is important to assist people to manage their anger when it has become a problem for them or for those around them. Intense or long-lasting anger is draining, and can affect concentration, the quality of interpersonal relationships, and one’s sense of wellbeing. Following a disaster, anger can make it difficult for individuals to engage in the activities necessary to rebuilding their lives, such as dealing with banks, employers, and government agencies. Anger may also make it more difficult to connect with others, including health providers who can support their recovery.
It is important to discuss with a person if they believe anger has become problematic. Anger may be a problem if:
Recommend monitoring anger episodes to increase the individual’s understanding of their experience of anger, in particular to help them identify common triggers and typical responses. Information obtained via monitoring may provide direction regarding the kinds of interventions that will most likely target the individual’s experience of anger. Ideally, monitor for one week prior to commencing treatment, to establish a baseline. Recommend that monitoring continue throughout the intervention to gauge success or otherwise, and provide direction for making necessary adjustments to the intervention, and to assist with monitoring effectiveness of strategies. See resources below: Anger Monitoring Form.
Enhancing motivation to address anger may be an important first step. For many people, in particular in the aftermath of disaster, anger may feel entirely justified and may seem to be a solution to problems in the short term. Where motivation to address anger appears ambivalent, it is important to explore the potential for unmanaged anger to create problems in the long term. People who have difficulty managing anger are more likely to have problems with personal relationships, work, verbal and physical fights, and damaged property. They may also experience anxiety, depression, low self-esteem, and problems with drugs or alcohol. In extreme cases, poor anger management skills can lead to legal problems. In the end, an individual’s needs are more likely to be met, and relationships remain healthy, if anger is managed appropriately.
It may also be helpful to explore common myths associated with anger. Previously, it was thought that venting anger was useful. However, research suggests that excessive venting actually escalates anger and aggression, and does not resolve the situation. On the other hand, not expressing anger may lead to the ‘pressure cooker’ experience, where anger simmers and builds and eventually results in explosive outbursts. Expressing some feelings of anger in a controlled way instead of bottling them up provides an opportunity to release some underlying feelings and an opportunity to begin to tackle some of the issues causing the anger in a contained and constructive manner.
Psychoeducation about anger often frames anger as a normal human emotion that may occur when we perceive threat or believe a situation to be unjust or unfair. When directed appropriately and managed well, it can be an energising emotion that encourages a person to address injustices and strive for change. When experienced at extreme levels, or not directed constructively, it may be experienced as:
It can be helpful to recognise that anger is made up of a number of domains including the emotional, physiological, and cognitive or thought-related, as well as the behavioural. These domains interact and reinforce each other in important ways.
The physiological basis of anger is known as the flight and fight response. It is activated by the perception of threat, which after disaster not only relates to issues of direct physical threat but more nuanced perceptions of threat such those relating to issues like loss of predictability and control, perceptions of vulnerability, and violations of expectations about how the world is ‘meant’ to be. This autonomic nervous system response is designed to help individuals defend themselves in a threatening situation by engaging a series of physiological responses such as increased heart rate, muscle tension, breathing and alertness, as well as responses such as increased sweating to cool the body.
The emotion of anger may be experienced along a continuum from feelings of mild annoyance and irritation to frustration, anger, rage and fury. Often anger is driven by other negative emotions such as hurt, fear, disappointment, worry, anxiety, embarrassment or frustration. At the most extreme end of the continuum, rage and fury may be accompanied by a desire to hurt, punish or control others, to ‘teach others a lesson’ and establish dominance. At this level extremes of anger may tip into the use of violence.
Typically, angry responses are prompted by interpretations of an event or series of events. When anger is problematic, angry thoughts are often based on the perception of injustice. Angry thoughts may be ruminated on, with a repeating cycle of negative thoughts that occur over and over again. Angry thoughts that are ruminated on cause the emotion of anger to intensify, which in turn leads to more angry thoughts and more anger. In this way, a person may stay stuck in an angry cycle.
When people are angry they tend to act in particular ways. Some people become sullen and withdrawn, others become physically or verbally aggressive or behave impulsively. Some people, when angry, behave more adaptively. They may remove themselves from a situation in which their anger threatens to escalate to an uncontrollable level, or they may use problem-solving or helpful communication strategies.
Consider offering individuals the handout in the resources below: Understanding Anger Handout.
Most helpful anger management strategies focus either on reducing the experience of anger in the first place, or responding more adaptively in the moment when anger is high or close to its peak. All helpful strategies are based on increasing understanding of anger triggers and typical responses, and assisting the individual to be more proactive in their use of coping strategies. Preparation and practice is key, as are learning and practising more effective ways of expressing anger and solving problems. Anger often builds within situations and many people are unaware of their anger signals. Coping strategies are easier to implement at lower levels of anger. Therefore, anger management strategies tend to prioritise identifying anger triggers and intervening early with more helpful strategies before anger escalates.
Techniques designed to assist with anticipating and proactively preparing to manage anger involve the following:
1. Understanding what it is that triggers anger
Encourage individuals to identify their triggers and symptoms of anger, especially physiological ones, and, if necessary, to leave the triggering situation. Encourage individuals to acknowledge to themselves and others that a particular issue has caused them to be angry. Regular use of monitoring forms assists this process.
2. Reducing general stress levels
In the aftermath of disaster stress levels may be high. Stress makes most people more prone to angry outbursts. When stressed, tolerance for daily hassles is reduced and even relatively minor annoyances may take on major significance, pushing a person closer to or over their anger threshold. Reducing overall stress levels allows a greater capacity to cope with situations that trigger anger. To combat stress, and therefore manage anger more proactively, it is important that individuals build relaxation into their lives. A range of strategies may be explored, the selection of which will be based on user preference. Helpful strategies include the use of controlled breathing and relaxation techniques, medication and mindfulness-based stress reduction strategies, as well as some of the activities listed below.
3. Paying attention to thoughts
Certain thoughts and thinking styles are more common in anger. Encouraging individuals to complete monitoring forms can lead to productive conversations aimed at challenging unhelpful thinking styles and developing more balanced thinking. While advanced cognitive therapy techniques aimed at identifying, challenging and replacing unhelpful thinking styles are often best conducted by specialist mental health practitioners competent in the use of cognitive therapy, identifying and discussing these issues may be useful.
Unhelpful thinking patterns can include the following:
4. Leaving the situation
Sometimes, and in spite of the use of a range of the strategies discussed here, anger escalates and may be entirely unproductive. The ‘Stop, Breathe, Leave‘ strategy may be effectively employed during an angry encounter. Encourage the person to say the word ‘stop’ to themselves, or visualise a stop sign. This will short-circuit their automatic response. The next step is to encourage the use of controlled breathing. The ‘breathe’ instruction involves encouragement to take in a few deep breaths to lower arousal levels. This may also be supplemented with the use of distraction strategies. Finally, if the situation threatens to become overwhelming and anger continues, individuals are encouraged to ‘leave’. Encourage a person to physically remove themselves from the situation. If possible, walking or doing some exercise can reduce physical arousal. Please see the Anger Management Strategies handout
Establish realistic expectations for change. Depending on the frequency, intensity or duration of angry episodes, changes may take several weeks to become obvious. In post-disaster periods the stressors associated with ongoing attempts to rebuild life may result in prolonged periods of frustration, irritability and anger, so anger management techniques may need to be employed for prolonged periods of time. Increased insight and regular practice of helpful coping strategies should be emphasised as necessary to the process of coping. Encouragement to write down information in the anger monitoring form will enable increased identification of patterns and situations in which anger is more likely, as well as the strategies that each individual finds more helpful. Monitoring may also assist in identification of difficult situations that may be discussed with the health practitioner.
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