Anger in the aftermath of disaster

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:

• they feel angry a lot of the time
• their anger involves verbal, emotional, physical or psychological abuse of those around them
• they think the only way to get what they want is to be angry
• their level of anger is out of proportion to the trigger that set it off
• they feel anxious, remorseful or depressed about their anger
• they use substances to manage their anger
• their anger is causing problems with their personal or work relationships, their health, or the law
• it takes a long time for their anger to subside after the triggering situation has passed
• their anger interferes with sleep
• their anger causes negative consequences, such as making it difficult to participate in the activities they need to participate in in order to rebuild their lives.

The DAR-5 is a self-report screening instrument that can help assess whether anger is at a problematic level.

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:

• an acute or ‘explosive’ reaction, and is often accompanied by physical components
• a prolonged anger or resentment, often accompanied by rumination (i.e., the reprocessing of negative thoughts over and over again) and faulty thinking.

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.

Physiological
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.

Emotional
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.

Thoughts
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.

Behavioural
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 Understanding Anger Handout.

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. View this Anger Monitoring Form.

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.

• a. Tension reduction strategies
  • See the toolkit titled Managing Difficult Emotions for a variety of self-help tension reduction and distraction strategies.
• b. Exercise
  • Physical exercise uses up the extra reserves of energy generated by activation of the fight-or-flight response. Physiological arousal increases during exercise then drops substantially when exercise is finished. This, in combination with the secretion of endorphins, helps the body to relax. Regular vigorous exercise is a powerful way to help reduce anger levels.
• c. Assertive communication
  • In the aftermath of disaster, many problems need to be solved, which often requires communication with a wide range of individuals and institutions such as government departments, insurance companies and banks, to name a few. This can be very frustrating and many people will experience irritability and anger as a result. Where disaster impacted individuals experience unproductive anger during these communications, or angry responses that do not support achievement of their goals, encourage them to consider alternative ways to communicate in the situation. For example, practising what needs to be said before a telephone call, reading from notes while talking to help stay focussed, writing a letter rather than making a telephone call, may all be helpful. Strategies should be selected on a case-by-case basis.
• d. Structured problem-solving
  • Often many problems need to be solved in the aftermath of disaster, and levels of distress and the weight of the demands inherent in the recovery process may be significant. Some individuals come to the situation with limited awareness of problem solving strategies, while others may forget to employ their usual strategies as a result of feeling overwhelmed. In both cases the use of structured problem solving strategies may be helpful. Here the health practitioner can guide the disaster impacted individual through the process rather than telling them what to do. Telling the frustrated and angry individual what to do can compound feelings of disempowerment and lead to escalations in distress.
  • Further, where the disaster impacted individual experiences irritability or anger as a result of perceived injustice, it may be helpful to think about constructive actions that can be taken to redress the situation. Where situations can be constructively addressed or resolved, even partially, problem-solving strategies can be important tools in working out the best course of action.
• e. Letting it go
  • Sometimes there is nothing that can be done to change a situation. At other times, the chance of achieving a just solution is small, while the cost of pursuing the solution is high. It may be better to practise ‘acceptance’ that the situation ‘is what it is’.
• f. Self-calming statements
  • Self-calming statements can be helpful when contemplating having to engage in a situation in which an angry response is predicted or likely. It is helpful to develop self-calming statements to be used before, during and after provoking situations. These statements can be written down on cards or set as reminders on smart phones, and individuals can read them when needed. Examples of self-calming thoughts include:
    • before: “If I feel myself getting angry, I’ll know what to do.”
    • during: “Stay calm, I’m OK, he is not attacking me personally.”
    • after: “I’m getting better at controlling my anger. I can do this.”

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:

• entitlement fallacy: “I want something very much, therefore I deserve it.”
• fairness fallacy: “There is an absolute standard of fairness.”
• change fallacy: “We can control and change others.”
• conditional assumption fallacy: another’s behaviour reflects their intentions
• people should be punished: “When someone hurts me, they should be punished.”
• good-bad dichotomising: “People are right or wrong.”
• mind-reading: we assume the intent of someone’s behaviour or that we know what they are thinking
• magnifying: the negative consequences are exaggerated
• blaming: “It’s his fault I’m in this predicament.”

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. View this Managing Anger 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.

Recommended reading list:

• Deffenbacher, J. L. (2011). Cognitive-behavioral conceptualization and treatment of anger. Cognitive and Behavioral Practice, 18(2), 212-221.
• Elwood, L. S., Soper, J. N., & Olatunji, B. O. (2014). Anger management techniques The encyclopedia of clinical psychology: John Wiley & Sons, Inc.
• Potter-Efron, R. T. (2005). Handbook of anger management: Individual, couple, family, and group approaches. New York, NY: Haworth Press.