Understanding, Assessing and Treating Anger

Overview of anger management

Anger management refers to the process of learning to recognise and control feelings of anger, and to respond to situations in a healthy and appropriate manner. This process involves a variety of techniques, ranging from cognitive and behavioural approaches to relaxation and stress reduction techniques.For mental health clinicians, a comprehensive understanding of anger management is crucial in helping clients identify and address the underlying causes of their anger, as well as in providing effective treatments for managing their anger.One important aspect of anger management is the identification of triggers or situations that cause feelings of anger to arise. This can involve exploring past experiences or events that may have contributed to the development of anger problems, as well as examining current stressors or relationship issues that may be fuelling anger.

What is anger?

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Text Revision (DSM-5-TR), published by the American Psychiatric Association, does not include a specific diagnosis for <q>anger.</q>However, it does include descriptions of various mental health disorders that may involve symptoms of anger or aggressive behaviour, such as Intermittent Explosive Disorder (IED), Conduct Disorder (CD), and Oppositional Defiant Disorder (ODD).Intermittent Explosive Disorder is characterised by repeated, impulsive outbursts of aggressive behaviour or verbal anger that are out of proportion to the situation. These outbursts may cause physical harm to others or result in damage to property.Conduct Disorder is a childhood-onset disorder characterised by persistent patterns of aggressive, destructive, and deceitful behaviour that violate the rights of others or societal norms.Oppositional Defiant Disorder is a childhood-onset disorder characterised by a pattern of defiant, disobedient, and hostile behaviour toward authority figures.Note that while these disorders may involve symptoms of anger or aggression, they may have different causes and require different treatments. As such, the definition of <q>anger</q> as it is commonly used in clinical practice often goes beyond the narrow definitions provided by the DSM-5-TR.

What are the symptoms of anger?

Anger is a normal and natural emotion, but when it becomes intense, frequent, and uncontrolled, it can be a problem. The following are common symptoms of anger:<ul><li>Physical symptoms: These can include increased heart rate, muscle tension, headaches, and a feeling of tightness in the chest.</li><li>Verbal expressions: Outbursts of yelling or shouting, name-calling, or making threats are common expressions of anger.</li><li>Aggressive behaviour: Physical expressions of anger can include hitting, throwing objects, or engaging in destructive behaviour.</li><li>Irritability: Persistent feelings of frustration, annoyance, or being easily annoyed.</li><li>Difficulty controlling emotions: Feeling like one's anger is out of control and unable to be managed.</li><li>Negative thoughts and beliefs: Thoughts such as <q>I'm always being treated unfairly</q> or <q>people are always doing things to annoy me</q> can contribute to feelings of anger.</li><li>Avoidance behaviours: Attempting to avoid situations or people that trigger feelings of anger.</li></ul>

Anger is a normal human emotion and occasional experiences of it are not necessarily a problem. However, when anger is intense, frequent, and interferes with daily functioning, it may indicate an underlying problem with anger management that requires treatment.

How to diagnose when anger management help is needed

Anger management issues are typically diagnosed by a mental health professional, such as a psychologist, psychiatrist, or licensed clinical social worker. The process usually involves a comprehensive evaluation, which can include:

Based on the results of these evaluations, the mental health professional can determine whether the person has anger management issues and develop a diagnosis and treatment plan. In some cases, additional assessments, such as neuropsychological testing, may be necessary to fully understand the causes of the anger and determine the best course of treatment.

1
Clinical interview

The mental health professional will ask the individual questions about their symptoms, experiences, and behaviours related to anger.
2
Psychological assessment:

The professional may use standardised questionnaires, self-report measures, or behavioural observations to assess the frequency, intensity, and triggers of the person’s angry outbursts.
3
Medical evaluation:

To rule out any underlying medical conditions that could be contributing to the anger, the mental health professional may refer the individual for a physical examination or medical tests.
4
Mental health history:

The mental health professional may ask the client about their past experiences, including childhood experiences, family history, and any previous mental health diagnoses.

Common treatment approaches for anger management issues

There are several effective treatment options to help clients manage their anger, including:

The type of treatment that is best for the client will depend on the specific symptoms and circumstances. A mental health professional can help the person determine the best course of treatment for their anger management issues.

1
Cognitive-behavioural therapy (CBT):

CBT is a type of therapy that focuses on helping individuals recognise and change negative thought patterns and behaviours. In the context of anger management, CBT can help individuals identify the triggers of their anger, learn to regulate their emotions, and develop more constructive coping strategies.
2
Mindfulness-based approaches:

Mindfulness-based approaches, such as mindfulness meditation, can help individuals manage their emotions by increasing their awareness of the present moment and reducing stress and anxiety.
3
Relaxation techniques:

Relaxation techniques, such as deep breathing, progressive muscle relaxation, and visualisation, can help individuals reduce physical and emotional tension and calm down when they feel angry.
4
Medication

In some cases, medication, such as antidepressants or beta-blockers, may be prescribed to help manage anger. However, medication should only be used as part of a comprehensive treatment plan and under the supervision of a mental health professional.
5
Group therapy:

Group therapy can provide a supportive and educational environment for individuals to learn about anger management and practice coping strategies with others who are experiencing similar challenges.
6
Lifestyle changes:

Making changes to lifestyle, such as improving sleep and nutrition, engaging in physical activity, and reducing substance use, can help reduce stress and improve overall wellbeing, which can in turn reduce anger.

Best practice treatment guides for helping clients learn anger management

These best practice treatment guides are designed to provide general guidance and may not be appropriate for all individuals. A mental health professional can help the client determine the best treatment approach for their specific needs and circumstances.

There are several best practice treatment guides for clients with anger management issues that are based on empirical evidence and clinical expertise. Some of the most widely used and respected include:

The American Psychological Association's (APA) Practice Guidelines for the Psychological Treatment of Patients with Anger and Aggression

This guide provides a comprehensive overview of the assessment and treatment of anger and aggression, including a review of the latest research and evidence-based practices.

The National Institute for Health and Care Excellence (NICE) Guidelines for the Treatment of Anger Problems

This guide provides recommendations for the treatment of anger problems, including the use of cognitive-behavioural therapy (CBT) and mindfulness-based approaches.

The Substance Abuse and Mental Health Services Administration's (SAMHSA) Treatment Improvement Protocol (TIP) 51

This guide provides an overview of effective treatment approaches for individuals with substance abuse and mental health problems, including those of anger management.

The International Society for Traumatic Stress Studies (ISTSS) Clinical Guidelines for the Treatment of Traumatic Stress

This guide provides recommendations for the treatment of trauma-related symptoms, including anger, aggression, and irritability.

Common comorbidities with anger

Anger management issues often occur in conjunction with other mental health conditions, known as comorbidities. Some of the most common comorbidities associated with anger  include:<ul><li>Depression: Depression and anger can be closely linked, as individuals with depression may experience feelings of hopelessness, irritability, and frustration.</li><li>Anxiety disorders: Individuals with anxiety disorders may experience intense feelings of worry, fear, and anger, which can lead to angry outbursts.</li><li>Substance abuse: Substance abuse, particularly the use of alcohol or drugs, can increase the likelihood of angry outbursts and violent behaviour.</li><li>Personality disorders: Individuals with personality disorders, such as borderline personality disorder or antisocial personality disorder, may experience intense and uncontrolled anger.</li><li>Post-traumatic stress disorder (PTSD): Individuals with PTSD may experience angry outbursts as a result of their traumatic experiences.</li><li>Attention deficit hyperactivity disorder (ADHD): Individuals with ADHD may have difficulty controlling their impulsive behaviours, including angry outbursts.</li></ul>

Importantly, these comorbidities can interact with one another and exacerbate each other, making it more difficult to effectively manage anger. A mental health professional can help the individual determine whether they have any comorbidities and develop a comprehensive treatment plan that addresses all of the person’s mental health needs.

MHA courses on anger management

<ul><li><a target='_blank' href='https://www.mentalhealthacademy.com.au/catalogue/courses/helping-clients-deal-with-problem-anger-understanding-and-de-escalating-anger'>Helping Clients Deal with Problem Anger: Understanding and De-escalating Anger</a></li><li><a target='_blank' href='https://www.mentalhealthacademy.com.au/catalogue/courses/helping-clients-deal-with-problem-anger-specific-interventions'>Helping Clients Deal with Problem Anger: Specific Interventions</a></li><li><a target='_blank' href='https://www.mentalhealthacademy.com.au/catalogue/courses/solution-focused-narrative-therapy-with-a-mother-and-daughter'>Solution-Focused Narrative Therapy with a Mother and Daughter</a></li><li><a target='_blank' href='https://www.mentalhealthacademy.com.au/catalogue/courses/supporting-clients-who-self-harm'>Supporting Clients Who Self-harm</a></li><li><a target='_blank' href='https://www.mentalhealthacademy.com.au/catalogue/courses/brain-changes-after-emotional-freedom-techniques-tapping-for-chronic-pain'>Brain Changes After Emotional Freedom Techniques (‘Tapping’) for Chronic Pain</a></li><li><a target='_blank' href='https://www.mentalhealthacademy.com.au/catalogue/courses/solution-focused-narrative-therapy-with-an-adolescent'>Solution-Focused Narrative Therapy with an Adolescent</a></li></ul>

Frequently asked questions about anger management

What strategies can a patient use to manage their anger in daily life?

There are several strategies that individuals can use to manage their anger in daily life, including:<ul><li>Deep breathing: Deep breathing can help a person calm down and reduce physical tension when they're feeling angry. Professionals can help the client learn to take slow, deep breaths and count to ten before responding to a triggering situation.</li><li>Progressive muscle relaxation: Progressive muscle relaxation is a technique that involves tensing and then relaxing different muscle groups to reduce physical tension.</li><li>Mindfulness: Mindfulness involves paying attention to the present moment and accepting one’s thoughts and feelings without judgment. This can help reduce anger by increasing a person’s awareness of their emotions and reducing stress and anxiety.</li><li>Cognitive restructuring: Cognitive restructuring involves changing negative thought patterns that contribute to anger. The professional can help the client learn to identify and challenge any irrational or exaggerated thoughts that trigger their anger.</li><li>Problem-solving: When faced with a frustrating situation, the client can focus on finding a solution rather than getting angry. Breaking the problem down into smaller parts and thinking about possible solutions can help.</li><li>Communication skills: Mental health professionals and other educator-helpers can improve the client’s communication skills by teaching them how to use <q>I statements</q> and expressing feelings in a calm and assertive manner. Part of this is listening actively to others and avoiding engaging in arguments.</li><li>Physical activity: Regular physical activity can help reduce stress and improve overall wellbeing, which can in turn reduce anger.</li><li>Time management: Poor time management can increase stress and contribute to feelings of anger. Prioritising tasks and managing time more effectively are crucial here in reducing stress.</li></ul>Naturally, everyone is different and what works for one person may not work for another. It may take some time and experimentation to find what strategies work best for a given client. The role of the mental health professional is also to provide guidance and support as the client works to manage their anger.

What therapeutic approaches are most effective in treating patients with anger management issues?

There are several therapeutic approaches that have been shown to be effective in treating individuals with anger management issues. Some of these include:<ul><li>Cognitive-behavioural therapy (CBT): CBT is a type of therapy that focuses on helping individuals recognise and change negative thought patterns and behaviours. In the context of anger management, CBT can help individuals identify the triggers of their anger, learn to regulate their emotions, and develop more constructive coping strategies.</li><li>Mindfulness-based approaches: Mindfulness-based approaches, such as mindfulness meditation, can help individuals manage their emotions by increasing their awareness of the present moment and reducing stress and anxiety.</li><li>Relaxation techniques: Relaxation techniques, such as deep breathing, progressive muscle relaxation, and visualisation, can help individuals reduce physical and emotional tension and calm down when they feel angry.</li><li>Group therapy: Group therapy can provide a supportive and educational environment for individuals to learn about anger management and practice coping strategies with others who are experiencing similar challenges.</li><li>Family therapy: Family therapy can help individuals with anger management issues to address any underlying family conflicts or relationship issues that may be contributing to their anger.</li></ul>The type of therapy that is best for a given client will depend on the specific symptoms and circumstances. A mental health professional can help the client determine the best course of therapy for their particular anger management issues. Therapy can be combined with other treatments, such as medication, lifestyle changes, and self-help strategies, to achieve the best results.

What are the potential complications of failing to manage anger?

Uncontrolled anger can lead to a range of negative consequences, both for the individual and for those around them. Some of the potential complications of poor anger management include:<ul><li>Physical health problems: Chronic anger and stress can have a negative impact on physical health, including increasing the risk of heart disease, high blood pressure, and headaches.</li><li>Relationships: Uncontrolled anger can damage relationships with family, friends, and co-workers and lead to social isolation.</li><li>Legal problems: Angry outbursts can result in criminal charges, such as assault or property damage, which can have serious legal consequences.</li><li>Career problems: Angry outbursts can impact work performance and lead to disciplinary action or job loss.</li><li>Substance abuse: Individuals with anger management issues may turn to alcohol or drugs to cope with their emotions, which can lead to addiction and further harm.</li><li>Mental health problems: Chronic anger can contribute to the development or worsening of mental health problems, such as depression, anxiety, and post-traumatic stress disorder (PTSD).</li><li>Suicide: In severe cases, uncontrolled anger can lead to thoughts of suicide or self-harm.</li></ul>Individuals struggling with anger management issues need to seek help. A mental health professional can provide support, guidance, and treatment to help the person manage their anger and reduce the risk of these potential complications.

How do anger management problems typically affect an individual's mood, energy levels, and motivation?

Anger management problems can have a significant impact on an individual's mood, energy levels, and motivation, which are affected by anger in these ways:<ul><li>Mood: Intense and uncontrolled anger can result in feelings of irritability, frustration, and anxiety, which can negatively impact mood and overall wellbeing.</li><li>Energy levels: Chronic anger and stress can lead to fatigue and decreased energy levels, as the body expends a lot of energy responding to intense emotions.</li><li>Motivation: Intense anger can interfere with the ability to focus, concentrate, and complete tasks, reducing motivation and productivity.</li></ul>These effects can be compounded by other mental health conditions, such as depression or anxiety, that may co-occur with anger management issues. Effective anger management can help improve mood, increase energy levels, and restore motivation by reducing stress and increasing overall wellbeing. A mental health professional can help a client develop a comprehensive treatment plan to manage their anger and improve their overall mental health.

What are the common physical and cognitive symptoms of anger?

Anger can cause both physical and cognitive symptoms. Some of the common physical symptoms of anger include:<ol><li>Increased heart rate: Intense anger can cause the heart rate to increase, leading to feelings of anxiety and agitation.</li><li>Sweating: Sweating is a common physical response to anger, as the body prepares for a <q>fight or flight</q> response.</li><li>Muscle tension: Intense anger can cause muscle tension, leading to physical discomfort and headaches.</li><li>Stomach ache: Chronic stress and anger can cause digestive problems, including stomach aches and nausea.</li><li>Shaking: Intense anger can cause shaking or tremors, as the body responds to the physical arousal of anger.</li></ol>In addition to physical symptoms, anger can cause cognitive symptoms, including:<ol><li>Racing thoughts: Intense anger can result in racing thoughts and a heightened sense of urgency, making it difficult to think clearly.</li><li>Negative self-talk: Negative self-talk, such as self-criticism or blaming others, can contribute to and perpetuate feelings of anger.</li><li>Distorted thinking patterns: Anger can be associated with distorted thinking patterns, such as black-and-white thinking, blaming others for one’s problems, or overgeneralising.</li></ol>These symptoms can interact with one another and exacerbate each other, making it more difficult to effectively manage anger. Mental health professionals can help clients identify and manage both physical and cognitive symptoms and develop a comprehensive treatment plan to improve overall mental health.

How does uncontrolled anger typically impact sleep, appetite, and sexual functioning?

Intense and uncontrolled anger can have a significant impact on sleep, appetite, and sexual functioning. Some of the ways that anger management issues can affect these areas include:<ul><li>Sleep: Chronic anger and stress can interfere with sleep, leading to insomnia or difficulty falling or staying asleep.</li><li>Appetite: Anger can interfere with appetite, causing overeating or loss of appetite.</li><li>Sexual functioning: Chronic stress and anger can interfere with sexual functioning, leading to decreased libido, erectile dysfunction, or difficulties with sexual performance.</li></ul>These effects can be compounded by other mental health conditions, such as depression or anxiety, that may co-occur with anger management issues. Effective anger management can help improve sleep, appetite, and sexual functioning by reducing stress and increasing overall wellbeing. Mental health professionals can have a prominent role in helping clients to develop a comprehensive treatment plan to manage anger and improve overall mental health.

Do anger management issues increase a patient's likelihood of suicide, and if so, how can a clinician assess suicide ideation?

In severe cases, uncontrolled anger can lead to thoughts of suicide or self-harm. Anger management issues, especially when they are accompanied by other mental health conditions such as depression, can increase the likelihood of suicide.Mental health professionals need to assess for suicide ideation in individuals with anger management issues, as early identification and intervention can save lives. Some of the ways that a clinician can assess suicide ideation include:<ul><li>Direct questioning: Asking the individual directly about thoughts of suicide can provide important information about their level of risk.</li><li>Mental health assessment: A comprehensive mental health assessment can help identify any underlying mental health conditions, such as depression, that may increase the risk of suicide.</li><li>Review of symptoms: A review of symptoms, such as feelings of hopelessness, anxiety, or irritability, can help identify individuals at increased risk for suicide.</li><li>Substance use: Substance abuse, especially alcohol or drug use, can increase the risk of suicide.</li><li>Family history: A review of family history, including any previous suicide attempts, can provide important information about the individual's risk.</li></ul>It is important for mental health professionals to take all potential risk factors into account when assessing suicide ideation and to provide appropriate interventions, such as hospitalisation or referral to a suicide crisis centre, as necessary.

Popular books on anger management

<ul><li>The Anger Trap: Free Yourself from the Frustrations that Sabotage Your Life (2003) by Dr. Les Carter & Frank Minirth</li><li>Anger: Taming a Powerful Emotion (2015) by Gary Chapman</li><li>Rage: A Step-By-Step Guide to Overcoming Explosive Anger (2007) by Ronald T. Potter-Efron</li><li>Letting Go of Anger: The Eleven Most Common Anger Styles and What to Do About Them (2006) by Patricia S. Potter-Efron</li><li>The Cow in the Parking Lot: A Zen Approach to Overcoming Anger (2010) by Leonard Scheff & Susan Edmiston</li><li>Anger: Wisdom for Cooling the Flames (2002) by Thich Nhat Hanh</li><li>The Cognitive Behavioral Workbook for Anger: A Step-by-Step Program for Success (2021) by William J. Knaus</li><li>Angry All the Time: An Emergency Guide to Anger Control (2005) by Ronald T. Potter-Efron</li><li>Mindfulness for Anger Management: Transformative Skills for Overcoming Anger and Managing Powerful Emotions (2018) by Stephen Dansiger</li><li>How to Stop Losing Your Sh*t with Your Kids: Effective Strategies for Stressed Out Parents (2019) by Carla Naumberg</li><li>Healing the Angry Brain: How Understanding the Way Your Brain Works Can Help You Control Anger and Aggression (2012) by Ronald T. Potter-Efron</li><li>Emotional Intelligence: Why It Can Matter More Than IQ (2005) by Daniel Goleman</li></ul>

Recent research on anger management

<ul><li>Harvard Medicine – <a target='_blank' href='https://hms.harvard.edu/magazine/science-emotion/anger-management'>Anger Management</a></li><li>Journal of Counseling Research – <a target='_blank' href='https://irancounseling.ir/journal/article-1-1599-en.html'>The Comparison of Effectiveness of Group Training Anger Management of Girl High School Students</a></li><li>Current Psychology – <a target='_blank' href='https://link.springer.com/article/10.1007/s12144-022-03143-6'>A systematic review of neural, cognitive, and clinical studies of anger and aggression</a></li><li>Neuroscience & Biobehavioral Reviews (vol. 108) – <a target='_blank' href='https://www.sciencedirect.com/science/article/pii/S0149763419302167?via%3Dihub'>The feeling of anger: From brain networks to linguistic expressions</a></li><li>Journal of Consulting and Clinical Psychology – <a target='_blank' href='https://psycnet.apa.org/doiLanding?doi=10.1037%2Fccp0000769'>Targeting maladaptive anger with brief therapist-supported internet-delivered emotion regulation treatments: A randomized control trial</a></li><li>Science Daily – <a target='_blank' href='https://www.sciencedaily.com/news/mind_brain/anger_management/'>Anger Management News</a></li><li>MensLine Australia – <a target='_blank' href='https://mensline.org.au/how-to-deal-with-anger/anger-management-toolkit/'>Anger Management Toolkit</a></li></ul>

References

<ul><li>American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: Fifth edition, text revision. Washington, D.C.: American Psychiatric Association Publishing.</li><li>Gupta, S. (2021). What is anger management therapy? Very Well Mind. Retrieved on 5 April, 2023, from: <a target='_blank' href='https://www.verywellmind.com/anger-management-therapy-definition-techniques-and-efficacy-5192566'>Anger Management Therapy: Definition, Techniques, and Efficacy (verywellmind.com)</a></li><li>Health Direct. (n.d.). Anger management. Health Direct. Retrieved on 5 April, 2023, from: <a target='_blank' href='https://www.healthdirect.gov.au/anger-management'>Anger management - Tips for managing anger and where to get help | healthdirect</a></li><li>Medical News Today. (2018). How can I control my anger? Medical News Today. Retrieved on 5 April, 2023, from: <a target='_blank' href='https://www.medicalnewstoday.com/articles/162035#controlling-anger'>Controlling anger: Tips, treatments, and methods (medicalnewstoday.com)</a></li><li>Stosny, S. (2015). Anger management failures. Psychology Today. Retrieved on 5 April, 2023, from: <a target='_blank' href='https://www.psychologytoday.com/au/blog/anger-in-the-age-entitlement/201505/anger-management-failures'>Anger Management Failures | Psychology Today Australia</a></li></ul>

Understanding, Assessing and Treating Anger

Guidelines, tools and resources for mental health clinicians

Jump to section

Overview of anger management

What is anger?

What are the symptoms of anger?

How to diagnose when anger management help is needed

Clinical interview

Psychological assessment:

Medical evaluation:

Mental health history:

Common treatment approaches for anger management issues

Cognitive-behavioural therapy (CBT):

Mindfulness-based approaches:

Relaxation techniques:

Medication

Group therapy:

Lifestyle changes:

Best practice treatment guides for helping clients learn anger management

Common comorbidities with anger

MHA courses on anger management

Frequently asked questions about anger management

Popular books on anger management

Recent research on anger management

References