Anger management therapy

As with all strong feelings, anger brings with it emotional, mental and physical signs and symptoms. Some signs and symptoms of anger can include but may not be limited to:

• Physical signs and symptoms:
  • Raised blood pressure
  • Raised heart rate
  • Tingling sensation
  • Unconscious tightening of muscles like a clenched fist, a clenched jaw, pulsating temples, flaring of nostrils, etc.
  • Facial flushing and redness
  • Physically feeling hot
  • Increased perspiration
• Emotional signs and symptoms: Anger is a complex emotion that arises in conjunction with a myriad of other feelings that can occur concomitantly, either leading up to, during, or after an episode of anger. These can be:
  • Irritability
  • Frustration
  • Anxiety
  • Rage
  • Stress
  • Overwhelmedness
  • Guilt

While it is possible to describe the feeling of anger, not all anger or aggression is expressed the same way. That is to say, even when some forms of expression of anger may be more visible to observers, other forms that are not visible should not be overlooked and can be just as damaging to the individual’s overall health. Following are some ways people express anger:

• Outward: Anger is expressed with obvious outward aggression. The angry individual may shout, scream, curse, abuse or throw or break objects. They may even get physically violent and abusive towards others. In this medium of expression, the individual expends considerable energy.
• Inward: This form of anger is directed at oneself. The angry individual experiences guilt, self-loathing and self-hate. They often deny themselves things that make them happy as well as their basic needs in an attempt to penalise themselves.
• Passive aggression: In this type of anger expression, instead of obvious acts of aggression, subtle verbal and non-verbal cues are used to display one's anger. Examples of passive-aggressive behaviour can include: 
  • Sulking
  • Giving the instigators or others the silent treatment 
  • Making sarcastic remarks
  • Making snide remarks or jibes

When, due to various reasons (psychological, social, medical, personality-related or otherwise), the instigator or the instigated are not able to employ interpersonal skills or self-control in heated situations, anger issues emerge. Although nearly all people have experienced the feeling of anger at least once in their lives, for some individuals it may become hard to control and they may feel angry more frequently than normal. When anger issues interfere with an individual’s attempt to lead a meaningful and productive life, anger management strategies, techniques, or therapy may be beneficial.

Anger management therapy can be sought from psychotherapists (talk therapists), psychiatrists (a speciality doctor), school counsellors or other therapists specialising in sub-specialities of anger management.

• Cognitive Behavioural Therapy (CBT): Cognitive behavioural therapy (CBT) is a type of talk-based therapy that helps patients identify negative thoughts, emotions and their actions and behaviours in response to them by breaking them down into smaller parts and replacing them with positive ones. When applied to anger management, patients can come to understand why they feel angry and can unlearn harmful thoughts and actions that cause them to react aggressively.
• Psychodynamic therapy: In this form of psychotherapy, with the help of the anger management specialist, the individuals discover the unconscious meanings and motivations behind their actions and responses to anger. By gaining insight into their unconscious thoughts and motivations behind their actions, patients can learn to respond to anger in a manner that does not harm them or their loved ones.
• Group therapy: Individuals who have been suffering from chronic anger and aggression can end up feeling isolated, guilty and even embarrassed. In such cases, sessions led on a weekly or monthly basis by a trained mental health professional in a group setting can make people comfortable enough to open up and benefit from therapy. Learning from other participants' experiences is a key benefit. Coping strategies and mechanisms can also be shared amongst members. This is usually a supplementary form of therapy, secondary to one-on-one sessions. A type of group therapy can be family-based therapy, which can be the most suitable in some cases, like when addressing anger or aggression issues in children or teenagers.
• Play therapy: When treating anger problems in younger children, a special type of psychotherapy delivered by a trained and licensed play therapist can be particularly useful. By using toys, music, puppets and other objects of child’s play, the therapist helps children express and navigate through their emotions. The aim is to help children understand why they feel angry and to help them manage their emotions in a more constructive way. In addition to other anger management therapies targeted towards younger children, is the parent management technique (PMT) which simply requires parents to reward children for good behaviour (reinforcement) but not admonish them for bad behaviour or anger tantrums.

All people experience anger at some point in their lives. However, when anger episodes occur with an unusual frequency or intensity, in response to seemingly inane triggers or impact one’s personal and social life, anger issues can be suspected. Following are some common underlying conditions, circumstances or traits that give rise to these issues; someone experiencing them could benefit from anger management therapy.

• Psychosocial causes: Many factors that bring on undue psychological or social duress can act as triggers for anger. Such factors can be: 
  • Stress
  • Abuse
  • Poor social circumstances
  • Familial conflicts
  • Marital problems
  • Financial hardships or poverty
  • Grief (anger is the second step in the five stages of grief, following denial and leading to bargaining, depression, and acceptance)
• Medical causes: While uncontrolled chronic anger itself gives rise to many health problems like hypertension, some medical conditions (besides psychiatric issues) can be associated with increased aggression and anger. For example:
  • Migraines: Irrespective of the frequency of migraine attacks, an increasingly angry and aggressive demeanour is noted in patients during the episode. Patients who experience migraine with aura are more likely to feel angry than those who do not. 
• Psychiatric causes: Many underlying psychiatric conditions and diagnosable disorders are associated with anger and aggression in patients. Some examples include: 
  • Depressive mood disorders: Major depressive disorder is diagnosed with the presence of low depressed mood and/or loss of interest in everything for at least two weeks or more. Usually, three or more other mood affective criteria need to be present along with the former criteria to establish the diagnosis of major depressive disorder. Although not essential to the diagnosis of depressive mood disorders, anger can be a common accompanying symptom. Anger may be expressed overtly or be kept suppressed by patients. The intensity of anger varies amongst individual patients. (Read more: Seasonal Affective Disorder)
  • Bipolar mood disorders: Another form of mood disorder is bipolar disorder in which the patient experiences, usually alternating, episodes that range from mania to depression. Anger, rage and irritability can be experienced by bipolar patients in either the manic or the depressive phase. The patient’s response and expression of anger can be different depending on the state of their mood.
  • Alcoholism or alcohol abuse: Chronic alcohol abuse has been proven to be linked to raised aggression levels by many research studies. Alcohol impairs rational thinking as well as interferes with an individual’s impulse control – a change similar to that brought about by triggering factors for anger. (Read more: How to quit alcohol)
  • Obsessive-Compulsive Disorder (OCD): Obsessive-compulsive disorder (OCD) is a form of anxiety disorder in which the patient experiences obsessive thoughts and displays compulsive behaviours. A significant portion of people suffering from obsessive-compulsive disorder (OCD) feels anger, which may be directed at themselves for being unable to control obsessive thoughts or their need to carry out repeated compulsive actions. At other times, anger can be directed to an external source or agent that causes an impediment to their ritualistic behaviour and their need to carry out their compulsions. (Read more: Diet for anxiety disorder)
  • Attention Deficit Hyperactivity Disorder (ADHD): It is a type of neurodevelopmental disorder that may be brought on by factors before, during or after the birth of the child. Attention deficit hyperactivity disorder (ADHD) is thought to be associated with maternal consumption of drugs while pregnant, exposure to early childhood trauma and environmental factors. The three main symptoms of ADHD are – lack of attention, hyperactivity and impulsivity. Although ADHD is usually diagnosed in childhood, many cases may remain undiagnosed till adulthood and are then given the misnomer of adult ADHD. Individuals suffering from the disorder, irrespective of their age, experience irritability and short-tempered anger issues.
  • Oppositional Defiant Disorder (ODD): It is a type of behavioural disorder diagnosed in school children that usually begins before the age of eight years and involves disobedience and defiance of authority figures like parents, teachers and other adults. While all children are known to have occasional outbursts, behaviour that lasts for six months or more continuously may be oppositional defiant disorder. These children are known to be easily annoyed and hot-tempered.
  • Intermittent Explosive Disorder (IED): People suffering from this disorder tend to feel angry and irritated most of the time and experience frequent angry episodes of aggressive, impulsive and violent behaviour that is usually disproportionate to the source of annoyance. These episodes usually last less than thirty minutes and the patient tends to feel remorseful and embarrassed after it.
  • Post Traumatic Stress Disorder (PTSD): A person who has witnessed or experienced a traumatic event may experience flashbacks upon perceiving certain stimuli. Symptoms can include physical signs (such as sweating, a rapid heart rate or high blood pressure, etc.), heightened senses and anxiousness. Anger can also be an emotion a person suffering from post-traumatic stress disorder (PTSD) may feel.