|Tutorial: Anger And Anger Management
WHAT ARE ANGER AND ANGER MANAGEMENT TECHNIQUES?
Anger is an emotional state that can be expressed as irritation, at one extreme, or as out-of-control rage at the other extreme, with many shades of behavior falling in between. As with other emotions, there are physiological changes associated with anger, including increased heart rate, flushed face, elevated blood pressure and increased volume of verbal output. Adrenaline may flow with its associated surge in strength. This anger system has value in that it helps people to fight off legitimate threats. However, anger and responses to anger often lead to trouble under everyday circumstances.
Many different events can result in an individual experiencing anger, including both internal events (e.g., perceived failure, frustration, perceived injustice) and external events (e.g., loss of an object or privilege, teasing or threats from others). Anger can result in externalizing behaviors (e.g., lashing out, verbal aggression, tantrums) or internalizing behaviors (e.g., shutting down, withdrawing, sulking, increased depression) or both. Most commonly, individuals respond to anger with aggression, since the biological function of anger is to enable us to fight off threats.
Anger management refers to techniques that individuals can use to regulate their feelings of anger and modulate their responses to those feelings. It also includes techniques that others can use to help the individual avoid situations that elicit or trigger anger and to help calm the person down once angered. These techniques are discussed below.
WHY ARE ANGER AND ANGER MANAGEMENT IMPORTANT FOR SOME STUDENTS AFTER TBI?
Anger and anger management are important issues for many students. However, they are particularly important for students with brain injury for several reasons. First, the part of the brain that modulates our emotional responses the bottom sides of the prefrontal parts of the brain is vulnerable to damage following a in brain injury. As a result, a situation that might make most students at most irritated may well result in a rapid and uncontrolled escalation of anger for the student after the brain injury.
Second, students with brain injury often have reduced ability to correctly “read” social situations and the intent of others’ behavior. When social cues are misread for example, if a student perceives someone making an insulting remark when none was intended the student may understandably feel anger, and based on this an incorrect interpretation, may respond with what seems as excessive or inappropriate levels of anger at the behavior of others.
Third, students with brain often have real losses that they are angry about. For example, they may not do things as well as they are accustomed to doing them; they may have restrictions on their activities that are frustrating; they may have lost friends. In some combination, these changes can easily result in the student feeling heightened levels of frustration and anger.
WHAT ARE THE MAIN THEMES IN INSTRUCTION AND SUPPORT FOR STUDENTS WITH BRAIN INJURY WHO NEED HELP WITH ANGER MANAGEMENT STRATEGIES?
Supports for students to address anger management include proper identification of the anger, behavioral strategies modeled or taught by adults and clinical support for the student in order to learn how to address limitations in a successful fashion. Each of these areas is addressed below:
1. Understanding the Problem: Identification of Anger. The first step in dealing with anger is to ensure that it is truly anger that we are dealing with. Sometimes aggression is interpreted as an anger response, when in fact it is attention seeking or serves some other purpose. It is important to be certain that the observed responses are truly the student’s response to the feeling of anger.
2. Environmental Management: Implementation of Anger Management Approaches by Adults in Authority
a. Removing Clear Provocation for Anger: Teachers and parents should know what the people or events are that typically provoke anger in the student (i.e., “triggers”) and attempt to remove these provocations proactively from the student’s daily routines. As the student become aware of these triggers, removal or minimization of triggers can be gradually turned over to the student to monitor.
[See Tutorial on Behavior Management: Prevention Strategies.]
b. Using Calm Times Wisely: When the student is in an emotionally calm state, adults should find opportunities to talk about difficulty the students have in controlling anger and about the limits that this might impose on what the student can do. These conversations should be balanced with talk of things that are going well, with plans for success, and with opportunities for the student to engage in positive roles that do not involve anger or aggression. Adults can also highlight the positive behavior of others and talk about how they have learned to control their anger and therefore become more successful.
c. Facilitating a Self-Concept Associated with Effective Anger Management: Some students develop a sense of self that includes aggression as a positive component. The student may come to think of himself or herself as a “tough guy” or “tough girl”, and resist efforts at anger management because “that’s not me; I’m a tough guy.” In these cases, it is critical to address the self-concept issue while also addressing anger management. These student may be helped by counseling to develop a sense of self that is compelling, but that also includes control of anger and other emotions as a positive feature. Anger management must be seen as strength, not weakness.
[See Tutorial on Sense of Self.]
3. Anger Management Procedures Acquired By Students In Collaboration With Others: Focused attention by school staff and/or involvement of professional counselors may be necessary to teach students adequate coping skills to deal with anger. Steps include the following:
a. Learning to be assertive versus aggressive: Dangerous responses to angry feelings lie on both ends of a continuum of responses. At one end, the student responds with aggression, lashing out at perceived threats or annoyance. This has obvious negative implications for the student and those around him. At the other end, the student suppresses angry feelings. This likely results in the anger being expressed covertly as passive aggression, cynicism, sarcasm, critical thinking about others or internalized as either physical complaints or depression. Neither of these extreme responses at the ends of the continuum is likely to lead to positive outcomes, like friendship and peer acceptance.
Between these two extremes lie two positive responses to angry feelings, both of which should be fostered. First is assertive (not aggressive) expression of these feelings. The student who is appropriately assertive recognizes his anger and can state why he is upset. These assertions serve the additional purpose of having the student verify that the perceived reason for anger is valid. The assertive student then tries to deal with the anger in a problem solving manner, without losing control. Second, the student may learn techniques to calm himself when angered (discussed below), knowing that in the final analysis, we can only control ourselves..
b. Self-Monitoring: Many students, particularly young children, experience the physiological correlates of anger without knowing what the emotion is, without being able to attach a word to it it is simply a nameless feeling that leads to negative behavior. Young students and older students with significant disability may need to learn that there is a name for these feelings and that we can understand them and even control them. Similarly, many students “catastrophize” small issues into major issues without realizing that they are doing this. They may use absolute or extreme terminology when describing their situation: “I never get a chance” “She always makes fun of me” “I never do anything right” and so on. With counseling, students can become more aware of this distortion in their thinking, the negative effects of their habit, and that “catastrophizing” makes a difficult situation much more difficult. Practice describing the realities of their situation in objective and accurate terms may be useful for these students.
c. Self-Calming: Particularly students who tend to over-react to even mild irritations, should developing a self-script in which they evaluate the seriousness of the situation. For example, students can be taught to ask themselves, “Is this really a big deal or a little deal?” and “Am I sure that what I am doing will help me?” These scripts of self-regulation can be internalized if they are used by others in the environment in a routine manner.
[See Tutorial on Self-Regulation]
d. Learning that One Can Only Control Oneself: For many people, their primary source of anger is what other people do or don’t do. They find the behavior of others to be disrespectful, unfair, unkind, or otherwise irritating, and they react angrily. The most important insight that these students can internalize is that they have no control over the behavior of others, only themselves. Furthermore, if the other person was in fact trying to hurt them in some way, then the anger response makes that other person the winner. Normally it is the student who reacts angrily who gets in trouble with authorities, or becomes very upset, or in some other way suffers a loss from the encounter. To be a winner is to refrain from reacting and therefore frustrating the other person the source of the irritation.
4. Avoid “Letting It All Hang Out”: While some say that it is therapeutic to express anger and just “let it all hang out”, such expression is typically short term and most likely to be counter-productive in the long run. First, it does nothing to address the underlying problem of unmodulated responses to angry feelings. Second, people may be hurt and relationships irreparably damaged.
Written by Mark Ylvisaker, Ph.D. with the assistance of Mary Hibbard, Ph.D. and Timothy Feeney, Ph.D.