Overview of Group Anger Management Treatment

Group Rules

1. Group Safety: No violence or threats toward staff and other group members is allowed. It is important that members perceive the group as a safe place to share their experiences and feelings without threats or possible physical harm.
2. Confidentiality: Group members should not discuss outside the group what group members say during group sessions. There are limits to confidentiality, however. In every State, health laws govern how and when professionals must report certain actions to the proper authorities. These actions may include any physical or sexual abuse inflicted on a child younger 8 Anger Management for Substance Abuse and Mental Health Clients than age 18, a person older than age 65, or a dependent adult. A dependent adult is someone between 18 and 64 years who has physical or mental limitations that restrict his or her ability to carry out normal activities or to protect his or her rights. Reporting abuse of these persons supersedes confidentiality laws involving clients and health professionals. Similarly, if a group member makes threats to physically harm or kill another person, the group leader is required, under the Tarasoff Ruling (Tarasoff v. Regents of the University of California, 529 P.2d 553 (Cal. 1974), vacated, reheard en bank, and affirmed, 131 Cal. Rptr. 14, 551 P.2d 334 (1976)), to warn the intended victim and notify the police.
3. Homework Assignments: Brief homework assignments will be given each week. Doing the homework assignments will improve group members’ anger management skills and allow them to get the most from the group experience. Like any type of skill acquisition, anger management requires time and practice. Homework assignments provide the opportunity for skill development and refinement.
4. Absences and Cancellations: Members should call or otherwise notify the group leader in advance when they cannot attend a session. Because of the amount of material presented in each session, members may not miss more than 3 of the 12 sessions. If a group member misses more than three sessions, he or she would not be able to adequately learn, practice, and apply the concepts and skills that are necessary for effective anger management. He or she can continue to attend the group sessions, but the group member will not receive a certificate of completion. He or she can join another session as space becomes available.
5. Timeout: The group leader reserves the right to call for a timeout. If a group member’s anger begins to escalate out of control during a session, the leader will ask that member to take a timeout from the topic and the discussion. This means that the member, along with the rest of the members of the group, will immediately stop talking about the issue that is causing the member’s anger to escalate. If the participant’s anger has escalated to the point that he or she cannot tolerate sitting in the group, the leader may ask the person to leave the group for 5 or 10 minutes or until he or she can cool down. The participant is then welcomed back to the group, provided he or she can tolerate continued discussion in the group.
   A timeout is an effective anger management strategy and will be discussed in more detail later in this session and in session 3. Eventually, group members will learn to call a timeout themselves when they feel they may be losing control as the result of escalation of their anger. For this session, however, it is essential that the leader calls for a timeout and that members comply with the rule. This rule helps ensure that the group will be a safe place to discuss and share experiences and feelings. Therefore, failure to comply with the timeout rule may lead to termination from the group.
6. Relapses: If a participant has a relapse during his or her enrollment in the group, he or she is not discharged. However, if the participant has repeated relapses, he or she will be asked to start the treatment again and will be referred to a more intense treatment setting.

The Problem of Anger: Some Operational Definitions

In the most general sense, anger is a feeling or emotion that ranges from mild irritation to intense fury and rage. Anger is a natural response to those situations where we feel threatened, we believe harm will come to us, or we believe that another person has unnecessarily wronged us. We may also become angry when we feel another person, like a child or someone close to us, is being threatened or harmed. In addition, anger may result from frustration when our needs, desires, and goals are not being met. When we become angry, we may lose our patience and act impulsively, aggressively, or violently.

[Question #8. Which of the following is a natural response to those situations where we feel threatened, we believe harm will come to us, or we believe that another person has unnecessarily wronged us:]

People often confuse anger with aggression. Aggression is behavior that is intended to cause harm to another person or damage property. This behavior can include verbal abuse, threats, or violent acts. Anger, on the other hand, is an emotion and does not necessarily lead to aggression. Therefore, a person can become angry without acting aggressively. A term related to anger and aggression is hostility. Hostility refers to a complex set of attitudes and judgments that motivate aggressive behaviors. Whereas anger is an emotion and aggression is a behavior, hostility is an attitude that involves disliking others and evaluating them negatively.

[Question #9. Anger is an emotion that does not necessarily lead to aggressive behavior.]
[Question #10. A complex set of attitudes and judgments that motivate aggression is:]

In this group, clients will learn helpful strategies and techniques to manage anger, express anger in alternative ways, change hostile attitudes, and prevent aggressive acts, such as verbal abuse and violence.

When Does Anger Become a Problem?

Anger becomes a problem when it is felt too intensely, is felt too frequently, or is expressed inappropriately. Feeling anger too intensely or frequently places extreme physical strain on the body. During prolonged and frequent episodes of anger, certain divisions of the nervous system become highly activated. Consequently, blood pressure and heart rate increase and stay elevated for long periods. This stress on the body may produce many different health problems, such as hypertension, heart disease, and diminished immune system efficiency. Thus, from a health standpoint, avoiding physical illness is a motivation for controlling anger.

Another compelling reason to control anger concerns the negative consequences that result from expressing anger inappropriately. In the extreme, anger may lead to violence or physical aggression, which can result in numerous negative consequences, such as being arrested or jailed, being physically injured, being retaliated against, losing loved ones, being terminated from a substance abuse treatment or social service program, or feeling guilt, shame, or regret.

Even when anger does not lead to violence, the inappropriate expression of anger, such as verbal abuse or intimidating or threatening behavior, often results in negative consequences. For example, it is likely that others will develop fear, resentment, and lack of trust toward those who subject them to angry outbursts, which may cause alienation from individuals, such as family members, friends, and coworkers.

Payoffs and Consequences

The inappropriate expression of anger initially has many apparent payoffs. One payoff is being able to manipulate and control others through aggressive and intimidating behavior; others may comply with someone’s demands because they fear verbal threats or violence. Another payoff is the release of tension that occurs when one loses his or her temper and acts aggressively. The individual may feel better after an angry outburst, but everyone else may feel worse.

In the long term, however, these initial payoffs lead to negative consequences. For this reason they are called “apparent” payoffs because the long-term negative consequences far outweigh the short-term gains. For example, consider a father who persuades his children to comply with his demands by using an angry tone of voice and threatening gestures. These behaviors imply to the children that they will receive physical harm if they are not obedient. The immediate payoff for the father is that the children obey his commands. The long-term consequence, however, may be that the children learn to fear or dislike him and become emotionally detached from him. As they grow older, they may avoid contact with him or refuse to see him altogether.

[Question #11. The apparent payoffs of anger are:]

Myths About Anger

Myth #1: Anger Is Inherited. One misconception or myth about anger is that the way we express anger is inherited and cannot be changed. Sometimes, we may hear someone say, “I inherited my anger from my father; that’s just the way I am.” This statement implies that the expression of anger is a fixed and unalterable set of behaviors. Evidence from research studies, however, indicates that people are not born with set, specific ways of expressing anger. These studies show, rather, that because the expression of anger is learned behavior, more appropriate ways of expressing anger also can be learned.

It is well established that much of people’s behavior is learned by observing others, particularly influential people. These people include parents, family members, and friends. If children observe parents expressing anger through aggressive acts, such as verbal abuse and violence, it is very likely that they will learn to express anger in similar ways. Fortunately, this behavior can be changed by learning new and appropriate ways of anger expression. It is not necessary to continue to express anger by aggressive and violent means.

Myth #2: Anger Automatically Leads to Aggression. A related myth involves the misconception that the only effective way to express anger is through aggression. It is commonly thought that anger is something that builds and escalates to the point of an aggressive outburst. As has been said, however, anger does not necessarily lead to aggression. In fact, effective anger management involves controlling the escalation of anger by learning assertiveness skills, changing negative and hostile “self-talk,” challenging irrational beliefs, and employing a variety of behavioral strategies. These skills, techniques, and strategies will be discussed in later sessions.

Myth #3: People Must Be Aggressive To Get What They Want. Many people confuse assertiveness with aggression. The goal of aggression is to dominate, intimidate, harm, or injure another person—to win at any cost. Conversely, the goal of assertiveness is to express feelings of anger in a way that is respectful of other people. For example, if you were upset because a friend was repeatedly late for meetings, you could respond by shouting obscenities and name-calling. This approach is an attack on the other person rather than an attempt to address the behavior that you find frustrating or anger provoking.

An assertive way of handling this situation might be to say, “When you are late for a meeting with me, I get pretty frustrated. I wish that you would be on time more often.” This statement expresses your feelings of frustration and dissatisfaction and communicates how you would like the situation changed. This expression does not blame or threaten the other person and minimizes the chance of causing emotional harm. We will discuss assertiveness skills in more detail in sessions 7 and 8.

Myth #4: Venting Anger Is Always Desirable. For many years, the popular belief among numerous mental health professionals and laymen was that the aggressive expression of anger, such as screaming or beating on pillows, was healthy and therapeutic. Research studies have found, however, that people who vent their anger aggressively simply get better at being angry (Berkowitz, 1970; Murray, 1985; Straus, Gelles, & Steinmetz, 1980). In other words, venting anger in an aggressive manner reinforces aggressive behavior.

Anger as a Habitual Response

Not only is the expression of anger learned, but it can become a routine, familiar, and predictable response to a variety of situations. When anger is displayed frequently and aggressively, it can become a maladaptive habit because it results in negative consequences. Habits, by definition, are performed over and over again, without thinking. People with anger management problems often resort to aggressive displays of anger to solve their problems, without thinking about the negative consequences they may suffer or the debilitating effects it may have on the people around them.

Breaking the Anger Habit

Becoming Aware of Anger. To break the anger habit, you must develop an awareness of the events, circumstances, and behaviors of others that “trigger” your anger. This awareness also involves understanding the negative consequences that result from anger. For example, you may be in line at the supermarket and become impatient because the lines are too long. You could become angry, then boisterously demand that the checkout clerk call for more help. As your anger escalates, you may become involved in a heated exchange with the clerk or another customer. The store manager may respond by having a security officer remove you from the store.

The negative consequences that result from this event are not getting the groceries that you wanted and the embarrassment and humiliation you suffer from being removed from the store. Strategies for Controlling Anger. In addition to becoming aware of anger, you need to develop strategies to effectively manage it. These strategies can be used to stop the escalation of anger before you lose control and experience negative consequences. An effective set of strategies for controlling anger should include both immediate and preventive strategies. Immediate strategies include taking a timeout, deep-breathing exercises, and thought stopping. Preventive strategies include developing an exercise program and changing your irrational beliefs. These strategies will be discussed in more detail in later sessions.

[Question #12. An effective set of strategies for controlling anger should include:]

One example of an immediate anger management strategy worth exploring at this point is the timeout. The timeout can be used formally or informally. For now, we will only describe the informal use of a timeout. This use involves leaving a situation if you feel your anger is escalating out of control. For example, you may be a passenger on a crowded bus and become angry because you perceive that people are deliberately bumping into you. In this situation, you can simply get off the bus and wait for a less crowded bus.

The informal use of a timeout may also involve stopping yourself from engaging in a discussion or argument if you feel that you are becoming too angry. In these situations, it may be helpful to actually call a timeout or to give the timeout sign with your hands. This lets the other person know that you wish to immediately stop talking about the topic and are becoming frustrated, upset, or angry.

In this group, you should call a timeout if you feel that your anger is escalating out of control. You also are encouraged to leave the room for a short period of time if you feel that you need to do so. However, please come back for the remainder of the group session after you have calmed down.

Participant Introductions

At this point, ask group members to give their names, the reasons they are interested in participating in the anger management group, and what they hope to achieve in the group. After each member’s introduction, offer a supportive comment that validates his or her decision to participate in the group. Experience shows that this helps members feel the group will meet their needs and helps reduce the anxiety associated with the introductions and the first group session in general.

Anger Meter

One technique that is helpful in increasing the awareness of anger is learning to monitor it. A simple way to monitor anger is to use the “anger meter.” A 1 on the anger meter represents a complete lack of anger or a total state of calm, whereas a 10 represents a very angry and explosive loss of control that leads to negative consequences. Points between 1 and 10 represent feelings of anger between these extremes. The purpose of the anger meter is to monitor the escalation of anger as it moves up the scale. For example, when a person encounters an anger-provoking event, he or she does not reach a 10 immediately, although it may sometimes feel that way. In reality, the individual’s anger starts at a low number and rapidly moves up the scale. There is always time, provided one has learned effective coping skills, to stop anger from escalating to a 10.

One difficulty people have when learning to use the anger meter is misunderstanding the meaning of a 10. A 10 is reserved for instances when an individual suffers (or could suffer) negative consequences. An example is when an individual assaults another person and is arrested by the police.

A second point to make about the anger meter is that people may interpret the numbers on the scale differently. These differences are acceptable. What may be a 5 for one person may be a 7 for someone else. It is much more important to personalize the anger meter and become comfortable and familiar with your readings of the numbers on the scale. For the group, however, a 10 is reserved for instances when someone loses control and suffers (or could suffer) negative consequences.

Homework Assignment

Have group members refer to the participant workbook. Ask them to review the group’s purpose, rules, definitions of anger and aggression, myths about anger, anger as a habitual response, and the anger meter. Ask them to monitor their levels of anger on the anger meter during the upcoming week and report their highest level of anger during the Check-In Procedure of next week’s session.