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Anger-management programs are springing up to meet societal needs for reducing anger and aggression. Individuals with anger problems may volunteer for such programs or may attend them as part of agreements for continued employment, school attendance, probation, and the like. This article outlines several issues and suggestions for providing anger-management programs.
Use research-supported interventions, and tailor them to user needs. Anger-reduction research is relatively new compared with research on reducing anxiety and depression. Anger-reduction research is hampered by the absence of DSM-IV diagnostic criteria for anger and reasonably well-established outcome measures. Most anger-reduction programs and classes in the community have not been adequately evaluated. Nonetheless, controlled outcome research to date shows anger-management programs are generally effective and better than no intervention. Positive findings support (1) relaxation interventions providing skills to reduce emotional and physiologic arousal; (2) cognitive interventions changing anger-engendering attitudes, beliefs, and self-talk; (3) social/communication/assertion skills programs developing alternative ways of handling situations to abort or reduce anger and negative interactions; and (4) combinations of these.
Thus, a research base from which to develop programs exists. Program developers consulting a study relevant to their needs should contact the study's authors and ask for treatment manuals or outlines, and some treatment protocols and accompanying manuals are available commercially.''
Anger-management programs are not one-size-fits-all, however. Programs for anger-involved medical patients, angry-abusive parents, angry youth referred by schools, and angry drivers may differ appropriately. The contexts of anger, forms of expression involved, and consequences of anger differ in these populations. Needed skills and strategies for effective anger reduction are also likely to differ. Client characteristics should be assessed and programs should be designed to address these specific needs.
Consider group therapy. Research shows anger management can be done effectively in groups. Groups are efficient and offer opportunities for sharing, discussion, feedback, and flexibility for rehearsing anger-reduction strategies. Unless legal, ethical, and therapeutic considerations argue against it, a group should be considered. While groups offer many advantages, it is important that they not degenerate into complaint sessions or settings in which anger is reinforced rather than reduced.
Allot time for practice. Information about anger-management strategies is often insufficient for change. Clients often need repeated practice and personalization therefore anger-reduction skills become applied readily. Time and attention within and between sessions should be devoted to active rehearsal of anger-management skills. For example, within sessions clients might visualize anger-arousing situations, become angry momentarily, and then rehearse anger-reduction
Strategies. Between sessions clients can apply anger-reduction skills and record their efforts. This homework can be discussed and integrated into the next session.
It is easy for this practice component to be lost in anger-management classes. In an effort to ensure all the material is covered, leaders often include more information and eliminate or dramatically reduce application and rehearsal activities. Staff should resist adding more information at the expense of practice. Increasing the length or number of sessions should be considered before jettisoning this important element of effective anger reduction.
Consider coexisting problems. Many people with anger problems have other coexisting problems. For example, angry- abusive parents may benefit from anger management but may also need information about reasonable, developmentally appropriate expectations and parenting skills. Anger management may play an important role, but other interventions and/or referrals may be necessary.
Address resistance and readiness. Individuals with anger problems often feel they are being told they are wrong, they are the problem and they, not others, must change. They may react defensively, discount anger management, resist change and, in some cases, terminate participation prematurely. Anger reduction programs should address this resistance. For example, therapists need not agree with everything an angry client says, but they should listen carefully and communicate an understanding of perceived injuries, losses, and injustices. If relaxation interventions are employed, introduce them early, because they reduce resistance and build the therapeutic alliance.
Some clients acknowledge problems with anger and are ready for interventions focusing on anger reduction. Others are not ready; anger is not their problem, they claim—others are to blame. Anger is denied, minimized, and/or externalized. Anger and aggression are seen as reasonable, justified responses. No matter how much anger is seen as a problem by others, such individuals do not see their anger as a personal problem in need of change. However, they may be sent or mandated to an anger-management program. Mixing them into anger-reduction programs is frustrating to them and those trying to learn anger-reduction strategies and often undermines the program's effectiveness. Client readiness should be assessed and programs should be developed specifically to address issues associated with low client readiness for change. For example, angry individuals who externalize anger and blame might receive an intervention focusing on self-monitoring of anger episodes, identifying short- and long-term positive and negative consequences of their anger and confronting beliefs that they should not be exposed to, experience, or have to cope with frustrating events.
Reflection Exercise #8