When anger complicates recovery

Anger is a big problem for many people and it's often one of the complicating factors for those struggling with addiction. There are lots of reasons for clients to be angry,1 and for many of them it seems as if aggression gets good results with very little downside.

Expressions of anger may feel good, and the media often deliver the message that nice guys finish last. Threatening and intimidating behavior sometimes achieves the immediate goal, and being aggressive takes less thought than being assertive. The latest research points to several ways to be helpful to our angry clients, and also suggests that some things we used to think were helpful aren't.

Harmful practices

One of the discredited practices is venting. Ask an angry person how he or she feels after screaming or pummeling a pillow, and the response is often “much better,” so it is easy to understand how the idea that venting helps gained currency. Elvis probably felt better—at least temporarily—after he shot his television set. But if he did, his feeling was not in line with the reality of his situation. Objectively, he was in no better a situation than he was before the “tele-cide.”

We want to encourage our clients to pursue long-range success, rather than a temporary satisfaction that makes long-term, quality sobriety less likely. Research shows conclusively that venting often makes things worse. It increases feelings of anger and aggressive inclinations.

A focus on anger management in domestic violence cases also has come into question. Domestic violence experts advise that the problem for perpetrators is a deeper one than impulse control. It is believed that anger management classes might even help perpetrators gain skills necessary to fine-tune the domination and exploitation of their victims.

Can anger be helpful?

But not all anger is created equal. Some anger in some clients might even be helpful, and our first step should be to help clients assess themselves in this area.

One believer in “helpful” anger is therapist Reneau Peurifoy, a regular presenter at Anxiety Disorders Association of America conferences. He thinks there are times when our anger empowers us to act in our own best interests. A Men's Health magazine article reported that to distinguish this helpful anger from the unhelpful kind, Peurifoy makes these suggestions:

1. Determine if the anger was a response to a real threat to the client's well-being;

2. Consider if the level of anger was proportionate to the actual threat; and

3. Determine if the actions inspired by the anger effectively reduced the threat with the least amount of harm to the client or others.

But even this “good” kind of anger has some not-so-good health consequences, and, most often we'll find that our clients' anger is counterproductive rather than helpful. This unhelpful anger will range from a minor inconvenience to what the DSM describes as Intermittent Explosive Disorder.

The physical symptoms of anger can be similar to the symptoms of poisoning. The heart may beat faster, accompanied by chest pains, stomach pains, dizziness, and sweating. This observation can help some clients realize that they are poisoning themselves while the objects of their anger have no symptoms at all.

Practical strategies

Depending on the severity of the problem, certain approaches are more likely to be helpful than others. For less deeply troubled clients, there are four relatively simple ways to decrease arousal:

• First, count to 10. Or 110. This simple and time-tested practice really helps. The more time a client buys by postponing anger, the more likely he/she will act rationally rather than emotionally.

• Second, relaxation techniques are often helpful: deep breathing, listening to soothing music, taking a hot bath, etc. These calm the physical sensations associated with anger.

• Third, distraction (thinking about something else) also can help. As our thoughts turn to another topic, there are fewer thoughts to feed our anger.

• Finally, do something incompatible with anger. Kiss your spouse, or pet your dog. These types of activities can help displace anger with more agreeable emotions.

Keeping a log also can be helpful. If clients list what they think, how they feel, and how they choose to act in an angry situation, they can become more aware of their “triggers.” They also can become more aware of what thoughts feed their anger, and what thoughts starve it. The more deeply ingrained the anger problem, the more likely it is that cognitive, rather than solely behavioral, interventions will promote lasting change.

Some anger problems are the result of unhelpful cognitions based on misinterpretations of reality. Clients might think that everyone is out to get them, or they might interpret innocuous interactions as hostile. Replacing such thoughts with more helpful ones can reduce or eliminate anger.

Cognitive therapy has proven successful for even the most severe problems of anger management. For perpetrators of domestic violence, for example, the belief that it's OK to use anger, power, and control to get what you want might be a focus of therapy. Successful change to a more prosocial type of thinking would reduce both the anger and the likelihood of victimizing others.

Reference

1. O' Keefe EJ, Berger DS. Self-Management for College Students: The ABC Approach. Hyde Park, N.Y.:Harrington Press; 1997.