CBT and anger
CBT is the treatment of choice for anger. Why? Because CBT has a huge evidence base for showing that it is effective, providing quick and cost-effective cures. I can provide help for anger both one-to-one and in an anger management group
What is anger?
Anger is a corrosive and unpleasant emotion and which might be accompanied by aggressive behaviour but it doesn't have to be. It is neither good for you nor for the people around you – your family, your friends and your colleagues (and other drivers if you drive).
Anger is the emotion, the feeling. It may be accompanied by the fight-or-flight chemicals washing around your body and by the effect these have on you.
Aggression is the behaviour that sometimes accompanies anger and this might be physical, verbal or passive aggressive. Physical aggression might be hitting or pushing another person, breaking the object that frustrated you, hitting the wall or slamming the door. Verbal aggression might be directed at yourself but it is normally shouting at someone else. Passive aggressive behaviours include sarcastic put-downs, overly sweet behaviour or making it quite clear that you are angry. None of these is very nice to be around.
The good news is that anger is one of the easiest negative emotions to treat once you have decided you want to do something about it, and provided you do your homework, you should gain a great deal of control over your anger within eight sessions.
Where does it come from?
Anger is the correct response to hurt or threat, but healthy anger doesn't last long; if someone steps on your foot in the supermarket and doesn't apologize and you're thinking of ramming them with your trolley five seconds later, this has gone on to be unhealthy. Unhealthy anger results from a few causes (though they all boil down to the same thing):
- A threat to our self esteem, such as thinking a group is talking about us behind our back
- Frustration, when we are prevented from doing something or can't make ourselves understood
- Feeling criticised, fairly or unfairly
- Someone breaking one of our personal rules.
The first two of these are disguised rules, though have different interpretations. The first might be from "people mustn't talk about me behind my back", or perhaps "people should show respect", while frustration tends to be from "life must go smoothly".
We can recognize our rules easily, they're the shoulds or musts or have-tos or ought-tos, and come in themes: people should have manners, people should show respect, you mustn't do that to me, life must be fair, how dare you. And if you ever find yourself angrily wondering why you or someone else is behaving as they do, then there's both a hidden rule (you shouldn't behave like that) and frustration. The precise nature of the rule will vary from person to person, but might be people putting feet on train seats, eating in public, mobile phones, another driver pushing in, not being listened to, kids leaving bicycles outside shop doors (there's a reason for this one), jobsworths, watching the news.
Healthy anger is the proper response to someone else hurting you, but if this turns into aggressive behaviour, or lasts for more than a few seconds, it becomes unhealthy anger. The most usual cause of unhealthy anger is when someone (and this might be you) breaks one of your rules - your rules come from your core beliefs and are your map of how people, the world and things must be.
Treatment of anger then is firstly recognizing what your rules are and then softening them. There is nothing wrong with the rules themselves as together they define your morality, but if we hold beliefs about how things must be, then we get angry when things aren't. You might hold the view that children should be brought up to polite and there's nothing wrong with that, but if a child then isn't polite it is you gets the emotional fallout. Or that people shouldn't drop litter. Or people mustn't put their feet on the train seats. Or that everyone must treat me with respect.
There are a number of unhealthy thought patterns that can be seen with unhealthy anger:
- we overestimate the extent to which the other person acted deliberately
- we overestimate the extent to which the other person acted maliciously
- we may overestimate the extent to which the person behaved towards me personally
- we might plot revenge, either fantasizing in our heads or threatening retaliation, or even by genuinely aggressive behaviour
- we might hold a grudge and refuse all apologies from another person
- in an argument we are unable to see the other's point of view and see ourselves as being definitely right while they are definitely wrong
And there are a number of unhealthy behaviours that come with unhealthy anger
- we may threaten or attack the other person physically
- we may attack the other person verbally, and this includes hooting for road rage
- we may attack the other person with passive-aggressive behaviour, such as sarcasm or sulking
- we may displace the attack onto another person, animal or object (such as hitting the wall or coming home from a bad day at work and kicking the dog)
- we may withdraw aggressively (storming off, slamming the door)
- we might rant, vent or unload onto others
- we might recruit allies, wanting other people to agree that we were in the right
Some people rage, which is an internal rant, conducting an argument in their head, and this might serve the purpose of making the person feel powerful. But in reality, this is just stoking up our righteous anger and draws out the process.
The healthy behaviour is to assert yourself to the other, which means requesting (but not demanding) that the other person changes their behaviour.
There is a rather good 29 question questionnaire (Buss-Perry) that measures how angry someone is compared with the population as a whole and we can use this occasionally to assess progress.
Apart from offering one-to-sessions for anger, I have run an Anger Control Training Group (Anger Management) for Mind in Croydon and supply the same course to Mind in Kingston and run the same course and other groups in private practice.