Anger Management: Cognitive Therapy Interventions

In the last section, we discussed rationalizations that perpetuate anger. Four rationalizations you may have encountered are My past is to painful, Forgiveness is too good, Why should I try when no one else does, and Anger is a familiar habit.

In this section, we will discuss Cognitive Behavior Therapy Assertiveness Training through Role-Playing.  I use five steps in my Assertiveness Training.  See how they compare with the model you use.  I also enlist the help of another therapist whenever possible. 

The five steps are select an incident, role-play with another group member, have the client visualize the situation once more, have the client role-play the situation twice with the other group member, and encourage the client.  As I describe the steps involved in Assertiveness Training, apply them to your last role-play or an upcoming one.

Nick, age 36, had a very demanding boss.  Nick stated, "My boss is such a jerk.  If I ask for help on a project, he tells me I’m incapable.  And he never lets me finish a project.  He’ll approach me while I’m in the middle of something and tell me to do something else.  Then I’ll be working on the second thing and he’ll yell at me for not finishing the initial project.  I just want to tell him off!  But, he’s my boss.  I’m probably better off getting mad outside of work."  Nick had been openly aggressive towards his friends and, more recently, people he didn’t even know.  Would you agree that Nick was an ideal candidate for assertiveness training?

CBT Assertiveness Training through Role-Playing - 5 Steps

♦ Step #1 - Select an Incident
In the first step, I asked Nick to select an incident or situation involving anger.  Nick selected a time when his boss, Mr. Thomas, berated him for not finishing a project after assigning him another task.  Once the incident was selected, I asked Nick to close his eyes and visualize the way the incident actually happened.  Right away this increased Nick’s understanding of what initially went wrong.  Next, I had Nick describe how the situation would normally play out.

First, Nick described the incident and the personality traits of Mr. Thomas.  Nick stated, "I was assigned to a marketing campaign for which I needed to write a financial proposal.  Shortly after beginning, Mr. Thomas requested me to begin an audit of company spending over the last six months!"  As Nick described it, the incident consisted of Nick being reprimanded by a pushy and overbearing Mr. Thomas.  

♦ Step #2 - Primary Role-Play
The second step involves role-playing with another group member.  In this step, Nick observed two group members role-playing the incident in a non-hurtful, non-anger-provoking, assertive manner.  One group member from the anger management group played Nick asserting himself to Mr. Thomas.  To help Nick share his reaction I asked him a few questions.  "Did the group member portray Mr. Thomas well?"  "Did he model an assertive confrontation with which you could feel comfortable?"  Nick’s answers were positive, however if he had said no, I would have requested details.

♦ Step #3 - Visualize the Situation
The third step I use in anger management group Assertiveness Training is to have the client visualize the situation once more.  The purpose here is to give the client the opportunity to incorporate the assertive techniques modeled by the other group members.  Nick visualized the situation between himself and Mr. Thomas differently this time.  It was interesting to observe how Nick exhibited progress in implementing assertiveness. Nick stated, "I see that I should be calmly reminding Mr. Thomas that I have not completed the previously assigned task."

♦ Step #4 - Secondary Role-Play
The fourth step in my group assertiveness training is to have the client role-play the situation twice with other group members.  The first time, Nick played Mr. Thomas to gain insight regarding his boss’s motivation.  Nick began to feel that Mr. Thomas actually held him in high regard.  As you probably know, this insight helped Nick to gain a broader, more objective perspective and develop more empathy towards Mr. Thomas.  

The second time through, Nick and the other group member switched roles.  During this role-play, I directed Nick by giving him cues and suggestions.  These cues included words or actions that Nick used to be more assertive.  For example, Nick stated, "I am overworked."  I asked Nick to specify his generalization of overworked by listing the specifics of the first task assigned that were not completed.  After this role-play was over, I asked both Nick and the other group member to share what they experienced in both roles.  Also, Nick was given feedback from the group.  

♦ Step #5 - Encourage the Client
In addition to selecting an incident, role-playing with another therapist or group member, having the client visualize the situation once more, and having the client role-play the situation twice with the other therapist or group member, the fifth step is encouraging the client.  I encouraged Nick to move forward at his own pace when he felt comfortable with the assertive techniques he had learned regarding his supervisor Mr. Thomas.  If Nick had expressed a need for more time to practice assertive confrontation skills with Mr. Thomas, another role-playing session would have taken place during this group meeting or a future one.  The main benefit I felt that Nick derived from role-playing was an increased empathy for Mr. Thomas and improved assertive confrontation and anger management skills.  

In this section, we discussed  CBT  Assertiveness Training through Role-Playing.  There are five steps in Assertiveness Training.  They are: select an incident, role-play with another group member, have the client visualize the situation once more, have the client role-play the situation twice with the other group member, and encourage the client.

Peer-Reviewed Journal Article References:
Christ, N. M., Contractor, A. A., Wang, X., & Elhai, J. D. (2020). The mediating effect of rumination between posttraumatic stress disorder symptoms and anger reactions. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication.

Deska, J. C., Lloyd, E. P., & Hugenberg, K. (2018). The face of fear and anger: Facial widthtoheight ratio biases recognition of angry and fearful expressions. Emotion, 18(3), 453–464.

Gable, P. A., Poole, B. D., & Harmon-Jones, E. (2015). Anger perceptually and conceptually narrows cognitive scope. Journal of Personality and Social Psychology, 109(1), 163–174.f angry and fearful expressions. Emotion, 18(3), 453–464.

HarmonJones, C., Hinton, E., Tien, J., Summerell, E., & Bastian, B. (2019). Pain offset reduces rumination in response to evoked anger and sadness. Journal of Personality and Social Psychology, 117(6), 1189–1202.

Hawes, S. W., Perlman, S. B., Byrd, A. L., Raine, A., Loeber, R., & Pardini, D. A. (2016). Chronic anger as a precursor to adult antisocial personality features: The moderating influence of cognitive control. Journal of Abnormal Psychology, 125(1), 64–74.

Wilkowski, B. M., Robinson, M. D., & Troop-Gordon, W. (2010). How does cognitive control reduce anger and aggression? The role of conflict monitoring and forgiveness processes. Journal of Personality and Social Psychology, 98(5), 830–840.

Online Continuing Education QUESTION 8
What are five steps in CBT Assertiveness Training through Role-Playing? To select and enter your answer go to CEU Test.