CBT for Client Anger Control

In the last section, we discussed 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.

In this section, we will discuss the need for clients to be accountable.  As you know, it is necessary for anger management clients to make significant adjustments in their lives to correctly manage anger and become accountable.  

Four concepts I consider regarding having clients making these behavior changes are setting goals, making amends, choosing positive communication, and being authentic.  As I describe these cognitive therapy concepts see if you can apply them to a client you are currently treating.

Behavior Change - 5 Considerations

♦ #1 Setting Goals
The first concept is setting goals.  Earlier in this course, I indicated that anger is linked to preservation of worth.  However, clearly when anger is expressed aggressively, it fails to achieve the goal of preservation of worth.  Negative anger also hinders a client from effectively connecting to others.  Some goals Nick, from the previous section,  created to help him assert himself were,  "I want to be known as someone who finds the good in others."  "I will find happiness." "I can be patient."  "I can be courteous."  "I want to be approachable."  "I will accept other’s imperfections and want them to accept mine." and "I won’t get uptight when things get hectic."

 In my practice, I have seen several clients like Nick who have achieved the look of success, but who are actually miserable due to their untamed anger.  Once Nick could understand the meaning and underlying causes of his anger, he could then formulate goals to create change.

♦ #2 Making Amends
The second behavior change concept is making amends.  For some clients, balance can be obtained by making amends to the people they have hurt.  As you are aware, one by-product of misguided anger is damaged relationships.  Tyler, age 46, stated "My ex-wife Heather and I don’t talk much anymore, except about finances and the kids; and then we yell, and I mean really yell!  I’ve hurt Heather by being stubborn and pigheaded some times.  She tells me I talk down to her a lot.   I want to change, but I’m not sure she will believe me if I ask her to forgive me."  

At that point, I felt Tyler’s primary task was his change in his yelling and condescending behavior towards his ex-wife; not convincing Heather of that change.  Do you agree that the people in a client’s life will come to terms progressively and believe the change as the client’s actions reflect true changes in their anger management?  

♦ Cognitive Behavior Therapy Technique: Making Amends Journal
To help Tyler make amends to Heather, I used the CBT "Making Amends Journal" technique.   First, I asked Tyler to write down how he felt about an angry situation that put stress on his relationship with Heather.  Tyler chose to write about the catalyst for his divorce.  The catalyst was Tyler’s anger, manifested in violence toward Heather.  Second, Tyler wrote about how he imagined Heather felt.  Tyler identified her fear and confusion. Third, Tyler wrote his plans for making amends. Writing his plans helped Tyler see the proposed change as less theoretical and more tangible.  

At a later session, Tyler stated, "I still get frustrated with Heather, but I’ve noticed I can re-read my journal and it helps me feel more responsible for some of the stuff I do."  Because Tyler’s plans for change became more real, it was easier for him to truly think about starting to make amends. Do you have an anger management client who might benefit from a "Making Amends Journal?"

♦ #3 Choosing Positive Communication
The third behavior change concept is choosing positive communication.  Through positive communication, Steve could deliberately establish a reputation as someone who cares rather than as someone full of grudges.  Steve, age 36, stated, "I get so pissed that I can’t think about what other people need.  Maybe I should be more friendly, but I don’t give a shit."  

♦ 4-Step Positive Communication Role Playing CBT Technique
With Steve, I introduced the idea of Positive Communication.  As with Nick in the previous section, I decided to use role-playing with Steve.  I played Steve’s co-worker, Randy, who was frequently giving Steve a hard time.  Randy often made comments such as "Good morning, Steve.  That’s an ugly tie," or "See you later, Steve.  Tell your mom I said 'Hi.'" 

a. I stated to Steve, "The first step in Positive Communication is sensing the attitude of the other person." Steve stated, "I knew Randy was joking, but I take his jokes as insults. I then just lose it!" 
b. Second, Steve analyzed the content of what Randy had said.  After analyzing the comments, "Good morning, Steve.  That’s an ugly tie," or "See you later, Steve.  Tell your mom I said hi;"  Steve found Randy was really just using these as a way to say "Hello" or "Goodbye." 
c. Third, after sensing the attitude of the other person and analyzing the content, I asked Steve to formulate a desired results statement.  Steve desired to remove Randy’s power to increase his anger.  
d. Fourth,  Steve generated options for the desired results.  At this point, Steve knew he could disarm Randy’s comments by simply replying "Hey, Randy" or "Bye, Randy."  Several sessions later, Steve stated, "The Positive Communication thing really works!  Now I just feel bad for the bastard when he tries to break my balls because he gets no satisfaction from me flying off the handle anymore."

♦ #4 Being Authentic
In addition to setting goals, making amends, and choosing positive communication, the fourth behavior change concept for clients to consider in accountability is being authentic.  As you know, some clients struggle with emotional trauma openly and authentically.  However, behavior management clients may pretend they have no problems.   Steve's suppressed anger hindered his authenticity and perpetuated his anger.

When Steve talked about his anger, he became more authentic.  This allowed two things to occur for Steve. First, he was  able to find help and support.  Also, Steve became more accountable to follow through with anger management plans and become more assertive, and less aggressive.

Do you have an anger management client like Tyler or Steve who could benefit from the behavior change concepts of setting goals, making amends, choosing positive communication, and being authentic?

In the next section we will discuss combating trigger thoughts.  Cognitive triggers for anger fall into two categories: judgment based on personal rules, and blame placement. 
Reviewed 2023

Peer-Reviewed Journal Article References:
Burns, J. W., Gerhart, J. I., Bruehl, S., Peterson, K. M., Smith, D. A., Porter, L. S., Schuster, E., Kinner, E., Buvanendran, A., Fras, A. M., & Keefe, F. J. (2015). Anger arousal and behavioral anger regulation in everyday life among patients with chronic low back pain: Relationships to patient pain and function. Health Psychology, 34(5), 547–555.

Burns, J. W., Gerhart, J. I., Bruehl, S., Post, K. M., Smith, D. A., Porter, L. S., Schuster, E., Buvanendran, A., Fras, A. M., & Keefe, F. J. (2016). Anger arousal and behavioral anger regulation in everyday life among people with chronic low back pain: Relationships with spouse responses and negative affect. Health Psychology, 35(1), 29–40.

Folyi, T., Rohr, M., & Wentura, D. (2020). When emotions guide your attention in line with a context-specific goal: Rapid utilization of visible and masked emotional faces for anticipatory attentional orienting. Emotion, 20(7), 1206–1224. https://doi.org/10.1037/emo0000621

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.

Hewage, K., Steel, Z., Mohsin, M., Tay, A. K., De Oliveira, J. C., Da Piedade, M., Tam, N., & Silove, D. (2018). A waitlist controlled study of a traumafocused cognitive behavioral treatment for intermittent explosive disorder in TimorLeste. American Journal of Orthopsychiatry, 88(3), 282–294.

Kubiak, T., Wiedig-Allison, M., Zgoriecki, S., & Weber, H. (2011). Habitual goals and strategies in anger regulation: Psychometric evaluation of the Anger-Related Reactions and Goals Inventory (ARGI). Journal of Individual Differences, 32(1), 1–13.

Lench, H. C., Reed, N. T., George, T., Kaiser, K. A., & North, S. G. (2024). Anger has benefits for attaining goals. Journal of Personality and Social Psychology, 126(4), 587–602. https://doi.org/10.1037/pspa0000350

Malinowski, S. D., Nicosia, F., Mehling, W., Woodstock, R., & Barnes, D. E. (2021). Guys and dolls: Two case reports of spontaneous interactions with dolls in male veterans with dementia. Psychological Services.

Sutton, A. (2024). Changing ourselves: How does personality change relate to well-being and authenticity? Journal of Individual Differences, 45(1), 1–15. https://doi.org/10.1027/1614-0001/a000408

Online Continuing Education QUESTION 5
What are four concepts you might consider regarding implementing behavioral change in your anger management client? To select and enter your answer go to CEU Test.