CBT for Anger

Anger is built on expectations. We expect people to treat us fairly and they don’t.  We expect children to respect the wishes of their elders and they don’t. We expect the government to have our needs at heart and it doesn’t. Each time there is a gap between expectation and reality, anger is more than willing to fill in that gap.  Each time someone breaks a rule of ours, violates a contract, or acts against our wishes, it is as if we are receiving a formal invitation to an angst-ridden affair. We may decline. We may accept. It’s our choice.

The following is a seven step model I’ve used with anger problems. It is adapted from two articles of mine published in the Beck Institute newsletter. These articles, in turn, were influenced by Aaron Beck’s works Prisoners of Hate and Cognitive Therapy of Substance Abuse.

Preparation

Weigh Your Options

The first step in dealing with anger is to recognize choice. There are a myriad of things we don’t control: the weather, the past, other people, intrusive thoughts, and physical sensations, even emotions. But there is something within these that we absolutely do control: our ability to choose. We choose what to do in response to the weather (Get an umbrella!), what we learn from the past, how to respond to other people, and what we do in the context of intrusive thoughts, emotions, and sensations. Importantly, we can choose whether to focus on the things we don’t control, or the things we do control. I suggest the latter.

A useful technique in recognizing such choice is a simple cost-benefit analysis.  Envision someone who handles anger in a way that you respect and admire. Call him Mike. What words would you use to describe his style? Cool, calm, and collected? Easy-going? Assertive? Controlled? Accepting? Forgiving? Whatever word applies, write it down.  But it has to be someone whose manner you respect and admire. Then ask yourself four questions: What are the disadvantages, the costs of being like Mike? What are the advantages, the benefits of anger? What are the costs of anger? And finally, what are the benefits of being like Mike? Then ask: Do the benefits of anger out weigh the costs? Are they about equal?  Or do the costs of anger outweigh the benefits?  Weigh them if you like: 50-50, 55- 45, 60-40, 70-30, 80-20, 90-10, or 100 to 0? Then, do the same with the costs and benefits of being like Mike. Here’s an example:

Advantages of angerAdvantages of control “being like Mike”
1. Makes me more competitive
2. Gives me a boost
3. Keeps me from exploding
4. Can be used constructively

Weight: 10

1. I don’t dwell on the anger
2. It’s a key to happiness
3. I get to move on
4. I can act constructively
5. I don’t hold a grudge

Weight: 55

Disadvantages of anger
Disadvantages of control “being like Mike”
1. It can be harmful
2. It can hurt someone
3. I can hurt myself
4. It puts wear and tear on the body
5. It makes the situation worse

Weight: 90

1. People could step all over me
2. I’d say, “Enough is enough”
3. They’ll continue to do things to annoy me
4. They won’t care how this will affect me

Weight: 45

Note that the costs of anger are really the costs of aggression. We may not control anger, but we have full control over what we do with anger. We can be angry and passive, angry and aggressive, angry and passive-aggressive, or angry and assertive. It’s our choice. Anger can quicken our reactions and make it seem like no choice is involved. Still, we need to empower ourselves by regarding these options as choices.

1. A Should Rule is Broken

The first step is to recognize the breaking of a should rule. We have rules and expectations for our own behavior, and for other people’s behavior. We even feel the weight of other people’s rules. The result is anger, guilt, and pressure. We demand: “She should listen to me,” “They should stay out of my way,” “I should have total control over this situation.” But the fact of the matter is that people don’t listen, they get in our way, and we don’t control the results of our actions.

First, at this point we can accept the circumstances as given: accept reality rather than hammer against it, demanding that it not exist. The bad news? We have little control over other people. The good news? We have full control over our choices.

Next, we choose a direction based on our values. How do we know our values? We know our values by what angers us, frustrates us, and enrages us. Ask: “What positive value may underlie this rule?” “She should listen to me” may imply values of communication, understanding, or cooperation. “They should stay out of my way” may imply values of freedom, respect, or progress. We have no control whether other people act in accordance with our values. We only have control whether we do.

Finally, we can act in the direction of our values. Ask two questions: 1) What do I want in the long run? 2) What constructive steps can I take in that direction? The fact of the matter is that people do ignore your wishes and intrude. What constructively can you do when that happens? You can continue to respect privacy, be truthful, fair, and principled in your interactions with others. In short, you can be part of the solution, not the problem.

2. What Hurts?

The second step is to examine what really hurts or scares us when our rules are broken. Some rules are more central to our self-esteem; others are more distant. For example, when we get enraged, he can ask ourselves, “What really hurts here?” This can reflect a general belief about others or ourselves. “People are rude and insensitive,” “I’ll be made the victim,” or “I’m powerless to do anything about this.” What may hurt the most is our inability to change people’s behavior. At this point, we can really examine the idea: “There is really no evidence that I should be able to change people. They are responsible for their own beliefs, behaviors, attitudes, and assumptions. Perhaps his suggestion to me is better seen as an effort to help me, and not as an intrusion. Perhaps I can see myself not as a victim, but as a person receiving assistance.”

3. Hot Thoughts

The third step is to respond to the hot, anger driven, reactive thoughts with cooler, more level-headed, reflective thoughts.

Reactive: “How dare he!”

Reflective: “He thinks he’s trying to help me.”

Reactive: “How stupid can she be?”

Reflective: “She’s human.”

4. Anger

The fourth step is to respond to the anger arousal itself. We can work with this by practicing forms of relaxation (progressive muscle relaxation, visualization, music.)  Or we can redefine the anger itself: anger is energy to problem solve. It is energy to do the right thing in the service of our deeper values, morals and principles. Anger is a problem primarily if we use it in violation of these principles.  It is a problem when we use it to treat people in ways we would find abhorrent. It is a problem when it fuels hypocrisy and aggression. Just as Martin Luther King was angry at racism and Mother Theresa was angry at poverty, we can turn anger into positive and principled action.

5. Moral Disengagement

The fifth step is to examine the beliefs that turn anger into aggression. These are rationalizations and excuses that justify destructive acts. “He deserved it.” “I just want them to hurt the way that I’ve been hurt.” “This is the only way I can get my point across.” “Screw it – I’m out of control” “I don’t care.” We need to recognize these ideas as con artistry. They con us into throwing aside our morals and engaging in threats, sarcasm, demands, and blame. We can remind ourselves of the costs of such strategies, and the benefits of striving for patience, understanding, empathy, and grace.

6. Aggression

The sixth step is to examine the specific dysfunctional behaviors that arise: We give ourselves permission to act aggressively and ignore the rights of other people. We can intervene by empathizing with those who trigger our anger: We put ourselves in their shoes, imagine what they are thinking and feeling, and really work to understand that perspective. This can help to

  1. decrease our anger;
  2. decrease the other person’s anger;
  3. increase the likelihood that we will be heard;
  4. increase the likelihood of us engaging in a rational and reasonable conversation.

7. Outcome

The seventh step is to reduce resentment and guilt. We may tend to view every anger episode as a self-perpetuating failure, as a setback.  But each episode can be a stepping stone to success, so long as we examine and intervene with the triggering “should statements,” the angering beliefs, the reactive thoughts, the anger arousal, the permission giving beliefs, and the strategies we employ. If we do this, the episodes can be fewer and further between, and less intense.

These seven steps represent points where we can intervene with aggression.  Typically, we are inclined to see anger as immediate and ourselves as out of control.  An alternative view is to see anger as energy that arises when our expectations conflict with reality. It is energy to deal with this discrepancy. And our most important decision is what to do with this energy. Breaking anger into steps can enable us to recognize control, and give us more choices regarding both intervention and prevention.

References

Beck, A.T. (1999).  Prisoners of Hate.  New York:  HarperCollins Publishers.

Beck, A.T., Wright, F.D., Newman, C.F., & Liese, B.S. (1993).  Cognitive therapy of substance abuse.  New York: Guilford Press.

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