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Conduct Disorders: Diagnosis & Treatment
Conduct Disorder  continuing education psychology CEUs

Section 17
Discussing Anger Cues with Conduct Disordered Clients

CEU Question 17 | CE Test | Table of Contents | Conduct Disorders
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs

As you know, every student has physical signs that can let him know he is angry: for example, muscle tension, a knot in the stomach, clenched fists, grinding teeth, or a pounding heart. The therapist might give some examples of the signs that let him know when he is angry and explain that individuals must know they are angry before they can use self-control to reduce the anger. Next, the trainees try to identify their own and each other's warning signs by role playing short conflict situations. The therapist gives feedback on how well each trainee could identify the warning signs or cues.

Discussing Anger Reducers 1,2, and 3
Now that the trainees have begun to be able to identify their anger warning signs (cues), they can start to make use of anger reduction techniques to increase their self-control and personal power when they notice themselves getting angry. Any or all of the three anger reducers can be a first step in a chain of new behaviors giving the trainees greater self-control and the time needed to decide how to respond most effectively. The key sequence here is that noticing the cues leads to use of an anger reducer. As the therapist presents each of the three anger reducers, he models its use, has the trainees role play the sequence "cues + anger reducer," and then gives feedback on the role plays.

Anger reducer 1: deep breathing. Taking a few slow, deep breaths can help in making a more controlled response in a pressure situation. Examples from sports of taking a few deep breaths (e.g., in basketball-before taking important foul shots, and in boxing) can be presented. Trainees are reminded about their signs of being angry and how deep breathing can reduce tension by relieving physical symptoms of tension. Then the therapist models, has trainees role play, and gives feedback on the sequence of "cues + deep breathing."

Anger reducer 2: backward counting. A second method of reducing tension and increasing personal power is to silently count backward (at an even pace) from 20 to 1 when faced with a pressure situation. Trainees might be instructed to turn away from the provoking person or situation, if appropriate, while counting. Counting backward is a way of gaining time to think about how to respond most effectively. The therapist models, helps trainees role play, and gives feedback on the sequence of "cues + backward counting."

Anger reducer 3: pleasant imagery. A third way of reducing tension in an anger-arousing situation is to imagine a peaceful scene that has a calming effect (e.g., You are lying on the beach. The sun is warm, and there is a slight breeze.). The trainees are encouraged to think of scenes they find relaxing. Then the therapist models, helps the trainees role play, and gives feedback on the sequence of "cues + pleasant imagery."
- Goldstein, Arnold P. and Barry Glick, "Aggression Replacement Training: A Comprehensive Intervention for Aggressive Youth", Research Press: Illinois, 1987

Personal Reflection Exercise #5
The preceding section contained information about discussing anger cues with your client. Write three case study examples regarding how you might use the content of this section in your practice.

Peer-Reviewed Journal Article References:
Goldstein, N. E. S., Giallella, C. L., Haney-Caron, E., Peterson, L., Serico, J., Kemp, K., Romaine, C. R., Zelechoski, A. D., Holliday, S. B., Kalbeitzer, R., Kelley, S. M., Hinz, H., Sallee, M., Pennacchia, D., Prelic, A., Burkard, C., Grisso, T., Heilbrun, K., Núñez, A., . . . Lochman, J. (2018). Juvenile Justice Anger Management (JJAM) Treatment for Girls: Results of a randomized controlled trial. Psychological Services, 15(4), 386–397.

McIntyre, K. M., Mogle, J. A., Scodes, J. M., Pavlicova, M., Shapiro, P. A., Gorenstein, E. E., Tager, F. A., Monk, C., Almeida, D. M., & Sloan, R. P. (2019). Anger-reduction treatment reduces negative affect reactivity to daily stressors. Journal of Consulting and Clinical Psychology, 87(2), 141–150.

Steinmann, R., Gat, I., Nir-Gottlieb, O., Shahar, B., & Diamond, G. M. (2017). Attachment-based family therapy and individual emotion-focused therapy for unresolved anger: Qualitative analysis of treatment outcomes and change processes. Psychotherapy, 54(3), 281–291.

Zimmermann, J., Woods, W. C., Ritter, S., Happel, M., Masuhr, O., Jaeger, U., Spitzer, C., & Wright, A. G. C. (2019). Integrating structure and dynamics in personality assessment: First steps toward the development and validation of a personality dynamics diary. Psychological Assessment, 31(4), 516–531.

Online Continuing Education QUESTION 17
What are anger reducing techniques? Record the letter of the correct answer the
CE Test.

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