Anger Management: Cognitive Therapy Interventions

On the last track, we discussed combating trigger thoughts.  Cognitive triggers for anger fall into two categories: judgment based on personal rules, and blame placement.

On this track, we will discuss Alternatives to Anger.  Three alternatives to anger are analyzing accusations, acknowledging imperfections, and teaching others.

 Three Alternatives to Anger

Alternative #1 - Analyzing Accusations
First, let’s explore the alternative to anger of analyzing accusations.  As you will see with Carrie, age 17, she felt accusations caused her anger.  I asked Carrie to analyze two alternatives when she felt she was being accused of something. 

Two Alternatives to Analyze when Accused
First, I asked Carrie to consider is the accusation true?  If it was true, I asked her how she felt about admitting her side of the situation while keeping her shame or guilt in check.  I stated to Carrie, "Clearly,  you, like all of us, are not perfect.  Like all humans, you have the right to faults."  

Second, is the accusation false? I suggested to Carrie to let other’s maintain their right to an opinion.  However, Carrie experienced difficulty letting anything go.  I informed Carrie that the problem is not her’s, but rather the accuser’s. Carrie stated, "it's like those damn cool girls  have rocks in their head and I should be aware of that." 

Carrie’s sensitive interpretations and highly personal reactions converted harmless accusations into stinging insults.  Carrie stated, "I always feel stressed about what my friends and the cool kids think.  This girl in my History class told my best friend that I wore cheap shoes.  Cheap shoes!  Me!  I couldn’t let her get away with it, so I slashed her tires.  These are eighty dollar shoes!"  I asked Carrie if she felt she gave the cool girl’s remark too much power over her?  I found the Fishbowl technique described at the end of this track to be beneficial with Carrie.

Alternative #2 - Acknowledging Imperfections
Second,  another alternative to anger is acknowledging imperfections.  Judy, age 48,  was often angry at her family.  She stated, "I have to yell at my family almost every day about the simplest things.  The closet light’s on, the hall light is off, the fridge is left open to long!  Sandy took to long at dinner!  Freddie didn’t make his bed! Obvious things. They are so damn inconsiderate!  It seems like whenever I’m home, I’m in hell."  Judy’s anger was triggered by the imperfections of her family. 

Cognitive Behavior Therapy: 3-Step Fishbowl Technique
To get Judy to acknowledge the imperfections of her family, and to help Carrie deal with accusations by the cool girls, I used the Fishbowl intervention. This CBT intervention is a creative visualization technique.  Therefore, it can help to ask the client to close his or her eyes for the first step. 

First, Judy focused on her most recent situation at home when she felt she had to yell all day at her husband and her kids. 

Second, I asked Judy to evaluate her internal communications.  I find it helpful to have the client write these evaluations down.  Judy wrote, "I am such a bitch! God I hate myself!" As Judy evaluated her internal communication, she found other emotions underlying her anger.  These emotions included insecurity, fear, frustration, hurt, and guilt.

Third, after visualizing a recent explosion and writing down internal communication and feelings, I asked Judy to evaluate her external communications with those in her family.  At this stage of fishbowl intervention,  as you know, clients can evaluate both nonverbal and verbal communications.  Judy began to cry as she realized how sometimes kind her family was to her in spite of her senseless rampages. 

Clearly, I feel one advantage in using the fishbowl intervention is that it teaches clients self-awareness.  For Judy, self-awareness was key to staying in control of her anger, maintaining her emotional balance, and breaking her destructive cycle of mismanaged anger.  The next therapy goal I had for Judy after increasing her self-awareness was to teach assertiveness skills, outlined on a previous track.

Alternative #3 - Teaching Others
In addition to analyzing accusations and acknowledging imperfections, another alternative to anger is teaching others.  After a client learns anger management techniques, clients can teach those techniques to others.  For example, one day after school, Judy's oldest daughter Angie, 18, came home and threw her coat on the floor. When Judy asked Angie to hang up her coat, Angie immediately began screaming at her.Judy stated, "I decided to try that Fishbowl idea with Angie. She was so mad, and I didn't know why!

I asked her to write down the things she was thinking, her internal communication, and finally she told me the boy she's been interested in asked someone else to the Prom today. It made her feel rejected and lonely, and then she got angry,  and so she came home and yelled at me. She calmed down a lot, and we were able to have a really good conversation about what had happened."  Do you have a client who might benefit from teaching another the fishbowl technique?

On this track, we discussed Alternatives to Anger.  Some alternatives to anger are analyzing accusations, acknowledging imperfections, and teaching others.

On the next track, we will discuss Positive Responses to Anger.  Two responses we will discuss are active and passive response.

Online Continuing Education QUESTION 11
What are three alternatives to anger? To select and enter your answer go to CEU Answer Booklet.