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Section 6
Anger-Reduction Treatment for Daily Stressors

Question 6 | Test | Table of Contents | Anger Management
Counselor CEUs, Psychologist CEs, Social Worker CEUs, MFT CEUs

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On the last track, we discussed the effects of stress on Anger Management clients:  increased irritability; less control over impulses; and susceptibility to paranoia.  We will also include "The Larson Anger Management Relaxation Breathing Exercise" to help stressed clients relax.

On track 2, we discussed four self-ordained rules of the road that caused Anger Management clients to react aggressively on the road. 

On this track, we will present the steps necessary to replace these rules with less stress-inducing rules:  discussion; attitude change cards; debate; and relaxation exercise.

4 Key Steps to Installing New Rules

Step #1 - Discussion
The step in installing new rules is discussion. This first step, discussion, is used to examine the attitude the Anger Management client holds at this point ant the new attitude that needs to replace it. For instance, one of the rules we discussed on track 2 was making good time. I tell my Anger Management clients that instead of holding to the rule making good time, to instead make time good. 

This involves making the journey a little bit more enjoyable and less stressful to the client, which will, obviously, prevent any of the effects we discussed on track 5.  For this particular rule, a client might want to consider planning their trip at a much slower pace.  Julie was a 24 year Anger Management client of mine who would try and make a competition out of long drives.  She would pride herself on getting from point A to point B faster than any other driver.  I asked Julie to commit herself to slowing down and planning for a slower paced trip. 

Instead of going 70-80 mph, to go 55-65 mph.  Julie promised to try it.  On the way down to the beach, Julie went her usual speed, but coming back, she decided to slow down her pace.  Julie stated, "There was such a difference in the quality of the trip.  My sister and I bonded and laughed the entire way back.  We even stopped at some interesting places and got even more photos to show our family when we got back.  Even though we arrived an hour later than we would have, I feel that hour was not wasted at all." 

As you can see, by slowing down, Julie enjoyed herself and avoided stress.  This tactic can also be applied to the other rules as well. 

Step #2 - Attitude Change Cards
The second step is attitude change cards. On the opposite sides of index cards, I asked my Anger Management clients suffering from road rage to put their old attitudes and their new attitudes.  Each side had three categories: stressor, urge, and statements. For the rule, being number one, the stressors were other speeding cars, the urge was to compete, and the statements that the clients would say to themselves were:  "be number one"; "lead the pack"; "Who’s going to be first?"; and "beat the other guy". 

The new attitude here was ideally "be a number one being". Instead of valuing competition, the value system needs to shift to being courteous. On the other side of the card, there are three more categories: event, urge, and statements. For the new attitude, be a number one being, the event was other speeding cars, but this time, the urge was to be courteous and the statements were:  "the road’s too dangerous for games"; "treat yourselves and your passengers respectfully"; and "enjoy your companions".  Julie, who also held the being number one rule, tried this new attitude in the example above as well. 

Instead of competing with other drivers, she enjoyed the company of her sister instead of the competition brought on by a stressful, long journey.

Step #3 - Debate
In addition to discussion and attitude change cards, the third step is debate. I feel that to really acclimate an attitude, it is important to defend it first.  For this exercise, I act as devil’s advocate.  I debate the old attitude while the Anger Management client argues for the new attitude.  For the rule not letting the other driver to get away with it, this new attitude is entitled, be my guest. 

Gerald, a 27 year old Anger Management client of mine, held this rule.  To debate for the old attitude, I stated, "I’m not going to let somebody just go around me if I’m in a hurry.  I’m driving the speed limit.  Why should I let them pass?  It doesn’t make sense.  They’re usually so pushy I can’t even see their headlights.  I hate people like that.  They can just wait.  I won’t give in; I’m not a wimp.  Somebody needs to show them that they can’t just do that to people."  To replace this attitude, a new sense of courteousness must be emphasized. 

Gerald responded to my statement with, "But these drivers aren’t bad people, they’re just in a hurry. They’re running late, the need to be on time, just like you. You’ve been in their shoes.  You don’t need to make it personal, but you can make it easier for them. I promise it’ll be painless if you get it over with quickly, just as you would if there were guests in your home. Let them go on their way and return to enjoying your life." 

Also, you might consider having the Anger Management client switch positions and argue for the other side as well.  By knowing all they can about how these rules affect a person’s personality, I find that clients are more willing to change their own attitudes.

Step #4 - Relaxation Exercise
The fourth step is the relaxation exercise.  I have found that if an Anger Management client is tense on the road, it becomes extremely difficult for them to concentrate on instilling these new beliefs into their behaviors. 

Kate was a 27 year old client of mine who held the belief that certain drivers should not be allowed on the road.   The new attitude I wished Kate to adopt was everyone has a right.  Before, Kate would become angry whenever she saw an older person driving.  She stated, "I used to think ‘Why aren’t they in a nursing home?  Everyone knows they drive slowly and put everyone else in danger.  Who keeps renewing their licenses?’" 

Kate would then become so wrapped up in her prejudices, she wouldn’t be able to concentrate on the road.  Even though Kate had grown to accept the new rule live and let live, when she was stressed, she found it near impossible to practice.

5-Step Relaxation Exercise
To help Kate keep from stressing herself out, I recorded the following relaxation exercise for Kate to listen to when she began to feel tense about other drivers. I also asked her to use this exercise in conjunction with the breathing exercise presented in the last track:

  1. Breathe in and out peacefully at about the same rate as when you were counting to five.
  2. Focus on the sensation of the air entering through your nostrils.  Focus all your attention on that sensation, so you can feel the air as it tickles your nose hairs going in.
  3. Continue to focus on the sensation of your breath while breathing in and out.  If you have any distracting thoughts, just notice them and gently bring your attention back to the sensation of your breath.
  4. Continue in this manner for as long as you wish.
  5. at the conclusion, let yourself gradually come back into the car.  Open your eyes and look around and maintain the feeling of peacefulness that you’ve come to.

Think of your Kate.  Could he or she benefit from this relaxation exercise?

On this track we presented the steps necessary to replace an Anger Management clients' predetermined rules with less stress-inducing rules:  discussion; attitude change cards; debate; and relaxation exercise.

On the next track, we will examine techniques to help Anger Management clients who respond negatively to other drivers:  "General Principles"; "Jekyll and Hyde Visualization"; and "Giving Warning."

Peer-Reviewed Journal Article References:
Hewage, K., Steel, Z., Mohsin, M., Tay, A. K., De Oliveira, J. C., Da Piedade, M., Tam, N., & Silove, D. (2018). A wait-list controlled study of a trauma-focused cognitive behavioral treatment for intermittent explosive disorder in Timor-Leste. American Journal of Orthopsychiatry, 88(3), 282–294.

Kuin, N. C., Masthoff, E. D. M., Nunnink, V. N., Munafò, M. R., & Penton-Voak, I. S. (2020). Changing perception: A randomized controlled trial of emotion recognition training to reduce anger and aggression in violent offenders. Psychology of Violence, 10(4), 400–410.

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.

Sprague, J., Verona, E., Kalkhoff, W., & Kilmer, A. (2011). Moderators and mediators of the stress-aggression relationship: Executive function and state anger. Emotion, 11(1), 61–73.

van der Ploeg, M. M., Brosschot, J. F., Quirin, M., Lane, R. D., & Verkuil, B. (2020). Inducing unconscious stress: Subliminal anger and relax primes show similar cardiovascular activity patterns. Journal of Psychophysiology, 34(3), 192–201.

What are five steps in replacing an Anger Management client's predetermined rules with less stress-inducing rules? To select and enter your answer go to Test.

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