Examine individual changes

'{{Other uses}} [[Image:US Navy 070719-N-2143T-002 Hospital Corpsman 2nd Class Joseph Garling, assigned to Naval Hospital Bremerton, teaches Sailors about anger management at the Bangor Naval Brig Correctional Custody Unit.jpg|thumb|right|320px|An anger management course.]] '''Anger management''' is training for temper control and is the skill of remaining calm and composed.<ref name="Schwarts">Schwarts, Gil. July 2006. ''[http://books.google.com/books?id=lscDAAAAMBAJ&lpg=PA114&dq=%22Anger%20management%22&pg=PA114#v=onepage&q=%22Anger%20management%22&f=false Anger Management]'', July 2006 The Office Politic. Men’s Health magazine. Emmaus, PA: Rodale, Inc.</ref> It has been described as deploying [[anger]] successfully.<ref name="Schwarts" /> Anger is frequently a result of frustration, or of feeling blocked or thwarted from something we feel to be important. Anger can also be a defensive response to underlying fear or feelings of vulnerability or powerlessness.<ref>https://www.union.edu/offices/health-counseling/counseling/_forms/anger-management.pdf</ref> Anger management programs consider anger to be a motivation caused by an identifiable reason which can be logically analyzed and if suitable worked toward.<ref name="Schwarts" /> <blockquote>"We all experience anger; anger only becomes a serious concern when an individual is angry too frequently, too intensely, and for too long." - Raymond W. Novaco, 1985</blockquote> == Some basics == "Anyone can become angry, that is easy...but to be angry with the right person, to the right degree, at the right time, for the right purpose, and in the right way...this is not easy." - Aristotle Ideal goal of anger management is to lead an anger-free life.<ref>W. Doyle Gentry, Ph.D. 2007. ''Anger Mananagement for Dummies,'' page 3. Hoboken, NJ: Wiley Publishing, Inc.</ref> Anger is an active emotion that calls the person feeling it to respond.<ref>W. Doyle Gentry, Ph.D. 2007. ''Anger Mananagement for Dummies,'' page 4. Hoboken, NJ: Wiley Publishing, Inc.</ref> People get into into anger issues because both the instigator and instigated lack interpersonal and social skills to keep their cool.<ref name="W. Doyle Gentry 2007. page 5">W. Doyle Gentry, Ph.D. 2007. ''Anger Mananagement for Dummies,'' page 5. Hoboken, NJ: Wiley Publishing, Inc.</ref> They can train to respond to their anger as unwanted and unpleasant rather than react to its need.<ref name="W. Doyle Gentry 2007. page 5"/> [[Turning a blind eye]] or forgiveness is a tool to turn anger off.<ref name="W. Doyle Gentry 2007. page 5"/> Getting enough sleep, exercise and good diet is a tool for preventing anger.<ref>W. Doyle Gentry, Ph.D. 2007. ''Anger Mananagement for Dummies,'' page 6. Hoboken, NJ: Wiley Publishing, Inc.</ref> Professionals who deal with those who have trouble managing anger include mental health counselors, social workers, psychologists and psychiatrists. ==History== The negative effects of anger have been observed throughout history. Advice for countering seemingly uncontrollable rage has been offered by ancient philosophers, pious men, and modern psychologists. In ''[[de Ira]],'' <ref name="L.D.Reynolds, M.T.Griffin, E.Fantham">{{cite book |url=https://books.google.co.uk/books?id=bVWcAQAAQBAJ&pg=PA93&dq=first+extant+copy+of+Seneca+de+beneficiis&hl=en&sa=X&ei=LEsEVYjFK8vvaLOqgNAD&ved=0CD4Q6AEwBg#v=onepage&q=first%20extant%20copy%20of%20Seneca%20de%20beneficiis&f=false|author=L.D.Reynolds, M.T.Griffin, E.Fantham|title=The Oxford Classical Dictionary|publisher= Oxford University Press, 29 Mar 2012 (edited by S Hornblower, A Spawforth, E Eidinow) ISBN 0199545561| accessdate=2015-03-15}}</ref> [[Seneca the Younger]] (4 BC- 65 AD) advised for pre-emptively guarding against confrontational situations, perspective taking, and not inciting anger in anger-prone individuals.<ref>Seneca, L. A. (1928). De ira [Anger]. In J. W. Basore (Ed. and Trans.), Seneca's moral essays (Vol. 1). London: Heinemann. (Original work written about 45)</ref> Other philosophers echoed Seneca with [[Galen]] recommending seeking out a mentor for aid in anger reduction.<ref>(Galen, C. (1963). On the Passions and errors of the soul (P.W. Harkins, Trans.). Columbus, OH: Ohio State University Press. (Original work written about 180)</ref> In the Middle Ages, saints would serve as both examples of self-control and mediators of anger-induced disputes.<ref>(Kemp, S., & Strongman, K. T. (1995). Anger theory and management: A historical analysis. The American Journal of Psychology, 108(3), 397. Retrieved from http://search.proquest.com/docview/224850445?accountid=12874)</ref> Examples of intercession for the common people from the wrath of local rulers abound in hagiographies. The story of [[St. Francis of Assisi]] and the metaphorical Wolf of Gubbio is one famous instance. In modern times, the concept of controlling anger has translated into anger management programs based on the research of psychologists. Classical psychotherapy based anger management interventions originated in the 1970s. Success in treating anxiety with [[Cognitive behavioral therapy]] (CBT) interventions developed by Meichebaum inspired Novaco to modify the stress inoculation training to be suitable for anger management.<ref>Meichenbaum‚ D. H. (1975). Stress inoculation training. New York: Pergamon Press.</ref><ref>Novaco‚ R. W. (1975). Anger control: The development and evaluation of an experimental treatment. Lexington‚ MA: D.C. Health.</ref> Stress and anger are sufficiently similar that such a modification was able to create a successful branch of treatment. Both stress and anger are caused by external stimuli, mediated by internal processing, and expressed in either adaptive or maladaptive forms. Meichebaum, and later Novaco, used each aspect of experiencing the relevant emotion as an opportunity for improvement to the patient’s overall wellbeing. == Potential causes for development of anger problems == {{expand section|date=April 2015}} ===Medical=== Matters like [[alcoholism]], a [[mental disability]], bio-chemical changes and PTSD can all lead to a person committing an aggressive act against another person. Also not having any skills on how to handle oneself in a time of aggression can lead to very undesirable outcomes. These things are typically associated with a heightened chance of anger, but there are other, less-known factors that can lead to people acting in a negative way. Prolonged or intense anger and frustration contributes to physical conditions such as headaches, digestive problems, high blood pressure and heart disease. Problems dealing with angry feelings may be linked to psychological disorders such as anxiety or depression. Angry outbursts can be a way of trying to cope with unhappiness, or depressed feelings. '''Migraines''': Something as small as a frequent [[migraine]] can actually cause certain levels of aggression and the need for anger management. A 2013 study examined migraines and its association with anger problems in young children (m = 11.2 years of age). The patients in the study were split into low migraine attack frequency (AF), intermediate AF, high frequency, and chronic migraine AF. The tendency for a participant to inhibit their anger and not lash out was found more in children with higher AF. Children that qualified for low migraine AF actually had more anger expression.<ref>Tarantino, S., De Ranieri, C., Dionisi, C., Citti, M., Capuano, A., Galli, F., & ... Valeriani, M. (2013). Clinical features, anger management and anxiety: A possible correlation in migraine children. The Journal Of Headache And Pain, 14doi:10.1186/1129-2377-14-39</ref> ===Psychosocial=== Psychosocial factors like stress, abuse, poor social or familial situations, taxing of physical and mental energy...etc. can cause anger problems.<ref>http://www.nasponline.org/publications/booksproducts/nas-cbiii-05-1001-009-r02.pdf</ref> == Types of treatment == Some popular anger management techniques include relaxation techniques, monitored breathing exercises, cognitive restructuring and imagery(e.g. Stosny's '''H'''ealing imagery '''E'''xplain oneself emphatically what and why it makes you respond angrily '''A'''pply kindness and compassion to self '''L'''ove oneself '''S'''olving the co-morbid problems phases<ref>https://www.psychologytoday.com/articles/200506/the-lion-tamer</ref>), problem solving, improving communication strategies and interpersonal skills ('''DEAR MAN''' & '''GIVE''').<ref>APA, apa.org 2013. ''Controlling anger before it controls you, [http://www.apa.org/topics/anger/control.aspx?item=4 Strategies To Keep Anger At Bay]'', part 4. Washington, DC: APA's Office of Publications and Databases</ref><ref>http://www.srmhp.org/0302/anger.html</ref> Here is a look at specific types of anger management treatment approaches supported by study's and effective empirical scientific evidence. Several of the studies examined used [[self-report]], which some psychologists{{who|date=August 2015}} feel could be a limitation for results. People do not want others to think of them as angry individuals, so their answers could be changed to fit how society wants them to behave.{{Citation needed|date=August 2015}} === Prevention and Relationship Enchantment Program === The Prevention and Relationship Enchantment Program (PREP) is a program that was used in a study consisting of Air Force families. The families were assigned to either a traditional multi-couple group format or a self- directed book version focusing on relationship satisfaction and anger management skills. There was a significant main effect for time related to both relationship satisfaction (pretest M = 49.8, SD = 17.6; post-test M = 53.8, SD = 17.6, F(1, 76) = 6.91, p < .01), and anger management skills, (pretest M = 32.2, SD = 4.2; post-test M = 34.6, SD = 4.0, F(1, 74) = 31.79, p < .001).<ref>Anderson, J. R., Stith, S. M., Johnson, M. D., Strachman-Miller, M. M., Amanor-Boadu, Y., & Linkh, D. J. (2013). Multi-couple group and self-directed PREP formats enhance relationship satisfaction and improve anger management skills in Air Force couples. American Journal Of Family Therapy, 41(2), 121-133. doi:10.1080/01926187.2012.671104</ref> The self-directed book version did not show as positive of results. Improving a couple’s anger management skills can be a vital step in ensuring there are no violent outbreaks throughout the relationship. === Cognitive behavioral therapy === The use of [[cognitive behavioral therapy]] (CBT) is something that many anger management treatment concoctions incorporate. By trying to get a patient to open up about their emotions and feelings and being driven to accomplish a specific task (in this case controlling anger), a person is cognitively motivated to use positive skills towards their behavior. Studies show using a mix of CBT as well as other therapies on the participants/clients increased the effective usage of the anger management techniques and that they also felt more in control of their own anger. Personal changes like these can lead to less aggression and cut down on violent acts. The use of play therapy with this is also found efficient in tackling anger issues among children.<ref>http://www.lianalowenstein.com/anger_frey_edited.pdf</ref> === Positive mentalization and personality development === This is a style that is commonly used in elementary schools for students expressing anger outbreaks. Researchers who have looked into the reason for young student anger have found that one common reason could be the inability to adjust socially. Students that were selected for this study received a daily one-hour session throughout one week of school. The researchers of this [[mentalization]] program educated children through group therapy in [[positive psychology]] and tried to do activities that put the child in a happy mood while interacting. At the end of the week, research showed that there was a negative correlation between anger and social adjustment. This process lowered the overall anger levels of the students involved in social adjustment deficits.<ref>Rohini, N. S., & Devi, R. (2011). Management of anger and enhancement of social adjustment among school students with the application of positive therapy. Indian Journal Of Community Psychology, 7(2), 249-255.</ref> Use of [[personal development|personalty development]] (PD) led to higher views of themselves and more positive self-esteem. Aggression has been shown to be a result of poor self-worth as well as thinking that those around you do not care or support you, so this PD is vital in helping change a person’s self-perception.<ref>Down, R., Willner, P., Watts, L., & Griffiths, J. (2011). Anger management groups for adolescents: A mixed-methods study of efficacy and treatment preferences. Clinical Child Psychology And Psychiatry, 16(1), 33-52. doi:10.1177/1359104509341448</ref> === Anger diary writing === Understanding your own emotions can be a crucial piece of learning how to deal with your anger. Children who wrote down their negative emotions in an “anger diary” actually ended up improving their emotional understandings, which in turn led to less aggression. When it comes to dealing with their emotions, children show the ability to learn best by seeing direct examples of instances that led to certain levels of anger. By seeing the reasons why they got angry, they can in the future try to avoid those actions or be prepared for the feeling they experience if they do find themselves doing something that typically results in them being angry.<ref>Renati, R., Cavioni, V., & Zanetti, M. (2011). ‘Miss, I got mad today!’ The Anger Diary, a tool to promote emotion regulation. The International Journal Of Emotional Education, 3(1), 48-69.</ref> There is not sufficient evidence of this needing to be implemented in elementary schools, but this activity is a common tool used in therapies, so it could lead to children writing down their negative feelings and anger and help them to re-evaluate their position and take personal time to cool down instead of lashing out and doing aggressive actions in person. === Other evidence based approaches === Anger management interventions are based in cognitive behavioral techniques and follow in a three-step process.<ref name="Beck">Beck, R., & Fernandez, E. (1998). Cognitive-behavioral therapy in the treatment of anger: A meta-analysis. Cognitive Therapy and Research, 22(1), 63-74.</ref> First, the client learns to identify situations that can potentially trigger the feeling of anger. A situation that elicits anger is often referred to as an anger cue.<ref name="Deffenbacher, L. J. 1999">Deffenbacher, L. J. (1999). Cognitive- behavioral conceptualization and treatment of anger. ''Psychotherapy'' in Practice. 55''(3), 295-309.''</ref> If a potential trigger can be avoided, the individual can not only avoid unwanted outbursts, but also avoid internal conflict. Often anger occurs through automatic thought and irrational beliefs, these poses a problem for treatment because the patient may respond too quickly to change the thought or behavior. Wright, Day, & Howells referred to this phenomenon as the "hijacking of the cognitive system by the emotional system".<ref name=":0">Wright, S., Day, A., & Howells, K. (2009). Mindfulness and the treatment of anger problems. ''Aggression and'' Violent Behavior. 14'', 396-401.''</ref> Second, relaxation techniques are taught as appropriate responses to the identified situations. Common techniques include regulating breathing and physically removing yourself from the situation. Finally, [[role-play]] is used to practice the application of the learned techniques for future encounters with anger-inducing situations in the individual’s life. The end result of repetition is an automatic response of learned beneficial techniques.<ref name="Beck" /> Modifications of each general step result in distinctive programs. Additionally, different fields of psychology will change aspects of the above three-step process, which is primarily based in cognitive-behavioral therapy. Group, family, and relaxation only therapies each contribute to the wider range of available anger management programs. [[Relaxation therapy]] can reduce cognition and motivations to act out, and through relaxation, clients gain coping skills to better manage their anger. This therapy addresses various aspects of anger such as physiological, cognitive, behavioral, and social. These aspects combined are what make relaxation an effective treatment for anger.<ref name="Deffenbacher, L. J. 1999"/> The Mindfulness therapy technique attempts to teach clients acceptance of bodily sensations and emotions. Mindfulness originated in Eastern spiritual traditions that are practiced through meditation. A two-prong component of Mindfulness includes: self-regulation and orientation toward the present moment. The center of this therapy technique is experiencing the present moment in a non-judgmental manner that is reflective of meditation. In practice, clients observe breathing, sitting and walking during meditations. The goal is for clients to understand that his or her thoughts of anger are merely thoughts rather than reality. Mindfulness is also a technique used in the relaxation approach, because the technique halts physiological arousal.<ref name=":0" /> [[Rational emotive behavior therapy|Rational Emotive Behavior Therapy]] explains anger through the client's beliefs and emotion, rather than the event itself. The concept involves clients interpreting events in a rational manner in order to avoid irrational thoughts that lead to anger. Delayed reaction technique is when clients attempt to uncover what is making them angry before acting out on their anger. This allows them to have time to change what is making them angry and increase time before their response; this encourages thought on a more rational level. In addition, clients are also encouraged to avoid demands in an [[Anti-oppressive practice|anti-oppressive]] order to avoid anger.<ref name=":1">Potts, L. (2008). Anger management (L. Krueger, Ed.). Farmington Hills, MI: Greenhaven Press.</ref> An example of a demand placed on a client may be that, "I have to have this done by my standards". Research is starting to show that the better individuals understand what anger management is and how it can help them personally and in relationships, aggressive actions are less likely to occur.<ref>http://freeanger.blogspot.com/</ref> Anger treatments' success rates can be difficult to estimate because anger is not a recognized disorder in the [[Diagnostic and Statistical Manual of Mental Disorders]]. This manual is used as a reference for mental health professionals. Some research does exist on comparing various treatments for anger, but they also describe methodological difficulties in making accurate comparisons. The most concrete evidence for anger treatment is that multiple techniques have proven to be more successful than a single technique.<ref>Kassinove, H. (2007). Finding a useful model for the treatment of anger and aggression. In T. A. Cavell & K. T. Malcolm (Ed.), Anger, Aggression, & Interventions for Interpersonal Violence (pp. 77-94). Mahwah, NJ: Lawrence Erlbaum Associates</ref> The relaxation approach had the highest success rate as a standalone treatment.<ref>Mayne, J. T., & Ambrose, K. T. (2009). Research review on anger in psychotherapy. ''Psychotherapy in Practice, 55''(3), 353-363.</ref> The effectiveness of the CBT-based anger management therapies has been evaluated by a number of [[meta-analyses]]. In a 1998 meta-analysis with 50 studies and 1640 individuals, measures of anger and aggression were used to compare the effects of the anger management intervention with no treatment. A significant effect for anger management was found with a 67% chance of improvement for individuals having received the anger management as compared to the individuals without the therapy.<ref name="Beck"/> In addition, a 2009 META-analysis compared psychological treatments for anger across 96 studies. After an average of 8 sessions, a significant improvement in anger reduction resulted.<ref>Saini, M. (2009). A meta-analysis of the psychological treatment of anger: Developing guidelines for evidence-based practice. Journal of the American Academy of Psychiatry and the Law, 37(4), 473-488.</ref> Overall, the completion of an anger management program is likely to result in long lasting positive changes in behavior. Diet treatments, [[reflexology]], and [[acupuncture]] are methods of treating anger that have mental health practitioners skeptical. The diet or nutritional treatments are aimed at uncovering the problem that is at the source of their anger. The process of uncovering the problem is done by researching biochemical imbalances that have an influence on mental health. For example, an individual who consumes gluten rich foods may be negatively influenced because his or her body is unable to process gluten properly. This negative influence may result in an increase in aggression, irrational thought process, and ultimately anger.<ref name=":1" /> Successful interventions can result in not only a reduction of the outward display of [[aggression]], but also a decrease in the internal level of anger.<ref>DiGiuseppe, R. and Tafrate, R. C. (2003), Anger Treatment for Adults: A Meta-Analytic Review. Clinical Psychology: Science and Practice, 10: 70–84. doi: 10.1093/clipsy.10.1.70</ref> ==Affected populations== ===Adults=== One motivation for seeking anger management can be career related. As both a preventative and corrective tool, anger management is available to help individuals [[Coping (psychology)|cope]] with potentially anger-inducing aspects of their jobs. One such situation applies to caretakers of individuals with [[mental illness]]. The daily stress combined with slow or no progress with the people under their care can create a high level of frustration. Skills training for caretakers of relatives with dementia has been developed to help cope with these feelings of frustration in a positive manner.<ref>Coon, D., Thompson, L., Steffen, A., Sorocco, K., & Gallagher-Thompson, D. (2003). Anger and depression management: Psychoeducational skill training interventions for women caregivers of a relative with dementia. Gerontologist, 43(5), 678-689.</ref> Anger management is also beneficial in [[law enforcement]]. The role of police officers is to protect civilians, however conflicts between the police and the general public can develop. The goal of anger management would be to reduce such occurrences like police brutality from negatively impacting the relation between law enforcement and citizens.<ref>Abernethy, A. D., & Cox, C. Anger management training for law enforcement personnel. Journal of Criminal Justice, 22(5), 459-466</ref> Anger management programs tailored towards this goal could orient themselves towards these means by focusing on conflict resolution and including specific law enforcement scenarios in the training. This need was noticed by Novaco, who originally designed an intervention for anger management based on cognitive behavioral therapy, resulting in a specialized skills training program for law enforcement.<ref>Novaco, R. (1977). Stress inoculation approach to anger management in training of law-enforcement officers. American Journal of Community Psychology, 5(3), 327-346.</ref> Couples also in the brink of dissolution of their marriage need to understand what to do about [[intimate partner violence]], and the more knowledgeable the individuals are on how to manage their anger, the better prepared they are when confronted with a problem with another person.<ref>Shorey, R. C., Seavey, A. E., Quinn, E., & Cornelius, T. L. (2014). Partner-specific anger management as a mediator of the relation between mindfulness and female perpetrated dating violence. Psychology Of Violence, 4(1), 51-64. doi:10.1037/a0033658</ref> ===Children and adolescents=== The ability for young children to understand their emotions and how to react in certain situations can greatly increase their chance of expressing themselves in an appropriate manner. A 2010 study from the ''Journal Of Applied School Psychology'' looked at four 4th grade boys who took part in different activities with the school psychologist, ranging from how to deal with your emotions to practicing anger reduction strategies. They found a positive correlation between partaking in these meetings and less anger expressing in a multitude of locations (school, home, etc.).<ref name="Sportsman">Sportsman, E. L., Carlson, J. S., & Guthrie, K. M. (2010). Lesson learned from leading an anger management group using the “seeing red” curriculum within an elementary school. Journal Of Applied School Psychology, 26(4), 339-350. doi:10.1080/15377903.2010.518823</ref> Anger management programs with a cognitive-behavioral basis have been modified for children and adolescents. There are three common types of CBT aimed at the youth. First, life skills development (Communication, empathy, assertiveness, etc.) uses modeling to teach appropriate reactions to anger. Second, effective education focuses on identifying the feelings of anger and relaxation. Finally, problem solving conveys a view of cause and effect for situations as an alternative to anger.<ref>P.C Kendall. Cognitive-behavioral therapies with youth: Guiding theory, current status, and emerging developments. Journal of Consulting and Clinical Psychology, 61 (1993), pp. 235–247.</ref> A wide range of methods can be used to convey these three components, with both age and severity being important factors. For younger children, involvement can be increased by presenting anger management in more of a fun format with educational games and activities being available.<ref>Plummer, D. M. (2008). Anger management games for children. London, GBR: Jessica Kingsley Publishers.</ref> For adolescents, group therapy can be an effective form given the resemblance to the individual's natural social environment.<ref>Snyder, K. v., Kymissis, P., & Kessler, K. (1999). Anger management for adolescents: Efficacy of brief group therapy. Journal of the American Academy of Child & Adolescent Psychiatry, 38(11), 1409-1416.</ref> The severity of expressed anger issues often relates to the intensity of the subsequent anger management program. A few violent outbursts in a classroom setting could result in several sessions with the school's counselor. However, more severe [[juvenile delinquency]] could result in court mandated anger management sessions in a juvenile correctional facility. The effectiveness of anger management has been studied in children and adolescents for the purpose of evaluating existing programs and designing more effective programs. In a meta-analyses of 40 studies, an overall effect size of 0.67 was found for CBT anger management treatment, suggesting anger management as a legitimate approach to problematic levels of anger. Skills development (0.79) and problem solving (0.67) both had a higher impact than affective education (0.36). This was believed to be due to behavioral aspects being more easily conveyed than cognitive for children.<ref>Sukhodolsky, D., Kassinove, H., & Gorman, B. (2004). Cognitive-behavioral therapy for anger in children and adolescents: A meta-analysis. Aggression and Violent Behavior, 9(3), 247-269.</ref> The true value from early interventions aimed at youths comes from the preventative aspect. Curbing negative behaviors early in life could lead to a more positive outlook as an adult.<ref>Candelaria, A. M., Fedewa, A. L., & Ahn, S. (2012). The effects of anger management on children's social and emotional outcomes: A meta-analysis. School Psychology International, 33(6), 596-614.</ref> ===Individuals with intellectual disabilities=== Individuals with intellectual disabilities can struggle with managing anger.<ref>Kiely, J., Pankhurst, H. Violence faced by staff in a learning disability service Disability and Rehabilitation 20 81–89 1998.</ref> When faced with aggression from individuals with an intellectual disability, caretakers often employ a combination of four different strategies.<ref>Taylor, J. (2002). A review of the assessment and treatment of anger and aggression in offenders with intellectual disability. Journal of Intellectual Disability Research, 46, 57-73.</ref> Depending on both the setting and individual, the following strategies for aggression minimization present in different ways. # '''Reactive strategies''' - Aim to minimize impact of overtly aggressive behavior by using established protocols. Ex. Enforced isolation after the start of a violent outburst. # '''Ecological interventions''' - Attempt to reduce aggression level by changing an aspect of the environment for a more calming effect. Ex. Reducing ambient noise to lower irritation. # '''Contingency management''' - Focuses on modifying behavior through a combination of reinforcement and punishment. Ex. Using a token economy to enforce rules concerning behavior. # '''Positive programming''' - Teaches positive reaction skills as an alternative to aggression. Ex. Anger management with a CBT background. The need for anger management is also evident in situations where individuals with intellectual disabilities are prescribed psychotropic medication as the result of aggressive and/or self-injurious behavior. The medication’s role as a chemical restraint does not help modify the underlying cause of aggression.<ref>Matson J. L., Bamburg J. W., Mayville E. A., Pinkston J., Bielecki J., Kuhn D., Smalls Y. & Logan J. R. (2000) Psychopharmacology and mental retardation: a 10 year review (1990–1999). Research in Developmental Disabilities 21, 263 – 96.DOI: 10.1016/s0891-4222(00)00042-1.</ref> [[Sedation]] is best used as an emergency measure with skills training as a long term solution to decreasing the overall rate of violent incidents. In a meta-analysis reviewing 80 studies, behavioral based interventions were found to be generally effective in modifying behavior.<ref>Robert Didden, Hubert Korzilius, Wietske van Oorsouw, Peter Sturmey, and James Bodfish (2006) Behavioral Treatment of Challenging Behaviors in Individuals With Mild Mental Retardation: Meta-Analysis of Single-Subject Research. American Journal on Mental Retardation: July 2006, Vol. 111, No. 4, pp. 290-298.</ref> Additionally, cognitive behavioral therapy as administered by lay therapists was found to be effective, which supports the feasibility of such anger management programs.<ref>Willner, P., Rose, J., Jahoda, A., Kroese, B. S., Felce, D., MacMahon, P., et al. (2013). A cluster randomised controlled trial of a manualised cognitive-behavioural anger management intervention delivered by supervised lay therapists to people with intellectual disabilities. Health Technology Assessment, 17(21), 1-+.</ref> == Targeted groups for anger management == Listed below are several different categories of people who would according to this ideology benefit from having anger management courses or training: === People with violent backgrounds === {{Main|Violence}} This is the easiest group to think of but is not a group of people you can skip right over. Just because someone has a violent past does not mean they would not benefit from an anger management (AM) program. One such study found that offenders who were currently in high security hospitals that went through a self-report 20 class training program actually had very positive results. Results of the self-report showed a decrease in aggression and a lack of responding when angry. There were two issues to keep in mind though; a hospital setting and a setting in which the researchers did not want to provoke much anger due to the instability of the patients.<ref>Wilson, C., Gandolfi, S., Dudley, A., Thomas, B., Tapp, J., & Moore, E. (2013). Evaluation of anger management groups in a high‐security hospital. Criminal Behaviour And Mental Health, 23(5), 356-371. doi:10.1002/cbm.1873</ref> When it comes to previous anger offenders, the normal course of action focuses on how to not respond when feeling angry. Few studies focus on forensic mental health settings like the one previously mentioned. More tend to focus on understanding the person’s mental health could lead to understanding what specific AM strategy would be most effective. === Bullies === {{Main|Bullying}} This category of individuals needs to be helped because of the ongoing school shootings across the United States. In a [[meta-analysis]] study composed of studies completed from 1979-2010, young school aged children who were identified as portraying aggressive personalities were given several different anger management classes. Overall, results showed slightly positive results for children receiving the classes (less aggression). The courses aimed at reducing negative emotions in the children and trying to help them with [[self-control]]. While no overarching conclusions could be made, researchers state that children going through anger management courses are more prepared to combat their anger internally and less likely to act out.<ref>Candelaria, A. M., Fedewa, A. L., & Ahn, S. (2012). The effects of anger management on children’s social and emotional outcomes: A meta-analysis. School Psychology International, 33(6), 596-614. doi:10.1177/0143034312454360</ref> This is such a prevalent issue in our society, and while the results were not overwhelmingly positive, any reduction in [[bullying]] is a step in the right direction. === Substance abusers === {{Main| Substance abuse}} There is no statistical information that shows people who substance abuse also have high rates of aggressive actions. However, researchers believe this is a group of people that should be studied due to their questionable decision-making and typically unstable mental health. Substance abusers could benefit from an anger management class not only in preventing potential aggression, but potentially to understand that they need to slowly work off the drugs in order to achieve a better mental state.<ref>Shopshire, M. S., & Reilly, P. M. (2013). Anger management treatment and substance use disorders. In E. Fernandez (Ed.) , Treatments for anger in specific populations: Theory, application, and outcome (pp. 74-91). New York, NY US: Oxford University Press.</ref> === People with intellectual disabilities === {{Main|Intellectual disabilities}} This is a group that a majority of the population might not associate with having AM problems, but research shows over half of the population of Americans with intellectual disabilities displays violent and aggressive actions somewhat regularly. People with a [[learning disability]] tend to express anger and aggression to even those who help them on a daily basis. Adults with intellectual disabilities are at high risk of acting aggressive and being sent to clinics due to their actions.<ref>Willner, P., Jahoda, A., & Larkin, P. (2013). Management of anger in people with intellectual disabilities. In E. Fernandez (Ed.) , Treatments for anger in specific populations: Theory, application, and outcome (pp. 92-113). New York, NY US: Oxford University Press.</ref> The "[[theory of the mind]]" approach states that people with anger management problems tend to be unsteady mentally and are not able to internalize any blame for their actions. One of the main reasons for anger outbursts is externalizing blame and having a quick impulse to lash out. These individuals need to have a better understanding of what their actions mean and that they should understand that blaming themselves for problems can sometimes be the right thing to do.<ref>Josephs, L., & McLeod, B. (2014). A theory of mind–focused approach to anger management. Psychoanalytic Psychology, 31(1), 68-83. doi:10.1037/a0034175</ref> === Posttraumatic stress disorder (PTSD) individuals === {{Main|Posttraumatic stress disorder}} PTSD is a symptom that tends to lead people to act very violent and aggressive. People with this condition are mentally fragile and people who interact with them need to be cautious. This group can benefit from extended CBT dealing with anger management issues. One study dealing with 86 war veterans found that during the 12 sessions of training, anger traits slightly dropped as well as small reductions in expressing anger. Research also indicates that their antisocial personality traits upon return can put them behind in society, so finding the right anger management courses is of vital importance. There were not significant enough findings from this study to definitely recommend veterans with PTSD to use CBT anger management courses.<ref>Marshall, A. D., Martin, E. K., Warfield, G. A., Doron-Lamarca, S., Niles, B. L., & Taft, C. T. (2010). The impact of antisocial personality characteristics on anger management treatment for veterans with PTSD. Psychological Trauma: Theory, Research, Practice, And Policy, 2(3), 224-231. doi:10.1037/a0019890</ref> === People with traumatic brain injuries === {{Main|Traumatic brain injury}} People with a traumatic brain injury (TBI) tend to display very aggressive and dangerous actions. A study in the ''[[Brain Injury (journal)]]'' showed that one way to prevent such actions is a community based treatment of people with TBI. Results indicated that the need to lash out diminished after the 12-week program, and a series of post-treatment testing showed a decline in self-reported frequency of angry actions. Other specific results included: significant decreases in the frequency of experiencing angry feelings and the frequency of outward expression of anger as well as significant increases in the frequency of controlling feelings of anger.<ref>Walker, A. J., Nott, M. T., Doyle, M., Onus, M., McCarthy, K., & Baguley, I. J. (2010). Effectiveness of a group anger management programme after severe traumatic brain injury. Brain Injury, 24(3), 517-524. doi:10.3109/02699051003601721</ref> == Associated people == === Seneca === {{Main|Seneca the Younger}} One of the first people to study anger and the control of anger was the Roman philosopher Seneca. He studied anger during his lifetime, c. 4 BC- AD 65, and from his experiences and observations he formulated ways to control anger. This could be considered an early form of anger management. Seneca noted the importance of how to avoid becoming angry, how to quit being angry, and how to deal with anger in other people.<ref name=":02">Kemp, S. & Strongman, K. T. (1995). Anger theory and management: A historical analysis. '''The American '''Journal of Psychology. 108[[Seneca The Younger|(3), 397- 417.]] </ref> Another theorist who came after Seneca was Galen, a Roman era philosopher, who built on the work of Seneca to formulate new ideas in the area of anger management. Galen stresses the importance of a mentor to help deal with excess anger.<ref name=":02" /> === Peter Stearns === {{Main|Peter Stearns}} Peter Stearns played an important part in researching the differences in anger between genders. Stearns concluded that there are similarities between male and females experience of anger. June Crawford came up with an opposing idea about how the two genders deal with anger. Her research concluded that men and women deal with anger by different means.<ref name=":02" /> === Raymond Novaco === Works from Raymond Novaco in the 1970s have contributed to many of the recent ideas on the management of anger. These ideas have led to the implementation of different anger management programs. An important idea from Novaco is the importance of looking at the situations that led up to the anger in order to have control over the anger. He stated that anger is an emotional response to situations. Novaco stated that anger occurs in three modalities, either cognitive, somaticaffective or behavioral. After discovering the anger there should be discussion and self-examination in order to relieve the anger. This process was thought to help the client identify the situations that lead to anger and deal with the anger depending on the step that the anger is occurring in. The client is able to use different relaxation skills to reduce their anger before it advances.<ref name=":02" /> ==Benefits== The benefits of undergoing anger management center brings around the successful reduction in anger and violent outbursts. Personal relationships that have been previously strained by a high level of aggression are likely to undergo improvement. Professionally, workplace relationships have a similar outcome that are beneficial to an individual's career and personal sense of satisfaction. Legally, continued attendance to anger management programs, mandated or not, can be seen as a sign of good faith. For incarcerated individuals, an earlier parole time can be the result of good behavior learned from anger management classes. From an emotional standpoint, reducing the internal level of anger results in a decrease in stress and an increase in overall happiness as a result. From a medical standpoint, physical illnesses also improve from positive emotional and behavioral changes. Anger management style and overall level of anger has been associated with both acute and chronic pain sensitivity.<ref>Burns, J., Bruehl, S., & Caceres, C. (2004). Anger management style, blood pressure reactivity, and acute pain sensitivity: Evidence for "trait X situation" models. Annals of Behavioral Medicine, 27(3), 195-204.</ref> [[Blood pressure]] is another physiological aspect effected by anger, with increased levels of anger being correlated with higher blood pressure.<ref>Faber, S., & Burns, J. (1996). Anger management style, degree of expressed anger, and gender influence cardiovascular recovery from interpersonal harassment. Journal of Behavioral Medicine, 19(1), 31-53.</ref> The implications of an effect on blood pressure for overall health is made evident by the link between high blood pressure and the increased risk of [[cardiovascular disease]]. An increase in the immune system's efficacy has also been observed as a result of the increased level of relaxation.<ref>Weber, C., Arck, P., Mazurek, B., & Klapp, B. (2002). Impact of a relaxation training on psychometric and immunologic parameters in tinnitus sufferers. Journal of Psychosomatic Research, 52(1), 29-33.</ref> Successful anger management could also lead to an overall longer life span due to the decrease in reckless behavior and violent altercations. ==Impediments== There are a number of factors that can lower the probability of a successful anger management intervention. One such obstacle is the level of the individual's [[motivation]]. Overall low readiness is an impediment to the effectiveness of anger management due to the lower attendance rates and negative effect on the [[therapeutic alliance]].<ref>Howells, K., & Day, A. (2003). Readiness for anger management: Clinical and theoretical issues. Clinical Psychology Review, 23(2), 319-337.</ref> Involuntary assignment to an anger management program, for example court mandated sessions, will result in a lower average motivation level than voluntary admission. In one study with incarcerated inmates, there was a correlation found between individual readiness and improvement.<ref>Heseltine, K. (2010). Brief anger interventions with offenders may be ineffective: A replication and extension.(report). Behaviour Research and Therapy, 48(3), 246.</ref> Additionally, given the component of anger as a [[social construct]], difficulty with communication between cultures can serve as another impediment.<ref>J.R. Averill. (1993). Putting the social in social cognition, with special reference to emotion. R.S. Wyer, T.K. Srull (Eds.), Perspectives on anger and emotion: advances in social cognition, vol. VI , pp. 47–56.</ref> What is deemed an appropriate expression of anger is culturally dependent. Therefore, a mismatch between client and therapist could result in a misunderstanding as to the end goal of the program. For example, a client could only wish to decrease physical violence, while the therapist aims to decrease both verbal and physical outbursts. Gender dependent expectations of anger expression can contribute as well to societal standards. The same [[Violence|violent]] outburst for a man and woman is subject to different interpretations due to anger being seen as more permissible in males.<ref>Kemp, S., & Strongman, K. T. (1995). Anger theory and management: A historical analysis. The American Journal of Psychology, 108(3), 397. Retrieved from http://search.proquest.com/docview/224850445?accountid=12874</ref> The cost of taking anger management could also be a significant obstacle. The time required for anger management depends on the program. Weekly one hour sessions with 8-12 sessions per program are common, but a single intensive all day session variety exists as well. The monetary cost can amount to $30–$50 per session for general therapy, or much higher fees for specialized coaching. The availability of anger management programs locally can be problematic for more isolated areas, creating an additional cost for travel. However, online options can follow the same structure as an in person intervention with similar outcomes.<ref>Morland, L. A., Greene, C. J., Rosen, C. S., Foy, D., Reilly, P., Shore, J., et al. (2010). Telemedicine for anger management therapy in a rural population of combat veterans with posttraumatic stress disorder: A randomized noninferiority trial. Journal of Clinical Psychiatry, 71(7), 855-863.</ref> == See also == * [[Anger]] * [[Assertiveness]] * [[Stress management]] * [[Conflict (process)|Conflict]] * [[Emotional self-regulation]] * [[Life skills]] == References == {{Reflist|2}} ==External links== * [http://www.apa.org/topics/anger/index.aspx American Psychological Association - Anger] * [https://www.cmha.ca/mental_health/feeling-angry/ Canadian Mental Health Association (CMHA) Tips] * [http://www.psychologicalselfhelp.org/Chapter7.pdf Psychological Self Help] * [http://www1.villanova.edu/villanova/studentlife/counselingcenter/infosheets/angermanagement.html Anger Management] Villanova University, Pennsylvania [[Category:Psychotherapy]] [[Category:Mindfulness (psychology)]]'