How can we tackle excessive or chronic anger?

Anger is an unavoidable (and sometimes necessary) part of life. Getting angry from time to time is part of being human, and can even contribute positively to life and survival. In evolutionary terms, we developed the capacity for anger to protect ourselves and the people we love, and to give us the energy and impetus to achieve and to thrive.

But excessive anger comes with a long list of downsides that affect us as individuals, and the societies within which we live. Intense, frequent anger, experienced inwardly and/or expressed outwardly, is linked with poorer physical health such as heart disease. Anger is an unavoidable part of lifeIt can lead to poor decision-making, chronic risk-taking, addictions, and social isolation. In a survey for the Mental Health Foundation undertaken in 2008, people reported that anger is the emotion that causes more suffering than any other to personal relationships – and many of us perceive that in general, society is becoming angrier.

Getting help with problem anger – the sort of anger that spills over into relationships, working life, and which leads to misery and inability to enjoy life – not only benefits the person who ‘owns’ the anger, but their family and friends too.

Anger tends to be under-researched and under-treated as an emotional or mental health concern. Research papers on anger are far outweighed by ones studying depression, or anxiety.

Why is this? After all, out in the real world, problem anger appears pretty common; 32 per cent of respondents in the Mental Health Foundation’s survey said they were close to someone who has trouble controlling their anger, and almost one in 10 reported that difficulty in control applied to them personally. One in four were worried about how angry they feel at times.

Part of the reason is that our society tends to disapprove of overt aggression, and when aggression becomes violent or disturbing perpetrators will find themselves judged, and in time, with a criminal record. The underlying anger that spurs this behaviour is either ignored, or else it becomes judged as a part of the aggression – so it’s ‘bad’ rather than ‘mad’ or ‘sad’. It’s not seen as something worthy of careful, concerned attention and possible management with or without actual therapy. It also provokes fear and avoidance – even in mental healthcare professionals.

Despite the lack of study, there is enough work to demonstrate that anger management programmes and can be very effective. Individuals can seek treatment one to one with a trained therapist, or there are group interventions which can work, too.

Psychological therapies such as Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT) and mindfulness are particularly applicable to clients struggling with anger. Most commonly used is CBT, which encourages the client to identify situational ‘triggers’ which tend to precipitate the onset of their anger responses. They learn to reframe the situation and facilitate healthy responses, with the help of a series of relaxation skills which can de-escalate a situation and prevent emotions from erupting into an anger response. They are given the opportunity to practice their new, adaptive, responses with role play and rehearsal within the therapy session, and with ‘homework’ tasks outside of therapy.

Mindfulness-based therapies such as ACT, as well as mindfulness itself, can teach the client how to recognise anger before it becomes explosive and before they lose control, so that they can release it and return quickly to a calm, rational state in which nonreactive and generally better decisions and communication can occur.

There are also some initiatives that can improve recognition of anger problems by health and social care professionals, thus improving chances of early intervention. More of this would enable clients to get the appropriate help, and could also work as a prevention, if the screening takes place before anger has led to worsening relationships, loss of employment or criminal acts.

The House Partnership, 29th March 2012