In the treatment of anger problems, I have always found collaborative empiricism, cognitive restructuring, and other interventions targeting cognition and beliefs to be relatively ineffective. Like other emotions, anger is often activated quickly, and the perceptual processes that occur very early in the generation of our emotions are mostly unavailable to conscious processing. Like other emotions, we are usually catching up to our anger, making sense and meaning of the physiological and psychological changes activated by our emotions post facto. In 1884, William James argued thatโฆ. the bodily changes follow directly the Perception of the exciting fact, and that our feeling of the same changes as they occur IS the emotion. As more contemporary emotion theorists have argued, emotions tell us what is important to us by organizing and mobilizing us to act. Any expectation that clients be able to effectively pause in the midst of the mobilization of an intensely angry reaction to examine their underlying interpretations of situations in situ is probably unrealistic. One of DBTโs innovations is to target emotions head-on: DBT targets dysregulated emotion by focusing primarily on emotions and the attendant behaviors that generate emotions and affect, what emotion researchers like Magda Arnold and Nico Frijda have called โaction readinessโ or โaction tendencies.โ While this is most directly addressed via skills like opposite-to-emotion action, skills tempering the style of clientsโ assertive communications (like the DEARMAN that Linehan modified from Bower & Bowerโs work) and skills calming intense emotional arousal also impinge directly on emotions, their underlying action tendencies, and affect. DBTโs direct targeting of emotions was one of the main inspirations for our groupโs initial development of a skills-based treatment for comorbid anger and addictions problems. Our first randomized control study demonstrated that this emotion-based treatment was significantly better than an addiction-based treatment in reducing both anger and addiction problems. More recently, Karen Choi and I have been writing a therapist manual detailing a comprehensive, skills-based treatment for problem anger that primarily targets clientsโ emotions. Our book focuses on addressing problem anger as predominantly a problem related to deficits in the awareness, generation, and regulation of anger and other emotions. The treatment aims to help individuals better regulate their emotions and improve assertiveness and self-advocacy rather than โmanaging anger.โ We have identified twelve common problems underlying anger issues and developed a set of skills to address each of these problems. Problem anger is primarily addressed via skills targeting:
- Awareness of the bodily and psychological referents signaling anger
- Symbolizing the experience and meaning of anger without acting
- Identification of the needs and concerns underlying angry reactions
- Strategies integrating the selective use of attention and action tendencies to modulate the intensity of anger in situ
- Identification in situ when anger is a secondary reaction to another primary emotion
- Identifying when it is likely to be helpful to express anger and when it is not
- Fair fighting strategies reducing hostile conflict and increasing the modulation of anger in situ
Lorne Korman, PhD, R.Psych., is a registered psychologist and Clinical Associate Professor of Psychiatry at the University of British Columbia. Dr. Kormanโs research has focused on adapting DBT to help adults and youth struggling with anger and addiction. Read his full bio here. Disclaimer: The Behavioral Tech Institute blog is designed to facilitate the sharing of ideas, experiences, and insights related to Dialectical Behavior Therapy (DBT). The content and views expressed in the articles, comments, and linked resources are those of the individual authors and do not necessarily reflect the views, policies, or positions of Behavioral Tech Institute or staff. Content is provided for information and discussion purposes only and is not intended as professional advice. Contributors to the Behavioral Tech Institute blog are independent, and their participation does not represent an endorsement by Behavioral Tech Institute.