Adult Treatment Planner
1: Anger Management
SNOMED Terms
- Intermittent explosive disorder
- Personality change due to medical disorder
- Posttraumatic stress disorder
Goals
- Decrease overall intensity and frequency of angry feelings, and increase ability to recognize and
appropriately express angry feelings as they occur.
- Develop an awareness of current angry behaviors, clarifying origins of and alternatives to aggressive
anger.
- Come to an awareness and acceptance of angry feelings while developing better control and more serenity.
- Become capable of handling angry feelings in constructive ways that enhance daily functioning.
- Demonstrate respect for others and their feelings.
Behavioral Definitions
- History of explosive, aggressive outbursts out of proportion with any precipitating stressors, leading to
assaultive acts or destruction of property.
- Overreactive hostility to insignificant irritants.
- Swift and harsh judgmental statements made to or about others.
- Body language suggesting anger, including tense muscles (e.g., clenched fist or jaw), glaring looks, or
refusal to make eye contact.
- Use of passive-aggressive patterns (e.g., social withdrawal, lack of complete or timely compliance in
following directions or rules, complaining about authority figures behind their backs, uncooperative in
meeting expected behavioral norms) due to anger.
- Consistent pattern of challenging or disrespectful attitudes toward authority figures.
- Use of abusive language meant to intimidate others.
Diagnoses
- Intermittent Explosive Disorder
- Bipolar I Disorder
- Bipolar II Disorder
- Conduct Disorder
- Personality Change Due to Axis III Disorder
- Posttraumatic Stress Disorder
- Physical Abuse of Adult (by Partner)
- Physical Abuse of Adult (by non-Partner)
- Borderline Personality Disorder
- Antisocial Personality Disorder
- Paranoid Personality Disorder
- Narcissistic Personality Disorder
- Personality Disorder NOS
Objectives and Interventions
- Identify situations, thoughts, feelings that trigger anger, angry verbal and/or behavioral actions and the
targets of those actions.
- Thoroughly assess the various stimuli (e.g., situations, people, thoughts) that have triggered the
client's anger and the thoughts, feelings, and actions that have characterized his/her anger
responses.
- Cooperate with a medical evaluation to assess possible organic contributors to poor anger control.
- Refer the client to a physician for a complete physical exam to rule out organic contributors (e.g.,
brain damage, tumor, elevated testosterone levels) to poor anger control.
- Cooperate with a physician evaluation for possible treatment with psychotropic medications to assist in
anger control and take medications consistently, if prescribed.
- Assess the client for the need for psychotropic medication to assist in control of anger; refer
him/her to a physician for an evaluation and prescription of medication, if needed.
- Monitor the client for prescription compliance, effectiveness, and side effects; provide feedback to
the prescribing physician.
- Keep a daily journal of persons, situations, and other triggers of anger; record thoughts, feelings, and
actions taken.
- Ask the client to keep a daily journal in which he/she documents persons, situations, and other
triggers of anger, irritation, or disappointment (or assign "Anger Journal" in Adult Psychotherapy
Homework Planner, 2nd ed. by Jongsma); routinely process the journal toward helping the client
understand his/her contributions to generating his/her anger.
- Assist the client in generating a list of anger triggers; process the list toward helping the client
understand the causes and extent of his/her anger.
- Verbalize increased awareness of anger expression patterns, their possible origins, and their consequences.
- Assist the client in coming to the realization that he/she is angry by reviewing triggers and
frequency of angry outbursts.
- Assist the client in identifying ways that key life figures (e.g., father, mother, teachers) have
expressed angry feelings and how these experiences have positively or negatively influenced the way
he/she handles anger.
- Ask the client to list ways anger has negatively impacted his/her daily life (e.g., injuring others
or self, legal conflicts, loss of respect from self and others, destruction of property); process
this list.
- Expand the client's awareness of the negative effects that anger has on his/her psychical health
(e.g., increased susceptibility to disease, injuries, headaches).
- Agree to learn alternative ways to think about and manage anger.
- Assist the client in reconceptualizing anger as involving different components (cognitive,
physiological, affective, and behavioral) that go through predictable phases (e.g., demanding
expectations not being met leading to increased arousal and anger leading to acting out) that can be
managed.
- Assist the client in identifying the positive consequences of managing anger (e.g., respect from
others and self, cooperation from others, improved physical health); ask the client to agree to
learning new ways to conceptualize and manage anger.
- Learn and implement calming strategies as part of managing reactions to frustration.
- Teach the client calming techniques (e.g., muscle relaxation, paced breathing, calming imagery) as
part of a tailored strategy for responding appropriately to angry feelings when they occur.
- Assign the client to implement calming techniques in his/her daily life when facing anger trigger
situations; process the results, reinforcing success and redirecting for failure.
- Identify, challenge, and replace anger-inducing self-talk with self-talk that facilitates a less angry
reaction.
- Explore the client's self-talk that mediates his/her angry feelings and actions (e.g., demanding
expectations reflected in should, must, or have to statements); identify and challenge biases,
assisting him/her in generating appraisals and self-talk that corrects for the biases and
facilitates a more flexible and temperate response to frustration.
- Assign the client a homework exercise in which he/she identifies angry self-talk and generates
alternatives that help moderate angry reactions; review; reinforce success, providing corrective
feedback toward improvement.
- Learn and implement thought- stopping to manage intrusive unwanted thoughts that trigger anger.
- Assign the client to implement a "thought-stopping" technique on a daily basis between sessions (or
assign "Making Use of the Thought-Stopping Technique" in Adult Psychotherapy Homework Planner, 2nd
ed. by Jongsma); review implementation; reinforce success, providing corrective feedback toward
improvement.
- Verbalize feelings of anger in a controlled, assertive way.
- Use instruction, modeling, and/or role-playing to teach the client assertive communication; if
indicated, refer him/her to an assertiveness training class/group for further instruction.
- Conduct conjoint sessions to help the client implement assertion, problem-solving, and/or conflict
resolution skills in the presence of his/her significant others.
- Learn and implement problem-solving and/or conflict resolution skills to manage interpersonal problems.
- Conduct conjoint sessions to help the client implement assertion, problem-solving, and/or conflict
resolution skills in the presence of his/her significant others.
- Teach the client conflict resolution skills (e.g., empathy, active listening, "I messages,"
respectful communication, assertiveness without aggression, compromise); use modeling, role-playing,
and behavior rehearsal to work through several current conflicts.
- Practice using new anger management skills in session with the therapist and during homework exercises.
- Assist the client in constructing a client-tailored strategy for managing anger that combines any of
the somatic, cognitive, communication, problem-solving, and/or conflict resolution skills relevant
to his/her needs.
- Select situations in which the client will be increasingly challenged to apply his/her new
strategies for managing anger.
- Use any of several techniques, including relaxation, imagery, behavioral rehearsal, modeling,
role-playing, or in vivo exposure/behavioral experiments to help the client consolidate the use of
his/her new anger management skills.
- Decrease the number, intensity, and duration of angry outbursts, while increasing the use of new skills for
managing anger.
- Monitor the client's reports of angry outbursts toward the goal of decreasing their frequency,
intensity, and duration through the client's use of new anger management skills (or assign
"Alternatives to Destructive Anger" in Adult Psychotherapy Homework Planner, 2nd ed. by Jongsma);
review progress, reinforcing success and providing corrective feedback toward improvement.
- Identify social supports that will help facilitate the implementation of anger management skills.
- Encourage the client to discuss his/her anger management goals with trusted persons who are likely
to support his/her change.
- Implement relapse prevention strategies for managing possible future trauma-related symptoms.
- Discuss with the client the distinction between a lapse and relapse, associating a lapse with an
initial and reversible angry outburst and relapse with the choice to return routinely to the old
pattern of anger.
- Identify and rehearse with the client the management of future situations or circumstances in which
lapses back to anger could occur.
- Instruct the client to routinely use the new anger management strategies learned in therapy (e.g.,
calming, adaptive self-talk, assertion, and/or conflict resolution) to respond to frustrations.
- Develop a "coping card" or other reminder on which new anger management skills and other important
information (e.g., calm yourself, be flexible in your expectations of others, voice your opinion
calmly, respect others' point of view) are recorded for the client's later use.
- Schedule periodic "maintenance" sessions to help the client maintain therapeutic gains.
- Read a book or treatment manual that supplements the therapy by improving understanding of anger and anger
management.
- Assign the client to read material that educates him/her about anger and its management (e.g.,
Overcoming Situational and General Anger: Client Manual by Deffenbacher and McKay, Of Course You're
Angry by Rosselini and Worden, or The Anger Control Workbook by McKay).
- Identify the advantages and disadvantages of holding on to anger and of forgiveness; discuss with therapist.
- Discuss with the client forgiveness of the perpetrators of pain as a process of letting go of
his/her anger.
- Assign the client to read Forgive and Forget (Smedes).
- Write a letter of forgiveness to the perpetrator of past or present pain and process this letter with the
therapist.
- Ask the client to write a forgiving letter to the target of anger as a step toward letting go of
anger; process this letter in session.
Index