Adolescent anger control

Feindler, E.L, & Ecton, R.B. (1994). Adolescent anger control: Cognitive-behavioral techniques. Boston: Allyn and Baker.

The Art of Self-Control

The therapist should understand Self Inoculation Training (SIT).

SIT Goals:

1. Prevention. Reduce the frequency of angry outbursts (56). Ask kids what acting out of anger accomplishes, teach them not to get angry if it “serves no positive function” (57).
2. Regulation. Show kids that “when their anger becomes extreme or out of hand, they are wasting personal power, energy, and time.” Instead of dwelling on “negative thoughts concerning an anger-provoking situation,” help them to stop these thoughts and replace them w/ an “alternative cognitive activity (e.g., anger-control, task-oriented self instructions”) (57).
3. Execution. Give kids skills “for appropriately expressing their anger” (57).

SIT Training Phases:

1. Educational: Teach kids to understand their angry outbursts “in terms of the interaction b/t cognitive, physiological, and behavioral components.” Teach them about “the situational antecedents that trigger or ignite” their outbursts “and how to use these antecedent cues as triggers to ‘chill out’” (58).
2. Skill-Acquisition: Teach them CBT “techniques that they can use to cope more effectively w/ anger-provoking situations” (58). CALM DOWN acronym (first three cognitive, last five behavioral):
1. Cue them “for anger provocation by training them” to “prepare for possible provocation b/f it happens” and helping them to identify “potential ‘triggers.’”
2. Alter their “views of anger provocation” by having them “identify, challenge, and moderate their irrational thoughts.”
3. Let them use their “private speech” “to prepare, guide, and direct them in a controlled manner through anger provocations.”
4. Moderate their “physiological anger arousal by providing them w/ skills training in relaxation.”
5. Direct them to be “more effective in communicating their anger” “by providing them w/ training in acting assertively rather than aggressively.”
6. Organize the way they solve their problems “by providing them w/ systematic training in problem solving.”
7. Work through ways to effectively use CBT “anger control skills.”
8. Negotiate “a commitment” to begin using these skills outside class (59).
3. Skill Application Phase. Here you rehearse new skills w/ kids, have them watch videos of right and wrong ways to respond to provocations, have former graduates serve as role models, use “preplanned barbs,” give homework assignments (60).

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Initial Interview

1) Share info received from teachers, etc., as way “to educate the adolescent about how others in the immediate environment view his/her anger patterns and to find out what they think are the possible events that trigger such reactions” (87).

2) Analyze student’s behavior in ABC terms (Antecedent-Behavior-Consequences). See Appendix 1.

Three steps:

1. Antecedent: Ask the student “to identify five triggers (A) that without fail lead to loss of anger control and to elaborate on those triggers that provoke the greatest amount of anger and aggression.” Write triggers on blackboard.
2. Ask student “to talk about how he/she reacts (B) to each of the triggers listed.” Divide triggers into three categories by asking:
1. “What do you think about when your anger is triggered?”
2. What do you feel like when your anger is triggered?”
3. What do you act like or what do you do when your anger is triggered?” (87)
3. Ask student to talk about consequences (C) of his angry outbursts.

3) Explain that student might not be able to control the triggers but he can learn to control his response to the triggers “so that the outcome will be more positive” (88).

4) Describe the self-control program to the student.

1. “The first goal of the program is to increase your personal power during anger provoking situations.” This is done by increase self-control, self-confidence, self-respect, self-responsibility, etc. (88).
2. Second goal “is to teach you how to stay out of the fool’s ring by cutting the fool’s strings.” Draw circle w/ X in it and an X next to circle. X in circle = “fool in the ring,” i.e., “the anger-provoking trigger,” X outside circle = student. The fool is trying to pull student into the rings (89). The If student allows the fool in the ring to pull his strings, the fool becomes his puppetmaster and student becomes his puppet, and he’s now in ring w/ fool. When this happens the student is giving up personal power (90).

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Session #1

1) “Review the two goals of the training program: (a) to increase personal power during anger-provoking situations, (b) to learn how to stay out of the fool’s ring by cutting the fool’s strings.”

2) Review the ABC model.

3) Teach “how anger really occurs.” Explain that “[w]hen the trigger goes off, it ignites two types of reactions at the same time. In your mind you will have certain negative thoughts and feelings about the trigger. You might think what’s happening to you is unfair, awful, or terrible. You might feel frustrated, annoyed, threatened,” etc. These negative thoughts and feelings cause your body to “react in an out-of-control manner. Inside your body you might experience muscle tightness or tension, butterflies in the stomach, increased heart rate and blood pressure, sweating, or shortening of breath. You might also exhibit the following: nervousness, clenched fists, rigid body posture, angry stares or squinting of the eyes, red face, cold and clammy hands, yelling, cursing, hitting,” etc. “Basically your body and mind will be feeding off each other’s reactions. The longer you have negative thoughts and feelings concerning the trigger, the more your body will react in an out-of-control manner. So it’s not so much the trigger that makes you angry, but it is actually the way your mind and body react to the trigger that makes you angry” (92).

Match = Trigger // Fuse = Thoughts and Feelings // Firecracker = Body

“The longer you let the fuse burn, the more you risk blowing up and losing control of your anger. How quickly you put the fuse out depends upon how well and how quickly you can stop and control your negative thoughts and feelings” (92-93).

4) “Begin brief relaxation training.” Examples pp. 93-95.

5) Assignment homework — pp. 95-96.

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Session #2

1) Review homework.

2) Review relaxation techniques. “Remind adolescent of the importance of using his or her tension as a signal to slow down and deep breathe.”

3) “Continue self-assessment training. Explain the difference b/t indirect and direct anger-provoking triggers. Prompt adolescent to identify additional cues that signal tension” (96).

4) Teach new muscle relaxation techniques.

5) Assign homework, including muscle relaxation practice.

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Session #3

1) Review homework.

2) Review muscle relaxation.

3) Teach new muscle relaxation exercise.

4) Assign homework.

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Session #4

1) Review homework.

2) Review muscle relaxation.

3) Teach new muscle relaxation exercise.

4) Assign homework.

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Session #5

1) Review triggers and hassle log.

2) “Asserting adolescent rights.”

1. Ask student to “generate a list of rights, things to which they feel they are entitled,” e.g., “I have the right to be listened to,” “I have the right to explain my side of the story b/f any judgment is passed,” “I have the right to my own property.”
2. Ask student to generate a list of rights of others. “Stress the importance of treating others like you would like to be treated.”
3. “Distinguish b/t passivity, assertion, and aggression by providing students w/ a continuum of responses to these rights.”
1. “passive — letting someone take away your rights”
2. “assertive — standing up for your rights but at the same time respecting other person’s rights”
3. “aggressive — demanding your rights w/ no regard for the other person’s rights”
4. “Discuss the concept of peer pressure or coercion, which is often exerted to get another person to give up their rights. Discuss how peer pressure works, how to discriminate b/t your own needs/wants and group goals” (75).

3) “Introduce assertion techniques as alternative response to aggression,” tell them “to use these assertion techniques in response to provoking stimuli that require action. These responses are designed to deescalate conflict situations while maintaining rights and an appropriate level of self-control”

1. Broken record — “This response involves a calm, monotone repetition of what you want, e.g., ‘Please give me my radio back.’ The student is trained to continue to repeat the response in the same calm manner until the property is returned.”
2. Empathic assertion — This “involves a sensitive listening on the student’s part to the other person’s feeling state. Particularly useful when dealing w/ authority figures who are angry.” Example: Staff: “This room is a mess. I can’t believe you guys are such slobs. Start cleaning immediately.” Student: “I know you’re upset w/ the mess, but we just got back from the rec room and haven’t had time to clean up yet” (75). Discuss how the staff person “would have felt better b/c [their] feelings were heard” (76).
3. Escalating assertion — “This is a sequence of responses that increases in assertiveness in order to obtain a desired outcome. Begin w/ a minimal assertive response (MAR) and escalate to final contract option (FCO) in which a threat to the other person for noncompliance to original demand is presented.” 1st MAR: “Please return my radio.” 2nd: “I asked you to return my radio.” 3rd: “I want my radio now.” 4th FCO: “If you don’t give me my radio, I will go tell staff and they will come and get my radio for me.”
4. Fogging — This is “used to short-circuit an aggressive verbal conflict by confusing the provoker w/ an agreement,” e.g., Provoker: “You are stupid,” Student: “You’re right, I am stupid” (76).

4) Summarize:

1. Discuss when to use “assertive responses rather than withdrawal or aggressive responses” — when the student “is certain of his/her rights in a situation and when there is a high probability of nonaggressive, successful outcome to the problem situation.”
2. “Review probable responses of others when the target student uses an assertive response — those situations...when others will increase their aggression. Suggest to students ways of handling this increased aggression. Calm persistence is usually best, esp. if you are certain of your requests/rights.”
3. Assign homework.

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Session #6

1) Review the four assertion techniques.

2) “Have students role play several conflict situations from their hassle logs utilizing the various assertion techniques.”

3) “Review w/ students when to use assertive responses rather than withdrawal or aggressive responses.”

4) Assign homework (77).

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Session #7

1) Review homework.

2) Review relaxation exercises.

3) Review four assertion techniques.

4) Teach new assertion techniques “to be implemented by the adolescent when feeling manipulated by others” (101).

1. Language assertion — Explain “that this technique can be used to assert or express difficult negative feelings. Provide the following script and model its proper use out loud: ‘When you (describe the other person’s behavior), I feel or the effects are (describe the consequences). I would prefer (describe the behavior change).’ In addition, model the I Language technique one step further by clarifying the consequences that will result from the other person’s behavior change.”
2. “How to say ‘no’ effectively” — Explain “that there are negative consequences that occur when you want to say no but can’t. Allowing others to manipulate you continually b/c of your inability to say no could lead to a possible anger build-up and outburst. Provide the following guidelines for saying no effectively: ‘When you want to definitely say no, be firm, clear, specific, and honest. Your answer should be short, to the point, and most importantly, start with the word no. Try not to be overly apologetic. When necessary, provide the other person another course of action” (101). Then model the technique.

5) Rehearse and role-play using the techniques.

6) Assign homework.

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Sessions #8, #9, #10

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Session #8

1)

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Appendix 1

More on ABCs:

1. Antecedents (or triggers) or “[p]rovoking stimulus” — what makes the student angry. “Overt antecedents” = “what is going on in the environment.” “Covert antecedents” = “physiological states of fatigue, hunger, etc.” (72).
1. Direct triggers: “Direct aversive provocations by another person” (73).
2. Indirect triggers: e.g., “misperceptions or misattribution of events such as feeling blamed or feeling like someone is disapproving of them” (73).
2. Behavior or reaction — “How do you know when you’re angry?” Covert and overt cues — e.g., “negative statements to self,” “physiological cue: ‘getting hot,’ muscle tension, rigid posture, angry stare, butterflies in stomach, hands clenched, facial muscles tense” (72).

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Appendix 2

Feindler, E.L., & Engel, E.C. (2011). Assessment and intervention for adolescents with anger and aggression difficulties in school settings. Psychology in the Schools, 48(3), 243-253.

Cognitive behavioral anger management training (AMT) is based on the hypothesis that aggressive behavior is elicited by an aversive “trigger” stimulus that is followed by both physiological arousal and distorted cognitive responses, which result in the emotional experience of anger. To prevent an aggressive reaction to a triggered stimulus, it is necessary for adolescents to learn to match the intensity of the response to the realistic aversiveness of the stimulus and to process the interpersonal exchange so that they can exhibit a more prosocial response. The typical anger management treatment protocol focuses on the three components of the anger experience (physiological, cognitive, and behavioral) and is designed to help students develop self-control skills in each of these areas…

To manage the physiological component, the anger management protocol first directs the client to identify the experience of anger, to label the various intensities of the emotion, and to recognize the early warning signs, such as a flushed feeling or quickened heart rate. The therapist validates the experience of anger as a normal and frequently occurring emotion having an intensity range that is under the adolescent’s control. Clients are then asked to identify and track common triggers of their anger using the Hassle Log. Charting daily occurrences of anger (whether handled well or not) helps to identify idiosyncratic patterns of anger loss and control and to increase awareness of external triggers and internal physiological and cognitive reactions. Finally, clients are taught arousal management skills such as deep breathing, imagery, and relaxation to reduce the accumulated physical tension and to increase the probability that they will think through the interpersonal event in a more rational fashion.

The cognitive component targets both the cognitive deficiencies and distortions that are characteristic of persons who respond aggressively and impulsively to perceived provocation. Aggressive youth lack specific problem-solving skills. They generate few possible solutions to interpersonal problems and seem unable to generate future consequences for their aggressive behavior. Furthermore, their assumptions, expectations, beliefs, and attributions are distorted in distinct ways that actually increase their anger experience. In particular, triggering stimuli are perceived to be intentional acts on the part of others—direct insults that are meant to be hostile. They believe that responding aggressively is optimal in terms of outcome, ego protection, and perceived power in the eyes of others. Expectations to behave aggressively and beliefs that others expect them to be aggressive dominate. Then they do not take responsibility for their actions and may blame others (245) for the provocation. These cognitive distortions combine to confirm that aggression is completely justified because it is seen as the only way to resolve a conflict.

Cognitive restructuring strategies are used to help adolescents identify their distorted thinking styles and to encourage them to substitute a series of self-instructions that will enable them to solve problems effectively. Strategies that assist in examining the irrational and narrow focus of their cognitions help them to develop alternative causal attributions and a nonaggressive perspective. They are encouraged to engage in self-coaching of attributions that protect their self-esteem while allowing them to de-escalate conflict and create mental distance from the trigger. This type of cognitive work is difficult for aggressive and impulsive adolescents, but it is the most critical element of any anger management intervention. Altering these internal processes is essential to help youth better manage their anger experience, rethink their possible responses to provocation, and select a more prosocial behavioral response. (246)