Anger is one of the most basic human emotions and is not inherently problematic. However, if anger is experienced in great intensity, for long periods of time, or is difficult to control, an individual may experience negative consequences – this is when anger becomes a problem. If a person identifies anger as a personal issue and is ready to address it, change-oriented therapy can be effective (Deffenbacher, 2011). Anger problems are part of many disorders including depression, anxiety, and trauma disorders like PTSD (Novaco, 2011).
Anger is defined as an internal experience with emotional, physiological, and cognitive components. The CBT model of anger emphasizes the role of triggering events. In this model, anger arises due to the interaction of triggering events, an individual’s pre-anger state, appraisals of the event, and coping skills (Deffenbacher, 2011). Triggering events are divided into different classes: specific external events (e.g. being stuck in traffic), a combination of external events and anger-related memories (often found in PTSD sufferers), or internal experiences like thoughts and emotions. The pre-anger state includes negative mood states (e.g. feeling tired or sick), as well as enduring characteristics of the individual. The enduring traits are comprised of cultural/familial norms regarding anger and an individual’s way of thinking about the world. Appraisals are the individual’s judgments about the triggering event, or a self-judgment about one’s ability to cope (e.g. feeling that you are overwhelmed) (Deffenbacher, 2011).
In CBT, the therapist helps the client to identify and understand the anger triggers, appraisals, behavioral responses, and outcome. Using an analysis of thoughts, emotions, and behaviors leading up to an anger episode, the client gains insight into the anger response and develops individualized anger-reduction strategies (Deffenbacher, 2011). They will learn to self-monitor: detecting thoughts and arousal that predict anger and recognizing situational cues that can elicit anger (Novaco, 2011). The goals of CBT interventions are to enhance self-awareness and acceptance, reduce avoidance, and identify and challenge maladaptive assumptions and beliefs. Cognitive restructuring and problem-solving interventions are used with relaxation techniques for coping with elevated emotional and physiological arousal. Behavioral interventions identify dysfunctional angry behaviors and train the patient in conflict-management skills, leading to increases in self-efficacy (Deffenbacher, 2011). Meta-analyses have shown that CBT treatment is efficacious in treating anger (Beck and Fernandez, 1998) and has the largest effect of any psychotherapy (Novaco, 2011).