Anger Management Takes More Than Coping Skills

Who doesn’t remember “Serenity now!” angrily spilling from Frank Costanza’s lips on the hit show Seinfeld? A coping mechanism he discovered on an anger management cassette his doctor gave him, Frank regularly blurted the phrase as if it should wipe him clean of anger. Later, fans would see this strategy did little to curb his explosivity. As anyone who has successfully tackled their maladaptive anger realizes, a repetitious phrase does not constitute therapy.

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The limits of coping skills

I've always been irritated by the popular culture idea that mental health care is "coping skills and medications." There's usually more to it, including for anger management, if there's to be long-term relief (e.g., Wampold, 2015; Amole, 2018). Anger management will likely conjure images of clientele in a group being educated on the components of anger and how to self-soothe. While not always in a group format, this is the common anger intervention scenario (e.g., Pilania, 2015; Dwika et al., 2020; Stallman et al., 2021).

As noted by Short (2016), the common approach isn't always effective, and he suggested that those with severe anger and rage require more sophisticated interventions. Anyone who has worked with very angry clientele can attest to this. Sure, some coping skills will likely provide tenuous stability, getting a patient from one day to the next, but it so frequently feels like a game of "whack-a-mole" as anger resurfaces with a vengeance.

I like to think of this as a fire that is ostensibly extinguished, given the flames are no longer visible, but had burned so hot that there is still a subterranean smoldering. The smoldering works its way under pressure until there's an opportunity to surface again, where it spreads across the landscape once more.

Working with untold numbers of angry inmates drove home for me that even the best efforts may produce only shaky stability—this, despite their being programmed to death about emotional control and anger management. For many, eruptions would return as sure as there were opportunities.

What's the problem?

The obstacle is, anger doesn't exist in a vacuum. It's great to get some control of it, but unless the conflicts encouraging the tendency for pervasive anger are addressed, we can expect a revolving door. That anger, like the smoldering fire gone underground, festers under pressure until there's an opportunity to release it. Maybe the person didn't act out on it using something learned in anger management, but the emotion probably got buried. This happens over and over until it piles up and they are choking on it, and just looking for a reason to expel it.

If significant anger isn't correlated to medical conditions (e.g., endocrinological difficulties, head injuries), severe autism, or the innate mood lability of mania, there's a good chance it's a character flaw—an ingrained, maladaptive way of relating to the world. In this case, the well-meaning, common corrective of "education and coping skills" is a proverbial Band-Aid being applied to an extensive wound.

Whenever I had the opportunity to work with people long-term about anger, it tended to yield better results. Take the case of Paulo (name disguised):

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Paulo was angry his whole life. Though he wasn't abusive to his wife, his chronically disgruntled nature threatened their future. While Paulo managed short-lived spells of stifling his explosions, they were sure to return. This made relationships troublesome, and that would be a cause for more frustration and explosion.

Paulo grew up in a tough place, and from the start learned from his family not to take any pushing around. He got good at channeling his anger into a few punches that gained him a reputation to keep away. He also learned to keep people at a distance by adopting a disgruntled tendency; in short, the best defense was offense. Although during his formative years this was adaptive to neighborhood and family situations, it didn't translate well into adulthood where it was perilous to his education, work, and relationships as he tried to start a family.

Paulo confessed he felt lonely and wanted people to like him. He wondered, however, if his aggressive reactivity and feeling the need to keep others at bay to stay safe was too-ingrained; the anger management class his primary care doctor suggested provided little relief.

What was an existential necessity in his youth evolved to be an existential crisis as he aged. Paulo was tired of his anger keeping him from achieving life satisfaction. Without allowing himself to be vulnerable, he realized, his relationships would never be fulfilling. This was all frustrating, and like others in his shoes, Paulo's frustrations mounted until he exploded.

As Paulo’s trust in our relationship and therapuetic process took root, he was open to practicing some laser-focused behavioral interventions. This showed him he had some control over what he believed he didn't. Parallel to this, we set out on a relational voyage that cultivated in Paulo a self-allowance to feel vulnerable and share himself. Discovering this potential with a male therapist was doubly helpful, given his family instilled the idea that it is emasculating to show softness, especially to another male.

Over a year, Paulo learned to constructively convey frustration in our relationship, and that the less defensive he was, the more validated and understood he felt—things that never happened in youth. His other relationships started to blossom as the office work trickled down.

This one-two punch, pardon the pun, diffused the problematic core schema he possessed that anger is the best language.

Considerations for treatment-refractory anger:

1. Have medical and substance-related causes of the anger been ruled out? In such instances, medical intervention/sobriety, not anger management, is required.

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2. Has it been considered that the anger isn't a standalone phenomenon? Few people are "simply angry." It is probably feeble to provide only coping skills to people whose anger is rooted in:

• Severely low frustration tolerance in ADHD
• The anger/irritability of depression, especially in younger males
• "Bipolar rage"
• PTSD
• The reactivity to feeling abandoned in borderline personality disorder

These conditions will require more than anger coping skills. In such situations, like Paulo, providing anger-specific interventions parallel to managing the wellspring from which it flows will likely provide the best results, as we see in Dialectical Behavioral Therapy (DBT).

3. Is it a matter of character flaw? While Paulo didn't meet the criteria for any personality disorder, anger was a maladaptive way of relating, and thus part of his personality, of which one's character is a part (Shannon, 2016). Showing the patient there's another way to relate and exist, along with providing focused anger interventions, can yield very positive results.

4. Is the anger/rage part of a more toxic presence, namely antisocial personality disorder, or malignant narcissism? Given these populations have little ability to take responsibility and tend to feel justified in their rage, it may be more of a matter of helping people in their lives learn to navigate being around them.

Disclaimer: The material provided in this post is for informational purposes only and not intended to diagnose, treat, or prevent any illness in readers. The information should not replace personalized care from an individual's provider or formal supervision if you’re a practitioner or student.