Managing Anger

Helen O’Neill, St Andrew’s Hospital, Northampton, UK

• Foreword. Acknowledgements.The purpose of the manual.Background Principles.Theoretical background.Definitions.What causes anger?.Does anger cause aggression?.A model of anger.Outline of the stress inoculation treatment for anger control.Cognitive preparation.Skill acquisition phase.Application training.Summary of key components.Does the treatment work?.Adapting the existing treatment to suit clients with cognitive impairment.Establishing the need.Additional influences.The evolution of OTSAR.Summary.Delivering anger treatment.Therapists.Experience.Self-awareness.The therapeutic relationship.Establishing a common goal.The therapeutic alliance.Listening to a person reporting their anger.De-escalation techniques.Checklist for suitability.Which individuals might be suitable for anger treatments?.History of behaviour.Insight and awareness.Sensory Impairments.Motivation.Cognitive abilities.– Intellectual function.– Information processing and memory.– Language and comprehension.– Executive function/skills.– Emotional recognition.Ability to self-monitor changes in physiological arousal.Checklist for suitability.Inclusion.Exclusion.Group or individual treatment?.Duration of treatment.Follow up.The treatment setting.Potential problems of working within an institution.Potential problems of working in a community setting.Facilities.Safety precautions.Starting the process.Assessment and evaluation.Methods of data collection.Pre-treatment gathering of information.Ongoing collection of data.Evaluation of treatment.Semi-structured interview.The interview.Plan for future treatment.Pre-sessional work.The way the manual works.The sessions.1. How to cope with being told No!.2. Dealing with teasing and provocation.3. Coping with criticism.4. Being on the receiving end of anger.5. Carrying a grudge.Recap sessions.Bringing the techniques out of the treatment room.A personal Action Plan.Summary of my anger management work – Blueprint.Other methods to assist generalisation of skills.Example of a personal action plan.Example of a ‘blueprint’.Appendix 1.The physiological component.Relaxation and arousal reduction.OTSAR or On The Spot Arousal Reduction.Step 1 of OTSAR – Calming breaths.Step 2 of OTSAR – Self-monitor/tense/relax.Step 3 of OTSAR – Sitting version.Step 4 of OTSAR – Standing version.Step 5 of OTSAR – Learning to turn it on/off anywhere, anytime Customising OTSAR.Some Do’s and don’ts of relaxation and breathing techniques.Practical resources.The anger thermometer (including worksheet).Outline of a person (worksheet).Appendix 2.The cognitive component.General coping self-statements.Coping or positive self-statements (four stages).Additional exercises for cognitive work.It’s easy to let your thoughts ‘wind you up’.Trying to see it from the other person’s point of view.What are your rules for life and do they work?.Practical resources.Bubble picture.Helpful calming thoughts.‘Wind up’ thoughts.The Think – Feel – Do sequences.The Think – Feel – Do worksheets.Take another look at the situation that made you angry.Starting to feel angry?.Getting to know your angry thoughts.Appendix 3.The behavioural component.Assertion training.The assertive way.The problem-solving routine (worksheet).Appendix 4.Diaries and worksheets.The wind-up scale.Record of emotions.Anger management diaries.The traffic light routine.Ways to calm (worksheet).Rules for life worksheet.References.Further reading.Participant feedback sheet.

“Overall, this practical manual should provide a valuable aid for all mental health professional with an interest in a cognitive approach for the management of anger.” (Journal of Psychiatric and Mental Health Nursing, March 2007) "...a helpful resource for anyone planning, running or supervising a managing anger treatment programme for people who have cognitive impairmant."  (Behavioural and Cognitive Psychotherapy, 2007)