Anger management 9-12 Session Treatment Protocol

Anger Management 9

Session ProtocolDr. Dawn-Elise Snipes PhD, LMHC

Executive Director, AllCEUs.com

AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 1

Objectives Learn about anger and it’s functions

Explore events and cues

Develop an anger control plan

Learn about the aggression cycle and how to change it

Review the ABCDEs and thought stopping

Assertiveness and conflict resolution skills

Alternatives for expressing anger

Relaxation Interventions

Explore how past learning from your family of origin can influence current behavior


Session One: Learn About Anger

Anger is an emotion triggered by a threat which

prompts the fight (aggression) or flight reaction

Hostility refers to a set of attitudes, thoughts and

judgments that motivate aggressive behaviors.

Aggression is behavior that is intended to protect

oneself by causing harm or injury to another

person or damage to property. (Fight or Flee)

Many times what we initially perceive as a threat

is not currently one



Session 1 cont.

Misperceptions

Example: Fire alarm

Example: Sean and Elias

Initial experience: Brewster perceived a danger

Future experiences—Elias is associated with a threat

Example: Rescues

Initial experience: A man hurt you

Future experiences are overgeneralized: All men are dangerous

Example: Domestic Violence

Initial experience: Raised voices leads to violence

Future experiences: Anytime someone raises their voice it is a threat


Session 1 Anger becomes a problem when it is felt too

intensely, is felt too frequently, or is expressed inappropriately

How does anger affect you:

Physically: Sleep, pain, GI, immunity

Emotionally: Regret, guilt, feeling helpless

Socially: Fear vs. respect, negative impact on relationships

Occupationally: How you work with others, customer service

Spiritually: Your sense of connectedness to and impact within the world, karma

Environmentally: Break stuff, holes in walls, throw out things impulsively


Session 1… Anger initially has apparent payoffs (e.g., releasing

tension, controlling people).

In the long-term, however, these payoffs often lead to negative consequences.

What benefits/payoffs does anger have for you?

Habits are things we do almost automatically.

In what ways is anger a habit

How can you use mindfulness to start to break that habit?

I am angry?

What am I angry about?

Is this actually a threat to me?

What is the best response in this situation to help me achieve my goals


Session 1

Identify anger control strategies you have used in

the past

Which ones worked? Why?

Which ones didn’t work? Why?


Session 1 Homework: Keep a log of your anger intensity the next week.

Keeping a log helps you become more aware of your triggers and cues

and see your progress.

On the top of the page, put the date (use a different sheet each day)

Make 3 columns with the following headers

9

Episode

Briefly state what happened

Intensity1: Mildly

irritated

2:Moderately

irritated

3: Angry

4: Enraged

Duration1: got over it quickly

2: Stewed on it for

less than an hour

3: It bothered me for

a couple hours

4: It ruined my day

1.

2.

3.

4.

Session 2: Identifying Triggers, Events & Cues When you get angry, it’s because you have encountered an

something that has made you feel threatened (provoked you)

What are some general situations that make you irritable? Angry or

enraged?

Many times, specific events touch on sensitive areas. These

sensitive areas or “red flags” usually refer to long-standing

issues that can easily lead to anger

Loss of Control

Rejection/Isolation

Death/Loss

Failure

Why does each of these “sensitive areas” make you feel

threatened/trigger your anger?

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10

Long waits at the doctor

Traffic

A friend joking about a sensitive

topic

A friend not paying back $

Being wrongly accused

Having to clean up after someone

Having an untidy roommate

Having a neighbor who plays the

stereo too loud

Being placed on hold forever

Rumors being spread about you

Having something stolen

Ingratitude

Someone openly contradicting you

Not getting a promotion

Session 2 cont… Cues are indicators that you are getting angry.

Cues can be broken down into four cue categories:

Physical Cues (how your body responds; e.g., with an increased heart rate,

tightness in the chest, feeling hot or flushed)

Behavioral Cues (what you do; e.g., clench your fists, raise your voice, stare

at others)

Emotional Cues (other feelings that may occur along with anger; e.g., fear,

hurt, jealousy, disrespect)

Cognitive Cues (what you think about in response to the event; e.g., hostile

self-talk (“I’ll fix her little red wagon!”), images of aggression and revenge)

Review your anger log from last week and identify your common cues.

What strategies can you use to become more aware of and deal with

these cues?


Session 3: Vulnerabilities Vulnerabilities are those things that make you more

likely to respond with anger

Types

Emotional: Overwhelmed, irritable about something else, stressed out, feeling sensitive or vulnerable

Cognitive: Expecting a negative outcome from a situation, person or meeting

Physical: Low blood sugar, alcohol, too much caffeine, pain, illness, insufficient sleep

Social: Being in situations that make you feel more on edge, or around people that tend to trigger anger or be negative themselves

What are your vulnerabilities and how can you best prevent or mitigate them?


Session 3..cont Homework from last week

What was the highest number you reached

What triggered that anger episode

What were the cues associated with the behavior

Physical

Behavioral

Emotional

Cognitive

What strategies did you use to avoid reaching 10 on the anger meter?

Are there particular “threat themes?”

What vulnerabilities may have existed that day?


Session 4: Anger Control Plan An effective plan should include both immediate and preventive

strategies

Immediate Strategies

Time out

When might you use it. How might you do it?

Distract with activities (doing something or listening to music),opposite emotions or taking a mental vacation

Block the situation from your mind temporarily (Thought Stopping)

What are some thought stopping statements you can use?

Practice mindfulness in 3s

Breathe!

Talk to a friend or journal

Create meaning.

Exercise

Radically Accept---It is what it is.


Session 4 cont… Preventative Strategies

What general things can you do to prevent or minimize vulnerabilities?

Emotional

Mental

Physical

Social

When you are vulnerable for some reason, what can you do to reduce the chances that you will get angry?

Emotional

Mental

Physical

Social


Session 4 cont… Review your anger log from last week. What immediate

strategies could you have used? What preventative

strategies might have made a difference?

Develop a plan to start reducing one or two vulnerabilities

each month


Session 5: The Aggression Cycle

An episode of anger can be viewed as consisting of three phases:

Escalation: Event and responses/cues/thoughts/feelings

What can you do when you notice emotional, physical, cognitive or social cues?

Explosion: Verbal or physical aggression urges

What can you do when you have the urge to be aggressive?

Postexplosion: Negative Consequences (emotional, cognitive, legal, social,

physical)

Review your anger log from last week and identify the event that

got you most angry or had the most negative consequences and

identify what you could have done to

Reduce the escalation

Prevent the explosion


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Session 5 Cognitive Distortions are unhelpful ways of perceiving things.

Think about a time something happened and you thought it was one way, but you turned out to be wrong.

Types

Personalization (All my fault/All about me)

3 other explanations

Minimization of the positive (Trained monkey)

What good happened, is happening or could come out of this?

Selective abstraction/Only seeing what you expect to see/Mental Filter

What are all the facts (Try taking someone else’s point of view)

Exaggeration of the negative/catastrophizing

How likely is this to happen


Session 5 Cognitive Distortions

All or nothing

Find the exceptions

Control fallacy

What parts do you have control over?

Overgeneralization

How is this situation different?

Arbitrary inference (Flying)

What is the evidence

Emotional Reasoning: I feel angry, therefore this must be a threat.

What are the facts?

Review your anger log and identify any cognitive distortions that were in play.

What cognitive distortions were/are common in your family?


Session 6: The A-B-C-D-E Model “A” stands for an activating event. The activating event is the

“event” or red-flag event.

“B” represents our beliefs about the activating event. It is not the

events themselves that produce feelings such as anger; it is our

interpretations and beliefs about the events.

“C” stands for the emotional consequences. These are the feelings

experienced as a result of interpretations and beliefs concerning the

event.

“D” stands for dispute. This part of the model involves identifying any

unhelpful beliefs and reframing them in alternate ways.

Identify the FACTS for and against your beliefs (Don’t use emotional

reasoning.)

Make sure you are not confusing high and low probability events

Identify and address thinking errors/cognitive distortions


Session 6: The A-B-C-D-E Model “E” stands for evaluate your response options and choose the

one that gets you closer to those people and things that are

important in your life.

“Is this worth my energy?”

What is the best way to handle this?

Reviewing your anger log, identify the most intense anger

episode from last week and apply the ABCDE model

What strategies are you currently using to:

Become more aware of cues?

Reduce vulnerabilities?

Deal with anger to prevent it from escalating?


Session 7: Assertiveness The basic message of aggression is that my feelings, thoughts, and

beliefs are very important and your feelings, thoughts, and beliefs are

unimportant.

The basic message of passivity is that your feelings, thoughts, and

beliefs are very important but my feelings, thoughts, and beliefs are

unimportant.

The basic message of assertiveness is that my feelings, thoughts, and

beliefs are important and your feelings, thoughts, and beliefs are

equally important.

Win/Win

Dialectics

What are some of the advantages of acting assertively when trying to

resolve conflicts?

What might some of the drawbacks to assertiveness be?


Session 7 Conflict Resolution Model

1) Identify the problem.

2) Identify the cues.

3) Identify the specific impact

Own your beliefs and emotions (I felt that…, I thought that…, It caused…)

4) Deciding whether to resolve the conflict.

5) Addressing and resolving the conflict.

Create a win-win by expressing how changing the situation in the future will benefit that person

What are some ways you can resolve the conflict

Review your anger log for last week and apply the conflict resolution model to one episode.

What strategies are you using that seem to be helping?


Session 8: Anger and the Family

We learn a lot about how to interpret events and cope with

distress by observing our family.

How was anger expressed in your family while you were growing up?

How did your father express anger?

How did your mother express anger?

Were you ever threatened with or exposed to physical violence?

How were other emotions, such as happiness and sadness, expressed in

your family?

Was emotional expression limited to feelings of anger and frustration, or

were many different kinds of emotions expressed?

What role did you take in your family? (Hero, rescuer, victim, wallflower,

scapegoat?)


Session 8: Anger and the Family

We learn a lot about how to interpret events and cope with

distress by observing our family.

What messages did you receive about your father and men in general?

What messages did you receive about your mother and women in general?

Did you feel accepted and loved, or did you feel like you couldn’t do

anything right?

How did your family deal with failure?

What feelings, thoughts, and behaviors carry over into your relationships

today?

What purpose do these behaviors serve today?

Review your anger management plan from the past 7 weeks.

What has changed? What progress have you made? What still

needs to change? What strategies are working well?


Session 9: Anger Myths Using what you have learned, dispute the following anger

myths…

Myth #1: Anger is inherited.

Myth #2: Anger automatically leads to aggression.

Myth #3: You must be aggressive to get what you want.

Myth #4: Venting anger is always desirable.

Myth #5: Anger is a negative emotion.

Myth #6: Anger is all in your head.

Myth #7: Venting or ignoring your anger makes it go away

Myth #8: Men are angrier than women

Men and women get angry over different things and often express it

differently

Men are more likely to be aggressive and impulsive in their expressions of

anger, women are more likely to use an indirect approach,

like cutting someone out of their lives, or stuff it and keep it in


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Session 9

Myth #9 "The older you get, the more angry you are. "The

data show that the angriest people are 14-year-old boys."

"As you go from 14 to 22 or so, it levels off and stays low, through

adulthood," he said. "As you get into middle age, in the 50s and

60s, it starts to go up again, but it never gets to the level it was

when you were 14."

Myth # 10: Anger results from human conflict.

Sometimes yes, sometimes no. People can get irritable by being

exposed to foul odors, aches and pains, and hot temperatures —

none of which involve (or can be blamed on) the actions of others.

Then they may react to something with unnecessary anger.


Summary

Anger is a natural emotion. It is designed to alert people that there MIGHT be a problem.

When people are vulnerable or learned maladaptive ways of dealing with anger or simply never learned healthy coping skills they can experience anger management problems

Excessive anger negatively impacts people emotionally, mentally, physically, socially, occupationally, legally and spiritually.

Effective anger management involves preventing vulnerabilities, being aware of and working on “sensitive areas” or “threat areas,” preventing anger whenever possible and developing immediate coping responses to deal with it when it occurs.


Anger management 9-12 Session Treatment Protocol

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