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Section 1
Cognitive Behavioral Therapy for Intermittent Explosive Disorder

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In this section, we will discuss the five Cognitive Behavior Therapy methods for handling anger as they relate to cognitive therapy.  These methods are suppression, open aggression, passive aggression, assertiveness, and dropping it.  As I discuss these five methods for handling anger you might use this as a checklist for an anger management client you are currently treating.

5 CBT Methods for Handling Anger

♦ Method #1 - Suppression
First, let’s discuss suppression. As you know, many anger management clients hesitate to admit their own anger. They suppress anger for one reason or another. First, it is important to clients to never appear upset to others. The second reason is they are in a state of denial. I spoke with Mary, age 38, who described her reason for suppressing anger. "I can’t afford to be angry. It would ruin my reputation. What would happen if I lost my social status?" Mary had taken an all or nothing approach to anger. Mary’s reasoning led her to believe that all anger is bad so she may never afford to express it.

♦ Method #2 - Open Aggression
The second method for handling anger is open aggression. This category of anger tends to denote rage and explosiveness, but as you know can also include criticism and sarcasm. In my experience, personal insecurities can be an explanation for open aggression. Tim, age 43, told me, "I used to be mild mannered, until my wife told me she was leaving me. I immediately felt alone. I started saying real mean things to her whenever she came by the house. I would throw things and raise my voice. I’m sure this pushed her away even further."

♦ Breathing to Relax CBT Technique
As you know, it is healthy to demand respect, but Tim took this normal desire too far. Aggressive clients’ emotional stability may rely on the cooperation of their partners. At the close of our session, I had Tim try the Breathing to Relax technique. The objective is to have the client focus on something else prior to displaying anger.

I had Tim sit comfortably and close one nostril. I then told him to take a deep breath through his open nare to the count of ten and hold it for two seconds. Next, I had Tim close the open nostril and open the closed nostril at the same time and exhale through the newly opened nostril. As Tim finished I explained he could repeat the exercise as many times as he needed to calm himself whenever he began to feel angry.

♦ Method #3 - Passive Aggression
In addition to suppression and open aggression, we will discuss passive aggression. As you are aware, a client’s determination to not succumb to open aggression can lead to passive aggression. As they suppress their emotions, anger manifests itself in other ways. Procrastination, silence, lying, evasiveness, and being obstinate are all manifestations of passive aggression.

The first three methods for handling anger that we have discussed tend to perpetuate anger. The next two methods can lead to success.

♦ Method #4 - Assertiveness
The fourth method is assertiveness.  Clearly, anger can be a method of preserving self-worth. You probably know that assertive anger means this preservation is accomplished while considering the needs and feelings of others.  I talked to Mary, age 38, about channeling her anger into assertiveness. She stated, "I’ll really have to change my way of thinking. I never thought anger could be constructive." I gave Mary two reminders that should help her learn to communicate assertively.

2 Reminders for Communicating Assertively
1. Make sure the issues receiving your attention are not trivial.
2. Be aware your tone of voice can create an atmosphere of respect.

I was sure to tell Mary that assertiveness is not always easy. As you may have experienced, assertiveness requires self-discipline and respect.

♦ #5 Dropping It
The fifth method for handling anger is dropping it. Clearly, this just means letting go and can be harder than assertiveness. You probably know dropping anger means accepting the inability to control a situation and recognizing personal limits.  Tim, age 43, was still bitter over his divorce and he talked to me about the difficulty of letting go of his anger. "What makes this so difficult is that she never gave me a chance. She never bothered to discuss our issues. Then I responded poorly and made matters worse."

I summarized: "So, feeling the divorce was unnecessary makes it difficult to forgive and forget." Tim responded by saying, "That’s an understatement! I know I need to move on, but it feels wrong. I wish I could tie up the loose ends." As you know, it is important a client understands the difference between dropping it and suppression.

In this section, we discussed the five methods for handling anger. These methods are suppression, open aggression, passive aggression, assertiveness, and  dropping it. As you probably have experienced, clients can benefit greatly from taking responsibility for their expressions of anger and focusing on channeling angry feelings toward assertiveness and letting go.

In the next section, we will discuss how feeling controlled causes anger.  Some main ideas to consider in a cognitive therapy environment are why control occurs, how a client responds to control, and the acknowledgement of freedom.
Reviewed 2023

Peer-Reviewed Journal Article References:
Christ, N. M., Contractor, A. A., Wang, X., & Elhai, J. D. (2020). The mediating effect of rumination between posttraumatic stress disorder symptoms and anger reactions. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication.

Deska, J. C., Lloyd, E. P., & Hugenberg, K. (2018). The face of fear and anger: Facial widthtoheight ratio biases recognition of angry and fearful expressions. Emotion, 18(3), 453–464.

Gable, P. A., Poole, B. D., & Harmon-Jones, E. (2015). Anger perceptually and conceptually narrows cognitive scope. Journal of Personality and Social Psychology, 109(1), 163–174.

Hewage, K., Steel, Z., Mohsin, M., Tay, A. K., De Oliveira, J. C., Da Piedade, M., Tam, N., & Silove, D. (2018). A wait-list controlled study of a trauma-focused cognitive behavioral treatment for intermittent explosive disorder in Timor-Leste. American Journal of Orthopsychiatry, 88(3), 282–294. 

Wilkowski, B. M., Robinson, M. D., & Troop-Gordon, W. (2010). How does cognitive control reduce anger and aggression? The role of conflict monitoring and forgiveness processes. Journal of Personality and Social Psychology, 98(5), 830–840.

QUESTION 1
What are the five CBT methods for handling anger? To select and enter your answer go to Test.

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