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Section 4
Anger Management Treatment for Veterans with PTSD

Question 4 | Test | Table of Contents

In the last section, we discussed sleep techniques for returning veterans who are struggling to establish healthy sleep routines due to PTSD.

In this section, we will discuss how your client making the transition from soldier to civilian can effectively express their anger. We will discuss the following techniques: Expressing Anger Reflection, How Anger Has Helped and Hurt Me Exercise, and Resolving Anger Must-Haves List.

Kyle, a 32 year old Guardsman mentioned in a previous section, struggled with expressing his anger while he was adjusting to civilian life. Kyle stated, "I have been lashing out at people, even my family, and friends, for little things that set me on edge and it is something that I can’t get a grip on. I don’t want to continue yelling at those I care about."

Expressing Anger Reflection:
I have found that veteran clients often benefit from a discussion about how they express their anger. I stated to Kyle, "See which of the following statements you do to express your anger." I then went through the following list with Kyle:
__ I force my opinion on others even if I have to get angry because I am the authority.
__ I strike with my anger when the person I am mad at is vulnerable, tired, distracted by something else, or does not have their guard up.
__ I am unbeatable by monopolizing conversations, ignoring the feelings of others and what they are saying, or talking until the other person gives up.
__ I always remember a wrong-doing against me.
__ I shout, throw things, scream, hit, or become violent when I am angry
__ I get even through revenge.
__ When I become angry, I leave the situation and refuse to talk. In this way, the other person does not get to participate.
__ I use sarcasm and say hurtful things when I am angry.
__ I play people against each other.
__ I put guilt on others buy playing the martyr.
__ I hold grudges and don’t accept apologies.
__When I am in the middle of a fight, I drag everything into the fight.
__ I pile ammunition to use against others for my next flight.
__ Talking about anger is a waste of time.
__ When I have bad thoughts, I make bad things happen.
__ I say hurtful and irreversible things when I am angry.
__ If I get angry with [someone], they will get angry back toward me but I still do it anyway.
__ If I share an explanation for my anger with [someone], it will hurt them to know the truth.
__ I will be more vulnerable if I allow myself to reveal who and what I am when I get angry.
__ People will think poorly of me if I express my anger.
__ I have to avoid making others angry at me or others at all costs.
__ I must avoid expressing my own anger.
__ I have to fix the situation or the person when someone is mad at me.

After going over this list, Kyle was able to identify with a few of these statements listed above. We then followed up with a discussion about steps to take to change these behaviors.

How Anger Has Helped and Hurt Me Exercise:
I have found that it is important that my clients understand that their anger is both good and bad for them. I share that anger can be helpful to him for the following reasons:
- it is natural and a part of us all
- it is a signal about what is happening around you
- it helps you understand yourself better
- it tells you to protect yourself
- it tells you to make necessary changes
- you can share the reasons for your anger with those who matter to you

I then asked Kyle to make a list of at least three ways in which anger has helped him deal with what happened and at least three ways in which it has hurt him.

Resolving Anger Must-Haves:
The next step for your client to address his or her anger is to take steps to resolve the anger. I stated to Kyle, "In order to resolve your anger, here are ten tips to keep in mind when you feel your anger rising."
1. Remain in touch with your feelings by re-experiencing and expressing your anger.
2. Obtain an understanding of yourself and what happened to you in order to get to the root of why you are angry.
3. Get a sense of closure and finality to your situation.
4. Attempt to reach a completion to your trauma by reaching for justice, confronting someone, or seeking an apology.
5. Choose to responsibly express your anger.
6. Use words or images to represent your feelings. In writing include information about your triggers, what sensations occurred, and others that were involved.
7. Identify what lies beyond your anger. It is usually fear or hurt. Is there a target for your anger? Who or what?
8. Identify the hurt that remains unhealed. Remember that it is important to self-soothe while you are identifying this hurt.
9. Put your anger outside of yourself. Don’t think badly of yourself because of your anger. Without criticism or attacking, allow yourself to tell those that hurt you why you are angry. Give them a chance to express what they have to say.
10. Protect yourself in other ways so it feels safe for you to release your anger.

Do you have a PTSD client like Kyle who could benefit from resolving their anger through these techniques?

In this section, we have discussed how your client making the transition from soldier to civilian can effectively express their anger. We discussed the following techniques: Expressing Anger Reflection, How Anger Has Helped and Hurt Me Exercise, and Resolving Anger Must-Haves List. We also discussed the ten must-haves for resolving anger: remain in touch with your feelings; obtain an understanding of yourself; get a sense of closure; attempt to reach a completion to your trauma, choose to responsibly express your anger; use words or images to represent your feelings; identify what lies beyond your anger; identify the hurt that remains unhealed; remember that it is important to self-soothe; put your anger outside of yourself; and protect yourself in other ways so it feels safe for you to release your anger.

In the next section, we will discuss an exercise your clients facing combat PTSD can use to combat unwanted images.


Source: Williams and Poijula
Reviewed 2023

Update
Effects of prior deployments and perceived resilience on anger trajectories of combat-deployed soldiers

Campbell-Sills, L., Kautz, J. D., Choi, K. W., Naifeh, J. A., Aliaga, P. A., Jain, S., Sun, X., Kessler, R. C., Stein, M. B., Ursano, R. J., & Bliese, P. D. (2023). Effects of prior deployments and perceived resilience on anger trajectories of combat-deployed soldiers. Psychological medicine, 53(5), 2031–2040. https://doi.org/10.1017/S0033291721003779


Peer-Reviewed Journal Article References:
Cowlishaw, S., Metcalf, O., Little, J., Hinton, M., Forbes, D., Varker, T., Agathos, J., Bryant, R. A., McFarlane, A. C., Hopwood, M., Phelps, A. J., Howard, A., Cooper, J., Dell, L., & O'Donnell, M. L. (2021). Cross-lagged analyses of anger and PTSD symptoms among veterans in treatment. Psychological Trauma: Theory, Research, Practice, and Policy.

Gonzalez, O. I., Novaco, R. W., Reger, M. A., & Gahm, G. A. (2016). Anger intensification with combat-related PTSD and depression comorbidity. Psychological Trauma: Theory, Research, Practice, and Policy, 8(1), 9–16. 

Marshall, A. D., Martin, E. K., Warfield, G. A., Doron-Lamarca, S., Niles, B. L., & Taft, C. T. (2010). The impact of antisocial personality characteristics on anger management treatment for veterans with PTSD. Psychological Trauma: Theory, Research, Practice, and Policy, 2(3), 224–231. 

Novaco, R. W., Swanson, R. D., Gonzalez, O. I., Gahm, G. A., & Reger, M. D. (2012). Anger and postcombat mental health: Validation of a brief anger measure with U.S. Soldiers postdeployed from Iraq and Afghanistan. Psychological Assessment, 24(3), 661–675. 

Weiss, N. H., Schick, M. R., Contractor, A. A., Goncharenko, S., Raudales, A. M., & Forkus, S. R. (2021). Posttraumatic stress disorder symptom severity modulates avoidance of positive emotions among trauma-exposed military veterans in the community. Psychological Trauma: Theory, Research, Practice, and Policy.

Weiss, N. H., Forkus, S. R., Raudales, A. M., Schick, M. R., & Contractor, A. A. (2020). Alcohol misuse to down-regulate positive emotions: A cross-sectional multiple mediator analysis among US military veterans. Addictive Behaviors, 105, Article 106322.

QUESTION 4
What are the ten must-haves for resolving anger? To select and enter your answer go to Test.

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