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Section 22
Anger & Support

Question 22 | Test | Table of Contents

There is a tendency to think of support primarily in emotional terms, as an expression of compassion or "reaching out" by some caring individ­ual. However, Dr. James House of the University of Michigan offers a more comprehensive definition. Support is "a flow of one or more of four things between people: (a) emotional concern, (b) instrumental aid, (c) infor­mation, and/or (d) appraisal."

There is no question that emotional concern is the most important type of support a person needs to change maladaptive behavior effec­tively. But there is also no question that this may be the most difficult type of support for the person with toxic anger to receive. As you might imagine, it is hard for most people to love, care for, and reach out to the person suffering from toxic anger when they have repeatedly been on the receiving end of that person’s wrath. In the last chapter, I discussed how toxic anger stifles social exchange and ends relationships. However, anger not only shrinks the size of the person’s social network, but also interrupts the two-way "flow" between people through which human be­ings give and receive support. David, the fifty-five-year-old angry man with chronic back pain, is a prime example. Over the years, his family learned to avoid his anger by literally avoiding him much of the time. "I can tell when he’s angry," his daughter said, "and I just go to my room." This young woman clearly loved her father, but she was unable to ex­press this love because she was afraid that his anger might erupt at any moment.

The other three types of support—instrumental aid, information, and appraisal—are equally as important. Instrumental aid entails doing some­thing tangible for the angry person. A young college student who came for treatment of toxic anger, for example, did not have a way to get to my office. He did not have a car, and my office was not reachable by public transportation. At first he considered holding off treatment, but finally he asked a friend to bring him for his weekly sessions. To his surprise, his friend was more than glad to help. If someone buys you a book on anger management or pays for you to receive professional treat­ment, that is an example of instrumental or tangible support.

Some years ago a man brought his sixteen-year-old son to see me for problems with intense anger that had resulted in a growing pattern of delinquent behaviors—truancy, drug use, and fighting at school—as well as increasing family tension. The boy’s problems had begun after his parents’ divorce several years earlier and seemed more pronounced now that he was a teenager. The father loved his son but was not terribly expressive emotionally. However, he was willing to take time from work to bring his son to therapy, pay for treatment, and also pay for him to enroll in both martial arts and theater classes, which I had suggested as outlets for his pent-up anger. The tangible support his father provided was vital to the success we achieved in turning this boy’s emotional life around.

Informational support involves advice or guidance about what one can do to recognize and treat maladaptive anger. The anger screening that my wife and I conducted at our local health and safety fair is an example. Self-help books, pamphlets, and audio- and videotapes on the topic of anger all provide informational support. They let you know that help is available, and they offer a "game plan" for detoxifying your anger.

"Tom listened to my anger sometimes for hours He didn’t en­courage it, nor did he condemn it He just listened He didn’t try to be my therapist He didn t pretend to have all the answers to my problems He was just a good friend, which is what I needed most."

This type of support can also be provided by legal and medical profes­sionals, who typically become aware of the costs and consequences of toxic anger long before the problem finds its way into the hands of a trained mental health professional.

The last type of support, appraisal, involves giving people with toxic anger feedback both about the inappropriateness of their anger and about any improvement—no matter how small—one might observe as a result of their efforts to diminish their anger. Getting honest, construc­tive feedback about your anger either before or after you embark on a program of change may be difficult, however. Those closest to you, who are in the best position to evaluate your behavior critically, may be the least likely to offer feedback. They may be afraid of making you madder than you already are or they may feel resentment toward you for making their lives hell, which makes it difficult for them to see positive change when it does occur.
- Gentry, Doyle, Anger-Free: Ten Basic Steps to Managing your Anger, William Morrow and Company, Inc.: New York, 1999.

Personal Reflection Exercise #8
The preceding section contained information about anger and support.  Write three case study examples regarding how you might use the content of this section in your practice.

Update
Impact of Perceived Social Support
on the Association Between Anger Expression
and the Risk of Stroke: The Circulatory
Risk in Communities Study (CIRCS)

- Tezuka, K., Kubota, Y., Ohira, T., Muraki, I., Hayama-Terada, M., Shimizu, Y., Imano, H., Okada, T., Kiyama, M., & Iso, H. (2023). Impact of Perceived Social Support on the Association Between Anger Expression and the Risk of Stroke: The Circulatory Risk in Communities Study (CIRCS). Journal of epidemiology, 33(4), 159–164.

Peer-Reviewed Journal Article References:
Rees, L., Chi, S.-C. S., Friedman, R., & Shih, H.-L. (2020). Anger as a trigger for information search in integrative negotiations. Journal of Applied Psychology, 105(7), 713–731.

Southward, M. W., & Cheavens, J. S. (2020). Quality or quantity? A multistudy analysis of emotion regulation skills deficits associated with borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 11(1), 24–35.

Tibubos, A. N., Schermelleh-Engel, K., & Rohrmann, S. (2020). Short form of the State-Trait Anger Expression Inventory-2. European Journal of Health Psychology, 27(2), 55–65.

Vansteelandt, K., Houben, M., Claes, L., Berens, A., Sleuwaegen, E., & Kuppens, P. (2020). Self-criticism and dependency predict affective variability in borderline personality disorder: An ecological momentary assessment study. Personality Disorders: Theory, Research, and Treatment, 11(4), 270–279.

Vest, N. A., & Tragesser, S. (2020). Coping motives mediate the relationship between borderline personality features and alcohol, cannabis, and prescription opioid use disorder symptomatology in a substance use disorder treatment sample. Personality Disorders: Theory, Research, and Treatment, 11(3), 230–236.

QUESTION 22
What are the four types of support for an anger management client? To select and enter your answer go to Test.

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