Practically Speaking: Behind the Episode - “ACTing on Anger, but In a Good Way”
Many years ago when I was working as a staff psychologist at Madigan Army Medical Center’s Behavioral Health Clinic, I started receiving referrals for a number of soldiers requesting therapy for “anger management.” The request was not unheard of necessarily, but there seemed to be a sudden uptick in requests at one point. Several Stryker units had returned from deployment recently and had gone through some post-deployment evaluations to identify possible problematic areas that may need clinical care and several, for whatever reason, had been identified as having anger management issues.
Before this, the clients I had seen presenting with anger issues were usually manifesting it as part of their symptoms of post-traumatic stress, or at other times part of larger issues around alcohol-related incidents or domestic disputes. For this particular “surge” of anger-related requests, it seemed that the requested services were more for anger not related to aggression, violence, or trauma per-se, which would be understandable for service members redeploying. Instead, there were several service members that said they wanted help to get rid of the anger all together. “Sometimes I get angry, and I don’t want to feel angry anymore,” seemed to be the stand-alone request.
Of course, “anger” is not a disorder. Anger is a natural emotion that everyone experiences from time to time. While it is normal to feel angry, the way we express it can often cause problems in our personal and professional relationships. The tools I had to address “anger management” at the time did not seem sufficient for this recent round of requests. Usually that meant treating the underlying post-trauma reactions, behavioral aggression, or unhealthy relationship dynamics. I wasn’t sure how to just help someone not be angry–or even if that was helpful.
Recently Dr. Andrew Santanello and I got to visit with Dr. John Donahue on an episode of Practical for Your Practice–”ACTing on Anger, But In a Good Way,” talking about approaching anger and “anger management” from the perspective of Acceptance and Commitment Therapy (ACT). Unlike traditional anger management techniques that aim to reduce or eliminate anger, ACT aims to help individuals develop acceptance and mindfulness skills that will enable them to observe their thoughts and emotions without judgment or suppression, and focus with curiosity on the function of their anger rather than rejecting it outright. By accepting their emotions and thoughts, individuals can learn to live with them rather than struggling against them. This approach allows individuals to cultivate greater self-awareness and to respond more effectively to anger triggers. Dr. Donahue reminds us “I think it's important to say that there's nothing wrong with anger. It's a really functional, useful, effective emotion, there's reasons why we feel it. And when there's an injustice, when we sense an injustice or are faced with an injustice, anger can motivate us to act on that, to change that.”
Dr. Donahue goes on to make a particularly important point that younger-me would have very much appreciated. He explains how in his experience, anger and aggression are often conflated, whether by our clients, the legal system (which often refers clients for anger management treatment), or even ourselves as providers. One of the primary ways that ACT differs from standard anger management techniques is in its focus on values. Rather than focusing solely on the reduction of anger, ACT encourages individuals to explore their values and to align their actions with those values. As Donahue points out, “I think in contrast to that traditional CBT protocol, [ACT is] focusing on, not just what is the anger experience, but what's your relationship with the anger experience and then also how do your behaviors line up or don't line up with what your values are and what's important to you and what you want to move towards in life.” In a very real sense, the focus is more appropriately put on reducing aggression or other values-inconsistent behaviors. By living in accordance with one's values, individuals can develop a sense of purpose and fulfillment that can help to reduce the impact of anger on their lives. As Donahue explains, “it's distinguishing between the experience of anger and reflecting on the anger. What are we doing when it shows up? Are we acting on it in ways that are perpetuating suffering? Are we acting on it in ways that move us towards values and meaning?”
For more of our conversation about ACTing on Anger, listen to the podcast episode here.
Also, for a coming podcast episode, we’d like to hear from our listeners! Do you have a question you want to ask our CDP hosts about implementing evidence-based psychotherapies in your practice? About something we talked about in a previous episode? Or perhaps have a suggestion for a future podcast topic? Email us at cdp-podcast-ggg@usuhs.edu. Or even better, if you’d like to leave a voice message for your question that may be included in a future episode, visit us at speakpipe.com/CDPP4P.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Kevin Holloway, Ph.D., is a licensed clinical psychologist working as Director of Online Training, Technology and Telehealth at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
Many years ago when I was working as a staff psychologist at Madigan Army Medical Center’s Behavioral Health Clinic, I started receiving referrals for a number of soldiers requesting therapy for “anger management.” The request was not unheard of necessarily, but there seemed to be a sudden uptick in requests at one point. Several Stryker units had returned from deployment recently and had gone through some post-deployment evaluations to identify possible problematic areas that may need clinical care and several, for whatever reason, had been identified as having anger management issues.
Before this, the clients I had seen presenting with anger issues were usually manifesting it as part of their symptoms of post-traumatic stress, or at other times part of larger issues around alcohol-related incidents or domestic disputes. For this particular “surge” of anger-related requests, it seemed that the requested services were more for anger not related to aggression, violence, or trauma per-se, which would be understandable for service members redeploying. Instead, there were several service members that said they wanted help to get rid of the anger all together. “Sometimes I get angry, and I don’t want to feel angry anymore,” seemed to be the stand-alone request.
Of course, “anger” is not a disorder. Anger is a natural emotion that everyone experiences from time to time. While it is normal to feel angry, the way we express it can often cause problems in our personal and professional relationships. The tools I had to address “anger management” at the time did not seem sufficient for this recent round of requests. Usually that meant treating the underlying post-trauma reactions, behavioral aggression, or unhealthy relationship dynamics. I wasn’t sure how to just help someone not be angry–or even if that was helpful.
Recently Dr. Andrew Santanello and I got to visit with Dr. John Donahue on an episode of Practical for Your Practice–”ACTing on Anger, But In a Good Way,” talking about approaching anger and “anger management” from the perspective of Acceptance and Commitment Therapy (ACT). Unlike traditional anger management techniques that aim to reduce or eliminate anger, ACT aims to help individuals develop acceptance and mindfulness skills that will enable them to observe their thoughts and emotions without judgment or suppression, and focus with curiosity on the function of their anger rather than rejecting it outright. By accepting their emotions and thoughts, individuals can learn to live with them rather than struggling against them. This approach allows individuals to cultivate greater self-awareness and to respond more effectively to anger triggers. Dr. Donahue reminds us “I think it's important to say that there's nothing wrong with anger. It's a really functional, useful, effective emotion, there's reasons why we feel it. And when there's an injustice, when we sense an injustice or are faced with an injustice, anger can motivate us to act on that, to change that.”
Dr. Donahue goes on to make a particularly important point that younger-me would have very much appreciated. He explains how in his experience, anger and aggression are often conflated, whether by our clients, the legal system (which often refers clients for anger management treatment), or even ourselves as providers. One of the primary ways that ACT differs from standard anger management techniques is in its focus on values. Rather than focusing solely on the reduction of anger, ACT encourages individuals to explore their values and to align their actions with those values. As Donahue points out, “I think in contrast to that traditional CBT protocol, [ACT is] focusing on, not just what is the anger experience, but what's your relationship with the anger experience and then also how do your behaviors line up or don't line up with what your values are and what's important to you and what you want to move towards in life.” In a very real sense, the focus is more appropriately put on reducing aggression or other values-inconsistent behaviors. By living in accordance with one's values, individuals can develop a sense of purpose and fulfillment that can help to reduce the impact of anger on their lives. As Donahue explains, “it's distinguishing between the experience of anger and reflecting on the anger. What are we doing when it shows up? Are we acting on it in ways that are perpetuating suffering? Are we acting on it in ways that move us towards values and meaning?”
For more of our conversation about ACTing on Anger, listen to the podcast episode here.
Also, for a coming podcast episode, we’d like to hear from our listeners! Do you have a question you want to ask our CDP hosts about implementing evidence-based psychotherapies in your practice? About something we talked about in a previous episode? Or perhaps have a suggestion for a future podcast topic? Email us at cdp-podcast-ggg@usuhs.edu. Or even better, if you’d like to leave a voice message for your question that may be included in a future episode, visit us at speakpipe.com/CDPP4P.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Kevin Holloway, Ph.D., is a licensed clinical psychologist working as Director of Online Training, Technology and Telehealth at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.