Anger management

Anger management is a form of counselling to help you cope with angry feelings that affect your health, work, behaviour or personal relationships.

Information written and reviewed by Certified Doctors.

Contents

Introduction

Anger management is a form of counselling to help you cope with angry feelings that affect your health, work, behaviour or personal relationships.

Anger is a natural feeling that affects everyone.

Things that can make you feel angry include:

  • losing someone you love (grief)
  • sexual frustration
  • being tired, hungry or in pain
  • coming off certain medicines or drugs
  • pre-menstrual syndrome
  • being insulted
  • feeling under threat
  • feeling that you are being ignored or not taken seriously
  • being under the influence of alcohol or drugs
  • something in the present reminding you of unpleasant memories

Mild anger can be expressed as annoyance or irritation.

However, some people become angry frequently and inappropriately, and may be unable to control their actions once they become angry.

Once anger gets out of control like this, it can cause problems with relationships, work and even the law. Uncontrolled anger can lead to arguments and physical fights. It can cloud your thinking and judgment and may lead to actions that are unreasonable or irrational.

In a recent survey for the Mental Health Foundation, 28% of adults said they worry about how angry they sometimes feel, and 32% have a friend or relative who has problems dealing with anger.

Physical signs of anger

Everyone has a physical response to anger. Your body releases stress hormones such as cortisol and adrenaline, which increase your heart rate, blood pressure, temperature and breathing (the "fight or flight" response).

This allows you to focus on the threat and react quickly. However, it can also mean that you do not think straight, and may react in ways you might regret later.

When your body has to cope with large amounts of stress hormones due to angry outbursts, you may become ill.

How anger can affect your health

Intense and uncontrolled anger is linked to health conditions such as:

If anger is hidden or buried, it can lead to:

Helping yourself

Dealing with anger in a healthy way includes:

  • recognising when you get angry
  • taking time to cool down
  • reducing your general stress levels in life

You can also look at what makes you angry and how you deal with those feelings. Find out about self-help tips for anger management or see the Mental Health Foundation’s Cool Down booklet, which includes advice on where to get professional help.

Anger management

For some people, self-help techniques will not be enough and they will need to attend an anger management course to learn how to manage their anger.

Anger management usually involves a combination of one-to-one sessions with a counsellor or therapist and group work with other people with anger management issues.

Read more about how anger management works .

If you think you need anger management, contact your doctor.

The alternative is to pay for a course or counsellor privately.

Florence's story

Intense anger caused Florence Terry, 39, from London, to hit her husband. An anger management course helped her get it under control, and changed her life.

“The first time I hit my husband was about 14 years ago. I was cross with him and lost my temper. He was upset and I felt dreadful, and cried and apologised. I felt scared and ashamed, but I thought it was a one-off.

"It didn’t happen again for a while, maybe as long as 18 months. During that time there was verbal criticism and crossness from me, but nothing violent. I can’t actually remember the second time I hit him. I’m sorry to say it became a pattern.

"Looking back, I was under a lot of stress from my job as a divorce lawyer, and I was packing my free time with other commitments, such as charity work.

"I began to lose my temper every few months or so. When it happened I would think that, despite being angry, I was calm and talking rationally. But I was actually getting enraged without realising. One minute I’d be talking with a raised voice, and the next my limbs were doing things I didn’t want them to.

"I remember feeling as though I was out of my body, watching myself and telling myself to stop, but I couldn’t. On one occasion I picked up a table and banged it down so hard it broke. On another, I poured a can of my husband's fizzy drink on the carpet because I was angry about his unhealthy diet.

"He said my outbursts weren’t a big issue, but I felt it was completely unacceptable. I felt ashamed, and didn’t talk to anyone about what was going on. It was a secret. I felt like a hypocrite. Everybody thought I was a sweet, calm person.

"After losing my temper I’d be in tears and apologise, but also had to say, ‘I can’t tell you it won’t happen again because I know it will’. I knew I was out of control.

"The turning point came when I saw a leaflet for the British Association of Anger Management (BAAM). I’d been looking for help but there didn’t seem to be anywhere apart from probation services that offered it. I’d even contacted a domestic violence group, but they only helped men.

"I enrolled on a weekend course called Beating Anger, run by BAAM. There were about 15 others on the same course as me. I was scared at first, but it really helped me. I realised I wasn’t alone, and I learnt that angry behaviour is a physical response you can control.

"I had thought that I went straight from talking to hitting, but there is an escalation from one to the other, and if you recognise the warning signs you can back off. For me, the warning sign is my heart beating faster. When I feel this, I know that I need to leave the room.

"After the course I was able to say to my husband, ‘I am sorry, and it won’t happen again’.

"It did happen again, two years after the course. I got over-confident and thought I could control my anger without backing off, even though I felt my heart beating faster. Suddenly my hand was striking his cheek. It hasn’t happened since. I get angry less often now, and much less angry when I do."

"The course also helped me look at other areas of my life, such as work and looking after myself.

"I decided to make fewer commitments in my free time, and I also pay more attention to eating healthily. I avoid having a lot of caffeine as it can make me agitated. The course raised some issues about my childhood, and therapy has been really effective in helping me deal with that.

"A key issue for me is sleep. My husband used to come to bed later than me and I’d wake up, which left me tired and annoyed, so I now often sleep in another room. It sounds odd to some people, not to sleep in the same bed every night, but it works well for us.

"I realised work was putting a lot of stress on me, and I’m now self-employed. I still work in law, but I also work in mediation and run anger management courses. It’s challenging but makes me deeply happy to see other people gain control.

"I’m passionate about helping people learn how to deal with anger and conflict. If I had found the course earlier I’d have been saved so much pain.”

For more information about Florence’s work, go to Stop Seeing Red.

Getting Help

If you cannot deal with your anger issues, speak to your doctor. They may be able to refer you to another service for support.

Different types of treatment to manage anger are summarised below, with links to more information.

Counselling

Certain types of counselling or talking therapies can help you explore the causes of your anger so that you can understand and work through them.

Counselling involves talking with someone who can help you find your own solutions to your problems and gain a greater understanding of your feelings and actions. For example, feelings of anger may be related to unresolved issues you may have with your parents, childhood, partner or your current place in the world.

Counselling is usually provided over several weeks or months.

Read more about counselling .

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is based on the theory that most unwanted thinking patterns, emotions and behaviours are learned over a long period of time.

CBT aims to identify the unhelpful thinking that is causing your unwanted feelings and behaviour and to learn to replace this thinking with more balanced thoughts.

A number of professionals use CBT, including clinical psychologists, occupational therapists, psychiatrists, nurses, counsellors and social workers.

CBT is usually provided over several weeks or months.

Read more about cognitive behavioural therapy .

Anger management programmes

A typical anger management programme may involve one-to-one counselling and working in a small group. The programmes may consist of a one-day or weekend course. In some cases, it may be over a couple of months.

Speak to your doctor to see if they offer anger management courses in your area.

The structure of the programme can differ depending on the provider, but most programmes involve using CBT techniques as well as counselling.

Domestic violence programmes

This type of programme may last up to 18 months and is necessary if you cannot control your temper and are violent to members of your family. The focus of this programme is to provide help and support so you will be able to take responsibility for your actions and understand how it affects others.

You will need to co-operate with the programme requirements, including tackling any other issues you may have, such as reducing your alcohol intake.

Co-operating with the requirements could be a condition of your parole or probation and failing to do so could have legal implications.

Counselling Counselling is guided discussion with an independent trained person, to help you find your own answers to a problem or issue. Psychiatrists Psychiatrists are doctors who treat mental and emotional health conditions, using talking and listening methods. Psychotherapy Psychotherapy is the treatment of mental and emotional health conditions, using talking and listening.

Self-help

If you have an anger problem, there are methods you can use to try to control this yourself.

Recognising your anger signs

Your heart beats faster and you breathe more quickly, preparing you for action. You might also notice other signs, such as tension in your shoulders or clenching your fists.

If you notice these signs and you struggle to stay in control, try to get out of the situation using the methods below.

Count to 10

Counting from 0 to 10 and then backwards from 10 to 0 gives you time to cool down so you can think more clearly and overcome the impulse to lash out.

Breathe slowly

You tend to breathe in more when you feel angry. Make sure you breathe out for longer than you breathe in, and relax as you exhale. This will help you calm down and think clearly.

Leave the environment

If your environment or the people you are with make you feel angry, then briefly leaving the environment may help. Try having a walk around the block or sitting on the toilet for a few minutes.

Talk yourself calm

Some people find it useful to repeat a phrase or word to themselves when they are feeling angry, such as "take it easy" or "these feelings will soon pass". Or you could imagine a calm person who you know talking to you and giving you advice to relax.

Distraction

Distracting yourself from the situation that is making you angry can help, such as reading a magazine or listening to relaxing music.

Relieving physical tension

It is possible to relieve pent-up physical tension without harming yourself or others. If you feel the need to hit something, use a mattress. And if you feel like screaming, you could try screaming into a pillow.

Exercise is an excellent way of relieving tension as well as improving your mood (see below).

Venting your feelings

Sharing your feelings and frustrations with friends can often help you get a better perspective on a situation.

You could also try writing about how you feel. However, don't post something in the heat of the moment on the internet or a social network site, which you may later regret.

Changing the way you think

Often how you think about people, problems and situations can determine how you then feel and act about them. It is common to fall into unhelpful patterns of thinking, which can then lead to unhelpful patterns of behaviour.

Changing the way you think plays an important part in a type of talking therapy known as cognitive behavioural therapy .

When people become angry, the language they use is often very black and white, such as: "It's all ruined now," which reinforces their feelings of anger. This type of language and thinking also stops you seeking a potential solution to a problem and can upset people around you.

When you begin to feel angry, avoid using words and phrases such as:

  • always ("You always do that")
  • never ("You never listen to me")
  • should/shouldn't ("You should do what I want" or "You shouldn't be on the roads")
  • must/mustn't ("I must be on time" or "I mustn't be late")
  • ought/oughtn't ("People ought to get out of my way")
  • it's not fair

Angry people tend to make demands rather than requests. This can make a bad situation worse. It is always healthier to say that you "would like something" than you "must have it".

Anger can quickly cause you to become irrational and lose all sense of perspective. Try to step back and think logically about a situation. For example, losing a wallet or purse can be annoying, but most people will lose a wallet at least once or twice during their life. Frustrating as this may be, it is not the end of the world.

Problem solving

Situations or issues in your life that cause you anger can be resolved by planning and problem solving.

For example, if driving to work in traffic causes you to become angry with other road users, it may be better to catch a bus or a train or, if possible, work different hours to avoid the rush hour.

If you tend to argue with your partner in the evening, it could be because you are both tired after a day’s work. You could wait until Sunday morning to talk about issues.

However, not every problem can be solved and you may need to focus your efforts on learning how to best cope with the problem, and then moving on.

Improving communication

Often when you enter into an angry exchange with someone, both your and the other person’s responses can quickly lead to misunderstandings and incorrect conclusions.

This is why it’s important to slow down, listen to what is being said, and then think carefully before responding.

If you are being criticised by somebody, it is natural to feel defensive, but this should not encourage you to respond with your own "verbal attack". Instead, try to remain calm and ask non-threatening questions about why the person feels the need to criticise you in this way. Often what you may first see as an attack is actually a problem that the other person is trying to cope with.

Humour

Humour can play an essential part in helping reduce feelings of anger and maintain a healthy sense of perspective.

For example, imagine you are having a really bad day where everything is going wrong. Rather than picturing yourself as a victim and getting more and more angry, try picturing yourself as a sitcom "figure of fun" – a Basil Fawlty, David Brent or Homer Simpson, for example. Then, if things continue to go wrong, you may start to find them ridiculous rather than frustrating, and your mood may improve.

Learning not to take yourself or your life too seriously can often help put things in the proper perspective.

However, it is important to avoid using sarcasm while dealing with other people. Sarcastic humour can be perceived as a form of aggression.

Managing anger in the long term

Once you can recognise the signs that you are getting angry and can calm yourself down, you can start looking at ways to control your anger more generally.

Exercise

Exercise is one of the best ways to release built-up anger and tension. Running, walking, swimming, yoga and meditation are just a few of the activities that boost your production of "good mood" hormones (such as endorphins) and help reduce stress.

Read more about the benefits of exercise.

Diaphragmatic breathing

Diaphragmatic breathing is a breathing exercise that focuses on fully inflating your lungs, helping you to unwind. A simple guide is:

  • Sit or lie comfortably and loosen your clothing.
  • Put one hand on your chest and one on your stomach.
  • Breathe in through your nose and slowly count to three in your head.
  • As you breathe in, feel your stomach inflate with your hand. If your chest expands, focus on breathing with your diaphragm.
  • Slowly breathe out through pursed lips and slowly count to six.
  • Repeat two more times.

Music

Listening to calming music, such as classical music, can help you relax. It can slow your pulse and heart rate, reduce stress hormones and lower your blood pressure.

Massage and relaxation

The kneading and stroking movements in massage relax tense muscle and improve your circulation.

Some people find that relaxation classes are good at reducing stress levels and help control anger. Yoga, pilates and tai chi may also be helpful.

Read more about how to start doing yoga, pilates and tai chi.

Content supplied by NHS Choices