Bruce Alan Kehr, M.D. is the Founder and President of Potomac Psychiatry, ranked “Best Psychiatry Care Provider in Maryland” in 2020 by Global Health & Pharma. He has been named a Washingtonian Magazine “Top Doctor” for each of the past eight years. Dr. Kehr is a best-selling author whose works have been read by over 800,000 people in 206 countries. In 2020, Dr. Bruce Kehr’s blog was ranked #2 in the nation among mental health-related blogs. Dr. Kehr’s book, Becoming Whole: A Healing Companion to Ease Emotional Pain and Find Self-Love, is an Amazon Best Seller in the self-help categories: Happiness, Counseling, Healing, and Self-Esteem.
I was on a plane recently that was approaching our destination in Miami, where I had a connecting flight to Reagan National with only a 45 minute layover. We were just starting to make our descent when the captain came on and said, “So sorry folks, but due to thunderstorms passing through the area, we are going to have to circle around up here for a bit.” “A bit” turned into almost 2 hours of the plane repeatedly coming in for a landing, and then making that unmistakeable turn at the last minute right back to where we started. When finally we were told that the storms had cleared for a few minutes and that we needed to quickly pack up before this golden opportunity passed, a flight attendant came by to check on our progress. She noticed that the man sitting across the aisle from me still had his briefcase out and asked him to please stow it in a safe area. He lost it. He stood up in anger, got in her face and started screaming, “We’ve been circling for hours but now all of the sudden you’re on me to hurry up?!” She asked him to please calm down and that she was only trying to ensure his safety, but instead he opened the compartment door above him and threw his briefcase in, then slammed it shut before yelling again that this was an outrage. Everyone on the plane was in shock—we were all tired and worried about missing our next flight but we were able to sit patiently until the situation resolved. So why did this man take out his frustration on an innocent party, and even risk being arrested, over a briefcase?
A two-pronged approach to treating anger issues
Anger is a strong feeling of annoyance, displeasure, or hostility aroused by a perceived injury or injustice. Anger becomes a problem when that perception is inaccurate, causing a person to inappropriately react to certain social situations and allow their rage to hijack their behavior. Most people would say that the man on my flight had an anger problem because there was no real “injury”—the flight attendant was only doing her job—and the man’s reaction reminds us of a toddler’s temper tantrum. But many of you out there can identify yourself or someone you know in this man. Maybe your boyfriend was put on leave at work after several verbal fights with coworkers, or your family members avoid spending time with you because even the TV remote has become a battleground. Dr. Paul Glass, one of our psychiatrists who treats people with anger issues, says that the majority of his patients are men between the ages of 18 and 55, and that often there aren’t two sides to the story—the patient is just out of control and those around him are not to blame. Dr. Glass uses a two-pronged approach to treating anger issues:
- First, you have to acutely manage your anger through behavioral techniques; and,
- Second, work on understanding the cause of your anger through psychotherapy or medication.
Manage your anger through behavioral techniques
The first step is addressing the immediate concern, which is stopping the anger outbursts. Dr. Glass focuses on interrupting the connection between an event that triggers anger and the anger reaction, by teaching patients how to just walk away. He has found that the most common misconception patients have is that they always need to act. He asks patients to give examples of when they think they were out of line, and assign a number out of 10 to rate how bad the episode was compared to others—and if a future episode reaches that number again, you know it is time to walk away from the situation. It is also useful to make others such as your boss or significant other aware of this technique, and inform them you will need to excuse yourself from a meeting or dinner if you feel it’s necessary. If walking away is difficult, the “Life Saver Technique” is helpful as well—if you feel that you’re approaching that number where you may lose control, you simply put a Life Saver® or similar type of dissolving candy in your mouth. You are not allowed to speak until the candy is fully dissolved. It may sound silly, but preventing yourself from speaking and giving yourself time to think about what is actually making you angry does help prevent your anger from reaching the boiling point.
Work on understanding the cause of your anger through psychotherapy or medication
The second step is digging deeper into the cause of your anger. Often anger is a symptom of an undiagnosed depression or mood disorder, so it is important to get a thorough evaluation to see if you meet the criteria for a clinical diagnosis. But even if you don’t have an underlying condition of depression or bipolar disorder, your doctor could prescribe an antidepressant off-label to treat your anger issue in isolation. Medication is only one possible component of treatment—many people with anger issues also benefit from a specific type of cognitive-behavioral psychotherapy called Dialectical Behavior Therapy (DBT), which was originally developed to treat borderline personality disorder, but is helpful to any individual who is prone to react in a more intense manner toward certain emotional situations. It typically involves 6 months to a year of weekly individual and group therapy sessions, where you learn how to identify your strengths and builds on them to gain more self-acceptance; and identify beliefs and assumptions that cause emotional distress and replacing them with more positive thoughts (instead of “I have to be perfect at everything” think, “I don’t need to be perfect to be loved”). Unlike traditional psychotherapy where you are encouraged to free associate, participants complete homework assignments using workbooks, role-play new ways of interacting with others, and practice skills such as soothing yourself when upset. DBT could be the right fit for you if you are struggling to manage your anger on your own.
Traditional therapy explores the feelings that underlie the anger (which is often a smokescreen hiding them). These feelings may include disappointment, embarrassment, shame, humiliation, sadness, feeling misunderstood, feeling abandoned, helplessness, “feeling stupid,” fear, and others. Identifying the triggers of the outbursts, and the origins of the underlying feelings (often based in emotionally painful childhood experiences), in the context of a caring and empathetic therapeutic relationship, can also really help.
If you are still looking at that hole in the wall where you punched through it last night, you are not alone and help is within your reach. It may feel like an impossible problem to solve, but you can stop allowing anger to define who you are. And you can look forward to taking a little trip to the candy store in the process.