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illustration by Ken Coffelt

Illustration by Ken Coffelt

Cool It

UTSA researcher studies causes, remedies to anger


We've all felt it … the clench of the jaw, the flushing of the cheeks, the fire in the eyes. We've all experienced anger, a completely normal and very human emotional state that ranges from mild to raging. But not everyone handles the emotion gracefully. When anger explodes, when it festers, when it sours work and personal relationships and even threatens health, the time to get help has arrived, says UTSA clinical psychology professor Ephrem Fernandez.

But just what sort of help has typically been available? In Fernandez's view, a fairly limited set of options. To remedy that, he has developed an anger management therapy that he believes will revolutionize the way anger problems are treated. His method, called Cognitive Behavioral Affective Therapy, grew out of more than a decade of research. It integrates techniques from multiple schools of psychotherapy and is tailored to each client's anger profile. This approach yields a comprehensive and customized therapy that Fernandez says is an improvement over the standard one-size-fits-most solution.

"There was a time when the treatment consisted mainly of stand-alone techniques," Fernandez says. "You went in for anger management in the past and usually you got relaxation and self talk: breathe deep and try to reason your way out of this anger. That's fine. I incorporate both of those in my anger regulation program, too. But I don't think it's enough."

Plainly put, Fernandez wants to help people deal with anger in a healthy way. Anger managed poorly can wreak havoc on career and family, not to mention your health. Cardiovascular problems, as well as substance abuse, are serious effects of dysfunctional anger, he says.

What is anger?

Until recently, this powerful emotion had gone relatively unexplored, particularly compared to depression and anxiety. There is much to learn—including why people experience and respond to anger in such different ways. The manner in which families and peers deal with anger seems to influence how we ultimately experience and express the emotion, Fernandez says. Also intriguing is the tenor of our times and its effect on anger in the community.

"Anger is ubiquitous, and maybe our threshold for anger seems to have been lowered over time," he says. Anger portrayed in the media has spawned stereotypes that aren't particularly useful. Fernandez emphasizes that only infrequently does anger lead to aggressive acts or even to violence. Aggression and violence sometimes are born out of thrill-seeking or other motives, he says. Sometimes, anger can be positive and useful.

"Anger has tremendous motivational energy which can be harnessed productively, too," he says.

But when someone's anger impedes his ability to function at work or in relationships, that's a sign it is maladaptive. That is where Fernandez believes he has developed better ways to diagnose anger disorders and treat people with such disorders.

"We've had people in our groups, people with no criminal records, men and women, white collar people, blue collar people, all walks of life, who have anger problems," Fernandez says.

Being angry feels bad, Fernandez explains, because it is a survival strategy that helps people deal with something that offends them. What sparks anger in one person may barely register with another.

"It's invariably an unpleasant emotion, in the company of other unpleasant emotions of which there are many: jealousy, fear, sadness, shame, contempt," he explains. "On the positive end, you have joy. … This is a reflection on the human species, that we have much more of a vocabulary for the negative. Evolutionary psychology gives us a reason for why that is the case, and it's basically that it has greater survival significance to know what is wrong than to be continuously reminded of what is right."

Anger expression styles

About seven years ago, Fernandez created the Anger Expressions Scale, a tool used to map the ways people express their anger. Anger may be a universal human emotion, but the ways people act on it—who they direct it toward, whether they hold it inside or put it out there for the world to see, whether they retaliate or resist the object of their anger, use words or fists, maintain or lose control, or seek revenge or an apology—all of these reactions say a lot about how constructive or destructive their anger is. These six dimensions form the basis of the Anger Expressions Scale.

The Anger Expressions Scale and another tool Fernandez developed, the Anger Parameter Scale, which rates the frequency, duration and intensity of anger, are used to assess and possibly diagnose the type and severity of anger problems. Those who meet the criteria for an anger problem or disorder then can participate in Fernandez's four-week program of Cognitive Behavioral Affective Therapy (CBAT). The next program will likely be offered in spring 2010 in Fernandez's office suite at UTSA.

Illustration by Ken Coffelt

The treatment is tailored to participants' own anger profiles. The program is currently designed for adults. Fernandez expects to refine it for use with adolescents, taking into account their cognitive development and social maturation.

CBAT is designed around a sequence of anger management skills. The first week begins by educating participants on anger and its effects on their lives. Each person is asked to self-monitor his or her anger for a week and report back. Prevention is the hallmark of the second week, and participants, armed with a battery of techniques such as stimulus control, sign a contract pledging to control their anger at its onset. Most of the approximately 100 people who have already undergone CBAT showed improvement at this phase; if they didn't, they received additional defusing strategies in the third week, dubbed the intervention phase. These skills include thought stopping—quietly repeating a word or phrase that means the opposite of anger, such as "peace" or "settle down," to interrupt anger. They also learn relaxation and attention diversion techniques, such as taking a walk or watching television. The key technique in this phase centers on reappraisal, in which each person assesses the intention of the offender and the extent of the damage. The fourth week usually shows even more improvement, with a drop in the duration, intensity and frequency of anger. The final week of the program offers what Fernandez calls "postvention" skills, another line of defense in anger management. These include expressive writing, art therapy and the Gestalt empty chair technique—speaking to the object of anger, in imaginary form, to release pent-up emotion.

"We are there to train them in skills they can use on their own to self-regulate anger," Fernandez says. "Because much of this anger is not going to happen in the sessions. It's going to happen at home, on the roads, at work, in the marketplace so to speak."

The goal is a better, more effective anger experience and resolution.

"I believe in the optimality concept here," he says. "We are not going to preach abstinence from anger or total restraint from getting angry. The aim is not to rid people of anger. Anger is a message to yourself that something is wrong, just as fear is a message that there is danger and you need to escape."

With the publication this year of a chapter explaining CBAT in the International Handbook of Anger, Fernandez is hoping the therapy will become part of standard practice in treating anger.

"Our objective is to identify problematic anger, and having identified it, to be able to help people find the optimal expression of anger, one that is presumably constructive as opposed to destructive," Fernandez says.

Anger in San Antonio

Fernandez and his undergraduate and graduate students are working on a community anger survey. From the estimated several hundred people who will undergo 20-minute structured interviews, he and his research assistants will identify those with problematic anger. These can be further screened before people will be eligible to participate in CBAT, he says.

"We're trying to create a baseline for how angry the community is," says research assistant Robert Vargas, who by the end of the spring semester at UTSA had conducted about 50 interviews for the study, which is intended "to help us pinpoint where people's anger is from."

One common source of anger among the first group of participants surfaces on the city's roadways, says research assistant Cynthia Garza, who received a B.A. in psychology in 2008.

"Traffic is a really big example that people hit on," she says, adding that some respond by simply steering clear of a driver who has cut them off, while others relate that the rude treatment ruins their day.

Although their current sample size is small, Garza says there appear to be some gender differences emerging. Men have been more likely to pinpoint their jobs as anger triggers. Women caring for children have cited family as a source.

One participant, a new stay-at-home mom of three young children, shared that her frustration mounts while caring for them single-handedly. She said she only vented when her spouse returned home. "She didn't want to let out her anger on the children," Garza says.

The goal: constructive anger

So, if anger is a fact of life, how can we get the most out of it while minimizing the unpleasantness? Constructive anger is the goal, says Fernandez. That includes verbal communication with feedback directed to the offending person instead of unrelated, convenient targets, and a willingness to forgo punishment in favor of a return to normalcy. Choosing constructive anger means avoiding active retaliation or passive-aggressive responses.

Fernandez encourages people to search for the good in the people who flip the switch on their anger.

"The big trap is anger cheats us in the moment into thinking that this person is all bad. … I will tell them you can, in the worst person, find something redeeming and to look for that. They'll come back to me the next week and say, 'I stopped in the moment and I thought, you know what, she's my wife. I married her.' Or, 'He's my father,' or, 'This is my daughter I'm talking to, and fundamentally I love her.' "

That is just one illustration of redemption that Fernandez believes can push problematic anger to a more peaceful and ultimately, positive, place.

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