Why Are Men So Angry?
New research confirms it: Men are mad as hell. Problem is, our rage isn't just hurting us, it's killing us.
By: Kevin Hoffman
The baby-faced kid is crushed against the chain-link octagon, swallowing punches from a fighter twice his size. His skin glows under the lights, until something gives way, and soon he's covered in blood. He's done--pinned, but too proud to tap out--yet the crowd jeers when the ref stops the fight. Even his father protests. Somehow, this Cleveland cage fight has become Caesar's coliseum.
Why so angry? That's the question I'm mulling ringside. And I'm not talking about the grapplers. As combatants in the unofficial minor leagues of the Ultimate Fighting Championship, one of the fastest-growing sports in America, their anger is subsidized. I'm talking about the fans. According to a 2006 Harvard study, 10 million adult men in the United States are so angry, they're sick. In fact, their disease has a name: intermittent explosive disorder, or IED.
The condition has been on the books since 1980, but the Harvard study claims it's far more common than anyone believed. Few people see psychiatrists because they can't control their tempers. And those who do, say the researchers, are often misdiagnosed with other mental problems. Previous estimates put the number of IED sufferers in America at less than 0.5 percent of the population. But if the Harvard researchers are correct, almost 1 in 10 adult men routinely display wildly disproportionate aggression, and are so angry that they're likely to damage property, or threaten or injure others. (The researchers estimate that only half as many women suffer from IED.)
"We never thought we'd find something this big," says Ronald Kessler, Ph.D., the lead study author. "People think their anger isn't a big problem. But there are very serious ripple effects. IED sufferers are also more likely to be divorced, they have worse jobs than others with the same education, and they have fewer friends."
Considered alone, the symptoms of the disorder are easy to dismiss: a commuter flipping off a fellow driver in a traffic jam, a basketball player charging the stands during an NBA game, the guy I saw a few rows back screaming at the hot-dog vendor because he had no mustard left. But there's more behind an IED diagnosis than a few isolated acts of rage. "If you're blowing up a couple of times a week, you probably have the disorder," says Emil Coccaro, M.D., a leading anger researcher at the University of Chicago. "The average person shouldn't be having arguments and temper tantrums."
A couple of times a week? That's my Monday-morning commute. Have the Harvard researchers defined IED too broadly? Many experts think so.
"Everyone has bad days," says William Narrow, M.D., the associate director of the division of research at the American Psychiatric Association (APA). "It's difficult for me to believe that 9.3 percent of the male population in America would destroy property or physically assault another person because of their anger."
As the debate over IED continues, our understanding of the health consequences of anger, in all its forms, grows. "Anger is like cigarette smoking," says Howard Kassinove, Ph.D., an anger researcher at Hofstra University. "In the short run, you feel good. In the long run, you're more likely to die of heart disease or stroke. People think it's macho to be angry. It's more macho to be alive."
Not all anger outbursts are created equal. Regularly grumbling about the long lines at the dry cleaner doesn't necessarily mean you suffer from IED. Along with how often a person blows his lid--and the intensity of his outbursts--the other hallmark of IED is how disproportionate the rage is to the insult. Think Michael Douglas taking a baseball bat through a Korean grocery over the price of a Coke, in the film Falling Down.
Michael Overstreet used to think his fuse was simply short. When the 46-year-old Minnesota engineer was 15, he chased his sister to her bedroom and booted away at the door until it splintered and he could see inside. Years later, he'd turn from loving husband to drill sergeant in a snap, leaving his 3-year-old son to referee between screaming father and sobbing mother. He tried anger management; it didn't work. Finally, his wife had enough and ended the marriage.
After his divorce, Overstreet found another love, but he quickly fell into old habits. One night, when his new fiancée took a wrong turn on the way home, he lost control. "You can almost make a machine-gun-intense argument, when you don't give someone a chance to respond," Overstreet says. "It's a verbal assault under the guise of some logical, reasoned argument. You're watching it happen, you know it's happening, but you can't stop it."
Only after Overstreet was finished reaming out the love of his life did he remember that her roommate, a meek foreign-exchange student, was riding in the backseat. When Overstreet turned around, he saw her cowering, like a witness to murder.
That outburst left him desperate for an explanation. He stumbled across an IED news report online, saw a psychologist, and was diagnosed. But even after starting medication--Overstreet takes Depakote, an anticonvulsant thought to raise the threshold for anger outbursts--he still has problems controlling his temper.
"An alcoholic might still say he's recovering after 20 years," says Overstreet. "When I haven't had an episode in 10 years, then maybe I'll know I have it under control."
Most anger is productive. In Anger: Taming the Beast, therapist Reneau Peurifoy proposes a three-part test to decide whether your anger is helpful, rather than hurtful: (1) A real threat existed. (2) The level of your anger was proportionate to the threat. (3) Your actions
effectively reduced the threat with the least amount of harm to yourself and others.
When we're threatened, the sensory regions of our brains trigger the autonomic nervous system's fight-or-flight response. We puff out our chests and bare our fangs, and the aggressor slinks away (or we fight, and someone wins). But today we rarely face hungry predators. Now most threats are abstract or indirect: e-mails, snide remarks, construction zones.
Some people--Overstreet, coach Bob Knight, Ron Artest--just aren't that good at assessing these threats. Dr. Coccaro's lab, the aggression clinic at the University of Chicago, has conducted facial-recognition tests, for example, that show people with IED are likely to mistake a neutral expression for hostility, meaning they feel under attack even if they're not. Another study shows men are extra-sensitive to angry expressions in a crowd, thanks to our evolutionary advantage of quickly detecting an aggressor. Put the two findings together and you'll see why someone like Overstreet thinks the world is against him.
"People pick up cues through emotions, facial expressions, body language, and vocal intonation," says Kurt Noblett, Ph.D., one of the clinic's researchers. "People with anger disorders, it's thought, don't accurately pick up on all those cues. They focus on hostility."
Perceiving anger is only part of the equation, though. How we react to a threat is the other. While most of us are able to rein in that primitive part of the brain that wants to beat somebody to death with a tree branch, people like Overstreet cannot. Dr. Coccaro and others believe they have narrowed the search for the cause of IED to the neurotransmitter serotonin. Low serotonin levels lead to disengaged frontal lobes, the top-down analytical parts of the brain that match a threat with a well-reasoned response.
"People with this problem have an insufficient 'stop' response," says neuropsychologist Royce Lee, M.D., adding that the clinic is now testing whether serotonin receptors and transporters are to blame.
Other researchers have linked this serotonin deficiency to a pair of genes that regulate neurotransmitter levels. The more expressive these genes are, the better you're able to deal with anger. That means there's likely a genetic component to IED.
Is it any surprise, then, that Overstreet's grandfather used to lash out when his mashed potatoes had too much gravy?
"Abandon. Loneliness. Hate. Suicide."
As I sit strapped to a chair in Dr. Coccaro's lab, these words flash on the computer screen in front of me. This experiment, I'm told, will measure how angry I am. I'm assured by a cheerful research assistant that future versions of the test will feature vivid photos of cross burnings, battered women, and other horrific scenes. Thank goodness for beta testing.
Lest I become too comfortable, a loud burst of static erupts in my ear every few seconds at random intervals. The noise is designed to elicit what psychologists call "the startle-blink response," or what the rest of us call flinching. A computer will track the intensity of my startle-blinks.
"Someone with a pronounced startle-blink is more aroused and more likely to have an emotional response," says Noblett. "He feels the stimulus as more magnified, so the reaction is greater." People with IED, Noblett says, are more sensitive to hostility, and more likely to respond with aggression, creating a vicious circle--or in this case, a circle of viciousness.
The sharp peaks and valleys of my startle-blinks, Noblett tells me after I complete the test, may be a sign of IED. Or maybe I'm just jet-lagged. Only a thorough interview would tell, and even then, diagnosing the disorder is a judgment call.
Dr. Coccaro proposes an easier test to determine whether you should seek help: "Ask yourself: Does it get me into trouble?" he says. "It really is that simple. If people tell you that you have to calm down, or that you have an anger problem, you probably have one."
Not everyone agrees. When the Diagnostic Statistical Manual--the bible of the mental-health field--officially recognized IED as a disorder in 1980, a fair number of psychologists were outraged. They argued that anger is simply a basic human emotion, and that Dr. Coccaro and his colleagues were providing a convenient psychiatric excuse for bad behavior.
The APA, in fact, is currently reexamining the criteria for an IED diagnosis. "We have to defend ourselves against accusations that we're turning everything into a disorder," says Dr. Narrow. "What if someone says, 'I'm bad at golf.' Does that mean he has golf disorder?"
The debate over whether IED is real--or as common as the Harvard researchers claim--is almost beside the point. We all blow our lids now and then, right? So the question remains: Why so angry?
Our culture may be as much to blame as our biology. Kessler is now studying IED rates around the world to find out whether significant differences exist that would suggest environmental causes. "Anger may be one of those crosses that comes with success in the material world," he says.
Statistics seem to support his theory. U.S. population density has almost quadrupled over the past 100 years. Today we squeeze 80 people into each square mile, on average. (In New York City, 23,700 people now live in each square mile.) The closer people live, the more likely they are to rub one another the wrong way, according to researchers at Cornell. They demonstrated that higher population density increases levels of the stress hormone cortisol in our blood--it's cortisol that readies us mentally to fight or flee.
As urban centers have become more crowded and suburbia has taken over the country, our commuting times have increased from 15 minutes to 26 minutes over the past 20 years. Cornell researchers have found that cortisol increases as a person's commute time lengthens. And they were studying rail passengers, not people trapped in rush-hour bottlenecks on I-10.
"People talk about the domino effect," says Jean Johnson, coauthor of Aggravating Circumstances: A Status Report on Rudeness in America. "You leave your house, someone cuts you off, then you go into a store and no one will help you. Eventually, all that stuff adds up."
And even if the traffic jam fades from memory after you park at your desk, your elevated levels of adrenaline and cortisol wreak havoc on your system all day. "Blood-pressure surges damage the lining of the coronary arteries and other arteries," says Redford Williams, M.D., the director of the behavioral research center at Duke University. "It's like a rushing stream. Over time, it erodes the banks."
In fact, more than 30,000 heart attacks each year are triggered by momentary anger, according to a 2004 Harvard study. "People who have a lot of anger invest a lot of energy in trying to control it, and that kind of friction is likely to increase the probability of a heart attack," says Charles Spielberger, Ph.D., a University of South Florida psychologist who developed the most widely used test to measure anger. "The more intense the anger, the more likely the heart attack."
Other studies have shown that angry men are three times more likely to develop premature cardiovascular disease, six times more likely to have an early heart attack, and three times more likely to have a stroke.
In other words, chill or die. But how?
For much of the 20th century, the most popular method for beating anger was catharsis therapy. Analyze This, the gangster parody, even committed this method to film. About halfway through the movie, Billy Crystal, playing the psychologist to Robert De Niro's tough guy, tries to treat his patient's outbursts.
"You know what I do when I'm angry? I hit a pillow," says Crystal. "Just hit the pillow. See how you feel." De Niro whips out a pistol and pumps the pillow full of lead.
"Feel better?" Crystal asks.
"Yeah," De Niro says. "I do."
That's catharsis theory, in a nutshell. Sigmund Freud and his brethren seized on the instant-release model in the early 1900s, but it wasn't until the 1990s that psychologists thought to actually test it. Their discovery: Catharsis may, in reality, make anger worse.
The most famous study required 700 undergrads to write essays about the hot-button issue of abortion. The students then had their papers returned, graded by someone posing as a fellow student and laced with vitriolic feedback: "This is one of the worst essays I have ever read," for example. Some students were told to distract themselves after the feedback by reading a short story or playing solitaire; others were allowed to work out their aggressions by pounding on a heavy bag. When volunteers were given the chance to confront the grader, the students most likely to shatter eardrums were the ones who'd been throwing leather, not the ones shuffling cards.
"When angry people hit something, they'll tell you they feel good afterward," says study author Brad Bushman, Ph.D., a University of Michigan psychologist. "But that's the worst possible thing you can do, because it just heightens your arousal."
So what to do with all your anger? Let it go, man. In meditation therapy, patients are typically asked to imagine themselves in a calming place--at the beach or nestled in front of a warm fire. They take deep breaths and progressively relax various muscle groups. "My grandma told me to count to 10, and that's great advice, because as you delay, your arousal decreases," says Bushman. "People who are aroused make really bad choices. They behave impulsively."
Another effective method: distraction. When you're having an anger episode, try detaching yourself. One way to do this is to have a running narration in your head--sort of like that annoying voice-over on Desperate Housewives, only talking about your life. Hmmm, that man just cut me off is a much healthier response than leaning on the horn.
Avoidance works, too, naturally. "It sounds simple, but some people aren't aware of their triggers," says Jon Grant, M.D., an associate psychiatry professor at the University of Minnesota. "If driving home every night sets you off, then maybe you have to drive home an hour later. Keep a journal of what's triggering your anger and look for patterns."
The last-resort treatment, of course, is medication. "Certain drugs will increase the threshold at which someone will explode," says Dr. Coccaro. "In an IED patient, the frontal part of the brain doesn't inhibit the primal, knee-jerk parts of the brain." Serotonin reuptake inhibitors (Prozac and other SSRI meds) can ensure more of the neurotransmitter stays in circulation, allowing the top-down crimping of the anger responses.
And anticonvulsant medications like the ones Overstreet takes can have a similar effect. Researchers actually don't know exactly why they work, just that they do . . . most of the time.
Last fall, Michael Overstreet felt like he had his anger licked when he took his fiancée to Breezy Point, Minnesota, for a friend's wedding. That night, they returned to the condo they were sharing with other couples, only to find the front door locked.
"Suddenly, I began pounding on the door, and my friend's wife came out and confronted me," Overstreet recalls. "I was screaming at her and calling her a bitch, saying, 'Why the f--- am I locked out?' Some of the guys got protective and stepped in. It was an unsettling event for everyone."
The blowup was textbook IED: A simple argument rapidly escalated. Overstreet was forced to sleep in a separate condo, and, afterward, he wrote personal letters of apology to all his friends and their wives who had witnessed his outburst. The rush of guilt is another telltale sign of IED.
Soon after, his fiancée returned the engagement ring. But he's had no major blowups since then, and now the engagement is back on. He says that maybe, just maybe, he finally has his temper under control. His only regret is that he didn't seek help sooner. His message to men: Don't let anger destroy your life.
"We need to open the conversation about IED, so people know it's not just them," he says. "There's help for people like us."
Posted 6/5/2007 @ 1:36 PM | About Anger | 11 Comments
The "Angry Brain"
Probing inappropriate rage
Looking into angry brains
By William J. Cromie
Harvard News Office
The scientists were trying to make people mad. While they lay in brain scanning machines, 30 individuals listened to tapes describing what they previously had admitted were the angriest moments of their lives.
There were tales of cheating and romantic breakups, wrongs done to them, even road rages. As the subjects seethed, the scientists measured blood flowing between the thinking and emotional parts of their brains.
Ten of the people suffered from a combination of major depression and anger attacks; ten dealt with depression alone; and ten were as close to normal as the testers could find. What would be the difference between people who controlled their anger pretty well, and those who could not handle it in a socially acceptable way?
These were the first such brain scans ever done with mental patients while they wrestled with their anger. They were done by researchers at Harvard Medical School and Massachusetts General Hospital.
A look into the brains of normal subjects revealed that anger increases blood flow to a reasoning part of their brains, an area over the left eye just behind the forehead, technically called the orbitofrontal cortex. This flow inhibits thoughts of rage. At the same time, blood flow increased activity in the amygdala, an almond-shaped knot of tissue deep in the brain that deals with emotion and vigilance.
Angry feelings arising in the amygdala are normally cooled by activity in the frontal cortex, part of the thinking region of the brain. However, in some severely depressed people a lack of both recognition and control of anger, can lead to violent rage.
"All of us get angry from time to time," comments Darin Dougherty, an assistant professor who led the research. "At such times, feelings of wrath in the primitive parts of our brains seem to be balanced by inhibitions of our will to act on those feelings."
But in people dealing with both depression and rage, things go a different way. A decrease in blood flow to these areas of the brain reduces both their ability to control impulsive acts and their feelings about the consequences of those acts, say punching someone in the mouth. There is both a lack of emotion and a lack of control. A double hit that adds up to inappropriate, even violent rage.
Those with major depression who are free of anger attacks show a lack of activity in both brain areas; both their feelings and reasoning about anger are deadened.
An angry blow
Studies by different researchers show the same kind of imbalance in other mental illnesses, such as manic-depression, intermittent explosive disorder, and antisocial personality. The latter is a common characteristic of violent behavior directed at both oneself and others.
There's the classic story of Phineas Gage, a 19th century railroad man who - in a freak accident - had a metal tamping rod driven through his skull just above his left eye. Gage survived but his easygoing personality did not. He went from a mild-manned, well-liked, and admired man to a violent, unstable brute, hated and avoided by all who knew him. The tamping rod had destroyed his cerebral center of anger inhibition behind his forehead.
Dougherty estimates that about one-third of the severely depressed people in the United States also suffer bouts of anger, totaling more than a million sad, angry persons in this country alone. When they start feeling irritable and dark, they know depression will follow. When the depression is successfully treated, the anger goes away.
But what happens in their brains when they're not angry anymore? Does their blood start to flow the way it does in so-called normal people? That's a medical mystery that Dougherty and his team want to tackle next. That team includes Scott Rauch, a Harvard Medical School-Massachusetts General Hospital (MGH) psychiatrist who specializes in imaging the brains of people with mood and anxiety disorders, and Maurizio Fava, a Harvard professor who directs the treatment of depression at MGH.
Their next goal is to study angry depressives before and after treatment. "We want to determine what is state and what is trait, what goes away and what stays," Dougherty says. "Once they are successfully treated for depression, do their brains revert to a normal pattern, or do some things stay abnormal? We would also like to do brain scans of other types of patients who exhibit impulsive and violent aggression."
In a report on their research in the August issue of the Achieves of General Psychiatry, Dougherty, Rauch, Fava, and their colleagues note that such aggressive people often have abnormalities in the size as well as functions of their frontal brain and amygdala. One study they mention found that patients with antisocial personalities and a history of violent crime had 17 percent less gray matter in the left frontal part of their brain than those without such a background. Another study concluded that levels of antisocial behavior in violent individuals increased as the size of their amygdalas decreased.
Hard on the heart
At present, excessive anger is treated by anger management techniques like cognitive behavior therapy. The basic research being done by the Harvard-MGH group and others may hasten the day when drugs known as serenics will become available to sooth irritability and calm wrath and rage.
Such drugs could reduce the staggering financial and public health costs of anger. Higher rates of heart attacks and coronary artery disease are closely associated with anger and hostility, the researchers point out. "We are trying to tease out the specific components of the type A personality, the bustling hustler who is more prone to heart disease than more laid-back people," Dougherty says. "Hostility seems to be the biggest trigger of heart disease. Adding outbursts of anger apparently makes things worse."
Depression, anger, and hostility also raise the risk of diabetes. Various studies have shown that such people are less glucose tolerant, that is, less able to process the sugar they consume in their food.
Add to this the social impact on families of yelling, throwing things, and striking children and adults. That can drive others to depression as well as distraction.
"Our findings," Dougherty notes, "underscore the importance of making clear the basic underpinnings of anger and aggression in mental illness and of conducting experimental trials in the search for effective treatments."
To be angry is to revenge the faults of others upon ourselves. -Pope
Copyright 2007 by the President and Fellows of Harvard College
Posted 4/24/2007 @ 10:55 AM | About Anger | 10 Comments
Anger in the Workplace
Stress hazard: the jerk at work
By Rita Pyrillis
April 16, 2007
Kim DiFrancisco, a suburban saleswoman, describes it as "absolute terror running down my back." Megan Larson, a Chicago marketing manager, says it gave her an ulcer. Others report nightmares, headaches and bouts of depression.
What they experienced can destroy morale, lower productivity and chase good employees out the door. It's workplace bullying, and experts say it is an epidemic.
Office ogres can be bosses or co-workers, men or women — and they are everywhere, says psychologist Gary Naimie, director of the Workplace Bullying and Trauma Institute in Bellingham, Wash. "It's a dirty little secret and it's not catching the eyes of executives."
By far most victims are women, and about half of all bullying incidents involve women harassing women, Mr. Naimie says. Nearly 70% of bullied employees end up quitting, most without confronting the problem. Victims fear retaliation, ridicule or being labeled a troublemaker. Those who do seek help often encounter managers and human resources professionals who don't know how to handle the problem or blame the victim.
Ms. DiFrancisco, 39, works in the food industry. Seven years ago, she was the top seller and the only woman in a six-person office. Young and ambitious, she became the target of an older colleague who seemed threatened by her success and began gossiping to co-workers and customers about her abilities and her character.
"He'd make snide comments and tell others disgusting things about how I got to the top," she says. "He turned the entire office against me and forced me to consider leaving. I was doing a great job, but I just couldn't stomach going in anymore."
Ms. Larson, 27, who worked at a mid-sized manufacturing firm in Chicago, says she was badmouthed and belittled by a colleague who also tried to sabotage her work.
"He'd shoot me down in meetings and twist things around," she says. "But it was subtle, so when I complained, I looked like the jerk."
WHAT MAKES A BULLY?
If employers aren't taking much notice of bullying yet, researchers, mental health professionals, grassroots activists and legislators are.
"People who report being bullied also report more physical symptoms like headaches and insomnia and use more sick days," says Suzy Fox, a Loyola University Chicago professor who studies bullying and other workplace issues. "We're in the same place with bullying as we were 10 to 15 years ago with sexual harassment. No one knew how to define it. Does it mean I can't smile at a female co-worker? Where do you draw the line?"
While sexual harassment or discrimination based on race, national origin, gender, religion or disability are now prohibited by law, bullying still falls into a gray zone.
This year, six states, including New York, Connecticut and Montana, introduced bills prohibiting bullying in the workplace. Several other states have tried to pass legislation but failed; Illinois hasn't considered a measure. According to a 2004 study by the Washington, D.C.-based National Institute of Occupational Safety and Health (NIOSH), one in four companies surveyed reported bullying, defined as "repeated intimidation, slandering, social isolation or humiliation."
Helen Brown, 35, once had to endure a screaming boss who seemed to enjoy making the women in the office cry. "He'd call them in, close the door, scream at the top of his lungs and they'd come out crying." She lasted five years there before quitting to start her own consulting business, but the memory lingers.
"There's nothing worse than going to work and hating every minute," says Ms. Brown, now president of Elmhurst-based Desert Rose Design. "I hung in there, but it was awful."
PERSONAL OUTBURSTS
Had there been a law on the books, Loraine Edwalds, 49, now a vendor manager at UBS Financial Services Inc. in Chicago, says she would have handled things differently when an employee at a previous job sought her help with an abusive co-worker.
While Ms. Edwalds was a manager at a professional association in Chicago, an employee told her that her co-worker berated her in meetings, exploded over trivial mistakes and made offensive remarks about her clothing and other personal matters. "I said: 'Maybe the bully is hormonal. Your work is fine; try to avoid her.' "
Helen Brown worked for a boss who would scream at employees until they cried. Photo: Stephen J. Serio
Ms. Edwalds saw it as a classic personality clash. Both women were competent, but the bully was a high performer whose "take no prisoners" approach fit better with the company's culture.
The bully's outbursts became more personal and less work-related. Eventually, Ms. Edwalds told the beleaguered employee to leave if she couldn't take it. And that's exactly what she did — something Ms. Edwalds still regrets.
"As a manager, I could only make her stop things that are work-related," she says. "There's not much we can do about personality issues. Now I see that that was shortsighted."
A few months ago, the bullied employee contacted her to talk about her experience. "She tracked me down out of the blue," she says. "I thought, wow, after seven or eight years, she was telling me about how bad the bullying had been like it happened yesterday."
Rick Samson, a Chicago labor and employment attorney, says courts are reluctant to take on the issue in the absence of laws prohibiting it. "Too bad, you have a lousy boss, but is that a legally actionable situation?" he says. "After all, one person's bully is another's demanding boss."
Leonard Ingram is founder and director of the Anger Institute of Chicago, which provides counseling to corporations, school districts, police departments, hospitals and other organizations. He says a bully's primary motive is to throw others off their game."They are like hunters," he says. "They can smell the victim, sense their fears and insecurities. Each bully has to first find that quality before they attack."
And they are skilled at sniffing out vulnerabilities because many have themselves been bullied, Mr. Ingram says. "The bullying is a direct response to how they've been bullied either at home or at school," he says. "It's a cycle of abuse. They bully their wives, their employees, their children."
And co-workers often tolerate it, he says, because "most people just don't want the hassle, so they give in."
Ms. Larson and Ms. DiFrancisco both fought back.
Ms. Larson complained to her supervisor and kept an incident log that she presented to the company's human resources department and to the CEO. They listened, investigated, conferred — and then did nothing.
"It's an injustice, and no one does anything to help you," Ms. Larson says. "The woman in human resources asked me if I was taking things the wrong way, that maybe he's just having a bad day. Management just wanted me to go away and shut up about it."
Disgusted, she found a new job. Three years later, Ms. Larson still takes medication for the ulcer she developed at the time. "It just eats away at you," she says. "But I'm proud that I stood up for myself."
DRASTIC MEASURES
Ms. DiFrancisco took a more drastic approach. She suspected her tormentor was badmouthing her but didn't have proof, so on several occasions she hid a tape recorder on a ledge beneath the office printer.
"I couldn't believe the stuff he was saying. They'd talk about me until the second I walked back in the door," she says. " 'Did you see what she wore, what a long lunch she took?' Sometimes it went on for 45 minutes to an hour."
She intended to confront the owner and the bully with the slanderous tapes, but her plan backfired: One day, the recorder went missing.
"The owner called me in and said, 'What's this?' I said, 'Play it,' " she says. "But (the tape) was blank. Everyone thought I'd get fired — I'm sure it was illegal — but he's the one who should have been let go."
Afraid to confess to the other taping sessions, Ms. DiFrancisco bided her time until she found a new job four months later. Still, she doesn't regret bringing the situation to a head.
"It put everything out in the open," she says. "After that, I had no fear of saying what was on my mind. I was being pursued by the company I'm with now, so I had some extra testosterone in me."
A few months into her new job, she nabbed a huge account from a competitor who had managed the client for years. She saw it as both a professional and personal victory: The competitor was her former bully.
©2007 by Crain Communications Inc.
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Posted 4/19/2007 @ 3:54 PM | About Anger | 2 Comments
Advances In Anger management
Researchers and practitioners are examining what works best for managing problem anger.
BY JENNIFER DAW HOLLOWAY
Monitor staff
Print version: page 54
Rob comes to therapy at the urging of his wife. He's prone to angry outbursts--especially while driving. He says things such as, 'I'm not doing anything unsafe, it's that jerk in front of us who's going too slow, who made me slam on my brakes.' He admits he spends a good portion of his day angry at one thing or another.
Most practicing psychologists have seen plenty of angry patients like Rob in therapy. While most recognize problematic anger in their patients, they may or may not be clear on how to treat it.
Psychologist Howard Kassinove, PhD, of Hofstra University, says the number of patients he saw clinically for problem anger just didn't correspond with the relative lack of attention to it in the academic literature. "Anger has been an understudied emotion," he says. "I was in clinical practice for more than 25 years. An enormous number of people come in with anger problems, but the literature base is small, there are no anger diagnostic categories and psychology textbooks rarely mention anger."
Diagnosing problem anger
Most normal people experience anger a few times a week, says Kassinove. According to a 1997 study by him and his colleagues, 58 percent of anger episodes include yelling or screaming. And less than 10 percent involve physical aggression. Even then, the aggression is usually mild and consists of throwing small objects, such as pencils, or shoving. Anger can even be positive (see page 44). But what characteristics define problematic or dysfunctional anger versus normal anger?
A study published last year by Kassinove, R. Chip Tafrate, PhD, and L. Dundin in the Journal of Clinical Psychology (Vol. 58, No. 12) found that people with high trait anger have anger reactions that are more frequent, intense and enduring. They also tend to report more physical aggression, negative verbal responses, drug use and negative consequences of their anger. In general, their anger negatively affects their relationships, their health and their jobs.
Such anger that "disrupts or interferes with sense of self or normal routines" could warrant therapy, says Colorado State University psychologist Jerry Deffenbacher, PhD.
Anger experts note, however, that unlike most clinical problems, there is no diagnostic category for anger. "The DSM doesn't have any diagnostic categories where anger is the presenting issue," says Deffenbacher. "We don't have any parallel diagnoses." So, he adds, the degree to which anger becomes a real problem is "a fuzzy call."
Some psychologists--among them Raymond DiGiuseppe, PhD--are working to fill this diagnostic need. DiGiuseppe, chair of the psychology department at St. John's University in New York, is conducting research to validate a set of criteria for an anger diagnosis. But that still leaves open the question of tailoring the treatment to the diagnosis. "Given all the different distinctions we have about anxiety disorders, they help us develop more treatments," says DiGiuseppe. "We have no such distinction for anger. Everyone gets the same treatment."
Though some experts believe an anger-related diagnostic category could be helpful, others argue against it. Some say it isn't necessary because anger may be a symptom of another disorder. Others argue that a distinct anger diagnosis could be used wrongfully in court, for example, to explain--and perhaps create a defense for--criminally violent behavior.
Techniques to reduce anger
Diagnostic categories or no, psychologists are still faced with treating anger in the therapy room. Yet how are they to do that?
"I think there are three strategies or combinations of them that have the most empirical research behind them," says Deffenbacher. The strategies--relaxation, cognitive therapy and skill development--are new applications of existing concepts, he says.
Since the 1980s, he and his colleagues have been studying whether cognitive and relaxation techniques affect anger. Angry college students and drivers in his studies reduced their anger levels from the 85th percentile to normal levels on Spielberger's Trait Anger Scale, using relaxation. "You can't be calm and relaxed and pissed off as hell at the same time," Deffenbacher jokes.
Here's how the relaxation technique works: Clinicians train patients in progressive relaxation until they can quickly use personal cues, such as words, phrases or images--one woman learned to visualize a cross--to relax in an anger-inducing situation.
"We have people identify what makes them very angry. With drivers, for example, when people flip them off or go too slow," says Deffenbacher. "Then we have them visualize that intensely for a minute or two and then help them relax...so they get angry and then relax it away. We do that over and over again." By the end of approximately eight sessions, the patients should learn to relax themselves, without therapist assistance.
"The analogy I like to use is it's like weight loss," he says. "They come in and get [rid of'> a lot of anger. I don't want to see them angry again, so we shift the focus to maintenance and prevention eventually."
Cognitive therapy--in which psychologists help patients see alternative ways of thinking and reacting to anger--is another helpful treatment strategy, says Deffenbacher.
"A lot of ways in which we think when we're angry make situations worse," he explains. "Suppose you're driving to work and you get cut off. You think, 'You idiot,' about the other driver. But you could think 'Whoa, that was an accident waiting to happen.'" He also recommends focusing on compatible and appropriate behaviors with patients. "If I'm an abusive parent, I may need parenting skills. If I'm an angry driver, I need safe driving skills," he says. Any of the three techniques, or any combination of them, takes "practice, practice, practice," says Deffenbacher.
The combination of techniques also seems to produce the most positive effect. For example, several of Deffenbacher's studies with angry college students, including one in 1996 in Cognitive Therapy and Research (Vol. 20, No. 6), using a cognitive-relaxation intervention showed that anger was lowered for most participants--with effect sizes of 1.0 generally, which is statistically significant.
Kassinove and Tafrate, co-authors of "Anger Management: The Complete Treatment Guidebook for Practitioners" (Impact, 2002), envision similar combinations of interventions in a model that incorporates four stages of change:
* Preparing for change. Deffenbacher agrees this stage is often overlooked but is key to success. Kassinove says clinicians need to start by helping patients increase their motivation and awareness of their anger.
* Changing. This stage includes assertiveness training, avoiding and escaping from anger-invoking situations, and a "barb exposure technique" that triggers patients' anger and then teaches them to relax.
* Accepting and adjusting. At this point, patients are taught how to reconceptualize their anger triggers, forgive others and avoid carrying a grudge against those who might anger them.
* Maintaining change. It's best to conclude treatment with a long-term plan. New triggers might re-ignite anger, so we try to include relapse prevention training, Kassinove advises.
The future of anger reduction
As researchers continue their search for effective treatments, emerging evidence suggests that some treatment types work better than others with problem anger. For example, most research now says that catharsis--"letting it all out"--isn't helpful and, in fact, may increase a person's hostility, according to a 1999 study by psychologist Brad Bushman, PhD, and colleagues, published in the Journal of Personality and Social Psychology (Vol. 76, No. 3).
And DiGiuseppe says that his own meta-analytic review has found group therapy to be less effective than individual therapy. "Group members tend to reinforce each other with their anger and antisocial attitudes of expressing it," he explains.
There are many other areas worthy of exploration, say DiGiuseppe and Deffenbacher, such as the use of motivational interviewing, readiness to change and the role of revenge in problem anger.
And though there is a growing body of literature on anger reduction, researchers need to step up their attention to anger treatment and diagnosis, according to Kassinove and Tafrate. The development of diagnostic criteria for anger won't happen until the experience of anger is better understood, they say.
For more information: go to www.angermgmt,com
Posted 1/28/2007 @ 1:41 PM | About Anger | 9 Comments
Leaders In Anger Management
Leaders And Trend Setters in Anger Management
Top anger management researchers, trainers and providers worldwide
As anger management is rapidly becoming an accepted intervention for person - directed aggression worldwide. Therefore, it is worthwhile to identify the leaders, trend setters/gurus and researchers, who are defining the scope of professional anger management practice. This is not an exhaustive attempt to explain the theoretical and intervention approaches of those mentioned on this list. Rather, it is suggested that readers who are interested in learning more about the work of those mentioned above to contact any or all of these leaders and get more information first hand regarding their views on anger management.
• Dr. Raymond Novaco, Professor of Psychology at the University of California at Irvine was one of the first researchers to use the term, anger management. He is responsible for developing an assessment scale for inappropriate anger.
• Dr. Jerry Deffenbacher, Professor of Psychology at the Colorado State University is identified as an expert on road rage. He is a panel member of an American Psychological Association task force charged with developing a proposed new DSM category for anger as a pathological condition.
• Williams LifeSkills was founded by renowned researcher and physician Redford Williams, MD and educator/historian Virginia Williams. PhD. Dr. Redford Williams is a Professor of Psychiatry and Director of the Behavioral Medicine Research Center at Duke University Medical Center. Dr. Virginia Williams, President of Williams LifeSkills, is a cultural historian and writer.
• Psychologist Howard Kassinove, PhD, of Hofstra University.
• R. Chip Titrate, PhD. is a colleague and co-researcher with Dr. Kassinove.
• Dr. Tony Fiore, one of the principles of Century Anger Management was trained in the Anderson & Anderson model of anger management and has recently developed a different model along with his partner Ari Novick. Both are Certified Anger Management Facilitators in the Anderson & Anderson model of anger management.
• Dr. Leonard Ingram was trained in Chicago at the Alfred Adler Institute and has an award winning website on the internet: www.angermgmt.com
• Mike Fisher is director of the British Association of Anger Management and major provider of anger management in the U.K.
The writer, George Anderson, was trained in Child Psychotherapy at the Harvard University School of Medicine. After many years in private practice and as a University Professor and Psychotherapist, I developed a curriculum in batterer’s intervention 15 years ago and a curriculum in anger management three years later.
I am currently working with Mike Fisher in co-sponsoring an international conference on anger management. I have partnered with Leonard Ingram in the mutual marketing of our respective training products. Tony Fiore and Ari Novick are active members of the American Association of Anger Management Providers and are working collaboratively to develop standards for facilitators of anger management. Jerry Deffenbacher and I have appeared jointly on NPR, national radio. I have read research conducted by the Williams as well as Dr. Titrate and Dr. Kassinove.
I strongly recommend that all students and providers who wish to development competency in anger management to carefully study the writings of all of the anger management leaders listed above. These are some of of the prominent movers and shakers in anger management.
For more information regarding trends in anger management click here: www.andersonservices.com/blog.
Posted 10/17/2006 @ 7:40 PM | About Anger | 18 Comments