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Clinical Prompt

The beginning of any technique starts with a trusting relationship with the child.

Teach language and concepts

  • self talk
  • coping strategies
  • triggers [frustration, annoyance, treatment, abuse, let downs]
  • anger process [perception – thoughts – feelings – response]

Focus on thoughts

  • experiment [hamburger]
  • thoughts that make us angry [failure, assumptions, tapes, amplification, & labeling]
  • detection problems [private, automatic, brief, catastrophic, & depressing]
  • homework

Coping

  • compare self talk to thoughts that make us angry
  • identify triggers
  • compare thoughts to fatal errors
  • review 5 disputes [self talk – approach – talk back]

PRACTICE – PRACTICE – PRACTICE – PRACTICE – PRACTICE

Forms & Charts

Triggers [Five Cards] CBT#19-001
Thinking That Makes Us Angry CBT#19-002
Distressed Thinking Worksheet CBT#19-003

Download Available | CBMT 19 Supplemental Docs  

 


Introduction

Aggression is not always driven by anger. Violent battles in the animal world do not seem to be based on anger. If they are between predator and prey, they often end in death, but are for reasons of hunger and survival. Territorial or sexual battles among species rarely end in death or go beyond what is necessary to demonstrate physical superiority. But humans do feel anger. And for them anger is a moral emotion. It is righteous. It aims not only to end current trespass but to repair any damage done. It also aims to prevent further trespass by disarming, imprisoning, emasculating or killing the trespasser. [Seligman – 1993] Since, for humans, anger justifies our aggressive action, these behaviors become distinctly social in character although asocial in nature.

Anger is highly opinionated, warning us that something evil is trespassing against us. It tells us to get rid of the object, to strike out against it. Anger has three components.

  1. There is the thought, a very discrete and particular thought: “I am being trespassed against.”
  2. There is the bodily reaction. Your sympathetic nervous system and your muscles mobilize for physical assault using the same mechanisms evolved for fear.
  3. After such preparation there is the action. The attack is towards ending the trespass – immediately.

The quality of righteousness is extremely problematic to the helping professions, since people with problems in living often “think” they are being trespassed, when the casual observer sees no such offense. In helping angry persons then, two factors become apparent: first, they need to examine what they think about self and others, and second, they need to find ways to mediate action.

Anger management is a process of seeking alternative solutions. Once having created alternatives, the person must learn to weigh the consequences of each alternative to him/herself and to others. In the midst of the emotion such weighing is difficult since the bodily response has already prepared the person for action. However, it is a process that is likely to help calm them down.

The client must count to the following steps in a thought mediated process –

  1. Stop
  2. Think!
  3. Is this a good choice or a bad choice?
  4. Decide. ‘What do I want?’
  5. What alternatives might be available?
  6. Which of the alternatives most meets my goals [end the trespass and avoid negative consequences]?
  7. Impact on me. [Short term & long term]
  8. Impact on others [Short term & long term]
  9. Decide.
  10. NOW act accordingly.

While it important psychologically to have the serenity to diminish the number of offenses and the degrees of anger, it is not the feeling of trespass which causes trouble socially. It is the action taken.

There are six constructs to emotional control over anger:

  • Learning the language and concepts. Children need to understand that there are thoughts, feelings and actions and that these can be separated.
  • Understanding that situations and events do not make us angry.
  • Different people respond differently to events – it is our thoughts about the event that make us angry.
  • There is a difference between ‘feelings’ and ‘behaviors’. Feelings are always OK, although they can be either comfortable or uncomfortable, but behaviors can be either OK or Not OK.
  • We must learn to recognize both the internal and external signs of anger.
  • We must understand the degree of intensity of feeling and be able to identify the signals about our own behavior.

Mentors must assume that all children need to learn all facets of anger control unless, or until, they are able to demonstrate that they understand the construct.

This particular procedure focuses on the second component of the process – Anger Producing Thinking. The first component perception is linked directly to the event and happens virtually simultaneously with the thought evaluating what is being perceived. The third component – feelings is a direct result of the thought and, therefore, is controlled by changes in thinking. The final element, behavior, is mediated by the feelings and, therefore, is controlled also by the thought which creates the feeling.

Instruction

LEARNING GOALS

  • Clients will learn how their own thoughts can contribute to arousal
  • Clients will identify 5 types of distorted thinking.
  • Clients will learn coping strategies for their thinking errors

LANGUAGE & CONCEPTS

The purpose of the session is threefold:

  1. To help the client learn that s/he contributes to his/her own anger by “self-talk”.
  2. To help the client identify the five types of thinking errors that are most commonly made by people with anger problems.
  3. To have the client prepare coping strategies to mitigate these thinking errors.

PROCESS

Review the triggers to anger. Make sure that the child understands each of these concepts. Have the child tell you in his/her own words what each means. Have the child tell you an example of when each made him/her angry.

Triggers to Anger

Frustration When you are prevented or blocked from doing something you want to do. Frustrations often lead to our becoming angry.

Annoyances When things such as repeated noises or interruptions get on your nerves. Barking dogs, equipment breakdowns, noisy neighbors and other repeated annoyances can lead to anger.

Mistreatment When you think you have been treated unfairly. If we believe someone is unjust or unfair to us, it is easy to become angry at that person.

Abuse When you are verbally or physically abused or attacked. When people put us down, call us names, or get physical with us it often leads to anger.

Disappointments When you are disappointed in your behavior or the behavior of others. When you think someone has let you down or you have let yourself down it can lead to anger.

Review the anger process with the child.

Perception –> Thoughts –> Feelings –> Response

Tell the child that you will be examining the second component of the anger process – THOUGHTS – and give the child the test.

Say: “We constantly speak to ourselves. This internal dialogue is how we ‘think’. Tell the child you are going to do an experiment. Tell them:

  • I am going to give you something to think about for 10 seconds.
  • I want you to think about ONLY this thing.
  • I want you to think about this thing WITHOUT ‘talking to yourself’.

Tell the child to think about a HAMBURGER.”

Give the child about 10 – 15 seconds.

Ask the child how it went. Have fun discussing how they ‘had trouble’. Examine whether the child:

  • had to ‘tell him/herself’ to think about a hamburger over and over again?
  • had to ‘tell him/herself’ not to think about other things (like Wendy’s or McDonalds, or Pickles, or Onions, or the time/date/place they ate their last hamburger, etc.)

Point out that most people will fail this challenge MISERABLY. This is because we “think” in language. We constantly “talk to ourselves” in our heads when we think.

Point out that sometimes this “self-talk” occurs without us even knowing it. This is especially true in stressful or tense situations.

Tell the child that most of the time we contribute to our getting angry by “talking ourselves into becoming upset” but often don’t realize we are doing this.

Give the child the Thinking That Makes Us Angry Handout. Discuss each of the five FATAL thinking errors that cause us to become angry.

FAILURE We tell ourselves we “should” or “ought” to be a certain way. When we don’t behave in accordance with these rules, we tell ourselves we are a failure, which makes us angry.

ASSUMPTIONS Often we “mind read” others. When we do this we make assumptions about why they are doing or saying things to us. Usually the things we assume about their motives tend to make us angry.

TAPES In our heads we carry a set of “rules” we expect others to follow. These rules play inside our heads like a tape in a boom box. When others don’t follow these taped “rules”, we can become angry.

AMPLIFICATION When disturbing things happen, we tend to make them seem more significant than they really are. We do this by amplifying the bad consequences that may occur.

LABELING Labeling others or calling them names such as “Jerk” or “Idiot” only increases our anger toward them. We judge them by a single incident rather than as a whole person.

Discuss with the child how difficult these thinking errors are to detect. Talk about the reasons for this:

  • They are private. We say them to ourselves but seldom say them to anyone else. We say things like “This is terrible, it’s the worst thing that could possibly happen to me”, or “I looked like a real fool, nobody will ever like me again now”.
  • They are ‘automatic’. They happen so quickly we don’t even notice we are saying them to ourselves. Part of this ‘automatic-ness’ is because we believe them to be true.
  • They are usually brief. We say things like “it’s over” and understand it to mean:

“This is it. I will lose my school place over this. I probably won’t be able to get another school this good again. I will probably go to jail. What am I going to do? This is terrible. I don’t think I can handle this. Everyone will hate me.”

  • They usually forecast the “end of the world”. One catastrophic thought leads to another and another.
  • Because they are so brief and so depressing in nature, they are very difficult to turn off. They seem to repeat themselves and lead to other negative or pessimistic self-talk statements.

Ask the child if any of this sounds familiar? Discuss with the child whether s/he can identify any such thoughts from past experiences. So that you can help him/her ‘capture’ these automatic thoughts.

Give the child the Distressed Thinking Worksheet. Go over the instructions thoroughly. Once the child understands the task, give the child ‘homework’ to fill in the Self Statement column between now and when you meet again. This can also be done on tape. Whenever the child feels him/her self getting angry, s/he will write the self talk statement down. Share with the child that there is hope. We can learn to “Talk Back” to our self-talk.

Break ———————————————————Review Homework

When the child presents you with his/her homework Worksheet, there should be a series of self statements which have occurred when s/he began to feel angry. Ask the child to review the Thinking That Makes Us Angry Handout and select what ‘fatal error’ has occurred. Discuss with the child the type of errors and when they occur. Ask the child whether she can identify the ‘trigger’ situation for each of the self statements.

You want the child to fully understand what triggers the thoughts, what thoughts occur, and which fatal error applies. This may take the whole session. If so, the child can repeat the Worksheet the following week.

Break ———————————————————-Review Homework

Compare to see if the child has already begun to control his/her thinking. Make sure that the child understands fully the ‘triggers’, self statements, and cognitive errors.

Now you can begin to help the child ‘dispute’ his/her own self statements.

Discuss with the child the five ways of talking back. Make up a card for each of the fatal errors so that the child can flip through each as required. [The “Talk Back” category suggests things the clients can ‘say’ to themselves in response to the self-talk.] Talk-back statements should be short so they can be said quickly (like self-talk).

I Failure.

Self-Talk: We tell ourselves we ‘should’ or ‘ought’ to be a certain way. When we don’t behave in accordance with these rules, we tell ourselves we are a failure, which makes us angry.

Approach: Question the set of “unwritten” rules you have for yourself. Ask yourself where they came from. Realistically look at what happens if you violate your rule (does the world really come to an end?).

Talk-back: “Who says?”
“Be flexible”
“Can too (do it this way) (client suggestions)

II Assumptions.

Self-Talk: Often we “mind read” others. When we do this we make assumptions about why they are doing or saying things to us. Usually the things we assume about their motives tend to make us angry.

Approach: Look at the other persons’s behavior. Look for the assumptions you are making. Ask them for their reasoning.

Talk-back: “Check it out!”
“What’s the deal?”
“How do I know?” (client suggestions)

III Tapes.

Self-Talk: In our heads we carry a set of “rules” we expect others to follow. These rules play inside our heads like a tape in a boom box. When others don’t follow these taped “rules”, we can become angry.

Approach: Listen for the “tape” that is playing in your head. Question the rules contained on that tape. Where did they come from? Think about them and ask yourself if you agree with them (we often don’t – they are more habit than well thought out).

Talk-back: “Get a grip”
“Be flexible”
“What’s the harm?” (client suggestions)

IV Amplification.

Self-Talk: When disturbing things happen, we tend to make them seem more significant than they really are. We do this by amplifying the bad consequences that may occur.

Approach: Take a realistic view of the situation. Do a risk assessment and decide what the realistic odds are that this will result in disaster. Stop using words like “terrible, disaster, awful, worst thing…”.

Talk-back: “Don’t exaggerate!”
“Check it out!”
“What are the odds?”
“I can deal with it!” (client suggestions)

V Labeling.

Self-Talk: Labeling others or calling them names such as “Jerk” or “Idiot” only increases our anger toward them. We judge them by a single incident rather than as a whole person.

Approach: Stop name-calling. Look at the big picture. Analyze the behavior, not the person. Think about times the person was OK

Talk-back: “What, not who”
“Not always true” (the label)
“Bad act, good person”
“Think Big Picture” (client suggestions)

Have the child review the self-talk statements. Tell him/her to write down two talk-back statements in the right hand column for each self-talk.

Point out that we can learn to automatically talk-back to our self. The way to learn to do this is to PRACTICE, PRACTICE, PRACTICE saying the self-talk statement immediately followed by the talk-back statement.

Have the child read each of their self-talk statements and the two associated talk-back statements aloud. [Have some fun with this or it can get really tense].

Tell the child that they should practice saying the self-talk and associated talk-back statements at least 3 times a day for the next week. The idea is to train themselves to respond automatically with the talk-back when they hear themselves doing FATAL self-talk.

Have the child continue to keep the worksheet and discuss with him/her at each contact how well they are doing.

THINKING THAT MAKES US ANGRY

When we think in a distorted manner, it can be FATAL to reducing anger. Below are some ways we often “think ourselves” into becoming more angry.

FAILURE We tell ourselves we ‘should’ or ‘ought’ to be a certain way. When we don’t behave in accordance with these rules, we tell ourselves we are a failure, which makes us angry.

ASSUMPTIONS Often we “mind read” others. When we do this we make assumptions about why they are doing or saying things to us. Usually the things we assume about their motives tend to make us angry.

TAPES In our heads we carry a set of “rules” we expect others to follow. These rules play inside our heads like a tape in a boom box. When others don’t follow if these taped ‘rules’ , we can become angry.

AMPLIFICATION When disturbing things happen, we tend to make them seem more significant than they really are. We do this by amplifying the bad consequences that may occur.

LABELING Labeling others or calling them names such as ‘Jerk’ or ‘Idiot’ only increases our anger toward them. We judge them by a single incident rather than as a whole person.