Application of a Flexible, Clinically Driven Approach for Anger Reduction in the Case of Mr. P

Abstract

We treat maladaptive anger in adults with a program based on traditional behavior therapy and cognitive behavior therapy. To these, we add client-centered motivational interviewing techniques. With the goal of modifying maladaptive stimulus-response relationships, our specific aim is to reduce anger reactivity to aversive triggers. Thus, in daily clinical work we have found it useful to focus on individual episodes of anger rather than underlying personality dimensions. Episodes include the trigger, the appraisal, the private experience, the public expression, and the outcome. This episode model is taught psychoeducationally. The treatment program itself has four stages: engagement and preparation, use of specific change strategies, learning to accept difficult life situations, and maintaining change and enhancing happiness. Since Mr. P had difficulties with his previous therapist, we would delay using specific interventions and would spend more time in the engagement phase so as to build the therapeutic bond and enhance awareness of his own reasons for change. We would also administer a standardized anger test and would provide feedback to help him see where he stands as compared to others. Although this would be done in the spirit of exploration, without evaluative judgments, verbalizations that favor better anger control would be encouraged. Once engaged, we would use strategies that allow for the repeated examination of solutions to individual anger episodes. Use of avoidance and escape, imaginal and in-vivo barb exposure, limited cognitive restructuring, and techniques to enhance happiness would be considered. Decision guidelines, roadblocks to success, and potential solutions are also discussed.