Two cases of anger management show why keeping our anger in check is critical – and achievable, says IMH’s Haanusia Prithivi Raj.

SINGAPORE: Jonathan*, 47, sought treatment with us as he was experiencing bad moods, high irritability and could not hold on to a job for long.

Sessions with his psychologist soon uncovered that he felt upset with himself because he couldn’t regulate his emotions.



He was not able to control his anger. Small things would trigger intense anger, and provoke him to throw objects he was holding, break items close to him, or yell loudly.

His anger also made it impossible to maintain a romantic relationship for a long time.



In fact, Jonathan shared there were many times when he came very close to getting into trouble with the law, as he had intense urges to hurt people because he felt that they had wronged him.

(Photo: Unsplash/Siavash Ghanbari)



He realised he needed help when his ex-girlfriend who was pregnant with their child left him because she did not want to bring up a child in such a hostile and unloving environment.

That event, while it initially triggered a lot of anger in Jonathan, helped him realise that he had to change his ways if he were to have a family in the future.

HURTING HER GRANDMOTHER

Samantha, a 25-year old executive shared that she came very close to hurting her 80-year old grandmother when she did not feel understood.

They would get into constant arguments over simple things such as where washed cups ought to be placed, or when her grandmother forgets to turn off light switches.

Samantha would shout at her grandmother to get her point across. She has also broken numerous plates and cups in an effort to get her grandmother to understand how much her actions was impacting her.

While she still works, Samantha is aware that her anger outbursts have killed off many friendships as her friends were unable to tolerate her harsh words and behaviour, especially in public.

Her intense outbursts, including the ones that happened in church, prompted one of her church leaders to convince her she needed help.

While Samantha was not keen on seeing a psychiatrist, her close friends rallied with her church leaders to help make her first visit less daunting.



(Photo: Unsplash/Chuttersnap)

WHAT IS ANGER?



A spate of events some months back suggest we have some way to go in keeping our anger in check.

In April, a man was jailed for attacking bus drivers two days in a row over bus fares to Yishun. Another got jail and caning after swinging a plank in a 60-person riot. And five men were arrested after a fight along Orchard Road.



Anger reflects a healthy sense of self. When we feel that our sense of self and worth is threatened, we react in anger.

The intensity of anger can range from mild annoyance to extreme rage. While it is normal to experience anger from time to time depending on the situation, one may need to get help when they feel that the slightest provocation triggers uncontrollable rage.

Some symptoms that anger is a problem would include: Anger affecting social relationships and work performance; constantly feeling impatient, irritated and hostile; frequent arguments with others and often getting angrier in the process; being physically violent when angry; and difficulty or an inability to control anger or being impulsive when angry.



The Diagnostic and Statistical Manual of Mental Disorders has also classified sudden episodes of unwarranted anger as Intermittent Explosive Disorder (IED).

Affecting 7.4 per cent of people globally, those with IED essentially “explode” into a rage despite minimal or lack of provocation or reason. They often share that they feel a lack of control over their emotions.

(Photo: Unsplash/Ayo Ogunseinde)

Apart from genetics and neurobiology, environmental factors especially early adverse childhood experiences, harsh parenting, poor social skills and poor empathy can lead to outbursts of anger.

ABUSIVE PARENTS

At times, the presence of physical or mental illness and addiction to drugs or alcohol can also fuel anger issues.

Both Jonathan and Samantha recalled growing up with harsh parents who were physically punitive. They were also bullied in school.

When Jonathan developed depressive symptoms because he could not sustain relationships and work, he resorted to alcohol to cope.

Samantha coped with her past by throwing herself into work, but her angry responses and high expectations caused her close friends and family members to shun her.

NOT THINKING RATIONALLY

Scientists have highlighted that when we are angry, we bypass our ability to plan, think rationally and respond in a way that benefits common humanity.



Renowned psychiatry expert Dan Siegel explains in his book Mindsight that when a person has sudden, irrational and emotional eruptions, the lower limbic and brain stem layers can explode out of control resulting in a meltdown.



Lack of sleep, hunger, and the way we perceive certain events can also fuel episodes of explosive anger.

(Photo: Unsplash/Yuris Alhumaydy)

In such episodes, part of the brain stops regulating the energy being stirred up, disrupting coordination and balance – meaning we become less flexible, less thoughtful and more reactive. Our anger impairs decision-making and judgement.

There are many situations that can trigger one’s anger. Like thermostats, each of us has a different threshold for such triggers.

Not getting one’s way, or hearing “no” can set someone off. Getting stuck in traffic and being the receiving end of other drivers' actions on the road, or when someone bumps or pushes you, even if it was an accident - all these can cause us to lose our cool.

Some of us can shrug it off while these same situations can trigger a major outburst in others.

MANAGING YOUR ANGER

The good news is anger can be tamed. While you cannot control or choose your emotions, you can always control how you express your anger.

There are three big steps in managing anger, namely identifying triggers, pausing, responding and not reacting.

1. Identifying triggers

Anger brings about physical changes. Adrenaline rushes through your body and you may experience an increased heart rate, heavier breathing, and your body (particularly your shoulders) becoming tense. In some people, their fists and arms become more fidgety.

(Photo: Unsplash/Michael McAuliffe)

Anger is usually a cover-up for other feelings, to mask embarrassment, insecurity, hurt, shame or vulnerability.

People who grew up in environments where the expression of emotions was discouraged, or in families that placed a high emphasis on “saving face”, may have a harder time acknowledging the emotions underlying their anger.

Recognising these signs is an important first step to creating some space where we can choose our next course of action. The more we practise noticing ourselves and how we are feeling, the easier it gets to manage our anger.

2. Pause

Taking time to analyse and understand your reaction to situations that trigger you is an important step in managing your anger.

Some common negative thoughts including overgeneralising what’s happening. Watch for thoughts like “You always interrupt me! He never listens to me. No one ever respects me”.

Others might start mind-reading to make assumptions about what others are thinking or feeling. Thoughts like “he did it on purpose because he does not like me” or “they intentionally ignored me” can be unhelpful.

It is important to own our emotions. When you notice that your thoughts and bodily changes reflect anger, take some time to pause and pay attention to yourself.

(Photo: Unsplash/Noah Silliman)

3. Responding, not reacting

Awareness of our emotions gives us the power to choose our actions. There are many ways that can help you cool down and keep your anger thermostat in check.



First, remove yourself away from the physical triggers. If you know that certain situations or people trigger you, reduce your contact accordingly. For example, avoid hanging out with the buddy who often puts you down or avoid that busy expressway.

Second, focus on your breath. Tuning in to your body actually helps to bring awareness to the pace of your breathing, and doing mindful breathing helps to reduce a racing heart.

Third, get more exercise. Releasing pent-up energy by exercising (i.e. walking, running, swimming or even kick-boxing) helps to calm a person down.

Fourth, think of the consequences. Try to identify the consequences of your action to help you to choose an alternative action.

Throwing things in anger will only result in broken items and increased expenses. Hitting someone in rage may feel good for the moment, but will only result in longer-term damage and potentially a fine or a jail term.

(Photo: Unsplash/Rostyslav Savchyn)

Jonathan and Samantha are both actively working on their anger management problems by identifying their triggers and employing different strategies to cope with their emotions.

Samantha took up kickboxing. She has also been attending family therapy to improve her relationship with her grandmother. The help from her close friends and church members has been very helpful in her recovery.

Jonathan, on the other hand, has been practicing yoga and mindfulness, and is currently working as a fitness instructor in a gym, doing what he really enjoys.



Haanusia Prithivi Raj is Senior Clinical Psychologist at the Institute of Mental Health.

