Spoiling the boiling rage
If, as psychologist Steven Korner suggests, lack of emotional regulation is at the core of many headline-grabbing crimes, can we teach emotional regulation and help us rein in those raging emotions?

While psychoanalysis strives to reconcile deep-seated difficulties from early childhood, "anger management" programs are aimed at gaining control of the anger -- and particularly the aggression -- without necessarily uncovering the emotional roots of anger. Partly it's driven by economics. With large numbers of youths showing symptoms of anger, it's expensive to provide long-term treatment.

John Lochman, professor of clinical psychology at the University of Alabama, says two subgroups stand out among aggressive children:

Proactive aggressive children -- bullies. "They know very well what they are doing ... they prey on others, are physiologically not very activated in threat situations," says Lochman. Bullies generally don't feel angry, sad, or fearful while they act aggressive.

Reactive aggressive children, who comprise roughly two-thirds or three-quarters of aggressive children. "They get into trouble because of aggressive behavior, but in large part it's a response to what they perceive as threats in the environment," says Lochman. "They become very aroused, the cardiovascular system really kicks in, they respond very impulsively in the moment, with escalating aggressive behavior to try to manage the perceived threat." This group tends to explode with anger on slight provocation.

It is this latter group that can benefit from anger management, says Lochman, who tests anger-management programs based on "social cognition," which is a fancy way of describing thoughts about how others see us.

Reactive aggressive kids tend to misread social cues and put the worst construction on them, so a brush in the hallway will be interpreted as a deliberate challenge instead of an accident made in a crowd.

Because these kids "jump to conclusions that others are out to get them," Lochman says it's important to teach them to read social cues, and then to teach social problem solving skills. "We help them think about different solutions that are available to manage problems without aggression," Lochman says. Even kids who normally can solve problems verbally "many times have not acquired very socially skilled ways for talking with others about disagreements" in the heat of the moment. "They become so aroused, they're not able to do that."

Beyond reframing the experience, the two anger management programs Lochman has worked on use three techniques to defuse anger once it develops.

Distraction. "If you feel yourself start getting angry and recognize that it's a problem, you focus on something else, such as what you're doing later that day," Lochman says. The classic distraction, counting to 10, actually seems to work.

"Self-talk" or "self-instruction" can be repeated silently, carrying a message like, "I'm going to keep cool, I won't let this person get me into trouble." Self-talk can act like a little recording, he adds. "We do role plays, they practice being taunted and teased."

A limited version of relaxation technique.

Furiously seeking results
The programs seem to work. In a three-year follow-up of the Anger Coping Program, held in 18 group sessions for kids aged 8 to 14, "The most notable finding was that the boys had lower rates of substance abuse at age 15," Lochman says. There were some improvements in problem solving and self-esteem, and a modest reduction in delinquent behavior (see "A Social-Cognitive Intervention..." in the bibliography).

Eager to make a bigger impact, Lochman helped enlarge the program into Coping Power, which involves kids and parents in 33 meetings. Long-term follow-up has not been done, but in the short term, the program reduced aggressive behavior at home and school, as well as substance abuse.

Lochman says affecting substance abuse indicates that major changes are occurring. "The literature suggests that as they move into adolescence, there are interrelated risks for negative outcomes, a constellation of anti-social behavior including substance abuse, early sexual activity, school dropout and delinquency. We're pretty intrigued that a program on anger has this interesting effect on substance abuse."

Treating the disease -- or the symptom?
Anger management is controversial to those who consider anger a helpful symptom, not a dangerous emotion. Cox, for example, maintains that anger can highlight larger emotional issues. "We don't consider anger to be a problem. It's a natural emotion, provides us with information, it happens to everybody... What is a problem is the way in which we divert our attention from it.

"Anger-management programs say go away, think positive thoughts, count to 10," she says. "But those are Band-Aids for the moment, they don't do anything about the long-term problem." Instead of ignoring or defusing the anger, it would be more helpful, she says, to explore its roots. "Why do I always feel this way around this person? What does it mean to me that I get angry when my partner wants to leave?"

Cox says that qualitative data suggest that women "report that during intense anger, when they've been able to stay aware of it, talk to somebody, they've made incredible life choices, major decisions that change their life, which doesn't follow the myth that anger makes you stupid."

Read our madder'n a hornet bibliography. Worse than a mosquito in your ear!