November 20, 2018
Angry businessman breaking pencil by hands in office.

‘Mad as Hell’? How to Get a Handle on Anger

by Jeanine Barone  

“I’m mad as hell and I’m not going to take this anymore!” This may be the most famous line from the 1976 movie Network, and one that may be especially relevant today where just about everyone seems to be angry, from politicians to high school students.

We all get angry at one time or another—perhaps more so than usual these days, due to the highly divisive political arena and often-upsetting national and world events. But frequent and uncontrolled anger is a problem, not just for one’s own health but also for the well-being of family members, coworkers, neighbors, and other people in the community.

According to a 2013 study in the American Journal of Medicine of people who had survived a heart attack, those with a very high anger score had a significantly higher risk of all-cause mortality. Another study, in Social Science Medicine in 2015, found that among more than 1,000 healthy men ages 20 to 40, those who were in the top quartile of anger (as assessed by the participants answering whether they become angry easily or if it takes a lot for them to get angry) had nearly a 60 percent higher risk of mortality over a 35-year follow-up, compared to those in the lowest quartile.

There are many ways that chronic anger can be harmful, including increasing the risk of heart attacks, strokes, and poorer health in general.

Anger management 101

The term “anger management” became part of the public discussion some 15 years ago with the Adam Sandler film of the same name. And many tabloids report when hot-headed celebrities, from Chris Brown and Shia LaBeouf to Mel Gibson and Kayne West, attend court-ordered anger management sessions. In brief, anger management involves learning how to recognize when and why you get angry and how to control your emotions, along with new ways to respond when confronted with anger-triggering stimuli, or anger triggers.

Here are some questions related to anger management and treatment, with some answers based on the expertise of two well-regarded anger experts: Raymond "Chip" Tafrate, PhD, professor and clinical psychologist at Central Connecticut State University, and Howard Kassinove, PhD, professor emeritus and clinical psychologist at Hofstra University in New York. They are co-authors of Anger Management for Everyone: Ten Proven Strategies to Help You Control Anger and Live a Happier Life (due out in January 2019), a second edition to their best seller from 2009. The book is for lay readers but can also be used as an adjunct to an anger management treatment program.

What types of anger management programs are available?

Some anger management classes involve little more than attending (in person or online) and listening to information passively for a few hours and perhaps completing some homework assignments. These may be enough to meet a court-ordered requirement, but they are not an effective way of dealing with anger problems. Better are anger management treatment programs, which emphasize repeated practice, rehearsal, and coaching and are more intimate, intense, and engaging. A typical program—which can be done individually, with a partner, or in a group setting—would be at least 8 to 10 weeks, with progress depending on how much work the individual puts into the process.

What will you learn in an anger management program?

The programs vary in the techniques taught. But typically, you learn to identify what situations trigger your anger and how you react physically (do you clench your fists or jaws or feel your face getting hot?) and emotionally (do you feel like you have to shout at someone or hold back what you want to say?) as you start to get angry. You learn to recognize these signs early, before the situation escalates, as well as manage your triggers, such as avoiding certain traffic jams if road rage is your issue. You also learn how to handle stress (such as through relaxation techniques and mindfulness), how to think differently about your past, how to forgive, and how to hone such skills as increasing empathy, setting boundaries, and using self-talk (internal conversation)—all to better negotiate the outcomes you want in more positive, non-angry ways.

Is there evidence these programs reduce anger?

Yes, though effectiveness depends on many things, including whether there’s a good match between the particular skills taught and the individual, as well as whether the person is attending the program voluntarily (and is thus self-motivated) or was court-ordered. Cognitive-behavioral therapy (CBT) for anger management is the most well researched of treatments, with numerous studies showing a significant reduction in anger, aggression, and, among adult male offenders, a reduction in recidivism. (CBT is also well studied for its benefits in treating sleep problems.)

For example, a meta-analysis published in Clinical Psychology: Science and Practice in 2006 and co-authored by Dr. Tafrate, found that anger management therapy resulted in a reduction in anger and aggressive behavior and improved positive behaviors, with lasting effects. Even the spouses or significant others of angry patients reported that their partners were less angry and aggressive after learning anger-management techniques. More recently, a 2018 paper in Current Opinion in Psychology reviewed 13 meta-analyses focused on anger management, concluding that there is substantial evidence for these interventions. There’s no proof that anger-management therapy will prevent a heart attack or other health problems, but it can’t hurt—and may help.

What is the cost? Does insurance cover it?

Prices vary widely depending on the location, type of facility, and type of therapist. It can range from less than $75 to more than $300 per 45- to 60-minute session. Your health insurance likely won’t cover anger management per se, however. That’s because intense, frequent, disruptive, or dysfunctional anger is not recognized as a disorder in the Diagnostic and Statistical Manual-5 (DSM-5), the "bible" or psychiatry, which insurance companies use as a basis for reimbursement. However, people with anger issues often have other psychological issues (such as a personality disorder) that are recognized in DSM-5 and are related to anger; therefore, treatment for that would be covered by insurance.

When should you consider an anger management program?

You’re a good candidate if you become moderately to intensely angry on a frequent basis; you often want to seek revenge or “get even” or you become verbally or physically abusive when angered; you exhibit behaviors that frighten other people; or you drive recklessly because you are so angry with a fellow driver. You should also consider treatment if you feel your anger is getting worse, you routinely hold a grudge against others or frequently feel hostile, or you become so irritated or frustrated that you often get into arguments or break things.

Where can you find an anger management program?

You can ask your health care provider to refer you to a mental health specialist, or you can contact one of the following resources, as suggested by Tafrate and Kassinove: The Association for Behavioral and Cognitive Therapies (to find a CBT therapist in your area), the Albert Ellis Institute in New York City, the Beck Institute for Cognitive Behavior Therapy in Philadelphia, or the Motivational Interviewing Network of Trainers. Therapists should be state-licensed and have training and experience in anger management. Anger management programs may also be available at your workplace through your employee assistance program (EAP) or through a variety of organizations in your community including community centers, religious institutions, colleges or universities, and hospitals. Programs of varying duration and price are available online, though they vary in quality.

Are anger management therapists certified?

The National Anger Management Association (NAMA), an international professional organization, provides training and certification for psychiatrists, psychologists, counselors, religious leaders, social workers, life coaches, and educators who seek to become anger management specialists in the U.S. But you don’t necessarily need to seek someone with this certification when looking for a skillful professional, since, according to Tafrate and Kassinove, “There are some good therapists who know a great deal about anger and appropriate interventions but who are not NAMA certified.” Instead, they recommend that patients interview potential therapists before committing to any course of treatment, asking them direct questions about their education, training, and experience working with people with anger problems.

Also see our infographic Can Anger Heart Your Heart?