DBT (Dialectical Behavioral Therapy) : Anger Management

Does your anger often turn into rage or aggressive behavior? Do you make decisions in the heat of the moment that you later come to regret? Are you looking for ways to keep your temper under control? If yes, you may want to consider Dialectical Behavioral Therapy (DBT). DBT aims to change negative thinking and push forward positive behavior changes. It was originally created as a tool for the treatment of Borderline Personality Disorder (BPD). Nonetheless, modern-day DBT is often used in the treatment of many other psychological problems, including violence and managing anger. Many experts claim that DBT is a very promising treatment for this purpose. Let’s take a look at DBT skills and components for anger management, their effectiveness, and how they are put to use.

 

What is DBT?

DBT is a type of Cognitive Behavioral Therapy (CBT). This means that the same core principles that apply to CBT also apply to DBT. CBT and DBT are both widespread and successful psychotherapies that focus on the connection between thoughts, emotions, and actions. Both techniques use talk therapy to help clients become more self-aware, reconsider self-destructive behaviors, and develop better habits. In addition, both therapies place a great value on the therapeutic interaction between the client and the therapist.

DBT expands on the roots of CBT. DBT, being a subset of CBT, will also address cognitive restructuring and distorted thinking over the course of treatment. The sessions can usually go up to 6 months to a year of weekly individual and group therapy sessions, in which you learn how to identify your strengths and build on them to gain more self-acceptance; and identify beliefs and assumptions that cause emotional distress and replace them with more positive thoughts (for example, instead of “I have to be perfect at everything,” think “I don’t have to be perfect to be loved”). In contrast to traditional psychotherapy, where you are allowed to free associate, participants do homework using workbooks, role-play new ways of interacting with people, and practice skills that can help calm themselves in distressing situations.

 

Techniques

DBT is evidence-based. There is quite a lot of research that shows its effectiveness in treating various populations. Doing a simple google search will help you find may open access DBT research papers if it interests you. Consequently, therapists often use it in a number of settings. These include:

  • Groups: group DBT is useful in teaching patients behavioral skills, while also helping them find comfort in relating to eachother.
  • Individual: the most common type of DBT therapy. A therapist will teach a person behavioral skills that they can adapt into their life.
  • Over the phone: patients call a therapist in between sessions to recive guidance during a ciris or difficult situation.

Some strategies and techniques of DBT include:

 

Mindfulness

Mindfulness is the foundation of DBT. It is a state of being aware of one’s thoughts, feelings, behaviors, and behavioral drives. We gain the ability to be in command of ourselves in a new way by mastering mindfulness. It has been demonstrated that awareness helps emotional control. We accept and modify ourselves as we learn more about ourselves. It is a discipline of focus and purpose.

Core mindfulness in DBT begins with the assumption of states of mind. According to it, we all have three states of mind at different times: wise mind, logical mind, and emotional mind. The wise mind is the ideal state of mind that we aspire for while making decisions. The other two mental states combine to make the wise mind.

The logical mind is the mental state that we use when doing math, reading a map, or any other practical thing. Furthermore, it is the “cool” state of mind which we use to cope with facts. The final mental state is the emotional mind. It is the state of mind in which we experience the depth of our emotions and act on them. At its most extreme, we would use it if we behaved rashly and without consideration for the repercussions of our actions. This is the “hot” state of mind.

“What” Skills

Learning to be fully aware of feelings and internal states is a primary component of DBT therapy. To teach these skills, the therapist uses the “what” skills of mindfulness:

  • Observe: observing and analysing thoughts, feelings, events, and behavior in our lives without trying to change anything. Think of this skill as data collection. It is mostly about looking into how we respond to situations.
  • Describe: learning to descirbe our experiences. When this skill is mastered, empathy and self control develops along with it. It is important to learn how to seperate experiences from reality becaucse thoughts and feelings are not always facts. For instance, assume you feel like nobody likes you. That does not necessarily mean it is true.
  • Participate: this is a skill to increase self-consciousness. We must be completely present in the moment in order to participate. We make an effort to be more present and alive in every minute of our life.

Collectively, the goal of teaching these three skills is to help patients increase their awareness because a lack of awareness is associated with impulsive and mood-dependent behavior.

“How” Skills

The next set of skills of mindfulness are the “how” skills:

  • Non-judegementally: taking a non evaluative-approach. Simply, this skill is based on teaching patients not to judge things as neither good or bad, but to look at the consequneces of behavior and events.
  • One-mindfully: This is a technique for improving concentration on the work at hand. The therapist teaches you to practice directing your attention to focus on one thing at a time. This is the oposite of multi-tasking.
  • Effectively: is defined as understanding and behaving in line with a purpose rather than with what we consider to be “right or fair.” It helps us to behave on the basis of our goals and objectives rather than our judgements. It is a tool for facilitating action on a single objective rather than endless thoughts.

 

Distress tolerance

Distress tolerance is a technique used by DBT therapists to help patients deal with distress in a more healthy way. People who have limited tolerance for distress may get overwhelmed by even the slightest amount of stress and may respond negatively. Many conventional therapy techniques focus on avoiding unpleasant circumstances, but in DBT’s distress tolerance approach, patients learn that there will be moments when suffering is inescapable and that the best course of action is to learn to accept and endure discomfort.

The idea of radical acceptance is an important component of distress tolerance. It refers to analyzing the circumstance and accepting the truth of it when there is nothing else you can do. The patient will be less prone to severe and lasting unpleasant feelings if they practice radical acceptance without being judgemental or fighting reality. There are four skill categories under the distress tolerance approach:

  1. Distracting
  2. Self-soothing
  3. Improving the moment
  4. Focusing on pros and cons

Interpersonal Effectiveness

Interpersonal effectiveness helps you become more assertive in relationships. For instance, being able to clearly express what you want and say “no”) while still maintaining a pleasant and healthy connection. You will learn how to listen and communicate more effectively, how to cope with difficult people, and how to respect yourself and others.

Emotion Regulation

Emotional regulation decreases susceptibility to negative emotions while increasing emotional resistance when these sensations do start to show. While DBT contains skills like distress tolerance to help you deal with negative emotions in time, emotion regulation methods are preventive. The emotion regulation model of DBT has three main goals. These include:

  1. Helping patients understand their emotions
  2. Reducing emotional vulnerability
  3. Decreasing emotional suffering

The first goal of emotion regulation is learning how to recognize and name emotions. Patients are taught to use descriptive words such as “frustrated” or “anxious” rather than generic phrases such as “feeling terrible,” because emotions that are loosely defined are far more difficult to regulate.

The second goal is aimed at reducing emotional vulnerability. Patients are encouraged to include daily activities that they enjoy and look forward to in their schedule. For instance, assume you are someone who enjoys working out but you haven’t really been able to find time for it. The therapist will ask you to include at least a few minutes of working out in your daily schedule. It could also be engaging in a pastime or activity, reading a book, spending time with friends and family, or anything else that makes you happy. It is critical to engage in these activities mindfully, by focusing attention on the present without letting the mind drift away.

Finally, decreasing emotional suffering consists of two skills:

1) Letting go

Letting go focuses on becoming aware of your emotions using mindfulness, identifying them, and letting them go rather than ignoring, focusing on, or resisting them.

2) Taking opposite action

Taking opposite action refers to acting in an opposite way to what the patient is feeling. For instance, if a patient is sad they could try being active, standing straight, and speaking confidently, as a happy person would. In addition, when a patient is angry, they can act calm or even help others out. This skill is not intended to repress or cover up present emotions; rather, the individual should name the emotion and let it go. Acting in the opposite direction, on the other hand, will likely reduce the duration and severity of the unpleasant emotion.

 

What does DBT help with?

Besides anger management and Bipolar Disorder, DBT is also useful for a range of other psychological problems including:

  • Attention-deficit/hyperactivity disorder (ADHD)
  • Bipolar disorder
  • Borderline personality disorder (BPD)
  • Eating disorders 
  • Generalized anxiety disorder (GAD)
  • Major depressive disorder (including treatment-resistant major depression and chronic depression)
  • Non-suicidal self-injury
  • Obsessive-compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)
  • Substance use disorder
  • Suicidal behavior

 

What is anger and when does it become a ploblem?

Anger is a normal human emotion that we all experience in our daily lives. Chronic anger, difficulties in anger management, and aggressive behavior, on the other hand, can throw your life out of balance and wreak havoc on relationships with family, friends, romantic partners, and coworkers.

So how do you know your anger and behavior surrounding it is a problem? Anger becomes a problem when people perceive social situations incorrectly, causing them to respond improperly to particular social circumstances and let their rage hijack their behavior. You may have met people who respond really rudely to seemingly normal situations, like a man on a bus who is mean to others sitting next to him for no apparent reason or an ex-boyfriend who never got along with any of your family members because of his rude comments and irritability.

 

Using DBT skills for anger management

DBT therapists will teach patients the skills mentioned above (emotion regulation, distress tolerance, interpersonal effectiveness, and core mindfulness) to help them deal with aggressive behavior and anger management.

Emotion regulation in anger mangement

If you are someone who has trouble with anger, or random angry outbursts, learning how to manage your emotions will most probably help you deal with it and act out less. As you learn emotion regulation skills you will learn how to take a moment to determine if your intense emotions are appropriate for the situation at hand. For instance, someone with an anger problem will come to understand that being angry is justified when they are attacked or injured by someone else, or when they are stopped from achieving a significant goal. However, being angry makes little sense when someone accidentally bumps into them on their way to the store.

When you start to realize that your anger can not be justified at the time, you learn how to solve problems wisely or control your emotions. To do this taking deep breaths when you are angry or taking a bit of time to process the situation at hand will help. Another approach to regulating your anger that a DBT therapist will teach you is to try and reduce your vulnerability to anger.

Here are some emotion regulation skills that can help you effectively cope with anger:

Problem solving skills

Anger and other “strong feelings” give you the energy to cope with difficult situations. Practicing proper problem-solving skills help navigate through the problem and solve it rather than making it worse by projecting your anger onto others or keeping it bottled up inside.

Assertiveness skills 

Assertiveness skills are a type of communication skill. Being assertive means that you are able to communicate your needs and wants to others respectfully and clearly.

Healthy thinking skills

Practicing healthy thinking skills will help you think in a balanced way. It implies that you have a realistic approach to events. For example, you may become angry when a friend cancels plans, and you may think to yourself that your friend most likely does not want to be around you because of this. However, if you think of the situation realistically you will start to see that your friend usually doesn’t back out of plans, however, they mentioned that they’ve been very busy at work lately. Consequently, you will notice how your anger is not always justified.

Core mindfulness in anger management

How can you use the core mindfulness skills in DBT to deal with your anger? Picture this scenario in your head:

You arrive at home after a long day of work, exhausted, tired, and hungry. You buy some food on the way home. However, before you have a chance to eat any of it, someone on the street accidentally bumps into you. The food gets splattered all over the pavement. This makes you really angry. What do you do next? You’re considerably better off discussing the problem calmly and resolving the issue. Here’s how you can do it based on mindfulness skills:

1) Become aware of the anger

Notice the sensations in your stomach, chest, and face. Recognize your fast heart rate and breathing rate. Check to see if your hands or jaw are clenched.

2) Breathe

Breathe into your body’s physical sensations. You can even close your eyes if you want to. Counting your breaths may be helpful. If you find this beneficial, envision the breath entering your nose and traveling into your belly, then when you breathe out, imagine the breath flowing out of your fingers and toes.

3) Stay with the sensations as best you can

Kindness and compassion can help you deal with your anger. Try to perceive the anger as a chance to learn about the sensation.

4) Notice your thoughts

Anger is fueled by thoughts like “it’s not fair” or “I’m not going to put up with this.” Consider letting go of these thoughts. If you find it difficult to let go of them, keep an eye on how your thoughts and feelings interact.

5) Take a step back

Try and remove yourself from your internal sensations. Keep in mind that you are the observer of your thoughts and feelings and you are not the thoughts and emotions themselves.

6) Communicate

When your anger is slowly starting to die down. Start by talking to the other person and tell them about your feelings. In the previous example, this would most probably be saying “it’s alright” when they apologize. This way they may even offer to buy you food as an apology. In addition, communication is important at times when your anger gets the best of when dealing with someone close to you. Start the conversation with ‘I’ statements rather than ‘you’ accusations. Stay conscious and attentive to your own feelings as you continue to talk, and let go of any anger if possible – less aggression and more honesty are more likely to lead to a harmonic and fruitful conversation as a result.

Coping with anger can be difficult. Sometimes it just comes flows out before we can stop ourselves. The goal is to remember these steps and follow them whenever you feel slightly annoyed rather than waiting until it turns into rage. You will grow more skilled at controlling your anger as you keep practicing.

In addition here are more DBT skills that you can use to control your anger:

Being mindful of negative thought patterns that bring out your anger

Negative thought patterns can include:

  • Over generalizations: you may find yourself thinking things such as “they always disrespect me”, “it’s always on purpose” or “this only happens to me”. Watch out for these and try to be specific instead.
  • Making assuptions: your assumptions of why you think something is happening or why someone is doing something to you is often not accurate. For instance, you may think that your spouse has lost interest in you if they don’t send much time with you, but in reality its because they have too much work on their hands. Try avoid making these assumptions, instead communicate.
  • Blaming: stop balming others for your own anger using statements such as ” this is all your fault”, “you always make me angry”, “I wouldn’t have lost it if it wasn’t for you”. You are respinsible for your own emotions.

Spare some time of your day to practice mindful physical exercise

A main component of the core mindfulness in DBT is mindfulness exercises. A DBT therapist will teach you a range of exercises that you can do mindfully to control your emotions (anger in this case).

You can also practice regular exercise. Regular exercise is linked to lower stress levels. This may help with stress-related anger. In addition, exercising mindfully will also lead to greater levels of awareness and less reactive, automatic-pilot behavior.

Connect with your senses

Listen to the noises around you or play some music mindfully. Smell some of your favorite, relaxing fragrances. Take a shower or bath and become aware of the sensations on your skin.

Question your reactions

When you are faced with a challenging situation ask yourself questions such as “is this worth it?”, “what will happen if I react in a negative way?” or “How else can I respond instead of being angry?”.

Distress tolerance in anger magement

DBT distress tolerance skills can help you:

  • Prepare in advance to deal with intense emotions
  • Enjoy a more positive long-term outlook for coping with them

According to research distress, tolerance skills in DBT are quite effective in helping patients regulate their anger and impulsivity. Reduced impulsivity may also have other beneficial effects, such as making people less likely to participate in harmful or even dangerous behavior as a way of coping with stress.

Here are some tips to help you practice and sharpen your distress tolerance skills:

Start getting active

Do things you enjoy. For example, go for a walk in the park, work out, go for a run or play a game.

Comparing

Think of times in the past where you have been even more upset and angry about a certain thing. Think about how you moved past it and what you could have avoided if you had not reacted the way you did. Be grateful to yourself for getting through it and try not to make the same mistakes again.

Think of opposite emotions

Ask yourself: “what is the opposite feeling to the anger I am feeling right now?” then do something to make you feel the opposite way like taking a walk or distracting yourself by watching some comedy.

Fill your mind with other thoughts

The idea behind this is to crowd your mind with a lot of other thoughts other than angry ones. This one requires a lot of attention to detail, so picture doing anything like designing a gorgeous new home room by room or guessing each person’s job in a crowd.

Self-soothing

This is a calming technique that will help you dissolve your anger. Think of how you may have helped a loved one deal with their anger in the situation you are in now and try doing it with yourself.

Interpersonal effectiveness

Interpersonal effectiveness can help you communicate more effectively with people instead of letting your anger get the best of you. In addition, it will also help you deal with difficult people without letting your emotions get the best of you.

Here are some tips to help you build on your interpersonal effectiveness skills:

Practice empathy

Empathy is being able to identify and comprehend the feelings of others. For example, instead of judging someone for acting the way they do, you can try getting into their shoes and looking at things from their perspective. Understanding how others feel allows you to convey your thoughts and ideas in a way that others can comprehend, as well as understand others when they speak.

To develop empathy:

  • Put yourself in someone else’s shoes. Even if you haven’t been in the same situation, recall a time when you had the same emotions as the other person.
  • Practice listening without interupting.
  • Observe others and try to guess how they are feeling.
  • Don’t disregard how others are feeling. For example, if you see a loved one who looks upset, don’t ignore them, instead try talking to them.
  • Rather than judging, try to understand first. For example, you may be first irritated by a coworker who appears cold and uninterested. However, if you learn that they suffer from social anxiety, you may become more empathetic.

Cultivate a positive attitude

People prefer to be around individuals who are nice and optimistic, even when they are in tough situations. In addition, if you have time, try volunteering at any local place to help others.

Become more self-ware

Self-awareness is the ability to perceive and understand your emotions, strengths, limits, and behavior, as well as how they influence those around you. You will be able to act more deliberately if you practice this skill.

Improve self-awareness by:

  • Keeping a thought diary to record the situations that trigger intense emotions such as anger along with your thoughts and behavior during that particular situation. Using that, you can develop better awareness of your emotions and reactions and work toward self-regulation.
  • Ask the people close to you for feedback about your actions and behavior, this way you can try and understand if there is anything that needs changing.

Develop assertiveness

People are more likely to appreciate and respect you if you communicate assertively rather than passively or aggressively. They will also have greater trust in you, and the conversations will flow more effortlessly.

Become mindful of your body language

We may not always realize it but sometimes our body language can give out negative communication signals. For instance, hunched shoulders, hands in pockets, and looking down suggest that you are not confident, folded arms might suggest that you are not interested in what the other person is saying, and pointing your finger may come off as aggressive. Your body language needs to show that you are engaged and showing genuine interest.

Tips:

  • Be aware of what you do during a conversation or when you meet someone
  • Practice open body language
  • Maintain eye contact. Having good eye contact with others is important in order to build trust.
  • Acess the other person’s body language

Think before speaking

When you are dealing with people that make you angry or when you are in a bad mood, always take a moment to think before you say something. Be honest but also be respectful.

Respect other’s opinions and thoughts

Even if you disagree with what someone else is saying, you should respect their right to speak before properly expressing your own. Even if you don’t agree at the conclusion of the conversation, you’ll both have a better knowledge of a different point of view.

Interpersonal skills may appear to be a simple idea because it mainly entails simply conversing with others, but as you can see, there are several variables to consider. It’s important to put these talents to use whenever possible since improvement comes with frequent use.

 

How effective is DBT for anger magement?

In a study published by the Canadian Center of Science and Education, a group of women who suffered from expulsive anger and impulsive behavior was placed in two groups. One was a control group and the other group was treated with DBT for two months in group sessions. The findings show that distress tolerance and emotion regulation components of DBT were effective in treating expulsive anger and impulsive behavior in the women in comparison to the control group.

Another study published in Aggression and Violent Behavior cross analyzed 21 peer-reviewed articles on DBT and anger management to conclude that DBT does in fact help people manage and reduce their anger and aggressive behavior.

 

How to get started?

If you have chronic anger, problems with managing anger, or aggressive behavior but don’t really know how to control or treat it, you may want to consider going for DBT.

The best way to get started and find out if DBT would work for you is to speak with a certified clinician who specializes in DBT. They will assess your symptoms, treatment history, and therapy objectives to determine whether DBT is a suitable fit for you.

If you believe you or a loved one might benefit from DBT, it is critical to consult with a healthcare clinician or mental health professional who has received DBT training. However, finding DBT therapists is not always straightforward. You can start by searching on the internet for any local DBT clinicians or going through online directories of clinicians. In addition, you can also ask your general practitioner or any other community-based health service for a reference or assistance in finding a DBT specialist.

 

Some things to keep in mind

DBT requires a large time commitment. Patients almost always need to do certain “homework” in addition to regular treatment sessions to work on skills outside of the therapy sessions. This may be tough for people who have trouble keeping up with these assignments on a regular basis.

Certain skills may be difficult to practice for some people. In addition, patients re-explore traumatic events and emotional distress at various phases of treatment, which may be an emotional or even painful experience. Nonetheless, if all these work out for you, DBT is a great option.

Here at Epsychitry, we have trained psychologists and psychiatrists who are qualified to provide you with DBT and help you with anger management. Consequently, if you are living in Australia you can always reach out to us using the contact information mentioned on the website. Don’t be afraid to reach out and get help.