Handbook of Anger Management and Domestic Violence Offender Treatment

Ron Potter-Efron

• Publisher: Routledge
• Year: 2015
• ISBN:
  9781317975823
• Edition: 2
• Topic: Medicine
• Subtopic: Health Care Delivery

Ronald T. Potter-Efron consciously connects anger management and domestic violence, two long separated fields, and addresses treatment options and intervention methods that meet the needs of individual clients, couples, families, and groups. Therapists, counselors, social workers, and other treatment specialists will find this book a useful overview and reference for anger and anger management techniques as well as domestic violence approaches.

This new edition is split into four distinct sections:
•A description of anger and domestic violence focused upon helping clients use the principles of neuroplasticity to dramatically alter their behavior
•Assessment for anger problems and/or domestic violence
•Group treatment for individuals with anger problems and/or domestic violence
•Individual, couples, and family treatment of these concerns.

Woven through this book is a fair and balanced treatment of gender issues, reflected in the diversity of case examples that address jealousy, chronic anger, behavioral problems, group and individual counseling, and more. Readers are also shown how anger develops and can lead to verbal and physical outbursts, the five types of rage reactions, and how to treat anger turned inward. Potter-Efron also details four different approaches to treating anger: behavioral, cognitive, affective, and existential/spiritual. Mental health professionals are provided numerous questionnaires and worksheets to utilize with their clients. Handbook of Anger Management and Domestic Violence Offender Treatment is an essential guidebook that illustrates effective theory and practice.

Part I

ANGER, DOMESTIC VIOLENCE, AND THE BRAIN

1

THE ANGRY BRAIN

In the first edition of this book (published as the Handbook of Anger Management, Potter-Efron, 2005) I included a small chapter on the emotional brain as somewhat of an afterthought at the end of the edition. This time I’m beginning the book with that topic. Let me explain why with this simple statement: angry people have angry brains. Now, because everybody becomes angry from time to time, let me revise that statement to a more accurate one: “chronically angry people have angry brains.” Here’s what I mean: a) anger can take over the emotional life of a person; b) as that happens the individual’s entire way of perceiving and reacting to the universe is altered to justify his or her anger and hostility; c) these perceptual and behavioral reactions reflect real and long-lasting changes in the neural networks within the brain of this person; d) considerable conscious effort must be undertaken by the chronically angry individual to change this overdeveloped brain pattern; e) anger management and domestic violence counselors can both help their chronically angry clients (partially) disassemble these anger-directed brain patterns and also help them develop and reinforce positive brain networks. Presumably a therapist can do so without specific knowledge of how the brain works. However, I believe such information is quite valuable to both client and counselor.

Knowledge about the brain has expanded greatly in the last couple decades due to the availability of instruments like functional magnetic resonance imaging (fMRI) machines and other devices that track magnetic pulses, blood flow, water flow, and other aspects of brain activity. These important devices allow researchers to discover how the brain works without destroying it. Before they were developed, research could only be done on animals and deceased humans. Still, most of the material I present here is based on animal studies, particularly research utilizing rats, mice, and cats (Siegel, 2005). Readers should be aware that almost every year new information casts into doubt older ideas about what is occurring within the brain. Indeed, if you take a quick glance at articles in such leading journals as Neuron, you will discover they contain a large number of sentences beginning with the word “surprisingly.” It is possible that by the time you read this book some of the information presented here might be outdated. However, I will concentrate on the core postulates that have stood up well over time.

What is an “Angry Brain”?

I will use the term “angry brain” in this book both metaphorically and more literally. Metaphorically, I mean that people with angry brains are individuals who have become so used to anger that they wake up mad, go through the day looking for things to get upset about, go to sleep angry, have mean dreams, and wake up angry again. It’s as if anger had become that individual’s default option. If so they respond to almost any stimulus with anger. They are also usually hindered in recognizing or utilizing other emotions because they are too focused upon anger. More literally, I use this term to describe people who have developed extensive neural networks consisting of hundreds of thousands or millions of neurons that fire together to bring about an angry word or action. These chronically angry people often lead unhappy lives. Their anger severely hinders them in day-to-day functioning. They often become clients seeking a better life. As I will elaborate upon soon, I believe many of these clients feel quite unsafe and that anger can be a way to defend against chronic feelings of danger and threat.

What causes someone to develop an angry brain? There is no single answer, of course. Here are some possibilities.

Deeply experienced feelings of danger, insecurity, and anxiety

I will emphasize this aspect of chronic anger throughout this volume. I believe that people who feel unsafe tend to develop chronic defensive anger patterns. Helping them feel safer both externally with regard to the world and internally with regard to an inner sense of safety will lessen the strength of their anger.

Family and cultural training

Angry clients often grew up in angry families. That’s where they learned norms such as “An angry person gets what he wants,” “When in doubt get mad,” and “It’s normal to say really mean things when you’re upset.” Modeling like this encourages anger to become habitual and desensitizes people from recognizing the harm their anger causes themselves and others. Later, when these children have families of their own, they will train their partners and children to abide by these same norms.

Families exist in larger cultures. Some nationalities are more volatile than others, such as Eastern European vs Scandinavian cultures. Volatile cultures are more likely to encourage the outward expression of anger, while less volatile ones may encourage their members to “stuff” their anger or to deny it completely. Membership in groups such as gangs can also create circumstances that create anger-dominant brain patterns.

Faulty neurochemical function

Neurotransmitters such as glutamate and GABA are critical for optimal brain functioning. Some neurotransmitters (glutamate, norepinephrine, acetylcholine, and dopamine) are generally excitatory; an excess of these chemicals might cause a person to feel agitated and thus become more defensively irritated and angry over time. As Niehoff (1998) pointed out, excess dopamine increases a person’s sense of danger and therefore is likely to increase their irritability, anxiety, and degree of agitation. Other transmitters (GABA, serotonin) are generally inhibitory. Lack of these neurochemicals has been associated with impulsive aggression and suicidality. Anyone coming for anger management should be assessed for depression and suicidality as they have a common denominator in serotonin.

Hormonal influences

Testosterone and estrogen both have modest correlations with anger and aggression, but not enough for them to be considered major contributors to most people’s chronic anger (Sapolsky, 2005).

“Bad genes”

No single anger gene has ever been identified. However, genes that increase someone’s tendencies toward anxiety, impulsivity, and sociopathy could contribute to the likelihood of someone developing chronic anger. The major research focus in the last decade, though, is the interplay between nature and nurture, a phenomenon called epigenesis. One well-studied example is the MAOA allele (variant) of the MAO gene. Men with this allele do have a tendency toward violent behavior, but only if they were raised in a violent home (Sapolsky, 2005).

Brain damage

Controlling one’s angry impulses is a difficult task that needs a well-functioning brain. Some forms of brain damage definitely affect this capability. For example, frontal lobe damage impedes executive control over the urge to attack, while damage to the temporal lobes at the side of the head, where the amygdala and other limbic system regions reside, has been associated with rage attacks. These clients should be assessed by a neuropsychologist or psychiatrist to protect themselves and others. It is also the case that some angry clients may have difficult-to-diagnose minimal brain damage in several areas of their brains.

Emotions

A capacity to feel emotions is an ancient part of the human repertoire. Emotions precede thought in the sense that they are primarily experienced in relatively older parts of the brain that were functioning well before the cortex and neocortex (the newest and farthest front region of the brain) existed (Panksepp and Biven, 2012). The amygdala, a sub-cortical structure, is critical for the experience of many emotions, most strongly fear and anger (LeDoux and Damasio, 2013), but also positive emotions. Perhaps even more critical to most emotional experiences is the even more ancient PAG (periaqueductal gray) region of the midbrain (Panksepp and Biven, 2012). However, parts of the cortex and neocortex do play a role in our emotional experience and particularly in the conscious awareness of emotion. Indeed, some researchers distinguish between the unconscious sensation they call emotions and the conscious experience labeled feelings (Damasio, 2000, 2003).

There are at least six “primary” emotions, so labeled because they appear to be hard-wired and available from birth: anger, fear, sadness, joy, surprise, and disgust. These emotions all have immediate physical survival value. They are complemented by at least four “social” or “self-conscious” emotions: shame, guilt, embarrassment, and pride (Tracy, Robins, and Tangney, 2007). The social emotions are useful for social survival, in other words our ability to meet social demands and expectations.

The words “affect,” “mood,” “emotion,” and “feeling” are so interwoven in both common and scientific discussion that it is difficult to distinguish meaningfully between them. In general, the word “affect” is used to refer to specific body sensation states, while “emotions” refer to a more complex state that has multiple components that are activated in response to some real or imagined object, person, or situation (Kring, 2001). LeDoux (1996, 2002) emphasizes the point that emotional processes are primarily unconscious or preconscious as the brain responds to certain situations by activating a cascade of physiological processes. Damasio (2000, 2003) distinguishes between three classes of emotions: background emotions that reflect a person’s general sense of well-being or discomfort of being; primary emotions such as anger and fear that are hard-wired in the brain for rapid response; and social emotions such as shame, guilt, and pride that regulate more sophisticated interpersonal processes. Although Damasio appears to agree with LeDoux that emotions are primarily preconscious, he adds that their full impact is only realized when they are sensed consciously, at which point he designates them as “feelings.”

Panksepp (2009; Panksepp and Biven, 2012) offers a somewhat different explanation of emotions. He discusses prepropositional affective processes common to mammals. By this term he means that all basic emotional operating systems are organized in precognitive subcortical regions so that raw emotional tools for feeling and living are not created by lived experiences but are available at birth. He describes seven of these basic systems, of which two closely related ones are FEAR and RAGE. He names a number of brain areas associated with these systems, including the amygdala, but stresses that no single area should be considered the center of emotionality. Rather, emotionality involves interactions among many subcortical and cortical regions.

But what good are emotions? Here is my list of their value:

Survival. The ultimate purpose of emotions is to help us survive in a physically and socially dangerous world. Anger is no exception. It is important to remember that anger is necessary for survival. Anger is a messenger that warns of impending danger. Emotions inform us about the present and predict the future (Panksepp and Biven, 2012; Dispenza, 2007).

Intensification. Emotions place an exclamation point on experiences. They tell us to pay attention, that whatever is happening right now is important. Furthermore, they place these important experiences into our emotional memory banks (located, unconsciously, in the amygdala) so we will react emotionally whenever those events are triggered.

Preparation and Action. Emotions cannot be separated from actions. Each primary emotion carries with it an immediate action tendency. Fear makes us flee; surprise stops us in our tracks with a startle reaction; sadness draws us toward those who might comfort and nurture us. Meanwhile, anger’s action tendency is to move toward an offending object, person, or situation with the intent of dislodging the obstacle or overcoming the threat.

Communication. Emotions, especially primary emotions, come with built-in, universally recognizable facial expressions (Ekman, 2003). Presumably a member of a tribe in unexplored jungle would recognize a Westerner’s smile as a sign of happiness and a scowl as that of anger. With regard to anger, then, your scowling face tells others that you are angry and they need to be careful around you.

Truth Claim. Emotions feel right. We tend to trust our “gut feelings” because they emerge from deep within us. Indeed, some authors (Gladwell, 2005) believe we are quite good at assessing another person’s personality and credibility within seconds of meeting them. However, it turns out that emotions are not particularly trustworthy informants. The last thing I want to tell my chronically angry clients is to trust their gut. That’s because their gut instincts can become just as distorted from chronic anger as their conscious thoughts. Still, it is important to assess one’s emotions and they do normally provide essential information to us.

The Limbic System

Emotions have developed, mostly from brain structures originally utilized to detect smell (Ratey, 2002), to help individuals quickly and effectively respond to significant situations, especially those situations that could threaten survival. Thus, emotions can be conceived as a chain of loosely connected brain pathways and behavioral sequences that are activated whenever physical or social survival is potentially threatened. Plutchik (2001) describes two of these sequences in which an external stimulus event creates physiological arousal that in turn triggers overt behavior. With fear, the sequence goes from: a) the immediate perception (not necessarily conscious) of a threat; to b) an inferred cognition of danger; to c) a physiological feeling state of fear; to d) escape behavior; so as to e) restore safety. With anger the sequence becomes a) an awareness of an obstacle; b) creates an inferred cognition of there being an enemy; c) that produces the physiological state of anger; d) which in turn leads to attack behavior with the goal of destroying the obstacle. Note, though, that safety is important with anger as well as fear. A sense of threat may as easily trigger the “fight” part of the “fight or flight” reaction as the “flight” component.

Before continuing, let me add a note of caution. It is important to recognize that actually very little is known about how the brain functions at this time since only recently has it been possible to gather systematic information about it from living individuals. Furthermore, the brain is a very complex organ, composed of approximately 100 billion neurons, each of which might make as many as 10,000 connections with other neurons (Ratey, 2002). Also, the brain’s development is never complete. One reason is that parts of the brain continue to develop well past childhood, including, for instance, cells in the hippocampus that contribute to impulse inhibition (Cozolino, 2002). Another equally significant fact is that new brain circuitry is continuously created as new pathways are developed as the result of new learning and experiences. A very thorough review of brain structures and mechanisms is presented in Principles of Neuroscience, 5th edition (Kandel et al., 2013), while Amthor (2...