This feature by Lorne Korman, PhD, R.Psych. is Part 2 of 2 in a series about DBT and Anger. In the first part, Lorne addressed how DBT offers a practical and theoretical framework for treating people with anger problems and those who have multiple comorbidities. Here in part two, he talks about the use of DBT in directly targeting anger problems in treatment.
In the treatment of anger problems, I have always found collaborative empiricism, cognitive restructuring, and other interventions targeting cognition and beliefs to be relatively ineffective. Like other emotions, anger is often activated quickly, and the perceptual processes that occur very early in the generation of our emotions are mostly unavailable to conscious processing. Like other emotions, we are usually catching up to our anger, making sense and meaning of the physiological and psychological changes activated by our emotions post facto. In 1884, William James argued that…. the bodily changes follow directly the Perception of the exciting fact, and that our feeling of the same changes as they occur IS the emotion. As more contemporary emotion theorists have argued, emotions tell us what is important to us by organizing and mobilizing us to act. Any expectation that clients be able to effectively pause in the midst of the mobilization of an intensely angry reaction to examine their underlying interpretations of situations in situ is probably unrealistic.
One of DBT’s innovations is to target emotions head-on: DBT targets dysregulated emotion by focusing primarily on emotions and the attendant behaviors that generate emotions and affect, what emotion researchers like Magda Arnold and Nico Frijda have called “action readiness” or “action tendencies.” While this is most directly addressed via skills like opposite-to-emotion action, skills tempering the style of clients’ assertive communications (like the DEARMAN that Linehan modified from Bower & Bower’s work) and skills calming intense emotional arousal also impinge directly on emotions, their underlying action tendencies, and affect.
DBT’s direct targeting of emotions was one of the main inspirations for our group’s initial development of a skills-based treatment for comorbid anger and addictions problems. Our first randomized control study demonstrated that this emotion-based treatment was significantly better than an addiction-based treatment in reducing both anger and addiction problems. More recently, Karen Choi and I have been writing a therapist manual detailing a comprehensive, skills-based treatment for problem anger that primarily targets clients’ emotions. Our book focuses on addressing problem anger as predominantly a problem related to deficits in the awareness, generation, and regulation of anger and other emotions. The treatment aims to help individuals better regulate their emotions and improve assertiveness and self-advocacy rather than “managing anger.” We have identified twelve common problems underlying anger issues and developed a set of skills to address each of these problems. Problem anger is primarily addressed via skills targeting:
- Awareness of the bodily and psychological referents signaling anger
- Symbolizing the experience and meaning of anger without acting
- Identification of the needs and concerns underlying angry reactions
- Strategies integrating the selective use of attention and action tendencies to modulate the intensity of anger in situ
- Identification in situ when anger is a secondary reaction to another primary emotion
- Identifying when it is likely to be helpful to express anger and when it is not
- Fair fighting strategies reducing hostile conflict and increasing the modulation of anger in situ
Our treatment also details how to identify clients’ specific patterns of anger problems and how to address these with skills and behavioral interventions. Our approach integrates information from emotion theory and interventions from DBT, emotion-focused, experiential, and mindfulness-based therapies.
DBT is an effective treatment for helping individuals with borderline personality, a disorder characterized by emotion dysregulation and intense anger. Existing approaches to problem anger often have neglected the importance of addressing emotion dysregulation. We have been inspired by DBT in our work with clients with anger problems to directly target emotion dysregulation.
Lorne Korman, PhD, R.Psych., is a registered psychologist and Clinical Associate Professor of Psychiatry at the University of British Columbia. Dr. Korman’s research has focused on adapting DBT to help adults and youth struggling with anger and addiction. Read his full bio here.
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