Anger/ Aggression

Management

Aashish Parihar
Lecturer
CON, AIIMS
Jodhpur
 Anger/ Aggression Management
Content-
Anger and Aggression- Introduction
Types
Predisposing Factors
Management
Role of The Nurse
 Anger/ Aggression Management
Anger and Aggression- Introduction
• Anger is a basic human emotion that is experienced by all people.
• Typically triggered by an emotional hurt, anger is usually experienced
as an unpleasant feeling that occurs when we think we have been
injured, mistreated, opposed in our long-held views, or when we are
faced with obstacles that keep us from attaining personal goals.
 Anger/ Aggression Management
Anger and Aggression- Introduction

• Anger is an emotional state that varies in intensity from mild irritation

to intense fury and rage. It is accompanied by physiological and
biological changes, such as increases in heart rate ,blood pressure, and
levels of the hormones epinephrine and norepinephrine.
( American Psychological Association,2013)
 Anger/ Aggression Management
Anger and Aggression- Introduction
CHARACTERSTIC OF ANGER
• Anger is not a primary emotion, but it is typically experienced as an almost
automatic inner response to hurt, frustration or fear.
• Anger is physiological arousal.
• It instills feelings of power and generates preparedness.
• The expression of anger is learned.
• The expression of anger can come under personal control.
• When anger is suppressed it is resentment , which often manifests
itself in negative, passive-aggressive behavior .
 Anger/ Aggression Management
Anger and Aggression- Introduction
FUNCTIONS OF ANGER
• Positive or constructive functions
• Negative or destructive functions
 Anger/ Aggression Management
Anger and Aggression- Introduction
FUNCTIONS OF ANGER
Positive or constructive functions
• Anger energies and mobilizes the body for self –defense.
• Communicated assertively , anger can promote conflict resolution.
• Anger arousal is a personal signal of threat or injustice against the self
• Anger is constructive when it provides a feeling of control over a situation
and the individual is able to assertively take charge of situation.
• It serves to increase self –esteem and leads to mutual understanding and
forgiveness.
 Anger/ Aggression Management
Anger and Aggression- Introduction
FUNCTIONS OF ANGER
• Negative or destructive functions
• Without cognitive input, anger may result in impulsive behavior, disregarding
possible negative consequences.
• Communicated passive-aggressively , conflict escalated and the problem that
creates the conflict goes unresolved .
• Anger can lead to aggression when the coping mechanism is displacement .
• It can be destructive when the feeling of control is exaggerated and the individual
uses the power to intimidate others.
• It masks honest feeling ,weaken, self –esteem and leads to hostility and rage
 Anger/ Aggression Management
Anger and Aggression- Introduction

• Aggression refers to behavior that is intended to threaten or injure the victim’s

security or self – esteem. It is a response that aims to inflicting pain or injury on
object or persons.
(Warren,1999 )
 Anger/ Aggression Management
Anger and Aggression- Introduction
CHARACTERISTICS
• Aggressive behavior is communicated verbally or non verbally
• Aggressive people may invade the personal space of others
• They may speak loudly and with greater emphasis
• Gesture is emphatic and threatening
• They usually maintain eye contact over a prolonged period of time so that the
other person experiences it as an intrusive
• Posture is erect and lean forward slightly towards the other person.
• The overall impression is one of power and dominance
 Anger/ Aggression Management
Anger and Aggression- Introduction
TYPES OF AGGRESSION
• Instrumental Aggression
Aggression aimed at obtaining an object, privilege or space with no deliberate intent
to harm another person
• Hostile Aggression
Aggression intended to harm another person, such as hitting, kicking, or threatening
to beat up someone.
• Relational Aggression
A form of hostile aggression that does damage to another's peer relationships, as in
social exclusion or rumor spreading
 Anger/ Aggression Management
Anger and Aggression- Introduction
MOYER CLASSIFICATION of Aggression
• Predatory aggression
Attack on prey by a predator
• Inter-male aggression
Competition between males of the same species over access to resources such as
females, dominance, status, etc.
• Fear-induced aggression
Aggression associated with attempts to flee from a threat.
• Irritable aggression
Aggression induced by frustration and directed against an available target.
 Anger/ Aggression Management
Anger and Aggression- Introduction
MOYER CLASSIFICATION of Aggression
• Territorial aggression
Defense of a fixed area against intruders, typically conflicts.
• Maternal aggression
A female's aggression to protect her offspring from a threat. Paternal aggression also
exists.
• Instrumental aggression
Aggression directed towards obtaining some goal, considered to be a learned
response to a situation.
 Anger/ Aggression Management
Anger and Aggression- Predisposing factors
• Aggression and violent behavior should be viewed along a continuum with verbal
aggression at one end and physical violence at the other.
• Anger usually occurs in response to a perceived threat and that threat may be
internal or external.
• Aggressive behavior is the result of the interaction among psychological,
sociocultural and biological factors and these may be considered as predisposing
factors of aggressive behavior.
 Anger/ Aggression Management
Anger and Aggression- Predisposing factors
Psychological Factors:
• It suggests that predisposing developmental factors or life experiences that limit
the person’s ability to use the nonviolent coping mechanism.
• They may limit a person’s ability to use supportive relationship and leave the
person very self centered.
• Social theory suggests that aggressive behavior is learned internally and
externally.
• Internally through reinforcement and externally through observation.
 Anger/ Aggression Management
Anger and Aggression- Predisposing factors
Sociocultural:
• Cultural norms help define acceptable and unacceptable ways of expressing
aggressive feelings.
• Punishments are applied to violators of the norms through the legal system.
• But, prohibition against violent behavior may be extended to include any
expression of anger and lead to maladaptive responses.
• Crowding, unemployment, poverty, social control, disruption of marriages, family
structure, interpersonal ties are some of the social factors which are responsible
for aggressive behavior.
• Environmental issues and seasonal heat appear to be related to violent behavior.
 Anger/ Aggression Management
Anger and Aggression- Predisposing factors
Biological:
• Neurobiological research focuses on three areas of brain believed to be involved in
aggressive behavior:
Limbic system/ amygdala
Frontal lobe
Hypothalamus
• Pre frontal cortex area inhibit the aggressive behavior.
 Anger/ Aggression Management
Anger and Aggression- Predisposing factors
Biological:
• Neurotransmitters are the brain chemicals that control the emotions like anger,
sadness, rage frustration etc.
• Alteration in their level may aggravate or inhibit the aggression. Like :
Low level of serotonin (5- hydroxyindole acetic acid)
Increase level of dopamine and norepinephrine.
 Anger/ Aggression Management
Anger and Aggression- Predisposing factors
Biological:
• Some other biological factors like gene, testosterone level are in conclusive. Still
needed more researches are needed in that area.
• However, it can be viewed with alcoholism, body built, races etc.
 Anger/ Aggression Management
Anger and Aggression- Risk Factors
• History of violence
• Psychopathic and antisocial personality traits
• Patients with active psychotic symptoms
• Substance abuse disorder
• Situational and environmental factors:
Group
Lack of privacy
Inexperienced clinical staff
Provocation by staff
Poor milieu management
Understaffing
Inconsistent limit setting
Close physical encounters
 Anger/ Aggression Management
Anger and Aggression- Management
Assessment:
• It is very difficult to predict the patient violence accurately.
• Thus as a member one should be alert for symptoms of increasing agitation.
• Because it may indicate the violence.
• These symptoms may be categorized in following manner:
Motor agitation
Verbal clues
Affect
Level of consciousness
 Anger/ Aggression Management
Anger and Aggression- Management
Assessment:
Motor agitation
Pacing
Inability to sit still
Clenching or pounding fits
Jaw tightening
Increased respiration
Sudden cessation of motor activity
 Anger/ Aggression Management
Anger and Aggression- Management
Assessment:
Verbal Clues
Verbal threats to real or imagined objects
Intrusive demands for attention
Loud, pressured speech
Evidence of delusional or paranoid thought content
 Anger/ Aggression Management
Anger and Aggression- Management
Assessment:
Affect
Anger
Hostility
Extreme anxiety
Irritability
Inappropriate or excessive euphoria
Affect lability
 Anger/ Aggression Management
Anger and Aggression- Management
Assessment:
Level of consciousness
Confusion
Sudden change in mental status
Disorientation
Memory impairment
Inability to be redirected
 Anger/ Aggression Management
Anger and Aggression- Management
Assessment:
These assessment of behavior help the health personnel to do the following:
• Assess the client potential for violence
• Establish the therapeutic alliance with client
• Develop a plan of care
• Implement the plan of care
• Prevent the aggression and violence in the milieu
 Anger/ Aggression Management
Anger and Aggression- Management
Assessment:
If the client is identified to be potentially violent following action should
implement immediately:
• Implement the appropriate clinical protocol to provide for patient and staff safety.
• Notify coworkers
• Obtain additional security if needed
• Assess the environment and make necessary changes.
• Notify the physician and assess the need for sos medication
 Anger/ Aggression Management
Anger and Aggression- Management
Interventions/ action:

Preventive Anticipatory Containment

strategies strategies strategies
• Self awareness • Communication • Crisis management
• Patient education • Environmental • Seclusion
• Assertiveness change • Restraints
training • Behavioral action
• Psychopharmacology
 Anger/ Aggression Management
Anger and Aggression- Management
Interventions/ action:
Self Awareness
• It is very important to identify own personal strength and limitations so one can
use effectively in anger management.
• One can compromise his/her effectiveness by:
Tiredness, anxiety, anger or apathy
Lack of confidence
Personal or work problem
 Anger/ Aggression Management
Anger and Aggression- Management
Interventions/ action:
Self Awareness
• While dealing with potentially aggressive patient assess the situation objectively.
• Eliminate the chance of occurrence of countertransference.
• Ongoing self awareness and supervision assist the individual in ensuring the
patient need, rather then personal need, are addressed.
 Anger/ Aggression Management
Anger and Aggression- Management
Interventions/ action:
Patient education
• Teaching patient about communication and the appropriate way to express anger is
the most successful intervention in preventing aggressive behavior.
• Teach the patient about appropriate expression of anger in following manner:
 Anger/ Aggression Management
Anger and Aggression- Management
Interventions/ action:
Patient education
Identification of anger
Focus on nonverbal behavior
Role play nonverbal expression of anger
Label the feeling
Permission and practice to Express of angry feeling
Describe situation in which anger is normal
Role play fantasized situation where is an appropriate response
 Anger/ Aggression Management
Anger and Aggression- Management
Interventions/ action:
Patient education
Expression of anger to real situation
Help the client to identify a real situation that makes the client angry
Confrontation with the object of anger
Provide positive feedback for successful expression of anger
Identify alternative ways to express anger
List several ways to express anger with or without confrontation to object
Role play alternative ways of expression of anger
Discuss situations where alternative ways of expression is appropriate
 Anger/ Aggression Management
Anger and Aggression- Management
Interventions/ action:
Patient education
Confront a person who is a source of anger
Provide support, if needed
Discuss experience after confrontation take place
 Anger/ Aggression Management
Anger and Aggression- Management
Interventions/ action:
Patient education
• After appropriate expression of anger ways to manage anger should also be taught to
client. Theses ways may be-
Positive self talk
Change of environment
Writing about feelings
Thinking consequences
Listening to music
Watching television
Deep breathing exercise
 Anger/ Aggression Management
Anger and Aggression- Management
Interventions/ action:
Patient education
• After appropriate expression of anger ways to manage anger should also be taught to client.
Theses ways may be-
Taking a walk
Counting to 50
Comfort wrap with a blanket
Relaxation exercises
Talking about your feeling
Using adaptive coping skills
Reading
Being alone
Medication
 Anger/ Aggression Management
Anger and Aggression- Management
Interventions/ action:
Assertiveness Training
• Teaching Assertive communication skills helps in reducing the interpersonal frustrations.
• Client should be encouraged to learn assertive skills by participating in structured group
and program.
• These programs demonstrate the skills and persons are asked to role play those skills
• After the program homework may be given which help them to generalize these skills
outside the group arena.
• During the sessions feedback should be given to clients on appropriateness and
effectiveness.