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Explosive rage: Does anger management training help?

Everyone has heard of road rage incidents wherein usually calm and responsible people “snap” and commit an aggressive or violent act. Turns out, that “losing one’s temper” can occur in many different life situations and cause serious emotional or physical harm to others. It is a pattern in which tension builds until an explosion brings relief, followed later by regret, embarrassment, or guilt. Called “Intermittent Explosive Disorder” (IED), it is defined by attacks of impulsive rage that seem out of proportion to the immediate provocation and has serious consequences such as verbal abuse, threats, property damage, assaults, and injury.

How common is it?

As reported in the September, 2006 edition of Harvard Mental Health Letter recent research on IED is showing that this condition is more common and more destructive than anyone had supposed. One study showed that people with more severe cases (at least three rage attacks in one year) averaged 56 life-time attacks resulting in an average of $1600 worth of property damage and 23 incidents in which someone required medical attention.

Who is most likely to have these episodes?

According to research, the percentages suffering from this disorder are about the same for men and women, blacks and whites. Only age made a difference. Younger people were more likely than older people to show these uncontrolled rage episodes. As you might suspect, persons who suffer from IED are more at risk for other emotional problems because of the increased stress in their lives.

What causes the attacks?

Behavior patterns such as rage attacks are complex and often are a combination of what is going on in your brain chemistry, what is occurring in your life and also what emotions your thinking patterns are causing.

Scientists do not yet have the answers as to what triggers rage episodes but it may have to do with brain chemistry problems as well as the outlook that people have about life as well as attitudes about how to handle life frustrations and stress.

What treatments help?

According to the Harvard Mental Health Letter, “Anger management through a combination of cognitive restructuring, coping skills training and relaxation training look promising.” This means that to control rage, people need to learn how to think differently about life events, and to learn specific skills to deal with common anger “triggers.” One of the recommended skills is that of learning to deal with stress through relaxation training.

Other skills that we our anger management clients have found to be extremely useful include:

  • Developing empathy toward others (seeing the world as they see it)
  • Taking charge of how you respond to stress, rather than just reacting instinctively
  • Changing self-talk to create different emotions in response to anger triggers
  • Learning to communicate assertively rather than with anger
  • Letting go of resentments, grievances and grudges
  • Retreating to think things over and calming down before blowing up in rage

How can you find a program for you?

Anger management programs are becoming more common across the country. The following resources provide directories of qualified providers, some of which teach the specific skills listed above:

In addition, there are a variety of home-study and online programs appearing on the internet. The quality of these programs vary a great deal, so it is prudent and wise to pick one that is authored by credible mental health professionals and is approved or certified by state agencies (although unfortunately most states do not approve or disapprove anger management programs) or other professional bodies.

Rage behind the wheel: Can we help it?

Recent headline: “Road Rage may be due to medical condition called Intermittent Explosive Disorder (IED)”

What is the science behind this?

The study, reported in the June (2006) issue of the Archives of General Psychiatry was based on a national face-to-face survey of 9,282 U.S. adults who answered diagnostic questionnaires in 2001-03. It was funded by the National Institute of Mental Health.

Results? About 5 percent to 7 percent of the nationally representative sample had had the disorder, which would equal up to 16 million Americans . That is higher than better-known mental illnesses such as schizophrenia and bipolar disorder.

The average number of lifetime attacks per person was 43, resulting in $1,359 in property damage per person. About 4 percent had suffered recent attacks. Many of these attacks violated both civil and criminal laws.

Is it real?

This study has created much controversy regarding exactly what is “medical” about road rage and how it differs from plain bad, inconsiderate behavior. Undoubtedly, criminal defense attorneys will be arguing in both civil and criminal courts that indeed it is a medical condition!

Take the two following headline which were published recently:

News Item #1: “Police search for shooter following road rage incident”
Date: June 10, 2006. City: Indianapolis, Indiana.
The event: At an intersection, two drivers were involved in a confrontation when one of them opened fire on the other at a stoplight.

News Item #2: “Man, 21, charged in road rage shooting.”
Date: May 21, 2006. City: San Antonio, Texas.
The event (according to news reports): “Around 3AM Samuel Hitchcock, 21, Daniel Pena, 17, and another man were driving when a pickup passed them on an inside lane, striking Hitchcock’s side mirror. Hitchcock followed the truck into a residential area to gather information and the truck made a sudden turn, stopping. Hitchcock pulled up next to the truck. Pena, who was in the front passenger seat told police the truck’s driver pulled a gun and started shooting at them, striking him and killing Hitchcock.

Are all cases like this due to Intermittent Explosive Disorder? Very unlikely! Some are and some are not. This is why it is important to have a professional assessment of each case of “road rage” to determine the underlying cause, such as IED — or some other problem.

Other causes that could come into play would include: alcohol or drug intoxication, stress, depression or bipolar disorder and, of course, bad, selfish or inconsiderate behavior. A good attorney will refer you to a doctor who specializes in diagnosing mood disorders to determine the specific cause in each situation of apparent road rage.

Road rage vs aggressive driving

The person who weaves in and out of traffic, tail gates, or cuts in front of you may not be showing “road rage” per se, but inconsiderate aggressive driving. He is not angry at you; he probably doesn’t even know you exist, being preoccupied with his own selfish needs.

IED seen in other life areas

It is also important to remember that persons who do indeed suffer from Intermittent Explosive Disorder may explode in many other situations besides road rage. Often they “blow up” at spouses, children, co-workers, or customer service employees.

Remedies for road rage

If road rage is indeed due to IED, there are two treatments that can help both adolescents and adults: (1)medications , and (2) cognitive training. The medications usually involve SSRIs (a type of anti-depressant). In my opinion, most people who show rage on the road do not need medication, but some do and will benefit greatly from them.

Cognitive Training means learning to think differently about driving, aggression on the road, and other drivers. Cognitive training is an important element in many anger management programs, which a few states now require for “road rage” behavior and/or aggressive driving.
Some anger management classes and programs teach specific cognitive and behavior skills to control aggressive, inconsiderate, and dangerous driving behaviors.

These skill include:

  • Managing life stress better, including time-management skills.
  • Developing empathy for other drivers.
  • Learning healthy “self-talk” phrases.
  • Adjusting expectations of others on the road.