CognitiveTherapy of Anger Management: Theoretical and Practical Considerations Darcy M. Reeder
Cognitive therapy, known for its treatment of depression, is fast becoming an approach to treating a wide variety of psychosocial phenomena. This article explores a model for anger management that incorporates elements of cognitive theory. The basic premises of cognitive theory will be presented. The application of these premises to the control of anger will be discussed. The anger arousal hypothesis by Novaco provides the foundation for the theoretical and clinical issues pertinent to psychiatric mental health nurses.
Copyright
C
0 1991 by W.B. Saunders
therapy is probably best known for its role in the treatment of depression, but it is fast becoming an approach for treating a wide variety of psychological phenomena. The documented success of cognitive therapy, combined with its innate common sense, makes a powerful addition to the therapeutic regiman (Freeman & Greenwood, 1987). The basic premise of cognitive theory is that there is an essential interaction between the way people feel and behave and the way they construe the world, themselves, and their future. The therapy is a short-term form of psychotherapy that is highly specific. directive, and collaborative. The goal of therapy is to help clients uncover their dysfunctional and irrational thinking, test the reality of their thinking and behavior, and build more adaptive and functional techniques for responding both interpersonally and intrapersonally. Therapy focuses on target symptoms (in this case, anger). The nurse therapist works directly with the client by proposing ideas and strategies, developing specific skills, and teaching a way to cope and adapt. (Beck, Rush, Shaw, & Emery, 1979; Freeman & Greenwood, 1987). Beck (1976) hypothesizes three factors in emotions: the cognitive triad, schema, and cognitive distortions. The cognitive triad was initially developed to understand the thinking of depressed clients. but it is equally appropriate for the client with OGNITIVE
Arch&s
Company
anger problems. The triad attempts to look at the idiosyncratic and negative view the client has of the self, the world, and the future. Statements such as, “I’m a loser” or “I’m no good” exemplify the self view. The client’s view of the world is evidenced by statements such as, “It’s unfair” or “They’re unfair.” The client’s view of the future can be described with statements such as, “It’ll never change” or “I’ll never change. ” Schema are the underlying assumptions humans have about life. All humans have the capacity to distort reality in a number of ways, and these distortions are amplified by the person’s schemata. These irrational belief systems become a catalyst for the formation of cognitive distortions. Cognitive distortions are the ways people misinterpret their environment. The distortions seldom appear in isolation, but in a number of combinations and permutations. To some degree, everyone engages in cognitive distortions. The major types of distortions are: (1) all-or-nothing thinking: evaluating performance or personal qualities in extremist, black-and-white categories: “I must never be
From Harbotview Medical Center, Seattle, Washington. Address reprint requests to Darcy M. Reeder, R.N.C., M.N., 14424 46th PI. W., Lynnwood WA 98037.
Copyright 0 1991 by W.B.Saunders Company 0883~9417l9llO503-0005$03.00
of Psychiatric Nursing, Vol. V, No. 3 (June), 1991: pp. 147-150
147
148
DARCY M. REEDER
angry or I will be hopeless”; (2) catastrophizing: the Chicken Little approach to life or seeing the cloud (or creating one) in every silver lining; (3) overgeneralization: arbitrarily concluding that a single event will happen again and again, at least in some form (“If I back down once he’ll walk all over me every time he sees me”); (4) selective abstraction: selectively choosing the single piece of evidence that validates or supports the idea of an angry outcome and ignoring all of the other available information. (5) arbitrary inference: jumping to the arbitrary, negative conclusion that is not justified by the facts or is in direct contradiction to the facts. A subcategory of this distortion is negative prediction-imagining and predicting that something bad is about to happen, then taking the prediction as fact even though it may not be realistic (it may become a self-fulfilling prophecy); (6) magnification or minimization: either exaggerating things out of proportion or shrinking them (especially magnifying mistakes and minimizing successes); (7) emotional reasoning: taking emotions as evidence for the way things are. The logic is “I feel angry, therefore that proves the situation is provoking”; (8) should/must/ought: statements that focus on trying to motivate with guilt; (9) labeling and mislabeling: often involves describing an event or person with words that are inaccurate, heavily emotionally laden, and extremely overgeneralized; e.g., someone behaves in an insensitive manner and is labeled a jerk, indicating the person is a jerk rather than the behavior is “jerky”; (10) personalization: taking events that have nothing to do with one and making them personally meaningful; e.g., the waiter doesn’t fill the water glass and the customer considers it to be the result of the waiter not liking the customer.
upset. The angry driver appraises the traffic jam as threatening or in some other way aversive, whereas the calm driver does not. The situation is the same, the perceptions and emotional outcomes are different. Beck (1976, p. 71) also identified appraisal as a prime motivator of anger, reporting that a “common factor for arousal of anger is the individual’s appraisal of an assault on his domain, including his values, moral code, and protective rules.” Thwarting of expectations has been found to influence anger (Novaco, 1979). When expectations are not met there is the implication of an insult or threat to the ego. The magnitude of the discrepancy between expected and actual outcomes often determines the level of anger arousal and the ensuing behavior. Appraisal processes are involved as the person estimates to what extent the unwanted outcome is provocative. The anticipation of an event can also affect anger arousal. When one expects an aversive event, and when the appraisal of the impending event is anger-inducing, it is likely that when the event does occur the person will react with anger. Novaco (1979) also describes a phenomena called “private speech”. This is the self talk that reflects people’s expectations and appraisals. Private speech is similar to what Beck (1976) defines as “automatic thoughts”. When the driver in the traffic jam became angry his private speech (or automatic thoughts) might have included, “These things always happen to me, or “These stupid idiots, why aren’t they moving faster?” The calm driver’s private speech might have included “It’s a nice day to be out of the house” or “No sense getting stressed-out, there’s nothing I can do about it.”
A COGNITIVE MODEL OF ANGER AROUSAL
INTERVENTION
Raymond Novaco (1979) hypothesizes a model for anger arousal that incorporates elements of cognitive theory. He proposes that events are perceived as aversive on the basis of the expectations people have of an event, as well as the appraisal of the event’s meaning. When people appraise an event as frustrating, insulting, threatening, etc., or when they expect a certain outcome and receive a different one, the result is anger. Appraisal of a situation as provocative is highly individual. For example, two drivers could be in the same traffic jam and only one will become
When do angry feelings need to be addressed by professionals? Not all angry feelings are a problem, and, in fact, can be positive when dealt with effectively. The determination of anger as a clinical problem can be evaluated in terms of its frequency , intensity, duration, mode of expression, and its effects on performance, health, and personal relationships (Novaco, 1976a). When people interact often, strongly, and violently with anger it will usually adversely affect all areas of their lives. Once a person comes to therapy, the cognitively-oriented nurse using Novaco’s model would
ANGER MANAGEMENT
intervene on both cognitive and behavioral levels. Cognitive techniques consist of highly specific learning experiences designed to teach the following operations: to monitor dysfunctional private speech; to recognize the connections between cognition, affect, and behavior; to examine the evidence for and against distorted private speech; to substitute more reality-oriented interpretations for biased appraisals and expectations; to identify and alter dysfunctional appraisals and expectations that predispose people to distortion of experiences (Beck et al., 1979). The cognitive strategies used include: (1) questioning the evidence: teaching clients to question the evidence they are using to maintain and strengthen an idea or belief; (2) examining options and alternatives: angry clients have trouble seeing other ways; (3) de-catastrophizing, “what-if” technique: “What’s the worst that can happen?” (4) advantages and disadvantages: clients list pros and cons of a belief or behavior to gain perspective and find a way to move away from all-or-nothing thinking; (5) turning adversity to advantage: sometimes a seeming disaster can be used positively; e.g., being arrested for assault could give a client time out to review priorities; (6) labeling of distortions: a way for clients to monitor and alter their dysfunctional thinking; (7) paradox or exaggeration: taking an idea to an extreme (the nurse must be sensitive and not make light of the client’s problem); (8) downward arrow: the “Then what?” technique, in which clients follow their reasoning through to each succeeding level of reasoning with the guidance of the nurse; (9) cognitive rehearsal: visualizing an event in the mind’s eye (the client can practice more effective coping skills). It is good for eliciting automatic thoughts about why a strategy won’t work, and then problem solving and testing it out. An important part of cognitive therapy is the premise that therapy isn’t just 1 to 2 hours a week in the nurse’s office, but that it needs to be a process that is constantly lived. To aid clients in this, psychosocial nurses use behavioral techniques or “homework.” These are specific assignments for clients to use when they are not in the therapy session. Freeman and Greenwood (1987) report that in their clinical experience, clients who do self-help work make progress more quickly. Examples of homework assignments are: (1) daily record of dysfunctional thoughts: clients keep a
149
record of situations that arouse anger; the private speech is recorded along with a rational response and the percentage of intensity of the feeling; (2) social skills training: helps clients who are having trouble with anger as a result of not knowing how to interact better; (3) assertiveness training: helps the client to learn how to achieve goals without aggression; (4) relaxation techniques: helps clients to cool down before they explode; (5) shameattacking exercises: clients actively perform activities that test their catastrophic thinking regarding how others will think of them (Beck et al., 1979; Freeman & Greenwood, 1987; Bums, 1980). Uniting the above strategies, psychosocial nurses organize their intervention into three phases: cognitive preparation, skill acquisition, and application training (Novaco, 1979). The beneficial effect of cognitive preparation for impending anger has become accepted as a proposition in various psychosocial and mental health areas. This phase consists of education about anger arousal and its determinants, identification of the circumstances that trigger anger, discriminating the adaptive and maladaptive occurrences of anger, and introducing the anger-management techniques as coping strategies to handle conflict and stress. At this point, the nurse and client are assessing which distorted cognitions are the ones the client uses most frequently. Clients keep a record of their dysfunctional thoughts for review at the therapy session. Learning cognitive and behavioral coping skills is the focus of the skill acquisition phase. The nurse uses strategies, such as examining options or reattribution, to assist clients to reevaluate their perceptions of the situations that they react to with anger. The fundamental idea is to promote flexibility in cognitive structuring. Another important part of skill acquisition is helping clients learn to not take things so personally. Encouraging a sense of humor, using paradox, and using decatastrophizing are important techniques. Self statements are addressed here. Nurses and clients use a sequence of stages to turn previously provocative internal conversations into self-control maneuvers. This technique emphasizes the “think first” aspect of anger management. The stages consist of ( 1) preparing for the provocation (“This could be a rough situation. but I can handle it”); (2) impact and confrontation (“As long as I keep my cool, I’m in control of the situation”); (3) cop-
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DARCY M. REEDER
ing with arousal (“My muscles are getting tight; relax and slow things down”); (4) subsequent reflection: conflict unresolved (“Forget about the aggravation; thinking about it only upsets you”) or conflict resolved: (“I handled that one pretty well; that’s a good job”). Relaxation training is taught to clients during this phase. The therapeutic objective is to induce a sense of control rather than to develop a response to inhibit anger. Studies have shown relaxation training to be an effective component of cognitive therapy for anger management (Hazaleus & Deffenbacher, 1986; Novaco, 1976b). The well-known adage that practice makes perfect applies to the application training phase. Clients are given the opportunity to practice what they’ve learned in the safety of the therapeutic arena. Generating anger in the nurse’s office can be difficult, but simulation procedures such as cognitive rehearsal and fantasized consequences can be quite provoking, as evidenced in the literature (Novaco, 1979). Application training is most effective when started at a simple level and slowly increased to more provocative levels as the client’s skills improve. Clients eventually are encouraged to test their coping skills with actual provocative situations.
and research continues to support it. Cognitive therapy is an effective, practical approach that provides a logical concreteness that clients often seem to need to help them establish boundaries. The idea that anger is created within rather than by others is an optimistic perspective, giving clients ultimate control over their future. Using the theory and practice of the cognitive perspective, the psychosocial nurse can help clients manage angry feelings and behaviors. REFERENCES Beck, A.T. ( 1976). Cognitive therapy and the emotional disorders. New York, NY: International Universities. Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G. (1979). Cognitive therapy of depression. New York, NY: Guilford. Bums,
Freeman, A., &Greenwood, V. (Eds.) (1987). Cognitive Iherapy: Applications in psychiatric and medical settings. New York, NY: Human Sciences. Hazelaus, S.L., & Deffenbaucher, J.L. (1986). Relaxation and cognitive treatments of anger. Journat of Consulting and Clinical Psychology, M(2), 222-226. Novaco,
R.W. (1976a). The functions and regulations of the arousal of anger. American Journal of Psychiatry. 133(10), 1124-1127.
Novaco,
R.W. (1976b). Treatment of chronic anger through cognitive and relaxation controls. Journal ofConsulring and Clinical Psychology, M(4), p. 681.
Novaco,
R.W. (1979). The cognitive regulation of anger and stress. In P. Kendall & S. Hollan (Eds.). Cognitivebehavioral interventions: Theo?, research, and procedures. New York. NY: Academic.
CONCLUSIONS
Handling anger is an universal problem. The role that cognitive therapy has in its management is slowly gaining prominence as the theory evolves
D.D. (1980). Feeling good: The new mood therapy. New York, NY: Morrow.
Cognitive therapy, known for its treatment of depression, is fast becoming an approach to treating a wide variety of psychosocial phenomena. This article explores a model for anger management that incorporates elements of cognitive theory. The basic premises of cognitive theory will be presented. The application of these premises to the control of anger will be discussed. The anger arousal hypothesis by Novaco provides the foundation for the theoretical and clinical issues pertinent to psychiatric mental health nurses.
Copyright
C
0 1991 by W.B. Saunders
therapy is probably best known for its role in the treatment of depression, but it is fast becoming an approach for treating a wide variety of psychological phenomena. The documented success of cognitive therapy, combined with its innate common sense, makes a powerful addition to the therapeutic regiman (Freeman & Greenwood, 1987). The basic premise of cognitive theory is that there is an essential interaction between the way people feel and behave and the way they construe the world, themselves, and their future. The therapy is a short-term form of psychotherapy that is highly specific. directive, and collaborative. The goal of therapy is to help clients uncover their dysfunctional and irrational thinking, test the reality of their thinking and behavior, and build more adaptive and functional techniques for responding both interpersonally and intrapersonally. Therapy focuses on target symptoms (in this case, anger). The nurse therapist works directly with the client by proposing ideas and strategies, developing specific skills, and teaching a way to cope and adapt. (Beck, Rush, Shaw, & Emery, 1979; Freeman & Greenwood, 1987). Beck (1976) hypothesizes three factors in emotions: the cognitive triad, schema, and cognitive distortions. The cognitive triad was initially developed to understand the thinking of depressed clients. but it is equally appropriate for the client with OGNITIVE
Arch&s
Company
anger problems. The triad attempts to look at the idiosyncratic and negative view the client has of the self, the world, and the future. Statements such as, “I’m a loser” or “I’m no good” exemplify the self view. The client’s view of the world is evidenced by statements such as, “It’s unfair” or “They’re unfair.” The client’s view of the future can be described with statements such as, “It’ll never change” or “I’ll never change. ” Schema are the underlying assumptions humans have about life. All humans have the capacity to distort reality in a number of ways, and these distortions are amplified by the person’s schemata. These irrational belief systems become a catalyst for the formation of cognitive distortions. Cognitive distortions are the ways people misinterpret their environment. The distortions seldom appear in isolation, but in a number of combinations and permutations. To some degree, everyone engages in cognitive distortions. The major types of distortions are: (1) all-or-nothing thinking: evaluating performance or personal qualities in extremist, black-and-white categories: “I must never be
From Harbotview Medical Center, Seattle, Washington. Address reprint requests to Darcy M. Reeder, R.N.C., M.N., 14424 46th PI. W., Lynnwood WA 98037.
Copyright 0 1991 by W.B.Saunders Company 0883~9417l9llO503-0005$03.00
of Psychiatric Nursing, Vol. V, No. 3 (June), 1991: pp. 147-150
147
148
DARCY M. REEDER
angry or I will be hopeless”; (2) catastrophizing: the Chicken Little approach to life or seeing the cloud (or creating one) in every silver lining; (3) overgeneralization: arbitrarily concluding that a single event will happen again and again, at least in some form (“If I back down once he’ll walk all over me every time he sees me”); (4) selective abstraction: selectively choosing the single piece of evidence that validates or supports the idea of an angry outcome and ignoring all of the other available information. (5) arbitrary inference: jumping to the arbitrary, negative conclusion that is not justified by the facts or is in direct contradiction to the facts. A subcategory of this distortion is negative prediction-imagining and predicting that something bad is about to happen, then taking the prediction as fact even though it may not be realistic (it may become a self-fulfilling prophecy); (6) magnification or minimization: either exaggerating things out of proportion or shrinking them (especially magnifying mistakes and minimizing successes); (7) emotional reasoning: taking emotions as evidence for the way things are. The logic is “I feel angry, therefore that proves the situation is provoking”; (8) should/must/ought: statements that focus on trying to motivate with guilt; (9) labeling and mislabeling: often involves describing an event or person with words that are inaccurate, heavily emotionally laden, and extremely overgeneralized; e.g., someone behaves in an insensitive manner and is labeled a jerk, indicating the person is a jerk rather than the behavior is “jerky”; (10) personalization: taking events that have nothing to do with one and making them personally meaningful; e.g., the waiter doesn’t fill the water glass and the customer considers it to be the result of the waiter not liking the customer.
upset. The angry driver appraises the traffic jam as threatening or in some other way aversive, whereas the calm driver does not. The situation is the same, the perceptions and emotional outcomes are different. Beck (1976, p. 71) also identified appraisal as a prime motivator of anger, reporting that a “common factor for arousal of anger is the individual’s appraisal of an assault on his domain, including his values, moral code, and protective rules.” Thwarting of expectations has been found to influence anger (Novaco, 1979). When expectations are not met there is the implication of an insult or threat to the ego. The magnitude of the discrepancy between expected and actual outcomes often determines the level of anger arousal and the ensuing behavior. Appraisal processes are involved as the person estimates to what extent the unwanted outcome is provocative. The anticipation of an event can also affect anger arousal. When one expects an aversive event, and when the appraisal of the impending event is anger-inducing, it is likely that when the event does occur the person will react with anger. Novaco (1979) also describes a phenomena called “private speech”. This is the self talk that reflects people’s expectations and appraisals. Private speech is similar to what Beck (1976) defines as “automatic thoughts”. When the driver in the traffic jam became angry his private speech (or automatic thoughts) might have included, “These things always happen to me, or “These stupid idiots, why aren’t they moving faster?” The calm driver’s private speech might have included “It’s a nice day to be out of the house” or “No sense getting stressed-out, there’s nothing I can do about it.”
A COGNITIVE MODEL OF ANGER AROUSAL
INTERVENTION
Raymond Novaco (1979) hypothesizes a model for anger arousal that incorporates elements of cognitive theory. He proposes that events are perceived as aversive on the basis of the expectations people have of an event, as well as the appraisal of the event’s meaning. When people appraise an event as frustrating, insulting, threatening, etc., or when they expect a certain outcome and receive a different one, the result is anger. Appraisal of a situation as provocative is highly individual. For example, two drivers could be in the same traffic jam and only one will become
When do angry feelings need to be addressed by professionals? Not all angry feelings are a problem, and, in fact, can be positive when dealt with effectively. The determination of anger as a clinical problem can be evaluated in terms of its frequency , intensity, duration, mode of expression, and its effects on performance, health, and personal relationships (Novaco, 1976a). When people interact often, strongly, and violently with anger it will usually adversely affect all areas of their lives. Once a person comes to therapy, the cognitively-oriented nurse using Novaco’s model would
ANGER MANAGEMENT
intervene on both cognitive and behavioral levels. Cognitive techniques consist of highly specific learning experiences designed to teach the following operations: to monitor dysfunctional private speech; to recognize the connections between cognition, affect, and behavior; to examine the evidence for and against distorted private speech; to substitute more reality-oriented interpretations for biased appraisals and expectations; to identify and alter dysfunctional appraisals and expectations that predispose people to distortion of experiences (Beck et al., 1979). The cognitive strategies used include: (1) questioning the evidence: teaching clients to question the evidence they are using to maintain and strengthen an idea or belief; (2) examining options and alternatives: angry clients have trouble seeing other ways; (3) de-catastrophizing, “what-if” technique: “What’s the worst that can happen?” (4) advantages and disadvantages: clients list pros and cons of a belief or behavior to gain perspective and find a way to move away from all-or-nothing thinking; (5) turning adversity to advantage: sometimes a seeming disaster can be used positively; e.g., being arrested for assault could give a client time out to review priorities; (6) labeling of distortions: a way for clients to monitor and alter their dysfunctional thinking; (7) paradox or exaggeration: taking an idea to an extreme (the nurse must be sensitive and not make light of the client’s problem); (8) downward arrow: the “Then what?” technique, in which clients follow their reasoning through to each succeeding level of reasoning with the guidance of the nurse; (9) cognitive rehearsal: visualizing an event in the mind’s eye (the client can practice more effective coping skills). It is good for eliciting automatic thoughts about why a strategy won’t work, and then problem solving and testing it out. An important part of cognitive therapy is the premise that therapy isn’t just 1 to 2 hours a week in the nurse’s office, but that it needs to be a process that is constantly lived. To aid clients in this, psychosocial nurses use behavioral techniques or “homework.” These are specific assignments for clients to use when they are not in the therapy session. Freeman and Greenwood (1987) report that in their clinical experience, clients who do self-help work make progress more quickly. Examples of homework assignments are: (1) daily record of dysfunctional thoughts: clients keep a
149
record of situations that arouse anger; the private speech is recorded along with a rational response and the percentage of intensity of the feeling; (2) social skills training: helps clients who are having trouble with anger as a result of not knowing how to interact better; (3) assertiveness training: helps the client to learn how to achieve goals without aggression; (4) relaxation techniques: helps clients to cool down before they explode; (5) shameattacking exercises: clients actively perform activities that test their catastrophic thinking regarding how others will think of them (Beck et al., 1979; Freeman & Greenwood, 1987; Bums, 1980). Uniting the above strategies, psychosocial nurses organize their intervention into three phases: cognitive preparation, skill acquisition, and application training (Novaco, 1979). The beneficial effect of cognitive preparation for impending anger has become accepted as a proposition in various psychosocial and mental health areas. This phase consists of education about anger arousal and its determinants, identification of the circumstances that trigger anger, discriminating the adaptive and maladaptive occurrences of anger, and introducing the anger-management techniques as coping strategies to handle conflict and stress. At this point, the nurse and client are assessing which distorted cognitions are the ones the client uses most frequently. Clients keep a record of their dysfunctional thoughts for review at the therapy session. Learning cognitive and behavioral coping skills is the focus of the skill acquisition phase. The nurse uses strategies, such as examining options or reattribution, to assist clients to reevaluate their perceptions of the situations that they react to with anger. The fundamental idea is to promote flexibility in cognitive structuring. Another important part of skill acquisition is helping clients learn to not take things so personally. Encouraging a sense of humor, using paradox, and using decatastrophizing are important techniques. Self statements are addressed here. Nurses and clients use a sequence of stages to turn previously provocative internal conversations into self-control maneuvers. This technique emphasizes the “think first” aspect of anger management. The stages consist of ( 1) preparing for the provocation (“This could be a rough situation. but I can handle it”); (2) impact and confrontation (“As long as I keep my cool, I’m in control of the situation”); (3) cop-
150
DARCY M. REEDER
ing with arousal (“My muscles are getting tight; relax and slow things down”); (4) subsequent reflection: conflict unresolved (“Forget about the aggravation; thinking about it only upsets you”) or conflict resolved: (“I handled that one pretty well; that’s a good job”). Relaxation training is taught to clients during this phase. The therapeutic objective is to induce a sense of control rather than to develop a response to inhibit anger. Studies have shown relaxation training to be an effective component of cognitive therapy for anger management (Hazaleus & Deffenbacher, 1986; Novaco, 1976b). The well-known adage that practice makes perfect applies to the application training phase. Clients are given the opportunity to practice what they’ve learned in the safety of the therapeutic arena. Generating anger in the nurse’s office can be difficult, but simulation procedures such as cognitive rehearsal and fantasized consequences can be quite provoking, as evidenced in the literature (Novaco, 1979). Application training is most effective when started at a simple level and slowly increased to more provocative levels as the client’s skills improve. Clients eventually are encouraged to test their coping skills with actual provocative situations.
and research continues to support it. Cognitive therapy is an effective, practical approach that provides a logical concreteness that clients often seem to need to help them establish boundaries. The idea that anger is created within rather than by others is an optimistic perspective, giving clients ultimate control over their future. Using the theory and practice of the cognitive perspective, the psychosocial nurse can help clients manage angry feelings and behaviors. REFERENCES Beck, A.T. ( 1976). Cognitive therapy and the emotional disorders. New York, NY: International Universities. Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G. (1979). Cognitive therapy of depression. New York, NY: Guilford. Bums,
Freeman, A., &Greenwood, V. (Eds.) (1987). Cognitive Iherapy: Applications in psychiatric and medical settings. New York, NY: Human Sciences. Hazelaus, S.L., & Deffenbaucher, J.L. (1986). Relaxation and cognitive treatments of anger. Journat of Consulting and Clinical Psychology, M(2), 222-226. Novaco,
R.W. (1976a). The functions and regulations of the arousal of anger. American Journal of Psychiatry. 133(10), 1124-1127.
Novaco,
R.W. (1976b). Treatment of chronic anger through cognitive and relaxation controls. Journal ofConsulring and Clinical Psychology, M(4), p. 681.
Novaco,
R.W. (1979). The cognitive regulation of anger and stress. In P. Kendall & S. Hollan (Eds.). Cognitivebehavioral interventions: Theo?, research, and procedures. New York. NY: Academic.
CONCLUSIONS
Handling anger is an universal problem. The role that cognitive therapy has in its management is slowly gaining prominence as the theory evolves
D.D. (1980). Feeling good: The new mood therapy. New York, NY: Morrow.
