15. Anger Inoculation

In this chapter you will learn to:

• Relax rather than tense up in anger-provoking situations
• Develop coping thoughts to control anger-triggering cognitions
• Use provoking images to rehearse new coping skills and to inoculate yourself against anger
• Develop situation-specific anger coping plans

Background

Anger inoculation (McKay and Rogers 2000) is based on the anger management protocol developed by Jerry Deffenbacher (Deffenbacher and McKay 2000). The idea behind anger inoculation is that if you progressively expose yourself to memories of more and more provocative anger situations—while using coping skills—you will learn to manage the anger response. Raymond Novaco (1975) was the first to utilize this technique, and his research showed that it worked to reduce anger-driven aggression. Deffenbacher et al. (1987) confirmed Novaco’s original findings, showing that combining relaxation and coping thoughts can significantly control anger. With anger inoculation, you learn to relax at the first sign of provocation, and to counter your anger-triggering thoughts with thoughts intended to calm you and disconnect you from the upset. This training doesn’t prevent you from feeling anger; but it gives you effective coping strategies so you’ll have the confidence that you can face a provocation without flying off the handle and damaging your relationships.

Anger inoculation involves four steps. They are as follows:

1. Relaxation skills. The specific relaxation training you’ll need is available in other chapters of this book: diaphragmatic breathing, progressive relaxation, release-only relaxation, cue-controlled relaxation, and special place visualization.
2. Coping thoughts. You will create your own anger coping thoughts that will help you combat distorted thinking that triggers upsets.
3. Inoculation. You’ll practice relaxation and cognitive coping skills while visualizing anger-evoking memories at five levels of intensity.
4. Real-life coping. You’ll combine your most effective coping skills into an anger management plan designed for specific provocations.

Symptom-Relief Effectiveness

Novaco (1975), Hazaleus and Deffenbacher (1986), Deffenbacher et al. (1987), and Deffenbacher and Sabadell (1990) have demonstrated across numerous studies that the anger inoculation protocol you’ll learn here works to control the anger response. Significant reductions in both trait anger and anger incidents were achieved with this program.

Time to Master

You can master the key relaxation techniques in three to four weeks. Developing coping thoughts for specific anger situations would likely take several hours. The anger inoculation process in which you visualize provocative memories uses five levels of intensity with two anger images at each level. This work could take three to four weeks. Developing real-life coping plans may take an hour or two for each specific plan.

Instructions

Step 1: Learn to Relax

The fight-or-flight response is an important component of anger. Although angry thoughts may trigger the response, often you are already at a high level of sympathetic nervous system arousal when something happens that provokes angry thoughts and further stimulates your physiological arousal. This then, of course, produces more angry thoughts. An all too common example of this occurs when you are driving home in heavy traffic after a long day at work, suffering from a tension headache, and someone does something reckless. Already tense, you may lash out.

One way to intervene in your cycle of anger is to lower your overall sympathetic nervous system arousal through regular practice of deep relaxation techniques. But it also helps to use quick, breath-based relaxation strategies as soon as you start to feel upset. So, instead of shouting or blowing your car’s horn and going crazy, you take several diaphragmatic breaths to release your pent-up tension.

The core relaxation skills you’ll need to manage anger are all in this book. They are listed here—in the order you should learn them. It’s hard to master cue-controlled relaxation without first learning progressive relaxation and release-only relaxation, so follow the sequence.

In provocative situations, some relaxation skills can be used quickly to get fast relief. Others are useful only as general stress relievers, and won’t help you at the moment you’re angry. Each technique is labeled as either “quick relief” or “general stress relief.”

The skills you’ll need are as follows:

• Diaphragmatic breathing (chapter 3)—quick relief
• Progressive relaxation (chapter 4)—general stress relief
• Relaxation without tensing or release-only relaxation (chapter 7)—general stress relief
• Cue-controlled relaxation (chapter 7)—quick relief
• Special place visualization (chapter 6)—general stress relief

You will need to master or overlearn these relaxation techniques so that the quick relief strategies are available to you at a moment’s notice. The general stress relief techniques provide you with deep release in two to three minutes. You must be able to relax with the same unconscious coordination with which you type or drive your car. Begin practice immediately. Do not go to step 3—anger inoculation—until you have mastered each of these relaxation skills.

Step 2: Develop Anger Coping Thoughts

Your thoughts have an enormous impact on your anger and your ability to defuse your anger. Anger-triggering thoughts are built on the following assumptions:

1. The belief that you have been harmed and/or victimized
2. The belief that the provoking person harmed you deliberately
3. The belief that the provoking person was wrong to harm you, and should have behaved differently (McKay and Rogers 2000)

During stressful experiences, thoughts that paint you as a victim of deliberate and heedless harm will instantly ignite an anger reaction. And the more you think such thoughts, the angrier you will get.

Anger Distortions

Anger-triggering thoughts often distort reality. There are six key cognitive distortions that typically inflame anger, and one or more of them are likely to be factors in many of your anger experiences. Here are the six distortions:

1. Blaming. This is the belief that someone else is responsible for your pain, and there is nothing you can do about it. By blaming others, you forget that you have the power to make choices that will change the situation. You end up feeling helpless and stuck—waiting for someone else to fix things that will stay exactly as they are—until you do something. Another problem with blaming is that people are moving through life, trying to make the best choices they can to meet their own needs. When you blame others for their actions, you are blaming them for taking care of themselves in the best way they know how.
2. Magnifying. This is the tendency to take what is uncomfortable or unpleasant and frame it as so much worse. Words like “disgusting,” “awful,” “terrible,” or “horrible” set you up to be angry because they exaggerate the impact of the provoking situation.
3. Global labels. These distortions use sweeping global judgments to inflame your anger. They paint the other person as totally bad, utterly worthless. Epithets such as “loser,” “jerk,” “bitch,” “selfish pig,” “bastard,” and so forth are typical global labels. Their danger lies in ignoring the full reality of who the human being is with whom you are angry, and reducing that person to a single negative term.
4. Misattributions. This distortion involves jumping to conclusions and mind reading. You assume malicious intent; you think you know people’s motives and feelings toward you. You imagine that you can peer into others’ hearts, seeing exactly why they do what they do. You don’t ask questions or get direct feedback because that’s too embarrassing, so you go on guessing and trying to read people, and a good part of the time you guess wrong.
5. Overgeneralization. This distortion uses words like “never,” “always,” “nobody,” “everybody,” and so on. “She’s always late.” “He’s never willing to help.” Overgeneralization makes an occasional occurrence feel like an ongoing event. The exaggeration makes everything feel intolerable and serves only to crank up your anger response.
6. Demanding/commanding. This distortion turns your personal needs or preferences into immutable laws—and when people ignore your preferences, you may feel as though they’ve broken one of the Ten Commandments. This gives you the right, it often seems, to really blast them. But there’s one big problem with demanding/commanding. Often, other people don’t agree with our definition of appropriate rules of conduct. They have their own rules, or at least their own interpretation of the rules, that leaves them feeling blameless while you think they’ve done wrong. Demanding/commanding is really nothing more than your values and needs imposed on others who may have very different values and needs.

Coping Thoughts

Each anger-provoking distortion requires a coping thought specifically designed to neutralize its effect. Here are some basic guidelines for developing these coping thoughts (adapted from McKay and Rogers 2000):

1. Blaming
   • Make a coping plan to solve the problem yourself.
   • Remind yourself that people are mostly doing the best they can to meet their own goals and needs.

   Example coping thoughts:

   Blaming only makes me feel helpless—what can I do to change the situation?

   My plan to change the situation is ______________________.

   I’m upset about this, but he/she is doing the best they can in the situation.

   They’re doing what they need to do. I’ll do what I need to do.

2. Magnifying
   • Be realistically negative (for example, the situation is disappointing or frustrating, not awful or horrible).
   • Answer this question: How bad is it really?
   • Restate using extremely accurate language.
   • Remind yourself of the whole picture—notice the positives as well as the negatives.

   Example coping thoughts:

   In the grand scheme of things, this is no big deal.

   This is a molehill-size problem. I don’t have to make it bigger than it is.

   This is irritating, but it’ll be history next week.

3. Global Labels
   • Be specific.
   • Describe the behavior, not the person as a whole.

   Example coping thoughts:

   Specifically what bothers me is

   Don’t make it ugly, just state what the problem is.

   Stick to the facts.

   It’s nothing more than a problem. I don’t have to make him/her into a monster.

4. Misattributions
   • Remind yourself that you’re guessing about motives—you don’t know.
   • Find alternative explanations for the problem behavior.
   • Make a plan to check out your assumptions with the person who provokes you.

   Example coping thoughts:

   I’m guessing one possibility, but there are probably other reasons for ’s behavior.

   Getting angry won’t help me figure out what’s going on. I need more facts.

   Some other possible reasons for this behavior are .

5. Overgeneralization
   • Revise your trigger thoughts so they don’t include words like “always,” “all,” “every,” and “never.”
   • Use only specific and accurate descriptions.
   • Look for exceptions—recall how people sometimes behave very differently from their tendencies.

   Example coping thoughts:

   I’ll just focus on the facts and I’ll get through without blowing up.

   Be accurate—how often does this really happen?

   It doesn’t always happen this way. There are lots of exceptions.

6. Demanding/Commanding
   • Focus on your desires and preferences—not “shoulds.” Think “I prefer,” not “You should.”
   • Figure out what needs the other person is meeting with his/her behavior.

   Example coping thoughts:

   I’m not getting what I want but it’s not the end of the world.

   I’d rather things were different but I’ll get through it.

   People do what they want to do, not what I need them to do.

   I wish this wasn’t happening but I can live with it.

If you find it difficult to develop your own coping thoughts, here’s a list of coping thoughts for dealing with anger that may help. Many of these coping statements were developed in an anger management program that proved to be very effective (Novaco 1975).

Generalized Coping Thoughts List

• Take a deep breath and relax.
• Getting upset won’t help.
• Just as long as I keep my cool, I’m in control.
• Easy does it—there’s nothing to be gained by getting mad.
• I’m not going to let him/her get to me.
• I can’t change him/her with anger; I’ll just upset myself.
• I can find a way to say what I want to say without anger.
• Stay calm—no sarcasm, no attacks.
• I can stay calm and relaxed.
• Relax and let go. There’s no need to get my knickers in a twist.
• No one is right, no one is wrong. We just have different needs.
• Stay cool, make no judgments.
• No matter what is said, I know I’m a good person.
• I’ll stay rational—anger won’t solve anything.
• Let them look upset and foolish. I can act calm and in control.
• His/her opinion isn’t important. I won’t be pushed into losing my cool.
• Bottom line, I’m in control. I’m out of here rather than say or do something dumb.
• Take a time-out. Cool off, then come back and deal with it.
• Some situations don’t have good solutions. Looks like this is one of them. No use getting all bent out of shape about it.
• Break it down. Anger often comes from lumping things together.
• Got angry, but kept the lid on saying dumb things. That’s progress.
• Anger means it’s time to relax and cope.
• If they want me to get angry, I’m going to disappoint them.
• I can’t expect people to act the way I want them to.
• I don’t have to take this so seriously.
• This is funny if you look at it that way.

Step 3: Anger Inoculation

Now it’s time to get to work. Think back and write down five anger situations you’ve struggled with over the past few weeks. List them in a journal or on a sheet of paper. Beneath each anger event you name, leave room to identify the following:

1. Your anger-triggering thoughts
2. Any anger distortions that might be embedded in your trigger thoughts
3. Counterresponse strategies (see previous section on coping thoughts) that might neutralize the distortion
4. One or more helpful coping thoughts—including revising the trigger thought to become more accurate

Example

Nancy, a forty-year-old schoolteacher, listed anger-provoking events in both her home and classroom. Here are three of them:

Situation 1. Julian pulls out Rebecca’s chair just when she’s about to sit down—she falls on her back.

Anger-triggering thought: He always does crap like this. He’s a mean kid.

Anger distortions: Overgeneralization, global labeling.

Counterresponse plan: Stop using the word “always,” be specific; look for exceptions; focus on behavior, not the kid.

Coping or revised trigger thought: “Julian gets in trouble maybe once a day. It’s mostly silly stuff where he doesn’t hurt anybody. And he’s actually pretty sweet to the boy with cerebral palsy. I’m not gonna let his pranks get to me.”

Situation 2. I’m assigned yard duty for the second week in a row.

Anger-triggering thought: They’re always taking advantage of me because I don’t complain. They’re making this job unbearable.

Anger distortions: Overgeneralization, misattribution, blaming, magnifying.

Counterresponse plan: Stop using the word “always”; be specific; find alternative explanations; how bad is the job really?

Coping or revised trigger thought: “This is only the second time in a year I’ve had to do two weeks in a row. It happens to other teachers, not just me. Maybe it’s because Hilda was absent this week and they’re shorthanded. It’s just a hassle, nothing more, nothing less.”

Situation 3. Bill takes off for his poker night and leaves the dishes in the sink.

Anger-triggering thought: He’s so damned thoughtless. If you’re going to go off and play, you’d better finish your work first.

Anger distortions: Global labeling, demanding/commanding.

Counterresponse plan: Focus on the behavior, not the person; stay with my desires and preferences, not “shoulds.”

Coping or revised trigger thought: “Bill sometimes forgets to do what he promised. I’d prefer he wouldn’t leave a stack of dishes, but it’s not the end of the world—he can do them when he gets home.”

On the next page is a worksheet for creating your own coping thoughts. Make copies of it and you can follow the steps for creating coping thoughts in any anger situation. Anger-triggering thoughts are those thoughts that set off your anger response.

Visualizing Your Anger Scenes

Now it’s time to practice your new coping skills (relaxation and anger coping thoughts) while visualizing anger scenes of increasing intensity. Let’s start by selecting ten typical anger events that will help you rehearse what you’ve been learning.

To establish a hierarchy of gradually more provocative anger scenes, you can use a scale called Anger Units (AU), where 100 AUs is the worst rage you’ve ever felt in your life and 0 AUs is no anger at all. In the spaces provided below, write:

• Two mild to moderate anger scenes (40 to 50 AUs)
• Two moderate anger scenes (50 to 60 AUs)
• Two moderate to high anger scenes (60 to 75 AUs)
• Two high anger scenes (75 to 85 AUs)
• Two extreme anger scenes (85 to 100 AUs)

As you write descriptions of your anger scenes, include details from the physical environment and what the provoking people are saying or doing. Also describe your trigger thoughts, feelings, and physical reactions. Here’s an example of one of Nancy’s moderate to high anger scenes:

“The school principal is presiding over a faculty meeting. It’s hot, and I’m feeling flushed. She announces that I need to switch classrooms next year to something that’s about the size of a broom closet. She’s smiling in a phony, apologetic way. I’m thinking that she’s taking my room away because I wouldn’t do that demonstration reading project. What a bitch! I’m perspiring and my stomach’s in a knot. I’m so angry, I want to let her have it, but I smother down the words.”

Anger Inoculation Protocol for Mild to Moderate and Moderate Anger Scenes

1. Create a Coping Thoughts Worksheet. Develop several anger coping thoughts prior to visualizing each scene.
2. Relax using cue-controlled relaxation and special place visualization. If there are specific areas of your body that remain tense, try progressive muscle relaxation or release-only relaxation.
3. Once you’ve relaxed, visualize the first anger scene at the mild to moderate level. Try to see as much detail as possible and hear whatever is being said. Intensify your anger response with some of your trigger thoughts. Keep at it, letting your anger rise as much as possible. Hold the scene in your mind for thirty seconds.
4. Now erase the scene and use your relaxation skills again. Also recall your anger coping thoughts. Keep this up until you feel calm again (0 AUs).
5. Repeat the whole sequence again, visualizing the second anger scene (at the mild to moderate level).
6. Alternate back and forth between these two scenes for four to six repetitions each. Then, using these same two scenes, have a second practice session a few days later.
7. Now move on to the two moderate anger scenes.

Anger Inoculation Protocol for Moderate to High Through Extreme Anger Scenes

For these higher-level anger scenes, you will make one important change in the procedure. Instead of erasing the scene after thirty seconds and beginning to cope (with relaxation and coping thoughts), you’ll use your coping skills while you continue to visualize the anger scene. You will hold onto the provocative image while at the same time practicing cue-controlled relaxation, and perhaps releasing tension in specific areas of your body. You will maintain the image while using your new coping thoughts or revised versions of trigger thoughts. Stay with the process until you feel completely calm (0 AUs).

After you’ve gotten down to 0 AUs in the first scene of a particular anger level, switch off the scene, do some cue-controlled breathing, and start imaging the second scene. Switch back and forth between each scene four to six times, always waiting to get to 0 AUs before changing scenes. You are encouraged to do two practice sessions, switching scenes four to six times each, for each anger level.

It’s hard to do two things at once (stay locked on an anger scene and, at the same time, cope). But with practice you can learn to do it. You’ll soon be able to balance visualization with relaxation and anger management thoughts. Remember this: coping with real-life provocation is going to require this same balancing act. You’ll need to deal with what’s going on at the moment and use your coping skills. So all the practice you do now will put you in a far better position to handle real upsets.

Example

Let’s go back to Nancy’s anger scene with her principal—where she was being assigned to a “broom-closet” size classroom. Nancy begins by relaxing with her special place visualization (Tuolumne Meadows in Yosemite) and some cue-controlled relaxation. She notices any places in her body that feel tense and deliberately relaxes those areas. Now she begins to visualize the scene in the faculty meeting. She remembers her principal’s phony smile as she told Nancy about her new classroom assignment. She recalls how hot the room felt and the flushed feeling in her body. She thinks, “What a bitch,” and assumes that the principal is taking revenge for Nancy’s refusal to do the demonstration project.

Now Nancy feels really steamed; this room assignment was a deliberate slap in the face. As her anger reaches the moderate to high level, Nancy begins to cope. She takes a cue-controlled breath; she reminds herself that her principal has done her favors as well as disappointed her. She thinks that the smaller room might reflect that her third-grade class is expected to have fewer students next year. While holding onto the scene of the faculty meeting and her principal’s phony smile, Nancy reminds herself that “getting upset won’t change anything—stay cool.” She takes several more cue-controlled breaths.

Only when her anger is completely gone does Nancy switch off the scene. Now she returns for a few moments to her Yosemite Meadows before beginning her second moderate to high anger scene. Nancy continues to switch back and forth between her two moderate to high anger scenes four to six times.

Step 4: Real-Life Coping

Although you can’t schedule real-life practice with provocations, you can prepare for them. You can have well-rehearsed coping thoughts ready, and you can stay alert for early warning signs of anger in your body and mind. The sooner you intervene with cue-controlled relaxation and coping thoughts, the more likely you are to maintain control.

If you know you are going to be in a situation that is likely to spark your anger, prepare your coping thoughts ahead of time and commit yourself to using them along with cue-controlled relaxation. With practice this will be easier to do, and in time it will become more automatic. If you forget to use your coping skills, or you start to use them and then give up in the heat of the moment, visualize the scene later and practice coping just as you did when you were doing the anger inoculation exercises.

In addition to relaxation and coping thoughts, it’s always helpful to plan your best coping behaviors. What can you say or do to defuse the situation and get through it without blowing up?

Your Anger Plan

For each provocation where you forget to use your new skills, make a written anger plan.

Special Considerations

1. If you have difficulty following the relaxation protocol, you may want to record your relaxation routine and practice with that.
2. If you have difficulty forming images of anger scenes, include more sense impressions. For example, if your images are primarily visual, try to bring in sounds, smells, or the sense of touch. Add as many of these additional sensory elements to the scene as possible.
3. If you can image clearly, but it produces little or no anger, focus more on anger-triggering thoughts. If that doesn’t work, dump the scene and develop one that is more anger-provoking. Or bring in a higher-level anger scene to work with.
4. If you are interested in learning more about irrational ideas that trigger unnecessary distress, refer to chapter 12, Refuting Irrational Ideas.

Further Reading

Deffenbacher, J. L., and M. McKay. 2000. Overcoming Situational and General Anger. Oakland, CA: New Harbinger Publications.

Deffenbacher, J. L., and P. M. Sabadell. 1990. A combination of cognitive, relaxation, and behavioral coping skills in the reduction of general anger. Journal of College Student Development 31:351-358.

Deffenbacher, J. L., D. A. Story, R. S. Stark, J. A. Hogg, and A. D. Brandon. 1987. Cognitive-relaxation and social skills interventions in the treatment of general anger. Journal of Counseling Psychology 34(2):171-176.

Hazaleus, S., and J. L. Deffenbacher. 1986. Relaxation and cognitive treatments of anger. Journal of Psychological Record 15:501-511. Out of print.

McKay, M., and P. D. Rogers. 2000. The Anger Control Workbook. Oakland, CA: New Harbinger Publications.

Novaco, R. 1975. Anger Control: The Development and Evaluation of an Experimental Treatment. Lexington, MA: D. C. Health.