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Help for hotheads

Anger is practically a daily ritual of our lives. From Los Angeles' traffic-choked freeways to the pop culture scene, it seems we can't get to work without someone flashing an inappropriate finger or to bed without witnessing the latest celebrity fit or fisticuffs on the Jerry Springer show.

Angry outbursts are now almost expected and encouraged as much for their sheer entertainment as for their redemptive value when used to explain away bad behavior. Just ask anyone who has worked on a television show or movie set in Hollywood. And most recently, baseball great Pete Rose blamed his gambling and lying in part on anger — something called "oppositional defiant disorder," a condition characterized by physical aggression and usually associated with children.

Into this stewing societal caldron has come "anger management," whose aim is to teach people to handle hot emotions without losing control. The past doesn't matter so much, as it does with psychotherapy, as the "now." Courses lay out how to deal with anger in the moment — a strategy that promises to improve personal relationships and lessen the chance of blowing up and getting fired or tossed in jail.

In recent years, the workplace, long-suffering spouses and the judicial system are chiefly responsible each year for channeling tens of thousands into anger management classes — and those figures are expected to rise. Every time a celebrity — from boxer Mike Tyson to actress Shannen Doherty — was ordered to attend anger management classes, the program got a boost in name recognition, and many instructors noticed an uptick in clients.

Last year's "Anger Management," a film that co-starred Jack Nicholson, who in real life once smashed a car windshield with a golf club during a traffic dispute, heightened the program's national profile. In fact, anger management instructors say, the comedy helped remove some of the shame angry clients had in asking for help. "It's part of the zeitgeist," said Redford Williams, director of behavioral medicine at Duke University Medical Center in Durham, N.C.

In the last couple of years, more and more business and governmental organizations have enlisted anger management services not only to treat hotheaded employees but also to stave off problems before they emerge. Federal postal workers, state prison guards and business leaders — who can pay more than $2,500 for one-on-one "coaching" — have taken workshops and seminars for anger management. Some medical schools, such as the University of Miami's, are putting medical students through special training to help them better cope with their own — and their patients' — anger.

The judicial system has created the biggest demand for anger management training. Judges across the country use the programs as a means to ease overcrowding in prisons and jails, and unclog courtroom calendars, said Pam Hollenhorst, associate director of the Institute of Legal Studies at the University of Wisconsin in Madison, who led one of the few comprehensive studies of anger management research. It may cost a county jail from $50 to $100 a day to lock up a defendant for road rage, physical assaults or disturbing the peace. Or the courts can release the defendant and order him to enroll in an anger management course.

"For these kinds of offenses, I think the courts were finding that putting someone in jail for two to six months wasn't doing the trick," said Jerry Deffenbacher, a professor of psychology at Colorado State University who studies anger and anger management. "So [anger management] developed as another tool to attack the problem."

Anger management classes can vary quite a bit. But most share basic principles of psychology — understanding, identifying and learning to control angry emotions and employing relaxation techniques to minimize the physiological responses to anger.

Most classes, usually led by instructors with backgrounds in social work or counseling, help clients decide what is worth getting angry over and what isn't. And when anger is appropriate, how to behave assertively — not aggressively and destructively — to get what you want. Programs, which may last from 10 weeks to almost a year, cost from $150 to about $1,000. In part because of the quick rise in popularity of such classes, no local, state or national standards govern what should be taught in anger management or who is qualified to teach it. Although precise figures are difficult to come by, some estimate that about 7,000 people have been trained nationwide to teach anger-related courses.

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Effectiveness questioned

Moreover, there is scant research on anger management to suggest whether these programs work. A few small studies, mostly involving prison inmates and juvenile offenders, have suggested the classes are helpful in discouraging aggressive behavior, but there is no conclusive evidence that they do any good within the general population.

Mental health professionals aren't convinced the programs work. The American Psychological Assn., based in Washington, D.C., and representing psychologists, has said that such programs can be beneficial. But the American Psychiatric Assn., an Arlington, Va.-based group that represents 35,000 physicians, has not taken an official position. "We don't really know enough about what type of anger management program is best," said the University of Wisconsin's Hollenhorst. "Or for whom it works, under what circumstances, or for how long."

Without regulation, some advocates of anger management programs are concerned that the field won't be taken seriously and that its reputation could suffer.

"There are as many ways to approach [anger management] as there are people," said W. Doyle Gentry, a clinical psychologist and director of the Institute for Anger Free Living in Lynchburg, Va. "And it's created a lot of confusing, even bizarre, methods that can't be taken seriously. I mean, if they ask you to beat a mattress with a tennis racquet [to work out your anger], it's not going to do you any good."

Anger management advocates say California is poised to take the lead in setting standards for the field. In 2001, the state became the first in the nation to enact a law giving judges the power to order drivers charged in road rage cases to complete anger management courses in addition to, or in lieu of, suspending driving privileges.

Regulations to standardize anger management are slowly being drafted, modeled on techniques used in domestic violence prevention programs, said George Anderson, a psychotherapist and founder of Anderson & Anderson, an anger management business in Los Angeles that claims to have trained about 4,500 instructors.

Anderson, who helped author the state's domestic violence legislation, has been working with Assembly Speaker Herb Wesson (D-Culver City) and other state leaders to establish standards for materials, teacher qualifications and an overall curriculum for anger management. But given the state's current budget crunch, progress isn't expected any time soon. "The state isn't going to have the money to implement it now," said Anderson, who gets nearly 40% of his clients from county court referrals. "It would amount to an unfunded mandate, and those are ignored."

Further complicating efforts to regulate the profession is the American Psychiatric Assn.'s designation of anger as a symptom of other, more serious, mental disorders and not a genuine condition of its own, say advocates. Without the kind of recognition accorded such disorders as major depression, the field of anger research is unlikely to attract much funding.

Dr. Darrel A. Regier, the director of research at the American Psychiatric Assn., said anger management programs lacked a body of research demonstrating their effectiveness, adding that designing such studies won't be easy. It is likely, he said, that many people who go through anger management training have other conditions, such as bipolar disorder or substance abuse problems, that would predispose them to aggressive behavior. That would pose a difficulty for researchers trying to evaluate the programs.

Beyond that, other critics contend that dozens of hours of anger management cannot miraculously change years of negative behavior, particularly if the person returns to the same environment that allowed it to fester.

Advocates agree that one key area of research must be resolved: Does anger management help people who are placed in such programs involuntarily? Although no figures are available, anecdotal evidence indicates a majority of participants go to classes grudgingly or unwillingly, as a means to avoid fines, jail time or the loss of employment.

"If you get a guy who is saying, 'I don't have a problem, the world just needs to get off my back,' he's probably not going to change," said Deffenbacher, the Colorado State University researcher who is working with the federal Centers for Disease Control and Prevention in Atlanta to study what types of programs might be effective for road rage drivers. "If we're going to require [anger management] interventions, we really need to find out if they work and under what conditions."

Denial of anger isn't the only indication someone might be having trouble with their temper. In addition to the obvious clues — excessive drinking, physical fights, hair-trigger tempers — psychologists say high levels of anger over time can cause physical illness, including headaches and upset stomachs.

Psychologists quickly add that feeling or showing anger in and of itself doesn't mean it's time to enroll. Anger is a natural, even healthy, response to certain situations. Without industry standards, there's no consensus on exactly when someone should seek anger management treatment. But generally, most in the field agree that people whose bad tempers erupt daily or alienate family, friends or co-workers are probably good candidates. (Likewise, constant, silent stewing, even when not expressed, is widely regarded as a sign it is time to seek help.)

On a recent Saturday morning in Los Angeles, a group of four people have come to an introductory class offered by Anderson & Anderson at its Wilshire Boulevard offices. Some of the students are interested in becoming instructors; others hope to gain better control of their own anger.

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Easing job stress

Renee Moncito operates a family services agency in Los Angeles where tensions can run high. Moncito said she was looking for ways that she and her staff can cope with stress. "You have to stay in a 'help' mode," said Moncito. Television producer Carol Trussell said she had witnessed her share of screaming, yelling, even fistfights on Hollywood sets, and she was looking for a way to improve the workplace atmosphere. "I've had several employees, good employees, who have come to me and said, 'Sorry, I'm leaving. I'm not going to take this. I don't care how much you pay me.' " she said. "The networks and the studios are beginning to realize anger is an issue in our business that we have to deal with."

Anderson's classes focus on different topics each session — strategies for handling high-risk situations in one class, developing emotional intelligence in another. But this morning's class was introductory, and the students were asked to explain to the group what had brought them there.

The class included one man — a young husband and new father — who said his wife had urged him to seek help after he erupted in anger at her when she put their toddler to sleep for a nap without a diaper.

"I've been told I'm a mean person," he said with his head bowed.

"I'm very hard on people who don't see things my way," said the man, who asked that his name not be used. "I know what the solution is, but I can't seem to do it [when I'm angry]."

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