Aggression management/ Anger Management

1. ANGER/AGRESSION
MANAGEMENT
PRIYANKA KUMARI
M.Sc. Nursing
(Mental Health Nursing)

2. Specific objectives:
Specific objectives are:
 Define and differentiate between anger and aggression and violence.
 Enlist types of anger.
 Discuss the predisposing factors to the maladaptive expression of aggression.
 Explain the phases of aggression.
 Recognize the signs/symptoms of aggression/anger.
 Explain the nurses’ response to patient aggression.
 Explain about the management of anger/aggression.
 Discus eight strategies that can help you get a handle on your anger.
 Apply the nursing process forthe personwho expressing anger or aggression.

3. INTRODUCTION:
Anger is a normal, healthy emotion that serves as a warning signal and alerts us to potential threat
or trauma.
• Warren(1990) outlined some fundamental points about anger:
 It is not a primary emotion.
 It Is physiological arousal.
 Anger and aggression are significantly different.
 Expression of anger is learned.
 Expression of anger can come under personal control.
DEFINITION:
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 increase in heart rate,
blood pressure and level of the hormones epinephrine and norepinephrine.
– American Psychological Association, 2010
Aggression is behavior intended to threaten or injure the victim’s security or self-esteem.
It means “to go”, “to attack”.
In Psychology, the term aggression refers to a range of behaviors that can result in both
physical and psychological harm to oneself, other or objects in the environment.
Social psychologists define aggression as behavior that is intended to harm another
individual who does not wish to be harmed.
(Baron & Richardson, 1994)
Violence is defined as “a physical act of force intended to cause harm to a person or an
object and to convey the message that the perpetrator’s point of view is correct and not the
victim’s.”
(Harper-Jaques and Reimer, 1992)
Aggression is verbal statement that are intended to threaten. Aggression and violent
behavior represent a continuum from suspicious behavior to extreme actions that threaten the
safety of others or result in injury or death.
THEORIES ON AGGRESSION
 Biological theory
 Psychological theory

4.  Humanistic theory
 Social learning theory
1. BIOLOGICAL THEORY:
Current neurobiological research has focused on three areas of the brain believed to be
involved in aggression: the limbic system, frontal lobe, hypothalamus. Neurotransmitters also have
been suggested as having a role the expression or suppression of anger or aggressive behavior.
LIMBIC SYSTEM (Amygdala, Frontal lobes and limbic system): Stimulation of the amygdala
results in augmented aggressive behavior, while lesions of this area greatly reduce one's
FRONTAL LOBE: dysfunctions alter neurochemistry, neurometabolism.
Impaired function of the prefrontal cortex leads to aggression as aggressive individuals have
reduced prefrontal activation.
Lesions in the frontal cortex are characterized by aggression, irritability and short tempers.
Damage to the frontal lobes can result in impaired judgement, personality changes, problems in
decision making, inappropriate conduct of aggressive outburst. competitive drive and aggression.
HYPOTHALAMUS: regulatory role. The hypothalamus causes aggressive behavior when
electrically stimulated, but also has receptors that determine aggression levels through the
neurotransmitters serotonin and vasopressin.
Stress raises the level of steroids, the hormone secreted by adrenal gland. Nerve receptors for these
hormones become less sensitive in an attempt to compensate, and the hypothalamus tells the
pituitary gland to release more steroids.
After repeated stimulation, the system may respond more vigorously to all provocation. That may
be one reason why traumatic stress in childhood may permanently enhance one’s potential for
violence.
Testosterone has been shown to correlate with aggressive behavior in mice and in some humans.
Progesterone, LH, and Prolactin (in birds) increase aggression. Estrogen decreases aggression.
Thyroid hormones: increase aggression.
Serotonin: Low serotonin could contribute to aggressive behavior.
Alcohol disinhibits an individual. Over half of all acts of rape occur while the aggressor is under
the influence of alcohol.
2. PSYCHOANALYTICAL THEORIES:
Sigmund Freud is well known as the father of psychoanalysis. In his early theory, Freud asserts
that human behaviors are motivated by sexual and instinctive drives known as the libido, which is
energy derived from the Eros, or life instinct. Thus, the repression of such libidinal urges is
displayed as aggression. Later, Freud added the concept of Thanatos, or death force, to his Eros

5. theory of human behavior. Contrary to the libido energy emitted from the Eros, Thanatos energy
encourages destruction and death. In this conflict between Eros and Thanatos, some of the negative
energy of the Thanatos is directed toward others, to prevent the self-destruction of the individual.
Thus, Freud claimed that the displacement of negative energy of the Thanatos onto others is the
basis of aggression. According to Freud: Aggression may be due to impaired mother-child
relationship (children of punitive parents are more aggressive). Aggression is developed during
the oral stage when the pleasure of biting is added to that of sucking. Fixation on the oral stage of
psychosexual development may lead to sadistic personality. Aggression may be due to impaired
development of superego. Aggression may be due to defense mechanisms:
 Projection
 Narcissism
 Repression
3. LORENZ THEORY- THE EVOLUTIONARY
THEORY OF AGGRESSION: Lorenz looked at instinctual aggressiveness as a product
of evolution. Aggressiveness is beneficial and allows for the survival, territory protection
and success of populations of aggressive species since the strongest animals would
eliminate weaker ones and over the course of evolution, the result would be a stronger,
healthier population.
Adler’s view:
Aggression is due to the striving for superiority and perfection.
Mc Dougall’s view:
Aggression is an instinct.
A civilized man modifies and replaces physical aggression and destruction with sarcastic
smiles, polished insulting words.
Only when these methods fail, may the individual regress to the primitive and childish way
of behavior.
4. HUMANISTIC THEORY: Aggression is a drive (basic concept). It arises from
deprivation of basic needs (Abraham Maslow). The drive theory attributes aggression to
an impulse created by an innate need. In this theory, frustration and aggression are linked
in a cause and effect relationship. Frustration is the cause of aggression and aggression is
the result of frustration. Frustration may cause apathy, depression, anxiety, etc…
5. SOCIAL LEARNING THEORY: Albert Bandura and his colleagues were able to
demonstrate one of the ways in which children learn aggression. Bandura's theory proposes
that learning occurs through observation and interaction with other people. The experiment
involved exposing children to two different adult models, an aggressive model and a non-
aggressive one. After witnessing the adult's behavior, the children would then be placed in
a room without the model and were observed to see if they would imitate the behavior they
had witnessed earlier. He predicted that children who observed an adult acting aggressively
would be likely to act aggressively. Aggression is initially learned from social behavior
and maintained by reward, which encourages the further display of aggression. Aggressive
responses are acquired so they are evitable (optimistic).
Media violence:

6. Although most young people who are exposed to violence in TV and movies
and playing violent video games do not become violent criminals, they can become more
open to acts of violence. However, media violence is explicitly not considered a causal
influence of aggression, but in a combination with genetic and early social influences could
have an influence.
TYPES:
Mainly aggression is having three types:
 Instrumental aggression.
 Hostile aggression.
 Relational aggression.
1. Instrumental aggression:
Aggression aimed at obtaining an object, privilege or space with no deliberate intent
to harm another person.
• Typically of toddlers.
2. Hostile aggression:
Aggression intended to harm another person such as hitting, kicking or threating to
beat up someone.
3. Relational aggression:
Defined as type of aggression that is ‘intended to harm others through deliberate
manipulation of their social standing and relationships.
• According to Daniel Olweus is a type of bullying.
• Is harming others through purposeful manipulation and damage of their peer
relationships.
• Type of aggression in which harm is caused by damaging someone’s
relationships or social status.
• It can be proactive (planned and goal oriented) and reactive (in response to
perceived threats, hostility or anger).
Other than these types aggression is also having following types:
 Verbal aggression.
 Physical aggression against others.
 Physical aggression against property or objects.
 Physical aggression against self.
PREDISPOSING FACTORS OF ANGER/AGGRESSION:
 Modeling:
Role modeling is one of the strongest forms of learning. Children model their
behavior at a very early age after their primary caregivers, usually parents. How parents or
significant others express anger becomes the child’s method of anger expression. Whether
role modeling is positive or negative depends on the behavior of the models. Much has

7. been written about the abused child becoming physically abusive as an adult. Role models
are not always in the home, however.
Evidence supports the role of television violence as a predisposing factor to later aggressive
behavior (American Psychological Association, 2006b). The American Psychiatric
Association (2006) suggests that monitoring what children view and regulation of violence
in the media are necessary to prevent this type of violent modeling.
 Operant conditioning:
Operant conditioning occurs when a specific behavior is reinforced. A positive
reinforcement is a response to the specific behavior that is pleasurable or produces
the desired results. A negative reinforcement is a response to the specific behavior
that prevents an undesirable result from occurring. Anger responses can be learned
through operant conditioning. For example, when a child wants something
and has been told “no” by a parent, he or she might have a temper tantrum. If, when
the temper tantrum begins, the parent lets the child have what is wanted, the anger
has been positively reinforced (or rewarded). An example of learning by negative
reinforcement follows: A mother asks the child to pick up her toys and the child
becomes angry and has a temper tantrum. If, when the temper tantrum begins, the
mother thinks, “Oh, it’s not worth all this!” and picks up the toys herself, the anger
has been negatively reinforced (child was rewarded by not having to pick up her
toys).
 Neurophysiological disorders:
Some research has implicated epilepsy of temporal and frontal lobe origin in
episodic aggression and violent behavior (Sadock & Sadock, 2007). Clients with
episodic dyscontrol often respond to anticonvulsant medication. Tumors in the
brain, particularly in the areas of the limbic system and the temporal lobes; trauma
to the brain, resulting in cerebral changes; and diseases, such as encephalitis (or
medications that may effect this syndrome), have all been implicated in the
predisposition to aggression and violent behavior. A study by Lee and associates
(1998) showed that destruction of the amygdaloid body in patients with intractable
aggression resulted in a reduction in autonomic arousal levels and in the number of
aggressive outbursts.
 Biochemical factors:
Violent behavior may be associated with hormonal dysfunction caused by
Cushing’s disease or hyperthyroidism (Tardiff, 2003). Studies have not supported
a correlation between violence and increased levels of androgens or alterations in
hormone levels associated with hypoglycemia or premenstrual syndrome. Some
research indicates that various neurotransmitters (e.g., epinephrine, norepinephrine,
dopamine, acetylcholine, and serotonin) may play a role in the facilitation and
inhibition of aggressive impulses (Sadock & Sadock, 2007).
 Socioeconomic factors:

8. High rates of violence exist within the subculture of poverty in the United States.
This has been attributed to lack of resources, breakup of families, alienation,
discrimination, and frustration (Tardiff, 2003). An ongoing controversy exists as to
whether economic inequality or absolute poverty is most responsible for violent
behavior within this subculture. That is, does violence occur because individuals
perceive themselves as disadvantaged relative to other persons, or does violence
occur because of the deprivation itself? These concepts are not easily understood
and are still under investigation.
 Environmental factors:
Physical crowding may be related to violence through increased contact and
decreased defensible space (Tardiff, 2003). A relationship between heat and
aggression also has been indicated (Anderson, 2001). Moderately uncomfortable
temperature appears to be associated with an increase in aggression, while
extremely hot temperatures seem to decrease aggression. A number of
epidemiological studies have found a strong link between use of alcohol and violent
behavior. Other substances, including cocaine, amphetamines, hallucinogens, and
anabolic steroids, have also been associated with violent behavior (Tardiff, 2003).
PHASES OF AGGRESSION:
 Triggering phase.
 Escalation phase.
 Crisis phase.
 Recovery phase.
 Post crisis.
1. Triggering phase:
An event or circumstances in the environment initiates the client’s response,
which is often anger or hostility.
• This is a circumstances where a person is still on a non-threatening manner. Which
can be managed easily and without any hostile or aggressive behavior. This is
associated with restlessness, anxiety, irritability, muscle tension and perspiration.
2. Escalation phase:
The client’s responses represent escalating behaviors that indicate movement
toward a loss of control.
• Here a man with a very high anger level will result to a pale or flushed face,
yelling, agitated, showing threatening gestures such as clenching fist and even the
ability to think clearly is loss.
3. Crisis phase:
During this stage the man will loss his control and will react to the environment

9. by kicking, punching, screaming, throwing objects and he will have loss the ability
to communicate clearly.
4. Recovery phase:
As the person regains physical and emotional control the man is showing a more
relaxed state by lowering his voice, has a decreased muscle tension and has
more rational communication with others.
5. Post crisis phase:
The man will attempt reconciliation for everything he has done. He will be on the
normal level of functioning. But sometimes when a person is on this stage they are
very emotional that they apologize in a quiet yet crying behavior. In here the man
can now be reintegrated to the environment to be more relaxed and
emotionally stable.
SIGN AND SYMPTOMS OF AGGRESSION:
1. In triggering phase-
 Restlessness
 Anxiety
 Irritability
 Pacing
 Muscle tension
 Rapid breathing
 Perspiration
 Loud voice.
2. In escalation phase-
 Pale or flushed face
 Yelling
 Swearing
 Agitated
 Threatening
 Demanding
 Clenched fists
 Hostility, loss of ability to solve problems.
3. In crisis phase-
 Loss of emotional and physical control
 Throwing objects
 Kicking, Hitting
 Spitting
 Biting, scratching
 Screaming
 Inability to communicate clearly.
4. In recovery phase-

10.  Lowering of voice
 Decreased muscle tension
 Clearer
 More rational communication and Physical relaxation.
5. In post crisis phase-
 Remorse
 Apologies
 Crying
 Quiet
 Withdrawn behavior.
NURSES’ RESPONSE TO ASSAULT:
Response type:
1. Affective:
a) Personal –
 Irritability
 Depression
 Anger
 Anxiety
 Apathy
b) Professional-
 Erosion of feelings of complete, leading increase anxiety and fear.
 Feelings of guilt or self-harm.
 Fear of potentially violent patient.
2. Cognitive and behavioral:
a) Personal-
 Suppressed thoughts of assault
 Social withdrawal.
b) Professional-
 Reduced confidence in judgement.
 Consideration of job change.
 Possible hesitation in responding to other violent situation.
 Possible over controlling.
 Possible hesitation to report future assault.
 Possible withdrawal from colleagues.
 Questioning of capabilities by coworker.
3. Physiologic:
a) Personal-
 Disturbed sleep
 Headache
 Stomach aches

11.  Tension
b) Professional-
 Increase absenteeism.
MANAGEMENT:
The use of various techniques and strategies to control responses to anger-provoking
situations.
The goal of anger management is to reduce both the emotional feelings and the
physiological arousal that anger engenders.
General Principles of Management
• The safety of patient, clinician, staff, other patients and potential intended victims.
• The doors should be open outwards and not be lockable from inside or capable of being blocked
from inside.
• One must take care to reduce accessibility to patients of movable objects, earrings, eyeglasses,
lamps and pens.
• Adequate caregiver training.
• Availability of appropriate supervision.
• Constant Observation in a calm and firm but respectful manner.
• Putting space between self and patient.
• Avoiding physical or verbal threats, false promises and build rapport with client.
• Training in basic self-defense techniques and physical restraint techniques are useful.
Environmental management: violence prevention
 Remove potential weapons from the environment.
 Search environment routinely to maintain it as hazard free.
 Search patient and belongings for weapons or potential weapons during admission.
 Monitor the safety of items.
 Assign single room to patient.
 Place the patient in a room near a nursing station.
 Place patient in least restrictive environment.
 Provide plastic, rather than metal, clothes hanger as appropriate.
NURSING PROCESS:
1. Assessment

12. Nurses must be aware of the symptoms associated with anger and aggression in order to make
an accurate assessment. The best intervention is prevention, so risk factors for assessing violence
potential are also presented.
Anger
Anger can be associated with a number of typical behaviors, including (but not limited to) the
following:
● Frowning facial expression.
● Clenched fists.
● Low-pitched verbalizations forced through clenched teeth.
● Yelling and shouting.
● Intense eye contact or avoidance of eye contact.
● Easily offended.
● Defensive response to criticism.
● Passive–aggressive behaviors.
● Emotional over-control with flushing of the face.
● Intense discomfort; continuous state of tension.
Anger has been identified as a stage in the grieving process. Individuals who become fixed in this
stage may become depressed. In this instance, the anger is turned inward as a way for the individual
to maintain control over the pent-up anger. Because of the negative connotation to the word anger,
some clients will not acknowledge that what they are feeling is anger. These individuals need
assistance to recognize their true feelings and to understand that anger is a perfectly acceptable
emotion when it is expressed appropriately.
Aggression
Aggression can arise from a number of feeling states, including anger, anxiety, guilt,
frustration, or suspiciousness. Aggressive behaviors can be classified as mild (e.g., sarcasm),
moderate (e.g., slamming doors), severe. (e.g., threats of physical violence against others), or
extreme (e.g., physical acts of violence against others).
Aggression may be associated with (but not limited to) the following defining characteristics:
● Pacing, restlessness.
● Tense facial expression and body language.
● Verbal or physical threats.
● Loud voice, shouting, use of obscenities, argumentative.

13. ● Threats of homicide or suicide.
● Increase in agitation, with over-reaction to environmental stimuli.
● Panic anxiety, leading to misinterpretation of the environment.
● Disturbed thought processes; suspiciousness.
● Angry mood, often disproportionate to the situation.
Kassinove and Tafrate (2002) state, “In contrast to anger, aggression is almost always goal directed
and has the aim of harm to a specific person or object. Aggression is one of the negative outcomes
that may emerge from general arousal and anger.”
Intent is a requisite in the definition of aggression. It refers to behavior that is intended to inflict
harm or destruction. Accidents that lead to unintentional harm or destruction are not considered
aggression.
Assessing Risk Factors
Prevention is the key issue in the management of aggressive or violent behavior. The
individual who becomes violent usually feels an underlying helplessness. Three factors that have
been identified as important considerations in assessing for potential violence include the
following:
1. Past history of violence.
2. Client diagnosis.
3. Current behavior.
Past history of violence is widely recognized as a major risk factor for violence in a treatment
setting. Also highly correlated with assaultive behavior is diagnosis. The diagnoses that have been
correlated with increased risk of violence include substance use disorders, psychotic disorders
(e.g., schizophrenia, bipolar disorder), personality disorders (e.g., antisocial and borderline
personality disorders), and organic mental disorders (e.g., dementia and delirium).
Dubin (2004) states:
The successful management of aggression is predicated on the ability to predict which
patients are most likely to become violent. Once such a prediction is made, rapid intervention can
defuse the risk of violence. Violence usually does not occur without warning.
He describes a “prodromal syndrome” that is characterized by anxiety and tension, verbal
abuse and profanity, and increasing hyperactivity. These escalating behaviors usually do not occur
in stages but most often overlap and sometimes occur simultaneously. Behaviors associated with
this prodromal stage include rigid posture; clenched fists and jaws; grim, defiant affect; talking in
a rapid, raised voice; arguing and demanding; using profanity and threatening verbalizations;
agitation and pacing; and pounding and slamming.

14. Most assaultive behavior is preceded by a period of increasing hyperactivity. Behaviors
associated with the prodromal syndrome should be considered emergent and demand immediate
attention. Keen observation skills and background knowledge for accurate assessment are critical
factors in predicting potential for violent behavior.
2. Diagnosis/Outcome Identification
The nursing diagnosis of complicated grieving may be used when anger is expressed
inappropriately and the etiology is related to a loss.
The following nursing diagnoses may be considered for clients demonstrating
inappropriate expression of anger or aggression:
 Ineffective coping related to negative role modeling and dysfunctional family system
evidenced by yelling, name calling, hitting others, and temper tantrums as expressions of
anger.
 Risk for self-directed or other-directed violence related to having been nurtured in an
atmosphere of violence; history of violence
Outcome Criteria
Outcome criteria include short- and long-term goals. Timelines are individually
determined. The following criteria may be used for measurement of outcomes in the care of the
client needing assistance with management of anger and aggression.
The client:
 Is able to recognize when he or she is angry, and seeks out staff/support person to talk
about his or her feelings.
 Is able to take responsibility for own feelings of anger.
 Demonstrates the ability to exert internal control over feelings of anger.
 Is able to diffuse anger before losing control.
 Uses the tension generated by the anger in a constructive manner.
 Does not cause harm to self or others.
 Is able to use steps of the problem-solving process rather than becoming violent as a means
of seeking solutions.
3. Nursing intervention:
o Remain calm when dealing with an angry client.
o Set verbal limits on behavior. Clearly delineate the consequences of
inappropriate expression of anger and always follow through:
 Have the client keep a diary of angry feelings, what triggered them, and
how they were handled.
 Avoid touching the client when he or she becomes angry.
 Help the client determine the true source of the anger.
 It may be constructive to ignore initial derogatory remarks by the client.
 Help the client find alternate ways of releasing tension, such as physical

15. outlets, and more appropriate ways of expressing anger, such as seeking
out staff when feelings emerge.
 Role model appropriate ways of expressing anger assertively, such as,
 “I dislike being called names. I get angry when I hear you saying those
things about me.”
o Observe client for escalation of anger (called the prodromal
syndrome):
 Increased motor activity, pounding, slamming, tense posture, defiant affect,
clenched teeth and fists, arguing, demanding, and challenging or threatening
staff.
o When these behaviors are observed, first ensure that sufficient staff
are available to help with a potentially violent situation. Attempt to
defuse the anger beginning with the least restrictive means.
o Techniques for dealing with aggression include:
 Talking down. (Ensure that client does not position self
between door and nurse.)
 Physical outlets: “Maybe it would help if you punched your
pillow or the punching bag for a while.” “I’ll stay here with
you if you want.”
 Medication: If agitation continues to escalate, offer client
choice of taking medication voluntarily. If he or she refuses,
reassess the situation to determine if harm to self or others is
imminend. Call for assistance. Remove self and other clients
from the immediate area. Call violence code, push “panic”
button, call for assault team, or institute measures
established by the institution. Sufficient staff to indicate a
show of strength may be enough to deescalate the situation,
and client may agree to take the medication.
 Restraints: If client is not calmed by “talking down” or by
medication, use of mechanical restraints and/or seclusion
may be necessary. Be sure to have sufficient staff available
to assist.
 Observation and documentation: Observe the client in
restraints every 15 minutes (or according to institutional
policy). Ensure that circulation to extremities is not
compromised (check temperature, color, pulses). Assist
client with needs related to nutrition, hydration, and
elimination. Position client so that comfort is facilitated and
aspiration can be prevented.
 Document all observations.
 Ongoing assessment: As agitation decreases, assess client’s
readiness for restraint removal or reduction. With assistance

16. from other staff members, remove one restraint at a time,
while assessing client’s response. This minimizes the risk of
injury to client and staff.
 Staff debriefing: It is important when a client loses control
for staff to follow-up with a discussion about the situation.
Evaluation:
Evaluation consists of reassessment to determine if the nursing interventions have been successful
in achieving the objectives of care. The following type of information may be gathered to
determine the success of working with a client exhibiting inappropriate expression of anger. Is the
client able to recognize when he or she is angry now? Can the client take responsibility for these
feelings and keep them in check without losing control? Does the client seek out staff/support
person to talk about feelings when they occur? Is the client able to transfer tension generated by
the anger into constructive activities? Has harm to client and others been avoided? Is the client
able to solve problems adaptively without undue frustration and without becoming violent?
Eight Strategies That Can Help You Get A Handle On Your Anger:
1. Know your triggers:
Sit down and make a list of the things that are most likely to infuriate you. This can help you avoid
anger-inducing situations or, when that’s not possible, know when you should take steps to soothe
your angry feelings.
2. Focus on relaxing:
One way to cool down: Try relaxation techniques in the moment.
Find what works best for you, whether it's taking deep breaths from the diaphragm, giving yourself
a "time out" and going for a walk, playing soothing music or another strategy.
3. Be assertive, not aggressive, to problem-solve:
Instead of lashing out, try communicating your feelings in a calm but direct way at the time the
incident occurs.
Addressing the problem with a cool head takes courage and patience. But if you're able to define
the problem, talk things through and reach an agreement, you can potentially eliminate the source
of your anger and prevent future outbursts. An outburst won't fix whatever is making you angry.
Once you're calmer, you can focus on actually solving the problem, which should always be the
goal.
4. Don't stew in your own juices:
If you tend to suppress your anger, it can build up. This can eventually lead to explosions at
unexpected or inappropriate times. Address issues as they arise rather than letting them pile up.
But remember: Be assertive, not aggressive.

17. 5. Look at the situation differently: "Changing your interpretation of the event will allow you
to cut the person slack and not take his actions personally," Burns explains. "You can't control
what other people do. You can, however, control how you react."
6. Let it go:
When you can't solve a problem, it can be frustrating and make you mad. Like when that driver
cuts you off and speeds away. Or when your boss makes you stay late and you have to miss an
important family event. "Sometimes, there's nothing you can do," Burns says. "You simply aren't
going to be able to solve the problem — either in the moment or in the future."
7. Own your anger:
That means being willing to listen — without getting angry or defensive — when others tell you
that you have a problem. Use feedback from family, friends and co-workers to reflect on your
behavior and find situations where your anger got the better of you.
8. Get help if you need it:
It's OK to start by trying to make positive behavior changes on your own. Get professional help,
however, if self-management isn't working and your anger is causing health issues or hurting
others.
"There's nothing wrong with admitting you need help," Burns says. "But whether you use self-
management techniques or see a professional, the important thing is to take control of your anger
so it no longer controls you."
RESEARCH ARTICLE
Anger Management among Medical Undergraduate Students and Its Impact on Their Mental
Health and Curricular Activities by: Gayathri S. Prabhu,
Department of Anatomy, Melaka Manipal Medical College, Manipal University, 12 July 2016
ABSTRACT
Background: This study was intended to determine the practice of students in good anger
management skills and to what extent their anger can affect their studies, work, and social
interactions.
Variable: In this study the relationship between anger management and the effects on the mental
health of medical students was evaluated.
Sampling technique: A survey was also done to determine duration of the feeling of anger which
lasts among medical students and its consequences.

18. Materials and Methods: A newly developed questionnaire was utilized which included a simplified
version of the Novaco Anger Scale and Provocation Inventory and the modified Patient Health
Questionnaire 9 (to measure the mental health).
Results: The data suggests that although students with high anger tendencies display poor mental
health, there is no lowering of the mental health/PHQ-9 score as the anger management technique’s
effectiveness rises. “Friends” was cited as the major triggering factor for anger, whereby the
feelings can last for up to a day and somewhat affect their concentration on normal activities.
Conclusion: When anger is suppressed and not let out, it can be an underlying factor for anxiety
and depression. Therefore, more emphasis needs to be placed on educating students on how to
manage their anger especially in a stressful environment away from home.
SUMMARY: Today we had discussed about anger and aggression, its’s predisposing factors,
various stages, sign and symptoms, nurse’s response toward aggression and management.
CONCLUSION:
Anger is a normal human emotion that is crucial for individual’s growth. When handled
appropriately and expressed assertively, anger is a positive creative force that leads to problem
solving and productive change. When channeled inappropriately and expressed as verbal
aggression or physical aggression, anger is destructive and potentially life threatening force.
Patients admitted to an inpatient psychiatric unit are usually in crisis, so their coping skills are even
less effective. During these times of stress acts of physical aggression or violence can occur.
Nurses spends more time in the inpatient unit than any other disciplines, so they are more at risk
of being victims of acts of violence by patients. For these reasons, it is critical that psychiatric
nurses be able to assess patients at risk for violence and intervene effectively with patients before,
during and after an aggressive episode.
BIBLIOGRAPHY:
 R Sreevani A Guide to Mental Health and Psychiatry Nursing JAYPEE Publications 2nd
edition page no- 242-243
 Psychiatric Nursing Contemporary Practice Mary Ann Boyd Lippincott Publications 2nd
edition Page no: 950-970
 Psychiatric mental health nursing concepts of care in Evidence-Based practice Mary C.
Townsend JAYPEE Publications 8th edition Page no: 262-271
 Kaplan HI, Sadock BJ. Synopsis of Psychiatry , Behavioral Sciences/ Clinical Psychiatry
.9th ed. Hong Kong :William and Wilkinson Publishers;1998.
 Stuart GW, Laria MT. Principles and Practices of Psychiatric Nursing. Ist ed. Philadelphia:
Mosby Publishers; 2005. Page no- 630-651.
 https://www.hindawi.com/journals/edri/2016/7461570/
 https://www.slideshare.net/MenanRabie/psychology-of-aggression
 https://www.slideshare.net/ > sunilkumar3828/theories-of-aggression-141218680