Anger is a strong feeling or condition of displeasure and antagonism that can depress the immune system and induce abnormal electrical activity in the heart (Wenneberg et al., 1997). Common sources of anger are illness and the health care experience (Whyte & Smith, 1997).
Some other sources of anger include: attacks from others (including other health care workers), lack of assistance and support, and differential treatment based on unchangeable characteristics (age, gender, ethnicity, etc.).
Work-related anger can result in severed relationships, feelings of guilt, power-lessness, isolation, humiliation, and incompetence (Brooks, Thomas, & Droppleman, 1996), or problem-focused coping (Mand-erino & Berkey, 1997; Thomas & Droppleman, 1997). A result of unresolved anger can be depression (Rosaletal, 1997). Rob-bins and Tanck (1997) asked 77 undergraduate students to complete the Beck Depression Inventory and keep a psychological diary for 10 consecutive days, answering questions dealing with felt anger and expressed anger and several measures of depressed affect. The tendency to attribute the cause of angry feelings to their own actions was positively related to depressed affect, and the tendency to inhibit expression of anger was positively related to the measure of depression.
Changes in health care management can lead to grief in the health care professional. Change involves loss and grief (including denial, anger, bargaining, depression, and acceptance) and arc expected responses (Daugird & Spencer, 19%). Although medical providers may recognize anger in clients, they may not have been educated to deal with it effectively, according to Doblin and Klamen (1997).
Research shows that anger can affect blood pressure negatively and can bring on asthma symptoms and angina attacks. Even recalling angry events from the past can trigger abnormal electrical activity and heartbeats in individuals with heart disease (Siegman & Snow, 1997), and high levels of expressed anger may be a risk factor for coronary heart disease, at least for older men (Kawachi et al.. 1996). Learning to forgive, staying submissive, reducing negative attitudes, taking on a confidant, taking care of a pet, and avoiding overstimulalion are key solutions (Gabay et al., 1996; Shapiro, Goldstein. & Jamner, 1996; Spicer & Chamberlain, 19%; Whiteman, Deary, Lee, & Fowkes, 1997).
A study by Wenneberg and colleagues (1997) found that modes of anger expression may be associated with increased platelet aggregation. Raikkonen and colleagues (1996) linked anger with insulin resistance syndrome.
Anger Management Training
Lark in and Zayfert (1996) provided anger management training for 13 people with essential hypertension. The program included 6 weeks of relaxation training, self-statement modification, and role-play as-sertiveness training. Participants in the program exhibited significantly lower dia-stolic blood pressures, significantly more assertive skills, and lesser diastolic blood pressure reactivity after training than did controls.
Appels and colleagues (1997) reported the use of breathing therapy to reduce anger and the risk of new cardiac events after a percutaneous coronary angioplasty. Thirty postangioplasty participants and 65 controls comprised the sample that was studied for an average period of 16 and 18 months, respectively. Breathing therapy resulted in u significant decrease of the mean exhaustion scores and reduced the risk of a new coronary event (cardiac death, coronary artery bypass grafting, myocardial infarction, angioplasty, and restenosis) by 50%. The results indicated that breathing therapy can reduce vital exhaustion and hostility, thereby reducing the risk of a new cardiac event.
Employing a randomized group design, Chemtob, Novaco, Hamada, and Gross (1997) used a 12-session anger treatment with severely angry Vietnam War veterans with combat-related posttraumatic stress disorder. Controlling for pretreatment scores, the researchers found significant effects on anger reaction and anger control measures even at 18-month follow-up.
Linchan, Tutck, Heard, and Armstrong (1994) used a 1-year clinical trial with 26 chronically suicidal female individuals assigned to either a dialectical behavior therapy or a usual treatment. The cognitive-behavioral treatment group had significantly better scores on measures of anger, interviewer-rated global social adjustment, and the Global Assessment Scale and tended to rate themselves better on overall social adjustment than treatment-as-usual subjects.
Petajan and colleagues (1996) randomly assigned 54 people diagnosed with multiple sclerosis to exercise or nonexercise groups. Anger scores were significantly reduced.
Jette and colleagues (1996) reported a videotaped, home-based strength training program (Strong-for-Life) with older adults age 66 to 87. Participants were identified from the Medicare beneficiary list and randomized to exercise or no exercise. Older males achieved significant differences in perceived anger, tension, and overall social functioning.
According to Hargrave and Sells (1997) forgiveness and anger are mutually exclusive concepts. Once forgiveness occurs, anger leaves. The researchers reported the development of a forgiveness scale and presented data to support the validity and reliability of the instrument.
Keltner and Bonanno (1997) investigated the use of laughter to reduce distress and anger. To test their hypothesis that laughter facilitates an adaptive response by increasing the psychological distance from stress and enhancing social relations, they created measures of bereaved adults’ laughter and smiling. Duchenne laughter, which involves orbicularis oculi muscle action, related to self-reports of reduced anger and increased enjoyment, dissociation of distress, better social relations, and positive responses from strangers.
Tabak, Bergman, and Alpert (1996) reported a novel response to anger. They examined changes in the behavior of 67 women and 33 men between the ages of 67 and 85. Looking in the mirror at first aroused feelings of anger or despair followed by relief and calmness.
Brownley, Light, and Anderson (1996) examined the effects of anger and social support on clinic, work, and blood pressure in 129 black and white healthy adults. Angry black men with high tangible support tended to exhibit lower blood pressure than other black men. For white women, high belonging support was associated with lower blood pressure and low tangible support; high anger was also related to higher clinic blood pressure. Regardless of ethnicity or gender, high appraisal support was associated with lower overall blood pressure. The researchers’ findings suggest that the adverse effects of anger on blood pressure can be reduced by social support.