The American Psychological Association (APA) recently asked anger expert Dr. Howard Kassinove the following questions about the common but difficult emotion of anger.

APA: What is anger and how does it differ from aggression?

Dr. Kassinove: Anger is a negative feeling state that is typically associated with hostile thoughts, physiological arousal and maladaptive behaviors. It usually develops in response to the unwanted actions of another person who is perceived to be disrespectful, demeaning, threatening or neglectful. Anger involves certain styles of thinking such as, “My boss criticized me in front of my colleagues. Now, I’m fuming. He shouldn’t be so disrespectful!” or “That woman in front of me is driving so slowly. This is exasperating. She shouldn’t be allowed to drive on the freeway!” Anger energizes us to retaliate. Our data indicate that about 25 percent of anger incidents involve thoughts of revenge such as, “I’m going to spread rumors about my boss to get even,” or “I’d like to just bump her car to put her in her place.” Interestingly, anger usually emerges from interactions with people we like or love, such as children, spouses and close friends.

Angry thoughts may be accompanied by muscle tension, headaches or an increased heart rate. In addition, the verbal and physical expressions of anger may serve as a warning to others about our displeasure. The verbal expressions include yelling, arguing, cursing and sarcasm. However, anger can also be expressed physically by raising a clenched fist, throwing a book on the floor, breaking a pencil or hitting a wall. Sometimes, anger is not expressed externally but remains as internal rumination.

Aggression, in contrast, refers to intentional behavior that aims to harm another person. Often, it reflects a desire for dominance and control. In the cases I see in my clinical and research work, weapons are often involved. Aggression can be shown by punching, shoving, hitting or even maiming another person, and it can occur in marital violence, child or elder abuse, bullying or gang and criminal activities.

Since anger is typically expressed only through loud verbalizations, it is the cases of aggression that wind up in the criminal justice system. Our research shows that about 90 percent of aggressive incidents are preceded by anger. However, only 10 percent of anger experiences are actually followed by aggression. People often want to act aggressively when angry but, fortunately, most do not actually take aggressive actions. Also, there is sometimes an impulse to engage in problem solving behaviors when angry.

Yet, anger is an important problem in its own right with negative consequences in many aspects of life such as marriages, the workplace, parent-child interactions and driving behavior. Anger is associated with interpersonal conflicts, negative evaluations by others, erratic driving, property destruction, occupational maladjustment, inappropriate risk taking, accidents, substance abuse and so-called crimes of passion.

APA: What are some of the positive aspects of anger?

Dr. Kassinove: Many of the longer-term outcomes of anger are negative. Yet, anger is part of our biological history. It is part of the fight-or-flight reaction. It had survival value in the past and it has some positives in the present. Many of these, however, are short-term benefits as few of us like to spend time with angry people.

Anger can be an appropriate response to injustice. No doubt, anger played a useful part in social movements for equality for blacks, the elderly and women, among others. Anger may also lead to better outcomes in business negotiations as well as an increased motivation to right the wrongs we see in the world.

The positives include its alerting function. Anger tells others it is important to listen to us – that we feel agitated and it is wise to be alert to our words and actions. It may also lead to compliance by others. Strongly asserting that we were first in line at a store counter may lead to better service. Also, in the short term, children and others may be more likely to comply with our requests when we are angry. “Don’t go in the street without holding mommy’s hand!” when said angrily to a small child, can be lifesaving.   

Anger sometimes just feels good and righteous. We may feel angry when watching a movie or a play where a character suffers inappropriately. Then, when good triumphs over evil, anger is replaced with a feeling of satisfaction.  Playwrights have known about this for eons. In a similar vein, anger provides a certain zest for life. Can you imagine a world with no anger? The healthier, milder levels of irritation and annoyance add spice to daily existence and we all seem to enjoy that.

APA: What are some of the potential health consequences of anger?

Dr. Kassinove: Many people consider excessive anger to be just a psychological problem. That is a gross simplification. When we become angry, the autonomic nervous system is aroused. For example, anger precipitated by the discovery of a spouse’s secret affair will likely lead to arousal of the sympathetic nervous system and associated hormonal and neurochemical changes. These physiological reactions can lead to increases in cardiovascular responding, in respiration and perspiration, in blood flow to active muscles and in strength. As the anger persists, it will affect many of the body’s systems, such as the cardiovascular, immune, digestive and central nervous systems. This will lead to increased risks of hypertension and stroke, heart disease, gastric ulcers, and bowel diseases, as well as slower wound healing and a possible increased risk of some types of cancers.

Research has found that anger is an independent risk factor for heart disease. Having a tendency to experience anger frequently, in many types of situations, is known as high trait anger. One study followed 12,986 adults for approximately three years and found a two to three times increased risk of coronary events in people with normal blood pressure but with high trait anger. Another study followed 4,083 adults for 10 to 15 years. Those who were lowest on anger control had the highest risk of fatal and non-fatal cardiovascular events. After reviewing the literature, experts have concluded that high trait anger, chronic hostility, anger expression and acute anger episodes can lead to new and recurrent cardiovascular disease. When anger is experienced moderately and expressed assertively it may be less disruptive than when it is frequent, intense and enduring.

APA: What has psychological research revealed about why some people are more prone to anger than others?

Dr. Kassinove: Proneness to anger has to be examined with regard to thoughts, physiological reactions and physical activity. With regard to the physiological reactions, some people are easily aroused and quickly respond to aversive stimuli. They rapidly become angered by bad smells, heat and annoying noises. Others are slow to react and seem not bothered by such stimuli. Genetic variability plays a big part here.

Physical expressions of anger, such as sulking, banging the desk or hitting the wall are learned by the forces of reinforcement and copying others.

Finally, some evidence suggests that violent video games and, perhaps, listening to angry music with violent lyrics may fuel anger and aggression in some people. In violent videogames, players hear quick-paced, excitatory angry music. They learn to be hyper alert, to respond impulsively and to kill opponents. This leads to reinforcement in the form of points, acquisition of new weapons, access to upper levels of the games and accolades by others in the gaming environment. 

APA: What are some of the steps that people can take when dealing with anger among family members or friends?  How would they differ from dealing with a stranger – such as a store clerk, taxi driver or other service person?

Dr. Kassinove: Anger felt when dealing with strangers emerges from transient interactions. You may never see the clerk or driver or waiter again. If you ask yourself how important the annoying situation really is, you usually come up with, “not very important at all.” At most, you have suffered from paying a bit too much for the taxi ride or being delayed a few minutes by the clerk. Recognize that these are unpleasant events, not catastrophes, and work around them. Go to a different restaurant or go to the store at off hours to return a purchase.

Also, recognize the difference between events that you can change and those that are beyond you. When you take a cab ride, tell the driver about your preferred route. When you order that steak in the restaurant, ask for extra ketchup before the waiter leaves the table never to be seen again. You have less control over other events. Airplanes, for various reasons, are frequently late. There is little you can do. Accept the delay as an opportunity to read or relax, not disastrous or worthy of anger.

Anger felt when dealing with family members or friends is different because of the ongoing interactions. To address this kind of anger, the self-help strategies that are quickest and easiest to use are avoidance and escape, relaxation, cognitive restructuring and assertive expression. 

Directly facing all problems may not be the best solution. Sometimes, avoiding an interaction that is likely to lead to anger is best. For example, allow a spouse to deal with an unfair store clerk or a disruptive child. Learn that you can occasionally lean on others to work out problems. Relaxation is a great tool to deal with anger, since angry folks tense their muscles and develop headaches and stomach aches. Find a comfortable chair that will support the arms and legs, and a quiet time. Take deep breaths and focus on allowing the muscles to voluntarily relax. Become aware that muscular relaxation is learned through practice. Soft music often helps. Cognitive restructuring refers to learning how to appropriately analyze aversive situations. Anger experiences are often associated with cognitive distortions, such as misappraisals about the importance of the event or about the capacity to cope. Anger is a moral emotion and typically associated with justice-oriented demands in the form of “should.” In addition, angry adults make overgeneralizations about the meaning of behaviors shown by others and they limit their options with “either/or” thinking, such as “Either he’s my friend or he’s not. It’s just that simple!” Learn to see negative situations as bad, but also as opportunities to develop coping skills and learn new behaviors. Recognize that others do good and bad things. Get rid of those broad generalizations about people.

To be assertive means expressing anger directly, in an appropriate tone and without demeaning the other person. If you have been offended or disrespected, it is OK to say, “When you said my work was subpar in front of the others, I felt angry. I’d like to talk to you about the situation so that we can improve our relationship.” It is quite another thing to say, “You acted like a real jerk today. How dare you talk like that in front of the others! You have plenty wrong with you also!”

APA: At what point should a person seek professional help for anger?

Dr. Kassinove: Some degree of anger will be with us for all of our lives. So, this is the question to ask: “Is my anger working for me?” When anger is mild, infrequent, dissipates quickly and is expressed assertively (directly to the problem person, in a non-accusatory manner) and without aggression, then professional help is not needed.  In such circumstances, anger may serve the role of simply highlighting your annoyance and it can lead to problem resolution. 

However, if your anger is moderate to intense, experienced frequently, endures to the point where you are holding a grudge and are planning to get even, and is expressed in aggressive verbal and physical actions, then there is cause for alarm. You are likely at risk for the negative relationship, health and sometimes legal repercussions related to inappropriate anger expression. 

APA: What are the most effective treatments for people who have a serious anger problem and wish to gain control over the emotion?

Dr. Kassinove: Anger management works. There have been six large-scale analyses of adult anger management programs. The latest one reviewed 96 different studies and concluded that psychological treatments are moderately effective for treating anger in various groups. This includes work to reduce anger in college and university settings, community treatment facilities, correctional facilities and hospitals. In some cases, significant effects were found in as little as eight treatment sessions and the results were maintained in follow-ups of a month to a year. The strongest effects are found with multicomponent treatment programs. Interventions based on cognitive or cognitive-behavioral therapy, psychodynamic therapy and skill training work best. Relaxation programs, stress inoculation programs and exposure-based interventions are also helpful.  

It is wise for individuals seeking anger management services to begin at their local universities or hospitals and to ask how long they have offered anger management services. Personnel with up-to-date research knowledge and specific training and more experience working in the area of anger management are likely to provide the best service. 

Howard Kassinove, PhD, ABPP, is professor of psychology at Hofstra University and director of the university’s Institute for the Study and Treatment of Anger and Aggression. A former director of Hofstra’s PhD program and chair of the Psychology Department, he has more than 40 years’ experience as a scientist and professional psychologist.

Kassinove is a fellow of the APA and the Association for Psychological Science. He is board certified in clinical psychology and is the current president of the American Board of Cognitive and Behavioral Psychology. He has co-authored two books about anger: Anger Management: The Complete Treatment Guidebook for Practitioners (2002, Impact Publishers) and Anger Management for Everyone: Seven Proven Ways to Control Anger and Live a Happier Life (2009, Impact Publishers).