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his/her/their new strategies for managing anger; create a hierarchy to guide practice of these situations.
Use any of several techniques, including relaxation, imagery, behavioral rehearsal, modeling, role-playing, or in vivo exposure/behavioral experiments to help the client consolidate and generalize the use of his/her/their new anger management skills into daily life.
Decrease the number, intensity, and duration of angry outbursts, while increasing the use of new skills for preventing or managing anger. (36) Monitor the client's reports of anger episodes toward the goal of decreasing their frequency and increasing adaptive management through the client's use of new anger management skills (or supplement with “Alternatives to Destructive Anger” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce); review progress, reinforcing success, and providing supportive corrective feedback toward sustained improvement.
Learn and implement relapse prevention strategies. (37, 38, 39, 40, 41) Discuss with the client the distinction between a lapse and relapse, associating a lapse with an initial and reversible angry outburst and relapse with the choice to return routinely to his/her/their old pattern of anger.
Identify and rehearse with the client the management of future situations or circumstances in which lapses back into maladaptive anger could occur.
Instruct the client to routinely use new anger management strategies learned in therapy (e.g. calming, adaptive self-talk, assertion, and/or conflict resolution) to prevent or respond to frustrations.
Develop a “coping card” or other reminder on which new anger management skills and other important information (e.g. “Recognize moments to stop, think, and act,” “Calm yourself,” “Be flexible in your expectations,” “Voice your opinion calmly,” “Respect others' points of view”) are recorded for the client's later use.
Schedule periodic “maintenance sessions” to help the client maintain therapeutic gains.
Identify social supports that will help facilitate the implementation of anger management skills. (42) Encourage the client to discuss his/her/their anger management goals with trusted persons who are likely to support his/her/their change. Participate in Acceptance and Commitment Therapy (ACT) for learning a new approach to anger and anger management. (43, 44, 45, 46) Use an ACT approach to help the client experience and accept the presence of anger-invoking thoughts and images without allowing them to change the client's commitment to value-driven action; reinforce the client's efforts toward engaging in activities that are consistent with identified, personally meaningful values (see Acceptance and Commitment Therapy by Hayes, Strosahl, & Wilson). Teach mindfulness meditation to help the client recognize the negative thought processes associated with anger and change his/her/their relationship with these thoughts by accepting thoughts, images, and impulses that are reality-based while noticing but not reacting to non-reality-based mental phenomena (see Guided Mindfulness Meditation [Audio CD] by Kabat-Zinn). Assign the client homework in which he/she/they practice lessons from mindfulness meditation and ACT in order to consolidate the approach into everyday life. Assign the client reading consistent with the mindfulness and ACT approach to supplement work done in session (see Get out of Your Mind and into Your Life: The New Acceptance and Commitment Therapy by Hayes). Gain insight into the origins of current anger control problems by discussing experiences that may be involved in their development. (47, 48) Assist the client in identifying past relationship dynamics (e.g. with father, mother, others) that may have influenced the development of current anger control problems; discuss how these experiences have positively or negatively influenced the way he/she/they handle anger. Verbalize an understanding of how anger has been reinforced as a coping mechanism for stress. (48) Teach the client how anger blocks the awareness of pain, discharges uncomfortable feelings, erases guilt, and places the blame for problems on others. Verbalize an understanding of the need for and process of forgiving others to reduce anger. (49) Assist the client in identifying whom he/she/they need to forgive, and educate him/her/them as to the long-term process that is involved in forgiveness versus a magical single event; recommend reading books on forgiveness (e.g. Forgive and Forget by Smedes); review the client's progress, reinforce success, and assess its impact on anger reduction. Verbalize an understanding of the concept of a higher power and the benefits of acceptance of such a concept. (50) Teach the client about the 12-step recovery program concept of a higher power, and how to turn over perpetrators of pain to his/her/their higher power for judgment. Implement regular physical exercise to reduce tension. (51) Teach the client the benefits of regular physical exercise; assign a program of implementation. Attend 12-step recovery group meetings regularly and share feelings with others there. (52) Teach the client the importance of actively attending 12-step recovery meetings, getting a sponsor, reinforcing people around him/her/them, and sharing feelings. Develop a long-term plan to recover from substance abuse and anger. (53) Assist the client in developing a five-year personal recovery plan.
Complete a survey to assess the degree of satisfaction

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