Frustration and Anger

Frustration is the feeling one gets when desires or goal-directed actions are blocked. Anger is an automatic reaction to a real or perceived threat to life or well-being. Frustration and anger responses can range from irritation to rage. These feelings are natural reactions to life events, but most of us learn to keep our anger responses under control to maintain good relationships with others.

People with chronic disabilities tend to have more anger control problems than people without disabilities. Their anger is often targeted at those closest to them, including life partners, children and other relatives. Individuals with chronic disabilities often experience anger issues along with anxiety and depression, making it difficullt to untangle the emotions.

Anger is not something to be ignored, even if it does seem natural under the circumstances. It can have devastating physical, emotional and interpersonal costs. Over the long term, anger increases the risk of illness and heart disease, damaged relationships, lost jobs, loss of self-esteem and feelings of powerlessness. Expressions of anger have significant effects on caregivers - there are limits to what anyone can tolerate.

Individuals with chronic disabilities may become frustrated when activities that were once simple become laborious and time-consuming, if not impossible, to manage independently. Empathy and a problem-solving approach can be helpful in such situations.

Take care not to minimize your loved one’s feelings and experience by claiming to “know how it feels.” No one is able to walk in another’s shoes unless their bunions and corns are in the same spots. Such statements also appear to shift the attention from the individual to yourself. An empathetic response (e.g., It must be so frustrating for you to have problems with something that used to be so easy for you) keeps your loved one as the focus. A problem-solving attitude looks for ways to reduce causes of frustration. For instance, if tying shoelaces is a challenge, replace them with slip-ons or shoes with Velcro closures. There is no need to make life more difficult than it needs to be.

Dr. Judith Beck, a psychologist known for her work in cognitive-behavior therapy, suggests that anger is based on how one perceives an event, rather than the event itself. For instance, people get angry when they believe that someone acted with the intent to hurt them, even if the action was accidental or simply thoughtless. Individuals with a strong sense of what people “should” do, based on their own standards, values and expectations of others, are likely to be disappointed - and angered - by others’ behaviour.

People have different anger styles. Some express their anger whenever the feeling arises, whether useful or not. Other people tend to stuff their anger deep inside because they believe that anger is an unacceptable feeling. This approach leads to stress-related health problems and a tendency toward passivity or passive-aggressive behaviour. Still others who suppress anger are like Mount Vesuvius, letting pressure build until they blow, often at incidents that, on their own, merit a more measured expression of anger. A variation on these anger styles is to build resentment toward a person or situation by creating a list of affronts. When these individuals engage in an argument, the old baggage comes out with the current issue, often surprising the target who has forgotten about these incidents. Besides specific resentments, some persons who have lost a great deal due to their disability may build a general resentment of those who are healthy.

People need to

• accept their own anger as a natural emotion
• develop skills for expressing their emotions or needs assertively (rather than aggressively or not at all)
• learn to recognize and respond to their emotional triggers differently, which includes resisting the tendency to assume intent or hold unreasonable expectations

Anger management therapies often include these elements, along with relaxation techniques already described in Module 3 on caregiver stress and in this module’s discussion of anxiety.

Caregivers can support individuals with anger management challenges by using the following strategies:

• Do not accept verbal, emotional or physical abuse directed toward yourself or others. A major barrier to managing anger is “minimization” of its impact.
• Agree that you will work on anger management issues together.
• Explain how you feel when confronted by your loved one’s anger. Use “I feel” rather than “You did” statements.
• Recognize and avoid patterns of behaviour that lead to arguments and angry responses.
• Identify and discuss triggers for anger together. Avoid known triggers when possible.
• Agree to take a time-out when needed to calm down. Respect each other’s need to be alone to calm down, knowing that the trigger issue will be addressed afterwards.
• Encourage self-monitoring of stress.
• Encourage regular relaxation exercises.
• Encourage participation in daily physical activity and exercise to manage stress. See Module E for more information on physical activity.
• Encourage your loved one to practise the anger management strategies.
• Seek assistance if there is a persistent anger problem, or if there is danger of harm to yourself or others. Assistance may include individual therapy, couples therapy or group therapy.
• Take an interest in your loved one’s anger management homework. Share exercises and discuss findings.

As noted in the earlier section on personality change, individuals who have experienced damage to certain parts of the brain may change from being easy-going to easily angered. Depending on the cognitive abilities that have been affected, therapeutic approaches to anger management may differ from the usual. Caregivers should recognize and try to reduce triggers whenever possible. They should educate others about any instructions the therapist has given to support the treatment of anger issues.