About anger and aggression and its management

2. What is Anger ?
Anger is a basic human emotion that is
experienced by all people.
Typically triggered by an emotional hurt,
anger is usually experienced as an
unpleasant feeling that occurs when we
think we have been injured, mistreated,
opposed in our long-held views, or when
we are faced with obstacles that keep us
from attaining personal goals.

3. In Other Words ,
It 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 increases in heart rate ,blood pressure,
and levels of the hormones epinephrine and
norepinephrine.
( American Psychological Association,2013)

4. CHARACTERSTIC OF ANGER
 Anger is not a primary emotion, but it
is typically experienced as an almost
automatic inner response to hurt,
frustration or fear.
 Anger is physiological arousal .It
instills feelings of power and
generates preparedness.
 The expression of anger is learned.

5.  The expression of anger can come
under personal control.
 When anger is suppressed it is
resentment , which often manifests
itself in negative, passive-aggressive
behavior .

6. FUNCTION OF
ANGER

7. POSITIVE FUNCTION
OR
CONSTRUCTIVE USES
 Anger energies and mobilizes the body for
self –defense .
 Communicated assertively , anger can
promote conflict resolution.
 Anger arousal is a personal signal of threat
or injustice against the self .

8.  Anger is constructive when it provides a
feeling of control over a situation and the
individual is able to assertively take charge
of situation .
 It serves to increase self –esteem and leads
to mutual understanding and forgiveness.

9. NEGATIVE FUNCTIONS
OR
DESTRUCTIVE USES
 Without cognitive input , anger may result
in impulsive behavior, disregarding
possible negative consequences.
 Communicated passive-aggressively ,
conflict escalated and the problem that
creates the conflict goes unresolved .
 Anger can lead to aggression when the
coping mechanism is displacement .

10.  It can be destructive
when the feeling of
control is exaggerated
and the individual uses
the power to intimidate
others.
 It masks honest feeling
,weaken, self –esteem
and leads to hostility and
rage .

11. Aggression refers to
behavior that is intended
to threaten or injure the
victim’s security or self –
esteem .it is a response
that aims to inflicting
pain or injury on object
or persons.
(Warren,1999 )

12. CHARACTERISTICS
 Aggressive behavior is communicated verbally or
non verbally
 Aggressive people may invade the personal space of
others
 They may speak loudly and with greater emphasis

13.  They usually maintain eye contact over a prolonged
period of time so that the other person experiences
it as an intrusive
 Posture is erect and often aggressive people lean
forward slightly towards the other person. The
overall impression is one of power and dominance

14. TYPES OF AGGRESSION
 Instrumental Aggression
Aggression aimed at obtaining an object,
privilege or space with no deliberate intent
to harm another person

15.  Hostile Aggression
Aggression intended to harm another
person, such as hitting, kicking, or
threatening to beat up someone.

16.  Relational Aggression
A form of hostile aggression that does
damage to another's peer relationships, as
in social exclusion or rumor spreading

17. MOYER CLASSIFICATION
Moyer (1968) presented an early and
influential classification of seven
different forms of aggression, from a
biological and evolutionary point of view.

18.  Predatory aggression:
Attack on prey by a predator.
 Inter-male aggression:
Competition between males of the same
species over access to resources such
as females, dominance, status, etc.

19.  Fear-induced aggression:
Aggression associated with attempts to
flee from a threat.
 Irritable aggression:
Aggression induced by frustration and
directed against an available target.

20.  Territorial aggression:
Defense of a fixed area against intruders,
typically conflicts.
 Maternal aggression:
A female's aggression to protect her
offspring from a threat. Paternal aggression
also exists.
 Instrumental aggression:
Aggression directed towards obtaining some
goal, considered to be a learned response to
a situation.

23. How does the Body React To Anger
And Aggression
 Anger doesn’t make the “blood boil” or your
eyes “see red”. But it does cause certain
changes in the body. Here’s what happens:
 ADRENALINE and other chemicals pour into
the bloodstream.
 THE HEART pumps faster.
 BLOOD PRESSURE rises.
 BLOODFLOW quickens.
 MUSCLE tense.
 IN OTHER WORDS, the body shifts into
higher gear, generating energy needed for
action. Learn how this energy can work to
your advantage or disadvantage.

24. THEORIES OF
AGGRESSION
PSYCHOLOGICAL THEORY
BIOLOGICAL THEORY
SOCIO-CULTURAL THEORY

25. PSYCHOLOGICAL
THEORY

26. SOCIO-CULTURAL
THEORY
Social determinants of violence are:
 Poverty and the inability to have basic
necessities of life
 Disruption of marriages
 Production of single-parent families
 Unemployment
 Difficulty in maintaining interpersonal ties,
family structure and social control.

27. BIOLOGICAL THEORY
Current biological research has
focused on three areas of the brain
believed to be involved in
aggression:
 Limbic system
 Frontal lobes
 Hypothalamus.

28. PREDISPOSING FACTORS
 GENETIC FACTORS
 NEUROTRANSMITTERS
 NEUROPHYSIOLOGICAL
DISORDERS

29.  PSYCHOLOGICAL FACTORS
 SOCIAL FACTORS
 ENVIRONMENTAL FACTORS
 SITUATIONAL FACTORS

30. NURSING PROCESS
FOR
ANGER
AND
AGGRESSION

31. General Principles of
Management
 The safety of patient, clinician , staff ,other patients and potential
intended victims is of most importance while looking after
aggressive patients
 The doors should be open outwards and not be lockable from
inside or capable of being blocked from inside.
 while working with impulsively aggressive or violent patients in
any setting one must take care to reduce accessibility to
patients of movable objects as well as jewelers and other attire
that might add to the risk of injury during an assault, including
neckties, necklaces, earrings, eyeglasses, lamps and pens.

32.  Adequate caregiver training and the availability of
appropriate supervision are critical safeguards in the
treatment of potentially dangerous patients.
 The caregiver may choose to present a few key
observations 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.
 For caregivers treating patients with a high risk for
violence behavior, training in basic self defence
techniques and physical restraint techniques are
useful.

33. DRUG TREATMENT
PURPOSES
 To use sedating medication in an acute
situation to calm the client so that client
will not harm self or others.
 To use medication to treat chronic
aggressive behavior.

34. ACUTE AGITATION AND
AGGRESSION
ANTIPSYCHOTIC
 Haloperidol-1 mg or 0.5 mg IM
 Risperidone 0.5mg-1mg- In dementia
and schizophrenia.
 Trazodone – 50-100mg . In older clients
with sun downing syndrome and
aggression.

35.  BENZODIAZEPINES
Used due to the sedative effect and
rapid action. Most commonly lorazepam,
oral or injection.

36. CHRONIC AGGRESSION
 Antipsychotic
 Anxiolytics- Buspirone
 Carbamazepine and valproate to treat
bipolar associated aggressive behaviour.
 Antidepressants –trazodone in aggression
associated with organic mental disorder.
 Antihypersensitive medication – Propanolol
to treat aggression related to organic brain
syndrome.

37. NURSING INTERVENTIONS
 Self awareness
 Patient education
 Communication strategies

38.  Environmental strategies
1. Room programme
2. Cathartic activities
 Behavioral strategies
a) Limit setting
b). Behavioral contracts
c). Time out
d). Token economy
e). Restraints

39. RESEARCH PAPER
 Azam Movahedi ,2016 conducted an research study on the effectiveness of
training anger control skills on housewives public health referring to the
consultation centers of district 4 of Tehran. The present study was a semi-
experimental study that was randomly performed on 64 housewives
referring to the consultation centers of district 4 of Tehran patients. The
clients were divided randomly into two experimental and control groups. To
collect data, the Eysenck personality questionnaire, General Health
Questionnaire (GHQ), was used. After random selection of experimental
and control groups, firstly the pre-test was conducted on two groups and
after the intervention (anger control training), it was presented in 90-minute
8 sessions and after completing the training program, the post-test was
performed on both groups. The data were analyzed using analysis of
covariance. At first, the two groups were no differences in general health
scores. General health mean in the group after the test was different. So
that anger management training was effective on general health of
intervention group after the training. Based on the results, anger control
training affected on three areas of anxiety, depression and social
performance (p<0.05). Based on the results, anger control training affected
on public health and its components. It is recommended to hold anger
management programs and sessions for women who referred to
consultation centers and health centers.