Background: Association Adolescent Child Care in India conducts Life Skills workshop (LSE) for children and adolescents across cities. This paper analyses the data of an anger management session in high school children.

Objective:

1. To analyse how anger is expressed in high school children and their families.
2. Teaching various aspects of anger and constructive ways to express anger.

Materials & Methods: A customized AACCI worksheet was given to 65 participants aged 13-15 years of age attending LSE workshop in Nagpur, India. Participants were asked how they express their anger; giving four choices and explaining what each is -venting, rationalization, withdrawal, and distraction. They were asked to fill in how their parents, siblings and their significant adult in their life express anger. Chi square test of independence was conducted to understand how children’s anger expression is related to familial expression of anger.

Results: In this sample, from children’s data, we found distraction 50%, venting 29%, withdrawal 7% and rationalization 14%. In family patterns of expressing anger, venting was most common- mothers (58%) and fathers (40%). Rationalizing was the second most common way of expressing anger - mothers 31% and fathers 35%. Chi square revealed significant relationships at p<0.00001.

Conclusion:

1. Parents need to learn constructive ways of anger expression as role models. This study has shown that parental expression of anger influences children’s expression of anger.
2. This sample of mid adolescence (13-15yrs) uses less impulsive and expressive means of expressing anger, those that reduce conflict situations.

Limitations:This is a pilot study, hence sample is small. Larger sample is required for further validation. However we have got statistically significant results.

Keywords: anger, venting, distraction, rationalizing, withdrawal, family pattern

Anger is one of the most basic emotions displayed in everyday life. However, it is often misunderstood as a problematic emotion because some of the reactions it elicits can put people in trouble. It can also easily lead to aggression and hostility.

The American Psychological Association¹ defines anger as an emotion characterized by tension and hostility arising from frustration, real or imagined injury by another or perceived injustice. It can manifest itself in behaviours designed to remove the object of the anger (e.g., determined action) or behaviours designed merely to express the emotion (e.g., swearing). Like any other emotion, anger has strong a cognitive, physiological, and behavioural component that guides its expression.

Familial patterns of expressing anger can play an important role in how children learn to handle their anger. Parents and significant others often get angry due their own frustration, interpersonal conflicts and possibly untreated mental illness. Attachment theory suggests that individuals’ history of interactions with their closest partners (“attachment figures”) shapes their ability to regulate emotions and behaviour, to ask for and benefit from social support, to care for others, and to capitalize on opportunities for personal growth and meaning through their social relationships.² Attachment processes are evident under conditions of stress and implicate a variety of health-related outcomes.^3,4

Anger in response to blocked goals emerges early in development and can be seen in infants as young as 4 months of age.⁵ School-aged children have reported feeling angry once a day on average and more often described their anger intensity as strong than as moderate or low. As children increase in physical mobility, parents respond with greater control (e.g., limit setting), and, in turn, elicit more anger from children.⁶ Mean levels of anger decrease after toddlerhood and into middle childhood,⁷ presumably as children become better at regulating their emotions and communicating and negotiating goals with parents and peers.

According to one author,⁸ emotion regulation is defined as “the processes by which individuals influence which emotions they have, when they have them, and how they experience and express these emotions”. The development of emotion regulation skills makes major progress throughout childhood.⁹ By early childhood, most children have developed strategies that enable them to regulate their emotions, and they have understood that the external expression of emotions does not have to match the internal emotional experience.¹⁰ They show an increasing use of strategies for regulating the anger expression (e.g., by substituting or neutralizing the anger expression) in order to comply with cultural display rules for the expression of emotions.¹¹ However, there is evidence that children find the regulation of anger more difficult than the regulation of other negative emotions like sadness.

Anger is different from aggression in that not all anger leads to aggression. Constructive anger can be seen in instances where it has driven people to fight against injustice and bring change. Destructive anger on the other hand can affect an individual’s health, his/her social, occupational and vocational life. Teaching anger management skills in middle childhood can be instrumental in helping children regulate themselves, assess their triggers and respond in a healthy manner. Teaching emotional regulation, teaching them to seek social connection and support when dealing with difficulty is essential. The goal of anger management is not to eliminate anger but to deal with its expression in a healthy way.

Sample size and selection

Convenience sample method was used. All participants, (n= 65) were children between 13 and 15 years of age from an LSE workshop conducted by AACCI in an English-medium co-ed school in Nagpur, Maharashtra in September 2009 were included. There were no exclusion criteria.

Procedure and Tools Used

In the workshop, children were first asked to brainstorm on how they express their anger. AACCI designed Anger Worksheet was given for them to fill. They were given four choices - venting, withdrawal or no reaction, distraction, rationalization or introspection and were explained what each meant. Students were asked to the put down the techniques used by them and the reasons for their choice. They were also asked to write about how their significant others i.e. their parents, siblings and any other individuals like grandparents who live with them express their anger. After the sheets were filled, a session was taken to explain all about anger - causes of anger, the expression of anger and how anger causes adverse effects on the mind and body and constructive ways of expressing anger was taught. Percentages were used to compare the results between children’s expression of anger and familial patterns of anger. Chi-square was used to understand the statistical significance of relationship between whether children’s anger management techniques and parental techniques.

Permissions and Ethical Considerations

Ethical clearance for this project was given by AACCI’s Institutional Ethics Committee. Parental permissions for conducting the workshop and the research studies were procured by the principal. Informed written assent (as legal consent can only be obtained from individuals above the age of 18 years) was obtained from students after explaining the rationale and benefits of the study in the language(s) that they could comprehend. The assent was part of the questionnaire and anonymity was maintained. This was not a clinical trial, and the participants were not patients.

Limitations

This is a pilot study, hence sample is small. Larger sample is required for further validation. However we have got statistically significant results.

The various ways in which anger is expressed were categorised under 4 major heads: viz. venting, distraction, rationalization and withdrawal (Table 1 & 2).

A Chi square value was also computed as a test of independence, to judge whether specific anger management techniques were being differentially used by students (self) and their family members (Table 3).

AACCI (Association of Adolescent and Child Care in India) (www.aacci.in) is a voluntary organisation that works for children and youth through parents and teachers and grandparents in schools and colleges. One of its main aims is Life Skill Education LSE for teens. Through life skill approach it aims at prevention of lifestyle disorders and promotion of mental health. Controlling and appropriately expressing anger involves many facets related to anger management. It involves understanding external and internal triggers of anger, understanding the cognitive and physiological aspects of the feeling of anger and eventually the healthy expression of anger.

As per Table 1, 50% of high school children use distraction as a means to express their anger. It is likely that high school students who live with their parents have learned to distract themselves from anger provoking scenarios in a wish to avoid altercation their parents or siblings. They may also have other modes of distraction like phone, television or even feel that they prefer to talk to their peers or romantic partners. When distraction is used as a primary mode of expressing anger, it can also suggest that high school children often feel misunderstood at home; that they are seen to exaggerate their problems and hence family members might be dismissive of their concerns. Children of this sample may also have bias about their family members in that they believe family members, including their siblings vent out much more than themselves. They may believe that they use distraction more as a means to resolve interpersonal anger, but parental information may differ.

Even though children of this age have developed cognitive and emotional maturity and are often able to integrate their experiences, they may not fully know how to express their feelings effectively in the context of an anger eliciting stimulus. It is important to remember that high school children are also financially and emotionally dependent on their parents and hence fear parental authority. They feel the need to placate or conform to parental rules because they need the parental support. In a previous study done by AACCI, where we compared anger expression between college students v/s school children,¹² we found that older college students tend to use distraction as a preferred way to cope up with anger more than any other method. This may be due to more emotional maturity and desire to cope up and avoid conflict situations.

Venting 29% was seen as the second most common way of school children expressing their anger. This suggests that some children might see this as a like for like treatment when their parents vent too, a behaviour that is vicariously learned. Alternatively, in overly permissive families, venting may be used as a form of demanding authority by the child, so that he needs are met immediately. When one vents, it is an immediate and impulsive expression of anger that the individual may or may not regret. In the same study by AACCI [12 when three groups were compared it was seen that the older students (17-21 years) from colleges used venting more often as did students who hailed from upper class. Students who had more vocational clarity and were more confident of employment in their future felt more autonomy to express their feelings outwardly than those students who were still dependent on their parents for financial and social support. In another study,¹³ it was observed that the relation between harsh parental coping strategies and children's emotional responding was moderated by parental distress. It was concluded that distressed parents who use harsh coping strategies in response to children's negative emotions have children who express emotion in relatively intense ways. According to the Cognitive Neoassociation theory,¹⁴ aversive events (e.g., frustrations, provocations, hot temperatures) produce negative affect which leads to cognitive and physiological responses of fight and flight thereby forming an associative network. Not only are associated aggressive thoughts linked together in memory but thoughts are also linked along the same sort of associative lines to emotional reactions and action tendencies.¹⁵ Cognitive Neoassociation theory predicts that venting should increase rather than decrease angry feelings and aggressive behaviours because venting, essentially, is practicing how to behave aggressively thereby keeping the memories of anger active.

14% of children were seen to rationalise their anger suggesting that they are developing cognitive maturity and are trying to integrate their experiences in a healthy way. Cognitive maturity comes from understanding their own feelings but also learning from others’ experiences which could be from exposure to real life scenarios, books and movies. A tendency to over intellectualise might also be present. With their busy schedules, it is also possible that children have learnt to rationalise as a coping mechanism to avoid unnecessary confrontations. In the study by AACCI,¹² students (16-18 years) used rationalization as a technique as did students (17-21 years). This suggested that some students were able to use introspection and rationalize their anger to manage it for themselves emotionally and also to diffuse the situation at home. In our sessions, we found that students from the middle socioeconomic group are more accepting of parental authority and are more prone to use anger expression that does not lead to conflict.

Barely 7% of school children were seen to use withdrawal as a technique to express their anger. This again, may be a learned behaviour at home and is a means to avoid conflict. It can also suggest that this subgroup feels misunderstood at home and hence prefers to ‘not react’ in anger provoking situations. Withdrawal can also concur with rumination at times with children. Rumination is defined as “self-focused attention,” or directing attention inward on the self, and particularly on one’s negative mood.¹⁶ In the study by AACCI,¹² only students who were still living with their parents’ used withdrawal as a technique to express their anger suggesting that when children are unable to process anger eliciting situations and manage them, they tend to withdraw. They withdraw to avoid conflict and might feel that they are not understood well enough. In one study,¹⁷ college students were angered by reading a story about a professor who treated a student unfairly and were told to imagine themselves in a similar situation. Participants who ruminated for 20 minutes reported being angrier than participants who were distracted.

Reasons for children’s anger according to a study¹⁸ indicate that the most anger provocative situations for the students are “being treated unjustly”, “attacks to personality” and “being criticized unfairly”. Moreover, high school students are significantly angrier when they are “criticized whatever the reason is”, university students are angrier “when others behave self-centred”.

According to Table 2, in this sample, when familial patterns of anger expression were observed, mostly patterns of mothers and fathers were taken into consideration. 58% of mothers used venting as compared to 40% of fathers. This suggests that mothers tend to use more venting because they are already multitasking a lot at home and/or work. They are easily distracted and interrupted by multiple factors. It is also possible that mothers find the need to be expressive about their emotions outwardly because otherwise their feelings might not be attended to. This suggests that venting is seen as a more acceptable pattern of anger expression in parents and mothers are likely to be more present in anger provoking situations than fathers. In general, venting seems to be accepted culturally, when done by a parental authority. Venting as an acceptable form of anger expression is learned by children’s parents from their parents as is suggested in the social learning theory.¹⁹

 In sensitization models, exposure to family animosity primes children to devote more attention to subsequent environmental inputs that are threatening and, in turn, increases their risk for psychopathology.^20,21 Thus, when faced with high levels of conflict in the home, children may be vulnerable to psychological problems due to the development of largely unconscious scripts organized around detecting and attending to cues that are potentially threatening.

31% of mothers and 35% of fathers were seen to ‘rationalise or intellectualise’ their anger. This suggests that parents often try to understand their child’s struggles and can be empathetic towards them. Parents are also likely to be showing maturity with their children and may be conscious of how they behave because of the influence they know they have over their children. Over rationalising or intellectualising however, can be a cause of ignoring the child’s problem altogether. It can also mean that both and children and parents do not use rationalising as the first means of expressing anger.

Fathers 21% tended to use more withdrawal techniques than mothers 11%. This might suggest that fathers can probably tune out of the familial environment more easily than mothers who find might find it difficult to tune out of the same environment. Distraction techniques were used rarely by fathers 2% and not at all by mothers 0%. This might suggest that distraction techniques are not seen as effective measures to cope with anger; they might be dismissed as temporary measures that give no personal or immediate relief to the parents. It is possible that mothers are so often distracted and interrupted that further using distraction techniques are seen as an irrelevant measure that takes away from tasks already at hand.

Table 3 shows there are a significant statistical significance between the relationship between which technique participants use to express their anger and how their family members express their anger. For father it is p<0.00001, and significant other adults in the family like grandparents, aunts, uncles and caretakers it is <0.00001 and siblings also it is <0.00001. The relationship between sibling expression of anger and significant adults is also significant but at a lower level i.e. P<0.05. This suggests that how adults and elders in the family express anger, has a great influence on how children react. The Chi-Square statistic could not be done for understanding the relationship between anger of self and mother’s anger expression because none of the mothers seemed to have used distraction as a method and the value was zero.

We share these results in our AACCI parenting workshops to emphasize that the adults in a family are role models for constructive expression of anger and they themselves need to learn and model constructive ways of anger expression for their children to follow

Recent clinical investigations talk about the importance of anger and rage for normal and abnormal aspects of personality growth. The expression of anger is regarded as a prerequisite in the acquisition of exploration of the environment,^22,23 achievement of goals and behavioural plans,²⁴ establishment of the sense of personal control over one’s own actions, conflict negotiation,²⁵ defence of personal integrity, differentiation of personal vs. other’s personal motives and points of view. Assertiveness and the sense of autonomy and mastery of the self should not be considered coincident with the expressions of anger and rage. The healthy manifestations of anger should be tamed by feelings of empathy for the others, acknowledgment of their point of view and full appreciation of the nature of the affective relationship with them, as well as the respect of the ethical and social norms unavoidably constraining individual assertiveness and achievements.²⁵

AACCI has conducted multicentric studies in over 3000 school children for understanding aggressive beliefs, attitudes and behaviour using standardised scales.^26–29 Results from these papers have shown that unless we teach children right from primary school about constructive ways of expressing anger, they grow up with the belief that aggression is normal and/or desirable in life and once this becomes an attitude it becomes very difficult to control and then leads to aggressive behaviour that results in bullying and violence at home and with peers and younger children in schools. Positive psychology is very important in bringing up children.³⁰

Developmental maturity, familial expression of anger and the family environment contribute to the anger expression of adolescents and young people. Our results showed that family expression of anger has a statistically significant impact on expression of anger in children. It can be concluded that school children and their families need to be educated and made aware of the various facets of anger and learn better ways of managing it. AACCI regularly conducts programs for both school and college students and parents and teachers for this. While all methods of anger have some merits and demerits, it is more important to understand the feelings, thoughts and physiological responses related to anger, thereby understanding its triggers. It is more important to manage anger better with more assertive communication. Active implementation as well as effective and consistent patterns of reinforcement for handling of emotions is necessary. We need to increase awareness and teach adolescents the various techniques and alternatives available to deal effectively and control anger at family & community levels. It is thus clearly evident that the participants will benefit from anger management sessions of the LSE workshops.

Though sample size is small we have got statistically significant results. When we share such studies with our parents in our AACCI parenting workshops, it has an impact that one has to learn constructive ways of anger expression, more so because children role model both the good and bad behaviours of parents.

We gratefully acknowledge the willing participation of all the management, parents from these two schools for their cooperation and permission to conduct this study.

We thank Dr Anuradha Sovani advisor AACCI, for her critical review of the final manuscript.

Self-funded by AACCI

The authors declare there are no conflicts of interest.

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