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"When I get mad, I stop thinking. I see red, and something takes over that I can't control," one of my patients said, adding that when he felt he wasn't being heard, he needed to assert himself, "even if I come across as angry."
His "microscopic fuse" was negatively affecting his life, he said. He was on probation at work for snapping at a colleague, and his partner said their relationship would end if he didn't seek help.
He asked me why such strong reactions happen and what he could do to prevent them.
Anger is very common and something we all deal with. It is useful to identify specific triggers and learn better ways to manage our responses. For instance, taking a pause and using breathwork can help in the moment, while working with a therapist to explore and heal from deeper issues may provide a longer-term solution.
It is also helpful to understand what happens in our brains when we are angry. Our emotional brain goes into overdrive, and our thinking brain becomes less active. Managing anger requires us to bring our thinking brain back online.
• Our brains on anger
There are two areas of the emotional brain that can fire too much when we are angry:
• the amygdala, which encodes the quality - such as positive or negative feelings - and intensity of our emotional reactions; and
• the insula, which creates a brain map of how our body feels during situations, including what we call "gut feelings." The degree of activity in the amygdala and the insula is controlled, in part, by two areas of the thinking brain:
• the orbitofrontal cortex (OFC), which helps us weigh the consequences of our behaviors before acting on them; and
• the ventromedial prefrontal cortex (vmPFC), which helps us empathize with others.
The more we use our thinking brain to evaluate our behaviors, including how they might affect others, the more we can guide decisions in balanced ways.
• Stress-related anger can affect our ability to think
We all have different cues and thresholds for becoming angry.
As in my patient's case, feeling excluded, devalued or disempowered by someone can draw anger. If we blame others for our emotions, we may try to make them feel uncomfortable by reasserting ourselves through strong words or actions. We may feel justified in punishing them.
Stress is another common reason for anger. Stress can correlate with how much norepinephrine, a neurotransmitter, is released. Norepinephrine is a chemical that acts in the brain and is closely related to epinephrine (a.k.a. adrenaline). Norepinephrine is needed for everyday thinking tasks and, when levels are ideal, it activates the OFC and vmPFC, allowing us to think about matters in focused, flexible ways.
As stress increases, though, norepinephrine does, too. When levels of norepinephrine are excessive, there is a shift in the brain areas it binds to - it stops activating the thinking brain and starts activating the emotional brain.
Stress can shut down the vmPFC, making it hard to feel connected with the minds of others, leaving us stuck in our emotion-driven interpretations of things. We move increasingly into fight mode, which limits our ability to respond flexibly.
• Anger leads us to act first rather than think first
Increased norepinephrine signals there is something we need to be suspicious or worried about, pushing us to act instead of think.
Faced with uncomfortable feelings, the pressure to get rid of them by doing something can make it hard to control our impulses and consider the consequences of our actions. One common scenario is wanting to send someone a nasty message. It can be hard to follow the advice to sleep on it or to write it but not send it.
When the brain is operating this way, we discover the consequences of our behaviors not by thinking about them beforehand, but rather by doing them and seeing what happens.
• Anger as a bodily discomfort
Anger is also felt physically. As my patient said, "I feel my body tense up, my head burn, my heart pound, my breathing get heavy. My mind is gone."
When we feel shamed or unfairly treated, the insula can become overactive, potentially leading to physical unease.
When we are angry at others, we can feel wronged and physically uncomfortable, and we may have an urge to respond through action. On top of such feelings, stress levels keep us from considering alternative viewpoints. The combination is a recipe for impulsive, and possibly harmful, responses. Notably, seeing someone punished who we believe is in the wrong is experienced as rewarding or pleasurable in the brain, and that feeling may encourage action even more.
• Tips to better manage anger
My patient said his partner and friends shut down when they see he is becoming angry, just to let him "win." He said, "I feel victorious at first. Then I feel guilty and end up apologizing, which I hate doing."
Once anger subsides, norepinephrine levels lower, and our thinking brain is reactivated. Our ability to empathize returns, possibly causing remorse and guilt over the damage our anger may have done, and we may wish to repair it.
Here are some strategies to respond differently when anger starts to take over:
• Pause. Find a space where the ability to think can be recovered. Step away, remain silent, ask for time. Hard as it is to consider in the heat of the moment, acting aggressively - as cathartic as it might feel - is often not worth it. Map out the progression of your anger by identifying cues in the body, mind and environment signaling it's time to step back before things worsen.
• Breathe. The only vital sign over which we have more immediate control is breathing. High emotions can push us to have quick, shallow breaths, feeding into our distress. Try slowing your breathing down, with long in-breaths and out-breaths (timing each helps maintain a rhythm and sense of stillness). Controlled breathing can limit respiratory rate, improve mood, lower stress hormone levels, decrease physical unease and help us think more calmly, improving recruitment of brain areas that process emotions.
• See anger as communication. There is often a context to anger, whether directed at ourselves, another person or a situation. For instance, we might feel pressured, exposed, belittled, anxious or powerless, and anger can cover up these unpleasant states, giving us a sense of power - fragile as it may be. Thinking about what lies behind anger can help us feel less at its mercy and provide insight as to what other emotions we may be trying to avoid. When feeling angry at someone, it is useful to consider why that particular dynamic generates such unpleasantness. As much as we're overtaken by the righteousness of our mind-set, anger can blind us to different ways others view the same situation. Considering other people's perspectives keeps the thinking brain going, creating more flexible outlooks and maintaining connectedness with others.
Christopher W.T. Miller, MD, is a psychiatrist and psychoanalyst practicing at the University of Maryland Medical Center and an associate professor at the University of Maryland School of Medicine. He is the author of "The Object Relations Lens: A Psychodynamic Framework for the Beginning Therapist."
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