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Introduction

Emotional regulation is an important skill that can enable or disable the way we engage in occupations (Strauss et al., 2016). Emotions influence adolescence in a way that can support or hinder their own well being. This is why emotional regulation skills are a key factor to their development and overall health (Strauss et al., 2016). A way to approach positive well being is through anger management approach, specifically towards adolescent males in the foster care system.

Theory

Anger management interventions fall under the model/frame of reference of Cognitive behavioral therapy. Cognitive behavioral therapy or CBT explains how “self defeating” thinking results in maladaptive behaviors (Deffenbacher, 2011). CBT based interventions focus on altering the clients view of self or “core schemas”. In terms of anger management, these interventions target and help identify triggering events or the causes of the negatives behaviors and allow the client to become more aware of triggers and consequences of anger. As clients become more aware, they can implement existing coping skills and initiate strategies developed in therapy (Deffenbacher, 2011).

Evidence

Evidence into the use of anger management (AM) as an intervention for emotional regulation specifically in adolescents in foster care is lacking. There is however research into the use of anger management as an intervention with adolescents in general. A mixed methods study including the use of AM showed an overall increase in coping skills and self-esteem (Down, Willner, Watts, & Griffiths, 2011). Feelings and expressions of anger are common among adolescents as well as the regret that follows thus, showing the need for emotional regulation interventions like AM (Nasir & Ghani, 2014). The biopsychosocial changes experienced by adolescents causes difficulty managing emotions and behaviors (Lök, Bademli, & Canbaz, 2018). A single blind, random control study verified the positive effects of AM on self-esteem and reductions of feelings of anger in adolescents (Lök et al., 2018).

Case Study

James is a 17-year-old male, currently in the foster care system. James is currently in the process of transitioning to the community for independent living. James frequently gets in fights with his roommates and often has to miss group activities and outings due to his aggressive behavior. He has had some childhood trauma is his past. James acknowledges that these frequent disruptions of behavior are not good and contribute to a hostile environment. James has met with his residential supervisor who has referred to an occupational therapist to help with his anger management. He is in agreement with the supervisors referral to Occupational therapy.

Intervention Plan

Problem Statement

James has difficulty participating in group home activities due to his inability to manage his anger

Long Term Goal

• In 4 weeks, James will share “triggers” and coping mechanisms for anger during group sharing time.
• Client will reduce his outbursts of anger to no more than 1 outburst per week during group activities in 2 months

Short Term Goal

• By next session, James will be able identify triggers using WRAP (Wellness Recovery Action Plan).
• By next session, James will be able verbalize 3 negative emotions a week to house parent
• In 3 sessions James will use an emotional journal do document what he feels throughout the day and any drastic changes in his emotions.

Intervention Format

Group

Settting

Residential Hall /Group Activity room

Supplies (if any)

• Paper
• Pencils

Agenda/Description

Set up safe learning environment (5 minutes)
1. Review the treatment goals and emotional journal entry for the past week
2. Assess client’s readiness to learn

Teach client about emotional regulation (15 minutes)
1. Provide hand-out of Wellness Recovery Action Plan
2. Engage client in therapist to client role-play of scenario and client-to-client role play scenarios

Evaluate learning outcomes (5 minutes)
1. Allow time for self-reflection and time to answers client question or concern(s)
2. Ask client to verbalize with the group methods on emotional self-regulation

SOAP

S: Client stated that he got into a fight with his roommate this week because he touched his belongings. He said that he wanted to punch a wall every time he thought about his roommate touching his things.

O: Client participated in a 30 minute group therapy session. Client completed the WRAP and identified 5 triggers that make him uncomfortable or angry. He preformed a role-playing scenario with his group members on how to  diffuse a disagreement  with his peers.

A: Client showed his willingness to learn and completed the role playing activity without getting into any arguments or having any outbursts of anger. The client demonstrates that he is improving and implementing some of the coping strategies introduced in therapy. Client will continue to benefit from OT services.

P:  Client will continue to see occupational therapist for 30 minute session/ 2x a week for anger management.

Reference

Deffenbacher, J. L. (2011). Cognitive-behavioral conceptualization and treatment of anger doi://doi-org.ezproxy.fiu.edu/10.1016/j.cbpra.2009.12.004

Down, R., Willner, P., Watts, L., & Griffiths, J. (2011). Anger management groups for adolescents: A mixed-methods study of efficacy and treatment preferences. Clinical Child Psychology and Psychiatry, 16(1), 33-52. doi:10.1177/1359104509341448

Lök, N., Bademli, K., & Canbaz, M. (2018). The effects of anger management education on adolescents’ manner of displaying anger and self-esteem: A randomized controlled trial. Archives of Psychiatric Nursing, 32, 75-81. doi:10.1016/j.apnu.2017.10.010

Nasir, R., & Ghani, N. A. (2014). Behavioral and emotional effects of anger expression and anger management among adolescents. Procedia – Social and Behavioral Sciences, 140(27-29), 565-569. doi:10.1016/j.sbspro.2014.04.471

Strauss, M., Raubenheimer, J. E., Campher, D., Coetzee, C., Diedericks, A., Gevers, H., & … van Niekerk, S. (2016). The development of an Emotional Regulation Scale for Adolescents. South African Journal Of Occupational Therapy, 46(3), 41-48. doi:10.17159/2310-3833/2016/v46n3a8