When I started my counselling practice, the first area I focused on helping clients with was anger management. I had completed specialized training in anger management so it seemed like a good place to start! I also reasoned, as a young male therapist that anger management would be the kind of thing that men reaching out to me might be looking for help with (naivete sure is a breeding ground for stereotyping!). In my first year of practice in real-world work, I noticed a few things regarding anger management. First, anger is not the exclusive domain of men; as many women as men reach out to my practice for help with anger management. Men also reach out for help for everything - not just anger management (in hindsight these realizations seem obvious, but hey, stereotypes!). The second thing I noticed, was that many clients were reaching out to me for help with anger, but on closer inspection seemed to be struggling more with anxiety! This realization gradually led me to expand the focus of my practice to help people with anger and anxiety. So what is it about anxiety that has people confuse it with anger? And how closely related are anger and anxiety? Read on and find out!
Fight-or-Flight: Your Survival System
In order to understand the relationship between anger and anxiety, we need to take a brief look at the fight-or-flight system. Let me paint you a picture. Say you are having a lovely stroll through a verdant meadow. The sky is blue; the sun is shining. Birdsong fills the air, and a lovely breeze wafts on by, putting you well at ease. All around there are lovely things to notice, including delicate butterflies, majestic mountain ranges off in the distance, and an array of all manner of brilliant flowers. Ah, what a nice relaxing scene. How at ease and at peace you must be. Out of the corner of your eye, slightly into the distance, you notice a bear making its way into the meadow with you. Keep in mind, that there are MANY things for you to notice at this moment. The bear is but just one small visual part of this scene. Still, you would probably find that what happens next goes something like this: your brain registers the threat - bears are dangerous! Your threat system then sends signals throughout your body activating the fight-or-flight system, which prepares you to either try and fight the bear somehow, run away from the bear (flight) or possibly freeze, staying really still and hoping the bear does not notice you (we're all rooting for you here!). With the fight or flight system activated a number of physical changes occur. You tense up. Your heart rate becomes elevated. Blood flow and processing power move from 'unimportant' - at this moment - areas of your body (i.e. your brain and digestive system) and to areas of your body that are essential for your survival here (i.e. your arms and legs!). Fight-or-flight also affects your attentional functioning. It becomes incredibly difficult to pay attention to non-bear-related things, such as those lovely butterflies or distant mountain ranges. Instead, you now have tunnel vision - the only thing that is relevant for you right now is that there is a bear in front of you. In this heightened threat response, you'll experience changes in your thinking as well. It becomes less possible for you to casually think of things like... how did this bear get in this meadow? Are bears related to capybaras? Man, I wish I was a bear; they get to be so furry and cuddly, but also ferocious and powerful - truly the ultimate living organism on this planet. Yeah, your brain is not going to allow any of that stuff! Instead, what you've likely got running through your mind is "oh my gosh, what do I do what do I do what do I do what do I do!?!?!"*. These are all some of the changes that fight-or-flight can trigger. Importantly, this all happens automatically. As soon as your brain registers the threat of the bear, there you are in full fight-or-flight activation. Thank goodness, too. Otherwise, you get eaten.
*You may also experience a brief passing regret that you never learned how to ride a unicycle and now possibly never will. But I digress.
Fight-or-Flight: Better Safe Than Sorry!
While this is all very well and good when we are faced with a bear, fight-or-flight activation does not always go so smoothly. The fight-or-flight system is a highly effective defense system, but the threat detection system that regulates it is often wildly inaccurate. In that way, fight-or-fight is kind of like an anti-aircraft system that may be highly effective against enemy aircraft but also for some inconceivable reason spends much of its operating day shooting pigeons and seagulls out of the sky. Fight-or-flight operates under a golden rule: better safe than sorry. It triggers when there's a bear in your path, yes, but it also triggers in any of the following situations:
your spouse doesn't follow through on a commitment they made to you
you realize you're running late on an important work deadline
any possible problem or difficulty that comes in any life domain, regardless of the lack of an actual impending life threat
In these situations - just as with the bear - the activation of fight or flight results in the same physiological, attentional, psychological, and behavioural changes. Attention narrows, your body tenses, and cognitive clarity disappears, replaced instead by the reactive, threat-focused mind. Remember, in the bear situation, this is great - you don't want your mind getting in the way of your actions! Yet, when you're in a confrontation with your spouse, overwhelmed by anxiety, or about to make a rash decision, you absolutely want your actions to be able to take a backseat to your mind. With fight-or-flight activated, your mind becomes rather hard to find.*
*(As a brief aside, this is one reason why regret is the close cousin of anger; with your mind offline you're not acting in a way that matters to you. When you move back to the driver's seat of your mind after fight-or-flight cools down, you get to see what you did in those 'mindless' moments.)
It's All About Safety
Fight or flight can also be thought of as an interactional process between anger (fight) and anxiety (flight). When the threat system is activated, you may find yourself moving towards fight or flight (or freeze or fawn, which are additional automatic responses available as well). What response you move towards by default will depend on a variety of factors including:
your past experiences with using these responses (did they get you what you wanted in other similar situations in the past?)
your learning and modeling history (did you see other important figures in your life respond in this way to similar situations as you grew up?)
the demands and context of the situation you are facing (is this a situation where a given response is likely to get you what you want or not?)
and your awareness and skill in managing situations like these without automatic responses (do you know any other ways to handle the situation?).
Regardless of the automatic response, however, keep in mind that what drives your response is the perception of threat, the activation of your threat system, and the corresponding move to 'being on alert.' Our threat system is not trying to make us angry or anxious for the sake of being in either of those emotional states. Our threat system cares about just one thing: resolving the threat and finding safety. Anger or anxiety may be intermediary, functional steps that arise with the aim of helping us find safety - even if they are not actually particularly effective at this - but they are not the end goal; safety is.
Vicious Cycles of Threat Activation
When the threat system is activated, or we are on alert, we may find ourselves moving back and forth between moments of anger and moments of anxiety. This makes sense - from your brain's perspective, whatever mechanism can be used to help you get to a state of safety gets used. Unfortunately, rather than help us move towards safety, anger and anxiety, and the unhelpful behaviours they elicit, generally exacerbate feelings of threat. Consider these examples:
- If you are feeling anxiety about your financial situation and so spend the day in your head worrying about it, you're likely to simply feel even worse by the end of the day (note: worry is different than problem solving!).
-If you are feeling upset about something that your partner did and so confront and yell at them, you're likely to feel your heart rate go up and your chances of a nice calm evening go down (note: yelling is just one form of communication - other approaches can work better!).
In either situation, your threat system gets triggered, you move into fight-or-flight, and the default actions you take increase your threat system activation, moving you into escalating cycles of fight-or-flight states.
So Why Does Anxiety Get Confused with Anger?
At lower levels of threat system activation, you may experience milder fight-or-flight states. Consider this scenario. You're running late to work and have a few passing worries about this pop into your mind and notice your heart beating faster. Okay, a bit uncomfortable but not too overwhelming. As you're worrying you get hooked by a thought, "If I run late again, I am going to be in big trouble with my boss." Okay, getting a bit more tense... Your mind continues, "I can't stand when my boss is disappointed with me - it's intolerable... if this keeps happening, I'm going to be fired. If I lose this job, there will be massive financial problems for me. I've got to get to work NOW!" Your heart rate continues to rise and your body and face gather tension and stress. Your threat system is in full activation - you feel like you've got to be at work now and if you're not it will be catastrophic. That's a real danger (from your mind's perspective!). Your threat system wants safety and safety in this case equals getting to work on time (remember the threat system doesn't care about making you angry or anxious, it cares about getting rid of the threat). You're running up the steps from the subway to work and some person is walking ever so slowly... talking on their phone.... meandering along the steps... oblivious to the fact they are blocking the way up the stairs. "MOVE!" you shout, pushing past the slow walker and gathering stares and rebukes from the onlookers. Others murmur, "Wow what's that person's problem... ", "Such an angry person - they've got real anger management issues!" Anger management? Ha! Sure, it looks that way to the casual onlooker. That was after all the most visible thing for them to notice. Driving that ever so brief moment of anger however, was a steady stream of threat-based signals causing a vicious anxiety cycle and preparing you - in this story - for your brief, but unmissable, anger performance. Anger is extremely salient; anxiety generally is not. Anxiety cycles amplify threat-signals. When we're already in threat-mode, anger is easily activated. If you're the person in this story and you seek out help for anger management, you're probably missing the bigger picture: your problem with anxiety keeps you perpetually in threat mode. You need anxiety management, not anger management.
"Anger is extremely salient; anxiety generally is not. "
To some extent, the relationship between anger and anxiety is codified in diagnostic classification systems for anxiety disorders. For example, in Generalized Anxiety Disorder, an anxiety disorder characterized by constant worry and stress, irritability is recognized as a commonly co-occurring symptom. In other anxiety disorders, there may not be a specific diagnostic reference to accompanying anger, but anger's influence is easily recognizable. For example, if you've got a family member with Obsessive Compulsive Disorder (OCD) and you try to interrupt them from completing a compulsive ritual, you might get a burst of anger from them. Or, if you struggle with social anxiety and you're feeling pressured by others to attend a social event that is giving you tremendous anxiety, you might similarly shout at them to leave you alone. These are not 'angry people' - they are cases of individuals operating with an always-on threat system. These moments of anger may result in significant relationship or interpersonal harm, leading one to seek out help for anger management. On closer inspection, however, it becomes clear that we need to work primarily on anxiety, not so much on anger.
Anger is Still Real and Still Problematic
This is not to say that true anger problems do not exist. They most certainly do! Even when anxiety is the primary precipitant for anger, strategies still do need to be learned for managing the anger that shows up when someone is overloaded and overwhelmed. Anger expression can cause harm regardless of the factors that lead up to it. The point is more that, anger independent of any anxiety or stress seems pretty rare! Moreover, understanding that your anger may be coming from a place of anxiety opens up many more options to you. For example, sharing that you are feeling stressed about going to an event is likely to elicit empathy whereas yelling at someone to mind their own business is likely to foster further conflict.
"Anger expression can cause harm regardless of the factors that lead up to it. "
The good news is that undertaking a detailed analysis to determine what degree of your problem is anxiety and what degree is anger, may not be all that necessary. Since anxiety and anger are both really threat-driven problems, learning ways to regulate one will likely help you regulate the other; in anger management or anxiety management; you can learn how to turn down and work with the threat system. Common interventions used for both anxiety and anger management include relaxation training, mindfulness training, learning new ways to work with difficult thoughts and feelings, assertiveness and communication training, exposure practices, and compassion-based techniques. These strategies help people learn how to regulate the threat system, a system which may at times produce high anxiety or strong anger.
Is It Anger or Is It Anxiety?
In this brief article, we took a look at the fight or flight system, exploring how the perception of threat leads to the activation of automatic responses. These automatic responses in turn lead to changes in our perception, attention, bodies, thinking, and actions. When triggered in truly life-threatening situations, these responses can be extremely helpful to us. When triggered in more everyday occurrences, these responses can lead to unhelpful actions that worsen our perception of threat and the associated experiences of anger (fight) or anxiety (flight). At elevated threat levels, we may find ourselves moving back and forth between experiences of anger or anxiety. Frequent experiences of anxiety and stress similarly increase the activation of our threat system, which is one reason why anger and irritability are common co-occurrences with some anxiety disorders. Learning ways to work with anger or anxiety are likely to help downregulate the threat system and result in reductions in both anger and anxiety. So, is it anger or is it anxiety may be a misleading question! It would be more accurate to say it is the threat system activation gone haywire. If you experience problems with anger, chances are you're dealing with some anxiety and stress as well. Living on high alert all the time is kind of prone to make someone irritable! The good news is that many psychotherapy approaches including Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, and Mindfulness Training can be used to help you deal with anger, while also giving you tools to manage any anxiety that may be coming along for the ride.