Anger Outbursts: Common Myths About Anger Management and Thought Based Interventions that Actually Work

Dr. David Perna

If you are a parent who is struggling with your child’s anger outbursts stop blaming yourself. Instead, join the crowd. I work with a multitude of educators and mental health professionals who are equally stymied by kids who display anger outbursts. And they are professionals. They typically use outdated solutions that do not work like, “I just have them hit a pillow,” or “I tell them to count to ten.” These interventions typically don’t work. How do I know that these interventions do not work? I simply ask my patients. They have said, “That is the dumbest thing I ever heard-count to ten.” Or, “I am getting really good at hitting my pillow, and my brother.”

Research shows that if you want kids to punch someone when he/she is angry then simply have him/her practice punching something on a regular basis, such as a pillow. Remember, practice make perfect. I help teach kids that angry oubursts are a choice. These behavioral choices are influenced by the thoughts that precede them. By working to understand their unhealthy thoughts they can avoid poor choices. It might sound complicated but it is pretty simple. Here are three examples.

1. Poor Reality Testing: We commonly think that everyone shares a common sense of reality when an event occurs. However, kids who struggle with their anger have a difficult time with shared reality whether they are participating in a sporting event, a birthday party, or a board game. Younger children are more prone to these kinds of challenges given their age and limited ability to understand many cultural/societal/group rules. Kids with anger challenges commonly maintain a more regressed view of the world. In essence they are not tracking the same information that most kids are paying attention to. In the end they make behavioral decisions that cause tension and then lash-out when other people challenge their perspectives.

Example #1: An example of Poor Reality Testing would include a child who “throws a nutty” while hitting during a baseball game. In this situation he is likely to think that the umpire’s call was wrong, quickly feel embarrassed and humiliated, and then start to throw his bat and helmet to the ground. Reviewing with him over and over again, “Take a deep breath,” will not work. He believes he was wronged. A better foundational intervention would be to talk with him about how people see things differently. How umpires sometimes make mistakes. And how although he has a right to an opinion in the end the umpire has the final say. Reminding him before he steps up to hit that he should try his best, but abide by the umpire’s feedback is most critical. After he bats you can encourage him to tell you his opinion of the umpire’s calls whether or not he gets on base. This will allow him to anticipate a difference of opinion and provide him with an outlet for discussion. Increased language usage leads to increased reality testing.

2. Pseudo-Paranoia: Pseudo-paranoia is evidenced by the extent to which certain kids seem to always start off with a negative view of others. No one is trusted until they “prove” themselves, and the proof required is tremendous. These kids are not fully paranoid in the sense that they do not think that the government is planting transmitters in their teeth, however, they tend to focus on what is wrong with others rather than what is right about them. Pseudo-Paranoid thoughts commonly piggyback on top of poor reality testing and enhance it.

Example #2: Sometimes kids will think that their schoolteacher does not like them. Despite any practical proof they think that other children in their class are favored. Many times they will erupt in class and lash out yelling that the teacher is not fair, cares more about the boys than the girls, or specifically chose a writing activity since the teacher knew that she “hates writing.” In such circumstances it is important for the teacher to articulate to the student why certain activities are important.

I will frequently tell teachers that they need to catch my patients “doing things right.” By balancing out one situation where a limit is set with five situations where they offer praise I have found that my patients will typically settle down and feel at ease. Parents will commonly comment to me, “I don’t want my kid to feel indulged or to become spoiled.” I will typically respond by saying that without such balancing their child will be so overwhelmed each day in school that he/she will not make progress. The first step is always balance and calming. During this phase the emphasis is on providing firm examples that substantiate that the teacher is fair. The second step is to offer better reality testing.

3. Rumination: Cognitive rumination is based upon the rather distasteful notion of actual “rumination” which is exemplified by a cow chewing and re-chewing its cud. Unlike most people who are impacted by an event, digest it, and let it go, kids with anger disorders are marked by an inability to let things go and cognitively move on. These issues keep coming back up again and again in their thoughts. When angry kids recirculate these “stuck thoughts” they display a limited ability to show restraint. Like a snowball that gathers energy and weight as it rolls down hill, ruminating thoughts generally gather steam and lead to an explosive release.

Example #3: Adolescents tend to struggle with ruminating thoughts. It is common for them to arrive home, go to their room and start to brew about an earlier conflict. When an unsuspecting parent knocks on their door to tell them it is time for dinner, he/she is typically bombarded with an emotional barrage that throws them for a whirl. Parents commonly start to scream in response, which in turn provokes a verbal trench war. And let’s be clear, trench warfare never really ends pleasantly. In contrast it would be better for parents to remain calm, note their surprise in not knowing that their child was upset, assume that their child has some legitimate reason to be upset and ask him/her to simply put his/her frustration into words. Be patient. Remember, verbal mediation is the “Holy Grail” of anger management. Good luck! Better yet, Good Skills!


Dr. David Perna

Dr. David Perna

Dr. Perna is a licensed psychologist who has an expertise in the treatment of child/adolescent anger management and its relationship to learning challenges. He is the owner of Copernican Clinical Services, a group practice with offices in Lexington and Newton, MA. He works with families, schools, and various professionals in addition to running specialized anger management groups. He maintains an academic appointment at Harvard Medical School and is a Clinical Associate at McLean Hospital, the medical school’s largest psychiatric teaching facility. He is the former Director of the Child/Adolescent Anger Management Program at McLean Hospital. Feel free to follow his newsletter/postings/ramblings about anger management, learning, adolescent psychology, and family therapy on the web:, or visit his personal website:

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