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Imagine a world where no one experiences the highly charged — and often destructive — emotions of fear and anger. We don’t live in that world. Humans are complicated beings with layered psyches. Most of us have experienced fear and/or anger at some point in our lives, and some people find that these negative emotions get in the way of living their lives the way they would like to.
It is possible to build new relationships with these very real human responses to stress and trauma.
What are the similarities and differences between fear and anger? What are the impacts of fear and anger on the body? How can behavioral health professionals better serve clients who are experiencing fear and anger?
Understanding Fear and Anger
Most people share an innate desire for safety, both mental and physical. Fear and anger are emotions that emerge in response to perceived threats to our mental and physical safety. They both activate the fight-flight or freeze response.
Studies have shown that people who are experiencing anger have even more changes in heart rate, blood pressure, skin conductance (electrical charges), and stimulated muscles. Meanwhile, people experiencing fear tend to withdraw and have more inflammatory responses.
Another thing that fear and anger have in common is the ability to narrow our attention or focus, sometimes called “tunnel vision.” They also both have negative effects on memory.
The Trauma Connection
Fear and anger do not exist in a vacuum. Humans who experience these complicated, interrelated emotions live in a society where vast inequalities, including adverse childhood events (ACEs) have an impact on the way we live in our communities.
The CDC‑Kaiser Permanente Adverse Childhood Experiences (ACE) study is one of the largest studies ever conducted to try to determine the effect of trauma on individuals. The researchers developed a confidential survey, the ACE Score Questionnaire, which is still used today. They gathered answers from more than 17,000 participants from 1995‑1997. The participants all received a physical examination and answered detailed questions about how they were treated (or mistreated) by adults. It also included questions designed to determine whether abuse of others was occurring in the home, and whether they grew up feeling like they didn’t have enough to eat, or if their parents were too impaired by drugs and alcohol to take care of them.
An awareness of the impact of the ACEs is part of a trauma-informed approach to helping people understand and cope with fear and anger.
Options for Treatment
Behavioral health professionals are learning more about how to address trauma to help people heal from the events of the past. Trauma‑informed treatment incorporates knowledge of trauma even though the treatment focuses on substance use, mental health disorders, or other issues. Trauma‑specific treatment, which is specifically designed to address trauma.
For some clients, group therapy is an affordable option that offers a chance to develop bonds with others in similar situations. For others, individual therapy provides a more intimate space for focusing on their specific experiences.
The following are some well‑known trauma‑specific treatment models for individual treatment:
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Trauma Affect Regulation: Guide and Education Therapy (TARGET) by Julian Ford, ages 10+
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Eye Movement Desensitization and Reprocessing Therapy (EMDR) by Francine Shapiro
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Accelerated Resolution Therapy (ART) by Laney Rosenzweig
And there are group models, too, including:
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Seeking Safety by Lisa Najavits
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Trauma Recovery and Empowerment Model (TREM) by Maxine Harris
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M‑TREM by Roger Fallot
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Beyond Trauma by Stephanie Covington
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Exploring Trauma by Stephanie Covington with Roberto Rodriguez
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Healing Trauma by Stephanie Covington with Eileen Russo
Surrendering
The Copper Beech Institute offers a day-long retreat titled “Creating Space: Surrendering to the Momentum of Anger and Fear.” This approach teaches participants to reframe fear and anger and deconstruct their learned responses. It calls upon mindfulness philosophies, which emphasize acceptance. Instead of fighting fear and anger, people look at ways to create healthier responses to the emotions.
Emotional Regulation Skills
Behavioral health professionals working with people with depression and anxiety share tools for emotional regulation called Dialectical Behavioral Therapy (DBT). (DBT) was created by Marsha Linehan, a groundbreaking psychologist and author who specialized in working with people with borderline personality disorder, suicidal behaviors, and substance use disorders. She also became a practitioner of Zen Buddhism.
As Connecticut Women’s Consortium trainer Charles Atkins, MD, shares in the CWC course, “A Day of DBT Skills Training,” DBT is a problem/solution-based approach. DBT skills training includes the following four elements:
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Mindfulness
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Interpersonal effectiveness
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Emotional regulation
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Distress tolerance/crisis survival
Other resources for clinicians working with clients experiencing fear and anger include
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DBT Skills-Emotional Regulation, CWC training taught by Jelan Agnew, LCSW
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DBT Skills Training Manual by Marsha M. Linehan
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Cognitive-Behavioral Treatment of Borderline Personality Disorder by Marsha Linehan
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The Dialectical Behavior Therapy Skills Workbook by Matthew McKay, Jeffrey C. Wood, and Jeffrey Brantley
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DBT Skills Manual for Adolescents by Jill H. Rathus and Alec L. Miller
Journey to Acceptance
Many paths lead to acceptance of our very human emotions. When clinicians are able to help clients learn powerful ways of reframing and moving through the trauma that exists in their lives and bodies, the powerful emotions of fear and anger can be harnessed and transformed into powerful healing.
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