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Anger is described as an emotional response to a perceived physical 
or psychological threat that induces feelings of vulnerability, 

powerlessness, and anxiety (Hollinworth, Clark, Harland, Johnson, & 
Partington, 2005). Anger can become a problem in multiple respects if it 
is experienced or expressed inappropriately. Physically, prolonged feelings 
of intense anger strain certain areas of the nervous system, increase blood 
pressure and heart rate, and may contribute to such health problems as 
hypertension, heart disease, and diminished immune system efficiency 
(Reilly & Shopshire, 2002). Psychologically, anger problems may inhibit 
psychosocial functioning and contribute to aggressive, anti-social behaviors, 
such as physical violence and verbal abuse. These behaviors carry many 
potentially negative consequences, including incarceration, assault, being 
viewed as untrustworthy, losing the emotional support of family and friends, 
expulsion from a substance abuse or other community support program, and 
feeling remorse, shame, or self-loathing (Reilly & Shopshire). 

Due in part to the rise in demand for mental health services placed upon 
agencies by the current geopolitical climate, the treatment of problematic 
anger among veterans is an issue of pressing clinical significance (Hoge, 

Anger problems are most evident in veterans who are diagnosed with 
Posttraumatic Stress Disorder (PTSD) and have been exposed to combat. 
Because of the institutionalized role anger plays in military training, identity, 
and culture, anger problems are also an issue for former soldiers who have 
neither PTSD nor combat experience. Consequently, anger problems are an 
issue for many veterans whose inability to manage and express their anger 
constructively inhibits psychosocial functioning in multiple areas, including 
personal relationships, employment, self-esteem, and behavioral self-control. 
Empirically supported group interventions addressing this issue adhere to 
the principles of evidence-based practice and are particularly important 
given the current geopolitical climate. This paper reviews some of the current 
literature on clinical interventions for veterans experiencing anger problems 
and acknowledges the increasingly important role social workers are playing 
as mental health service providers to veterans with anger problems at 
institutions such as the Department of Veterans Affairs.

Scott Miller

 Journal of Student Social Work, Volume IV    �  

Anger and Military Veterans



Auchterlonie, & Milliken, 2006). Anger problems among the members 
of this population (primarily male, although increasingly diverse) are 
associated with multiple factors related to military service including 
combat exposure, military culture, and war-induced psychological trauma 
(Gerlock, 1994). Veterans who were exposed to combat and are diagnosed 
with Posttraumatic Stress Disorder (PTSD) are most likely to suffer from 
anger problems, although former soldiers who have neither PTSD nor 
combat experience are also at risk (Calhoun et al., 2002; Chemtob, Hamada, 
Roitblat, & Muraoka, 1994; Novaco & Chemtob, 2002). Current treatments 
used to address this issue follow a group format based upon the principles 
of cognitive behavioral therapy that is time-limited, goal-oriented, and 
supported by empirical research attesting to its clinical efficacy (Beck & 
Fernandez, 1998; Gerlock, 1996; Reilly & Shopshire, 2002; Tang, 2001). 
The Department of Veterans Affairs uses these interventions because they 
are congruent with the practical and ethical expectations of evidence-based 
practice as well as the professional objectives of clinical social work.

The Etiology and Psychosocial Implications of Anger Problems  
in Military Veterans

Prior to 1920, psychological models focused solely on the sexual drive, 
or libido, as the primary behavioral and cognitive drive among humans  
(Horowitz, 1988). According to these early models, aggression is the result 
of sexual repression and is evident throughout the course of psychosexual 
development prior to the successful resolution of the Oedipus/Electra  
Complex. The identification of aggression as a separate drive element in 1920 
introduced the notion that anger is instinctual and part of a natural dichotomy 
between two inherently opposed impulses: Eros, the ego and libidinal instinct 
for survival, and Thanatos, the death instinct. In this paradigm, negative 
energy displaced onto others to prevent the self-destruction of the individual 
is considered to be the basis of aggression and is first apparent in the infantile  
desire to possess and destroy the maternal breast (Hinshelwood, 1989). 

The development of relational models in the 1940s rejected drive theory’s 
emphasis on aggression as an independent energy source and replaced it with 
the view that aggression is the behavioral expression of an induced emotional 
state that occurs due to the inability to achieve primary motivational aims 
(Greenberg & Mitchell, 1983). This approach provided the groundwork for 
the idea that feelings of anger and their subsequent behavioral expressions 

anger and military veterans

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are ostensibly elicited by anger-provoking events that trigger thoughts of 
disappointing and unresolved conflicts. According to this latter perspective, 
trigger events vary from individual to individual and are dependent upon 
one’s personal experiences and worldview. Similarly, anger cues — or 
the physical, emotional, behavioral, and cognitive reactions that occur in 
response to anger-provoking events — vary according to individual, as well 
as societal and cultural norms. 

Among military veterans, anger problems are associated with trigger 
events and cues related to specific aspects of military experience, namely 
combat exposure, combat related psychological trauma, and military 
culture. Anger problems are especially prevalent in those who were exposed 
to combat and have been diagnosed with PTSD (Calhoun et al., 2002); 
Chemtob et al., 1994; Novaco & Chemtob, 2002). As noted in the Diagnostic 
and Statistical Manual of Mental Disorders (4th ed., text rev.: DSM-IV-TR; 
American Psychiatric Association, 2000), problematic expressions of anger 
are a persistent symptom of PTSD, an Axis I diagnosis that may develop after 
one experiences, witnesses, or is confronted with a life-threatening event. 
Combat-exposed military veterans with PTSD are more likely than other 
veterans to suffer from anger problems that lead to impaired relationships, 
social isolation, and feelings of helplessness (Novaco & Chemtob). Research 
conducted by Calhoun et al. indicated that combat-exposed veterans with 
PTSD report more frequent arousals of unchecked anger accompanied by a 
hostile attitude towards others in a variety of situations. Similarly, Chemtob 
et al. reported that combat veterans with PTSD have significantly more 
incidents of problematic anger towards their partners and are also more 
likely to experience employment difficulties due to their inability to express 
anger in socially acceptable ways. 

Veterans who were not exposed to combat and do not have PTSD typically 
exhibit fewer anger symptoms than those who were in combat and do have 
PTSD (Calhoun et al., 2002; Chemtob et al., 1994; Iversen et al., 2005; 
Novaco & Chemtob, 2002). Nevertheless, non-combat veterans, too, are at 
risk of suffering from anger problems and may seek anger treatment for 
similar or related symptoms. According to Gerlock (1994), this may be due 
to the role of unchecked anger as an integral part of military culture. Anger is 
presented in the military environment as a necessary element of the idealized 
version of masculine identity that defines the psyche of the successful combat 
soldier. Military training emphasizes the need to repress feelings such as 
sadness and fear so that soldiers are psychologically equipped for external 

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 Journal of Student Social Work, Volume IV    �  



expressions of aggression (Gerlock). For the soldier, anger thus becomes a 
mechanism that enables him or her to ignore and overcome the emotional 
challenges inherent to the combat experience without succumbing to the 
deep and complex psychological reactions associated with such traumatic 
events as witnessing the death of a comrade. 

Treating Anger Problems in Military Veterans

Current interventions that address anger problems in military veterans 
generally utilize a treatment plan based upon the principles of cognitive 
behavioral therapy (CBT) (Beck & Fernandez, 1998; Gerlock, 1996; Reilly  
& Shopshire, 2002; Tang, 2001). The group format of the cognitive behavioral 
model postulates that interventions should include five to ten participants and 
meet once per week for a period of up to 12 sessions. CBT interventions for 
anger problems are based upon the Stress Inoculation Training (SIT) model, 
which consists of three parts: (1) cognitive preparation, (2) skill acquisition, 
and (3) application training (Beck & Fernandez; Dwivedi & Gupta, 2000). 
According to Gerlock, a typical CBT anger management intervention follows 
a curriculum that focuses on identifying situational triggers, learning coping 
skills, and practicing role rehearsal through exposure to anger-provoking 
stimuli. Group sessions are typically divided into two parts. A didactic 
portion examines cues to anger, learned responses to anger, anger triggers, 
personal vulnerabilities to anger, and short-term payoffs versus long-term 
consequences of anger. A practice component included in each session offers 
structured role-plays and break-out periods during which participants may 
test their newly learned social skills.

Experts believe using CBT in the treatment of anger is justified by its 
effectiveness in achieving desired treatment goals via a time-limited, goal-
oriented intervention format that empirically evaluates clinical change 
(Beck & Fernandez, 1998). For example, Tang’s (2001) retrospective quasi-
experimental study on the effectiveness of a CBT anger management group 
for patients with mental health problems used the Anger Control Inventory 
(ACI) and the State-Trait Expression Inventory (STAXI) to measure clinical 
outcomes. The study revealed that the participants experienced a decrease in 
overall feelings of anger and an increase in anger coping skills as evidenced 
by reductions in maladaptive cognitions and behaviors, cognitive deficits, 
and behavioral deficits (Tang).

Interventions involving client samples consisting of current and former 

anger and military veterans

10    Journal of Student Social Work, Volume IV



members of the military suggest clinical outcomes similar to the results 
presented by Tang (2001) regarding the efficacy of CBT group therapy in  
the treatment of problematic anger. Conducted at a Veterans Affairs outpatient 
mental health center, Gerlock’s (1994) retrospective quasi-experimental 
study revealed that an anger management group using a CBT approach leads 
to significant improvement in anger coping mechanisms and a significant 
drop in sensitivity to anger provocation as evidenced by significant decreases 
in respondents’ self-reported feelings of anger. Similarly, a 4-session CBT 
anger management group study conducted by Linkh and Sonnek (2003) 
in a setting frequented by current and former members of the military 
concluded that a brief cognitive behavioral psychoeducational approach 
to treat anger problems is empirically justified; participants experienced a 
marked reduction in their subjective experience of anger and in potentially 
aggressive expressions of anger.

Strengths and Weaknesses of the Current Approach to Treatment

CBT anger management groups, such as those tested by Gerlock (1994), 
Linkh and Sonnek (2003), and Tang (2001), are particularly useful in the 
treatment of the military veteran population because they induce clinical 
change in clients from all genders, cultures, races, and ethnicities. This is 
particularly important given the increasingly diverse nature of the military 
veteran population. According to Reilly and Shopshire (2002), the strategy 
of identifying trigger events, cues to anger, and developing personalized 
coping skills effectuates equally positive clinical outcomes among members 
of both gender groups. Interventions based upon the CBT model can also 
successfully accommodate the culture-specific needs and situations of 
individuals from various racial and ethnic groups (Reilly & Shopshire). 
Finally, CBT anger management groups are valuable because they have 
been found to be effective in treating clients who have a history of substance 
abuse or who are diagnosed with co-occurring psychiatric disorders. For 
such clients, participation in CBT anger management groups leads to clinical 
improvement so long as participants abstain from drugs and alcohol, adhere 
to the stipulations of their medication treatment plan, and receive appropriate 
care for co-occurring disorders (Reilly & Shopshire). This latter point is 
especially relevant to treating military veterans, who, as was previously 
mentioned, often trace their anger problems back to combat experiences 
that precipitated the onset of psychiatric disorders, such as PTSD. 

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 Journal of Student Social Work, Volume IV    11  



Despite its apparent clinical supremacy, shortcomings exist in the CBT 
approach that may call into question its position as the intervention of 
choice for the treatment of problematic anger. These shortcomings relate 
to CBT’s ability to affect long-term clinical improvement, as well as its 
capacity to address specific clinical symptoms vis-à-vis other types of 
interventions. Concerning the former shortcoming, Durham et al. (2005) 
suggested that improvements immediately following CBT treatments 
often fail to translate into lasting results and cannot be maintained by 
simply extending the CBT treatment. On the other hand, psychodynamic 
interventions have been shown to effectuate lasting clinical improvement. 
A study conducted by Muratori, Picchi, Bruni, Patarnello, and Romagnoli 
(2003) revealed that participants who received an intervention consisting of 
short-term psychodynamic psychotherapy were more likely to experience 
long-lasting clinical improvements than the members of the control group. 
Finally, psychodynamic group interventions have proven to be better able to 
improve clients’ behavioral control and coping despite CBT’s emphasis on 
these goals (Sandahl, Gerge, & Herlitz, 2004).

These clinical shortcomings call into question the two non-clinical 
elements that make CBT so appealing, namely its time-limited and cost-
saving qualities. Participants in CBT anger management groups may have to 
participate in the group multiple times or receive another form of follow-up 
intervention given the increase in the number of veterans seeking treatment 
for anger management problems and other forms of psychological trauma. 
This is a critical point, especially in the wake of Operation Iraqi Freedom 
and Operation Enduring Freedom, as well as the limited amount of resources 
available to put towards treatment of veterans. 

Implications for Clinical Social Work Practice

The need to treat military veterans with anger problems in a way that is 
clinically effective, ethical, and cost-efficient has never been greater. Military 
campaigns in Iraq, Afghanistan, and elsewhere mean more troops are being 
exposed to combat and other stressful situations that put them at risk of 
returning home with anger problems. A recent study conducted by Hoge et 
al. (2006) indicated that 19.1% of veterans returning from Iraq and 11.3% 
of veterans returning from Afghanistan reported a mental health problem. 
Overall, 35% of all returning Operation Iraqi Freedom veterans requested 
mental health services. As with previous research, this study indicated that 

anger and military veterans

12    Journal of Student Social Work, Volume IV



combat-exposed veterans are more likely to report and request services for 
mental health problems than other veterans. Given the relationship between 
combat exposure, psychiatric trauma, and problematic anger, this may mean 
more veterans will present with significant anger problems that require 
clinical intervention in the near future. 

Institutions that offer services to returning veterans find themselves 
under increasing demands to treat more clients with fewer resources. These 
institutions are simultaneously incorporating elements of evidence-based 
practice into their institutional culture that are congruent with the ethical 
demands of accrediting organizations, such as the Joint Commission on 
Accreditation of Healthcare Organizations, and the financial realities of  
managed care. This is particularly true of the Department of Veterans Affairs 
(VA). As one of the nation’s primary providers of medical and psychiatric 
services to military veterans, the VA medical system is the largest integrated 
health care system in the country; it has a health care budget of approximately 
$30 billion, employs 196,000 health care professionals, and maintains 1,300 
sites of care (Department of Veterans Affairs, 2006). The VA provided 
health care services to over 5 million veterans via its system of inpatient 
and outpatient clinics and hospitals in 2004. This represents an increase 
of 22% in the number of patients treated since the end of fiscal year 2001 
(Department of Veterans Affairs, 2005). 

The VA is also known for its position as the employer of over 4,000 
licensed social workers and for its desire to become the employer of choice 
for qualified clinical social workers (Department of Veterans Affairs, 2004). 
Social workers at the VA fill a variety of roles that reflect the diversity of the 
social work profession. Social work services provided at VA medical centers 
include psychosocial screening and evaluation, pre-admission planning, 
discharge planning, psychosocial diagnosis and intervention, patient 
advocacy, end of life planning, and bereavement services (Department of 
Veterans Affairs). In the realm of mental health, social workers provide a 
specific array of services using a psychiatric, DSM IV-TR-based assessment, 
diagnostic, and treatment model. Services provided include individual 
psychotherapy, group psychotherapy, and psychosocial assessments. Social 
workers facilitate their interventions in partnership with other mental health 
professionals and are considered to be integral members of an interdisciplinary 
mental health team consisting of psychiatrists and psychologists.

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 Journal of Student Social Work, Volume IV    1�  



Conclusion

Participation in the military exposes individuals to numerous potentially 
traumatic situations that can have long-lasting psychological, economic, and 
social ramifications (Dalenberg, 2000; Friedman, 2005; Iversen et al., 2005; 
Solomon & Kleinhauz, 1996). As a result, military veterans face multiple 
psychosocial stressors, one of the most salient of which is problematic anger. 
Anger problems, which are particularly chronic among combat veterans 
with PTSD, are believed to be due in part to the socially constructed role 
of aggression in military identity and culture, as well as combat exposure 
and war-induced psychological trauma (Calhoun et al., 2002; Chemtob et 
al., 1994; Gerlock, 1994; Novaco & Chemtob, 2002). Veterans with anger 
problems are at increased risk of suffering from economic, interpersonal, 
psychological, and physical problems. Multiple studies have illustrated 
the efficacy of CBT anger management groups in causing clinical change 
among military veterans who suffer from anger problems (Gerlock; Linkh 
& Sonnek, 2003; Tang, 2001).  

Clinical social workers play an integral role in clinical work with military 
veterans who have anger problems at such institutions as the VA. Social 
workers’ efforts are sorely needed as demands for psychosocial services 
among military veterans are increasing and more anger-prone veterans are 
expected to return in dire need of assistance as a result of current military 
engagements overseas. To improve the odds of effectively helping returning 
veterans with anger problems, research might be conducted to assess the 
level of stigma perceived by veterans regarding obtaining mental health 
services. Though beyond the scope of this paper, additional research could 
look at how women in the military experience anger. Research might also 
address the current racial, gender, and other forms of demographical diversity 
that exist in today’s military. Greater empirical knowledge in each of these 
areas could be incorporated in culturally competent CBT anger management 
group interventions that are increasingly cognizant of how veterans with 
anger problems can be treated in a manner that is ethical, empirically-based, 
and resource efficient. 

References

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 of mental disorders (4th ed., text rev.). Washington, DC: Author. 

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Beck, R., & Fernandez, E. (1998). Cognitive behavioral therapy in the  
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 through group work. Support for Learning, 15(2), 76-81.
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 American Medical Association, 295(9), 1023-1031.
Hollinworth, H., Clark, C., Harland, R., Johnson, L., & Partington, G.  
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Scott Miller is a second year master’s student at CUSSW 
specializing in Advanced Clinical Practice in the field of mental 
health. His current field placement is at the Department of Veterans 
Affairs/New York Harbour Health Care System, where he provides 
individual and group psychotherapy to veterans in the outpatient 
psychiatry unit. He holds a bachelor’s degree in Foreign Service 
from Georgetown University. His email is swm2106@columbia.edu.

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