You’re trying to prepare a shopping list for a family get-together. Your mother wants to cook Grandma’s “famous” meatloaf recipe that no one likes. Aunt Rosie has allergies and her dishes need to be dairy and gluten free. Your sister Sally is a vegetarian and doesn’t want her vegetables cooked near meat, and your cousin Tim is a carnivore who’d be happy if dinner was only steak.

No decisions can be made, and you begin to feel heat rising to your face. Your heart and respiration rates increase. But just before you yell at the top of your lungs, “Everyone shut up,” you take a breath and wonder, “Will expressing my anger be bad for my heart?”

While some research claims that venting anger may be harmful to cardiovascular health, there is new evidence that suggests that moderate or constructive demonstrations of anger may actually decrease the risk of cardiovascular disease. In other words, it’s not whether you should express anger or not, but how you express it.

Constructive expression

Scientists have hypothesized that anger may have a direct physiological effect on the human heart. Anger triggers the “flight-fight response,” (also known as the stress response), which increases heart and respiration rates, constricts blood vessels and prepares the body to react to a situation (like indecisiveness about a family dinner). When the body does not return to normal after a response to stress, there are physiological consequences such as an increased risk of heart disease.

But research shows that expressing anger can help lower stress on the heart. A 2010 study by Columbia University Medical Center researchers discovered that discussing anger in order to resolve a problem is associated with a lower rate of cardiovascular heart disease (CHD), while destructive anger or blaming was linked to increased incidences of CHD over a 10-year follow-up.  And a 2006 study published in the Annals of Behavioral Medicine found that explosive anger or suppressed rage plays a role in heart disease, while moderate anger expression can be extremely functional and heart healthy.

Learning to cope

A study published in 2000 in Health Psychology revealed that people who cope with their anger constructively have lower blood pressure than people with fewer coping skills. In The Dialectical Behavior Therapy Skills Workbook (New Harbinger Publications, 2007), Matthew McKay, PhD; Jeffery Wood, PsyD; and Jeffrey Brantley, MD, list the following examples of coping skills: being mindful and aware of anger, regulating emotion, developing social skills that include negotiating conflict and asking for what you need.

In Nonviolent Communication, A language of Life (Puddledancer Press, 2003), Marshall Rosenberg, PhD, provides skills for working with anger. He claims that at the core of all anger is a need that is not being fulfilled, and that when anger is expressed with blame or punishment, it is superficial. We trick ourselves into believing that our feelings result from what others do, Rosenberg says. The goal, therefore, is to take responsibility for our feelings of anger so that we can understand which need is not being fulfilled.

Rosenberg suggests that there are four steps to positively expressing anger:

• When you realize you are angry, stop and do nothing except breathe. We must have awareness in order to stop, so let anger be the alarm that “wakes you up.” In the Cleveland Clinic Journal of Medicine, Robert Shields Jr., MD, reported that deep breathing and heart rate are reliable measurements for early detection of cardiovascular dysfunction. Remembering to stop and breathe will lower your heart rate and stress.
• Identify your judgmental thoughts, such as:  “My family is so dysfunctional, no one can make a decision.”
• Connect with your needs. What need is not being met that is creating the feeling of anger? This could be a need for inclusion, being heard, respect, connection, space or any number of factors.
• Express the feelings of your unmet needs. This may include sharing with the person that you feel angry, going for a run, doing yoga, taking a time out or writing in a journal.

Rosenthal says developing these skills takes practice, but you will find over time that you will not have to think about them as much as you did initially. Anger is an inevitable emotion that all human beings experience at one time or another. The ability to notice these intense feelings and do something constructive, instead of holding them in or projecting them onto others, can be beneficial for your cardiovascular health. By adding some simple skills into your life, you will feel less stress, less anger and more connection to yourself and others.