 This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. I'd like to welcome everybody to today's presentation on anger management. And we're going to be talking about a nine to 12 session protocol. And basically we're going to go over the nine things that you need to cover. But depending on how participatory your group is and you know, a variety of other factors, you may decide at a certain point that you want to expand it a little bit and either put in some consolidation sessions where you actually have a whole group where you don't teach a new skill or you split some of the things that we're going to talk about into two different groups. So we're going to learn about anger and its functions, explore events and cues that can trigger anger. We're going to learn how to help clients develop an anger control plan. We'll learn about the aggression cycle and how to help clients change it. We'll review the ABCD ease and thought stopping. So basically some techniques to help people address their anger. We'll discuss assertiveness and conflict resolution skills. We'll review alternatives for expressing anger. Look at relaxation interventions and explore how past learning from your family of origin can influence current behavior. So in session one, what we're going to do is basically introduce everybody and we're going to talk about what is anger and help people realize that anger really doesn't have to be unhelpful. Anger is a helpful emotion if we just understand it. It's an emotion that's triggered by a perceived threat which prompts the fight or flight reaction. So the fight reaction is our anger reaction. Flight is fear and we talk about different things. When I do this group that might prompt somebody to fight or flee. You know, you run into a mugger in an alley. Are you going to fight or are you going to flee? And what differentiates when you fight versus flee? So you can talk about that and help people start recognizing that when they feel either one of these emotions, it's their body triggering them that there may need to be something done. There may be something amiss. So to pay attention, but it doesn't necessarily mean that's the case. Hostility refers to a set of attitudes, thoughts and judgments that motivate aggressive behaviors. So if we're working with somebody who's hostile, you know, they're going to tend to have attitudes and perceptions that are more negative. So we're going to work on maybe addressing those. Aggression is a behavior that's intended to protect the person by causing harm or injury to another person or damage to property. So this is the fight or flee. And you know, sometimes the harm to a person, it doesn't have to be physical harm. It can be emotional harm if you lash out at somebody in anger verbally. You know, there can be harm associated with that. So helping people see that aggression is the response. When you say there's a threat, I need to protect myself. Now what do I need to do? Do I need to run or do I need to push that threat away or push that threat down and gain control over it? Many times what people initially perceive as a threat really isn't one. It's just past stuff coming up. So for example, Google sent me a message the other day that I needed to declutter my inbox. And clutter is a term that my mother always uses whenever she comes anywhere. It doesn't matter how clean I think the house is, she sees clutter. So anytime I hear clutter, I'm just like, Oh, and so I got that from Google. And I'm like, how dare Google tell me that I need to declutter. And I'm like, really? I'm getting mad and automated thing. But I help people and I give people examples of times that I've had anger or irritation or whatever degree of anger triggered by stuff from my past that was really not worth getting upset in the present. So we start talking about things that trigger your anger over the past week. And what triggered your anger? And I put up an anger meter and we go from mild irritation to all outrage. And we mark some anchor points along there with anger itself being like in the middle. And I tell people, talk about some things that irritated you this week. Talk about some things that made you angry. And we put them along the anger meter. And we talk about whether it was actually a threat right then to them, you know, to their person, to their finances, to their self-esteem, you know, threats can come in many different ways, shapes, and forms. Or if it was something from their past that they were just, they were reacting to more strongly. Maybe somebody said something and they got angry. And the person didn't intend to hurt their feelings or insult them, but they reacted with anger because it reminded them of being bullied when they were little or whatever. So we talk about those things. We talk about the cognitive triangle, how thoughts, behavior, and feelings all influence each other. So when something happens, when you do something, you feel a certain way about it. Like I went to the gym this morning and I felt great about it. And I had positive thoughts about it. Other times, you know, you might do something and then you feel regretful about it. And then you have self-depreciating thoughts afterwards, you know. I really shouldn't have done that. I said I wasn't going to lose my temper anymore. And then we'll talk about, okay, maybe it starts with a feeling. You're feeling angry. So you start having angry thoughts that correspond to that. And then you may do things out of anger that are more impulsive. And it may be, I remember one day when I was working at the clinic, it was just a really hectic day and I was just in an awful mood. And somebody came up to me and, you know, startled me a little bit and said something. And it was just like, can you not see that I've got a whole bunch of stuff sitting on my desk and I'm working. And I was irritable and I kind of bit her head off. So my behavior, I lashed out. That was my behavior because I was feeling already irritable. It wasn't anything that she did. But she just kind of happened to be the straw that broke the proverbial camel's back. And so being aware of, it may not be something somebody does. You know, you could be in awful mood from your day at work and your kid comes home and, you know, daddy, daddy, daddy, daddy. I want to show you something. You've just like, go to your room because the child, you know, you can't take one more thing. And the child's like, what did I do? So we talk about that. And then we also talk about thoughts. If you're having negative thoughts about people, if you're dreading going to this meeting or dreading going to this reunion or whatever it is, then it might start bringing up feelings, you know, of dread. If you think that you're going to go there and it's going to be an awful time and yada, yada. Then you start having those feelings of dread and irritability that, oh, you know, I have to go to this. It's mandatory fun. And then the behaviors, you can kind of create a self-fulfilling prophecy. So we go over all of these with each, you know, starting at each different point in the triad. So people can see that it's not just a behavior, not just a feeling that can lead to problems. But the good thing is you can intervene in any place. So if you're having negative thoughts about this upcoming class reunion, you know, you're getting ready to go to your 30-year reunion or whatever. And so you're having these feelings of dread and you just don't want to go and you're procrastinating packing or whatever. What can you do? You can change your thoughts. You know, what could possibly good come out of it? What things, you know, could you focus on that could help you feel less impending dread and irritability? Because a lot of times you start focusing, people start focusing on stuff from the past. You know, done me wrongs from high school that never got resolved, so then you start getting irritable. Okay, that's fine. But we want to help people figure out, do you want to focus on those negative thoughts? Or what would happen if you started having optimistic thoughts? Like, well, at least it's 72 hours away from the kids in the farm and everything else where I can just kind of cut loose. I don't have to spend a whole bunch of time at the reunion. I can hang out in my hotel room if I want. So encourage them to change their thoughts, to change their feelings and potentially change their behaviors. We talk about misperceptions and I alluded to that a little bit earlier. I've told you before we had fire alarms in our house. And, you know, for whatever reason, when the fire alarm, when we would, wow, when we would have the windows open, try saying that three times fast, and it was really breezy outside, we'd live on a ridge, the fire alarms would go off. And the only thing I can figure is dust would get in there and set the fire alarms off. But my dog would lose her mind. She would just absolutely lose her mind. Well, I'm sure the fire alarm sound hurts her ears. So after that, you know, we fixed the fire alarms, but after that, whenever it would be a breezy day and we would have the windows open, she would just start shaking and quaking and whining and trying to burrow under things. So because of her past experiences with it, you know, setting off the fire alarms and that being unpleasant, whenever it would start to get breezy now, she associated that so she would have that same, she would have the fear reaction. She wouldn't get angry. Another example, my son and his best friend were outside and they were practicing martial arts, which, you know, they're both black belts now, so wonderful. But our dog perceived danger. He went out there and he saw this other boy beating up on my son and they were just sparring, they weren't beating up on each other. But my dog lost his mind and he was just like, somebody's after, somebody's after Sean and all his hackles went up and started barking. And so after that, it took multiple times of Elias coming over to the house and us reintroducing him and Elias giving him peanut butter because he loves peanut butter before he realized that okay, Elias isn't a threat. Now they still can't roughhouse in front of him because Brewster can't differentiate between sparring and fighting, which, you know, that's a understandable mistake for a dog. But, you know, we have these things that we experienced in the past is dangerous. You know, we think this is a problem. And then in the future, it can trigger misperceptions. Another example with rescues and I use rescues a lot because most people can relate to animals. I've gotten a lot of animals that have come in where and unfortunately a lot of times it has been a male who has hurt them, you know, been a little bit more aggressive. And so these rescues don't respond as well to male adopters. Or it takes a little longer for them to warm up and one of the criteria we have is does the person do well with men does the person do or not the person sorry does the animal do well with men does the animal do well with children. Because we don't know necessarily what his prior experiences were before they came into rescue. And finally domestic violence and obviously that's humans. Initial experiences if somebody was raised in a household where raised voices led to violence you knew if you heard dad come home and he started screaming, you know, the stuff was about to hit the fan. Then in the future, when somebody raises their voice, you may perceive it as a threat. Now intellectually you may know, you know, I'm bigger now and whatever yada yada. But there's that microsecond where you may flash back to is this a threat or not. And that's okay. That's your brain going. Are you safe? Is this a threat? Is this something you need to worry about? Anger tells us to be aware. It doesn't tell us we have to act. It just tells us to be aware and look around and see if there really is a problem. I call it our threat response system tells us that there might be a problem and to look around. Anger becomes a problem when it's felt too intensely, too frequently or is expressed inappropriately. So another thing that we sometimes talk about in session one and you can break this off here and make this session two if you need to. How does anger affect you? And then we go through each one in stations usually because I like to have people not have to just sit there in a circle and look at me because I find it's better if people can move around. But physically, you know, does it affect your sleep? Does it increase your pain? Does it affect your gastrointestinal stuff? Does it affect your immunity? And I have a handout that I create for clients and I give them at the end of this session that talks about the different effects of anger on all these things. But I want them to think about it for themselves before I hand it to them and go, well, research says because I don't know how it affects them. I have a I can probably guess, but I don't know how it affects them specifically. So I want them to start really thinking about the far reaching impact of excessive anger. Emotionally, you can have regret. You know, if you get angry at somebody and then you're like, oh, sorry, I didn't mean to bite your head off. Or, you know, whatever you can regret getting angry or acting on your anger, you have that anger feeling, which is normal. That's okay. But it's what you do with it that you tend to regret. And I try to help people separate that, that concept. Anger is a natural emotion. It happens automatically. You know, no need to regret that. That's just your body going, hey, pay attention. It's what you do with it from that second forward that you may regret and that you have the ability to alter. People can have feelings of guilt about being angry all the time or feel helpless if they feel like their anger is just overpowering and they don't have any control over their temper. It can lead to a feeling of helplessness and powerlessness. And when you feel helpless and powerless, what happens? You tend to feel like you're in a threat situation because none of us like to feel like that for the most part. So people tend to get angry that they feel helpless over their anger and it just spirals. Socially, anger impacts our relationships. Yeah, you can have people do what you want, but is it fear or is it respect? So we can spend some time talking about the difference between do you do things or do you want people to do things for you because they respect you or because they're terrified of you. Think of the parent who used to walk around with the switch or the belt or whatever and the kids were like, I just don't do it. Versus the children who did their chores and did what they were supposed to because they respected their parents and wanted to make them proud. It has a lot of other negative impacts on relationships because if you have uncontrolled anger, your social supports, you know, your close people as well as your distant friends may kind of walk on eggshells because they don't know what's going to trigger you. Or they know, you know, there's a couple of family members that we know there are certain topics you just don't even bring up because that vein in the side of their neck will start pulsing and they're going to turn red in the face. So being aware of how it impacts your interaction with people. Occupationally, it may affect who wants to work with you and how well you do customer service. If heaven forbid you should be in a customer service role, you know, like a customer service manager and every person irritates you. Obviously, that's probably not a good fit for you if you're looking at it going, really, you're bringing this to me. You know, that sort of is not full blown anger, it's irritation, but it still, you know, will impact your work performance. Spiritually, how does anger affect people's sense of connectedness to an impact with the world? You know, do you feel like you're part of the world and it's a happy place to be? Or do you feel like everybody's against you and you're out there in isolation? And some people talk about karma, you know, if you put anger out, you get anger back. Talk about different concepts of spirituality and how anger impacts that. And I mean, look at some of the spiritual literature and in all of the spiritual literature, there are evidences of anger. So how is anger handled in Christianity and Judaism and Buddhism and in these different religions, if that seems appropriate? And environmentally, anger can affect your environment because you may break stuff. I had a boyfriend when I was in college, whenever he would get angry, he put his fist through things. And the last time he got angry, thank goodness it was never at me, but he put his fist through the windshield of his car and he broke three knuckles and obviously needed a new windshield and, you know, drywall is a lot softer than a windshield. So things can be problematic, but even if it doesn't get to that extreme, I think we know people or we've even done it where you get in a fight with somebody, you break up with somebody and you just start throwing things out impulsively. And then six months later, when you've made up, you know, think about best friends or whatever and you're like, oh, you know, I wish I still had those pictures or I wish I still had such and such. You know, the nice thing with digital pictures now is even if you delete them, somebody probably has a backup or Facebook does. But, you know, these sorts of things, when you're angry, you can start purging things and then regret doing it later. Anger initially has apparent payoffs by releasing tension, controlling people, helping you get your own way. But in the long term, payoffs lead to negative consequences. So examining the benefits and payoffs for anger for our clients. You know, what's the benefit? And generally you don't need to do stations for this. You can have people just kind of shout out what the benefits are and then shout out what the drawbacks are. We've already gone through a lot of the drawbacks when you went through the section on how anger affects you. Habits are things we do almost automatically. So another way you can look at it is talking about in what way is anger a habit for you? Sometimes people know that if they get angry, they get their own way. So it's just kind of a habit. Whenever something happens, they throw a hissy fit and, you know, then they get their own way and it's like, well, score. Most of the time that's not on a conscious level. It's subconscious that behavior has been reinforced so they do it again. So we want to ask people to start practicing and trying to use mindfulness to break the habit of anger. So when they get angry, you know, they got to check in and they say, okay, I think I'm angry. Am I angry? Yeah, I'm angry. Got it. What am I angry about? Is this actually a threat to me right now? And what is the best response in this situation to help me achieve my goals? If I was getting angry about this, a good use of my energy would be another way to put that. And have people just start thinking about how much energy they're using. You can even do an anger pie and have people identify what proportion of the day and what proportion of their energy they spend on anger versus happiness, relaxation, stress. Encourage people to identify anger control strategies they've used in the past. Look at which ones worked and why they worked and which ones didn't work and why they didn't work. A lot of times I'll have people do this as part of their homework because they start brainstorming and why a particular intervention works or doesn't work for a person is going to be very personal to that person. And then we can talk about it in the next session when we talk about anger management strategies. And then people can say, well, sometimes I go on a walk and three other people may go, yeah, I do too. And one person may go, I tried that, but it doesn't work. And we can start having a discussion about why it may work for some, why it may not work for others. The homework, keep a log of your anger intensity in the next week. Keeping a log helps people become more aware of their triggers and cues and helps them see their progress. So I have them on the top of the page and you can print out pages with this if you're doing it in a group. Put the date and use a different page each day. That way people, it doesn't get as jumbled. And have three columns on the page. The episode briefly what happened. The intensity was it mildly irritated, moderately irritated, angry or enraged. And then the duration and why do we look at the duration? Well, because do they get over it quickly? If you get really angry and then you get over something, how does it impact you differently than if you get moderately angry and you stew on it all day long? Did you stew on it for less than an hour? Did it bother you for a couple of hours or did it completely ruin your day? So we're getting a look at the intensity and duration. Because sometimes when people start addressing their anger, their intensity may not go down right away, but the duration may. They get really angry. That knee-jerk reaction is just, wow, really intense. But then they can start using some of their skills and the duration goes from it ruined my day to, yeah, it knocked me off balance for an hour or so. And that's progress. So I want people to be able to see that. So in session two, you're going to start every week they're going to use this log. And that's important for them to do every week because we're going to start building on this and not only identifying what the anger triggers were, but what did you do to try to address it, what worked, yada-yada. And yes, when one of you pointed out when people get angry, another question you can have them ask themselves. Themselves is, what am I getting out of this? If you're getting angry at somebody, what is it that I'm getting out of it, except for worn down, exhausted and an ulcer? So session two, when you get angry, it's often because you've encountered something that has made you feel threatened or provoked you. I don't like the term provoked. They used it in the text in your class. That feels less controllable to me for some reason. So I don't like that word, but that's a personal choice. So I encourage people to identify some general situations that made you irritable. And, you know, you can do that anger line again. And I say, look back over the past week. What are some general situations that made you irritable? What are some things that made you angry and enraged? And as we get to, once we get to vulnerabilities, we're going to start looking at if you have a bunch of stuff that's making you irritable, it's a lot easier to get angry and enraged because it's cumulative. You know, you start getting worn down and worn down and worn down and then you're on your very last nerve. Many times specific events touch on sensitive areas. These sensitive areas or red flags usually refer to long standing issues that can easily lead to anger. For some people, a loss of control. You know, if they feel like they're not in control of their situation or if they feel like they're not in control of their reputation, for example, they may become enraged. Rejection or isolation, and generally it's more on the rejection end where people feel like their ideas or their help or themselves were rejected by someone. Death or loss, and this could be, you know, something that threatens your death, you know, somebody cutting you off in traffic, or loss of something tangible, maybe loss of a job, or even loss of self-esteem. You know, if somebody, if you lose face to somebody, a lot of times it'll make people angry. And then failure. If something happens and it makes somebody feel like they failed, they may initially get angry if they don't get a job promotion they wanted. They may get angry at their boss or something and go, you know, how dare you? Or get angry at themselves for not getting that promotion. So encourage people to look at each of these sensitive areas and identify which ones make them feel threatened or trigger their anger. Because some are going to be more salient for some than others. When you're identifying triggers and events, you know, encourage people to put up whatever they can think of on the board. But I have some suggestions, long wait to the doctor. You have an appointment at 10 o'clock and it's 1040 and you still haven't been called back. Traffic, a friend joking about a sensitive topic, somebody not paying back money that they borrowed from you, being wrongly accused of something, having to clean up after someone. And I've got teenagers at home. So this is one of my triggers. But you realize at a certain point that getting angry about it and stewing on it isn't going to do any good. So the question is, what do you do to change the situation? Having a neighbor who plays the stereo too loud, if you've lived in an apartment, you know how that can be annoying when you're trying to sleep and it's 2am and they're just thumping away. Rumors being spread about you being placed on forever hold. Oh, I hate being placed on hold. Having something stolen in gratitude or someone openly contradicting you. So those are some things that I'll throw out there if I need to kind of seed the list a little bit to get people thinking about a wide range of things that might trigger their anger. Cues are indicators that they're getting angry and can be broken down into four categories. Physical cues, how your body responds, the increased heart rate, tightness in your chest, feeling hot or flushed. Behavioral cues such as clenching your fists, raising your voice, staring at others, you know, try to stare them down. Emotional cues, which are other feelings that may occur along with anger such as hurt, jealousy or this feeling of being disrespected. And cognitive cues, what you think about in response to the event such as hostile self-talk. I'll fix her a little red wagon if she comes around here again. That's what my mother always used to say, I'll fix her a little red wagon. I don't know what a red wagon had to do with anything, but I digress. Or you might start having cognitive images of aggression and revenge and all how good it would be just to get revenge. Linda Lambert had a song called Mama's Broken Heart and that's just kind of one of those songs about anger that you can look at and use to identify certain cues of anger and aggression. At the end of session two, review the anger log from the last week and identify common cues because for most people there are going to be some common ones. When you start to get angry, what happens to you personally, physically, behaviorally, emotionally and cognitively? So they can start developing a cue awareness. And what strategies can you use to become more aware of and deal with these cues? So how can you become more mindful basically? Vulnerabilities is what we start on with session three. Vulnerabilities are things that make you more likely to respond with anger. So for example, emotional vulnerabilities. If you're already feeling overwhelmed, you may be more likely to get angry or irritable or defensive. When you're feeling pulled in six different directions, you know, you feel kind of like you're drowning, which can make you feel threatened. If you're already irritable about something else, you know, then the dog walks in and starts barking. You know, you may just scream at Fido and Fido's looking at you going, what I do? And feeling sensitive or vulnerable for some reason, if, you know, something triggered you to feel vulnerable, maybe you broke up with somebody or you got laid off or you got in trouble with your boss or you're feeling vulnerable and, you know, criticized maybe. All these things can make you more vulnerable to getting angry about other stuff. Cognitively, if you're expecting a negative outcome from a situation, person or meeting, that can make you more vulnerable to interpret things as a threat and get angry. Physically, low blood sugar. When our blood sugar gets low, our HPA axis kicks in and releases cortisol to get blood glucose into the system. Well, we're not really processing all that. We just kind of realize we may be feeling a little bit jittery or irritable. And, you know, so sometimes when people have low blood sugar, they can be cranky. My husband gets hypoglycemic. And whenever he was on patrol, if he drew a complaint, you could pretty much guess that he hadn't eaten in a while because he's usually really level, level mood. But whenever he wouldn't eat, yeah. So low blood sugar was a cue for him that he had to pay attention to. Alcohol is a disinhibitor so it can make people more likely to get angry. Too much caffeine is a stimulant. So if you're already revved up, you may respond with more irritability, more anger. Pain. I don't know about you, but when I'm in pain, I tend to be at cranky pants. And illness, same thing. Or insufficient sleep. If you're groggy, you may be more likely to be less patient and less tolerant, which leads to more irritability. Socially, being in situations that make you feel more on edge. So have people identify what kinds of situations make you feel on edge. You know, for me, you know, big meetings with the C level executives, not my favorite place to be. You know, mixers for the Chamber of Commerce, not my favorite place to be. So those things make me feel a little bit more on edge. Whereas there are other places that I feel more comfortable. And if there are people that being around makes you feel more on edge or makes you feel more negative, then it's important to be aware of that. If there are people that make you feel bad about yourself, not because they're trying to, but you just have this cognitive thing going on, knowing that when you're around them, you tend to be more irritable is important because then you can start mitigating and preventing. Again, go over the homework from last week and I said we were going to build on it. So this time we talk about when look at your anger episodes. What was the highest number that you reached? You know, hopefully we're seeing it go down a little bit, but as far as intensity and duration, what was the highest number you reached? What triggered that episode? The worst episode last week, what triggered it? What were the cues associated with it? Physical, behavioral, emotional, cognitive, and we talk it out because I want people to get used to going over this so they don't need the paper. You know, they can stop and go, okay, I'm starting to clench my fists, so this is probably a not great situation. What strategies did you use to avoid reaching 10 on the anger meter? And actually my anger meter is four, so I need to change that. But for people, you know, what strategies did you use so you didn't explode? Are there particular threat themes, those sensitive areas that you notice like rejection or isolation? And what vulnerabilities may have existed that day that may have predisposed you to getting that angry? So having people become more aware of the precipitants as well as the triggers and the aftermath. An effective anger control plan is the next step. It should include immediate and preventative strategies because obviously when you're in the heat of it, you need to have some immediate strategies to start calming down. So last week, you know, in the homework, we asked them what strategies have you used because I want to know what they already have, what strengths, what tools do they already use. Now, we're going to start building on those in session four. What are your immediate strategies? So we'll talk about some, like timeout, when might you use it and how might you use it? Obviously as a 50-year-old woman, I'm not going to go sit in a chair in the corner. You know, that's not how I do timeout. So we want to talk about it in terms of how can you take a timeout for yourself? What does that look like? And you know, maybe it means if you're in a household where you just can't get a moment's peace, maybe it means going to the bathroom. Maybe it means going out on a walk, you know, somewhere where you can get some quiet and you can let that adrenaline kind of bleed off. When you're in your timeout place, period, can you distract with activities? You know, sometimes during that timeout, you don't want to just sit there and stew on it. You need to push it out of your head so the adrenaline can go down and you can get into your wise mind and think more logically about what's going on. You can block the situation from your mind temporarily using thought-stopping. Thought-stopping, if you haven't used it before, is exactly what it sounds like. You tell yourself, I am not going to think about that right now. No. And you intentionally start thinking about something different. Encourage people to identify three or four thought-stopping statements they can use and three or four things that they can switch their attention to. Practice mindfulness in threes, three things you see, three things you hear, three things you smell, three things you feel, and maybe three things you taste, depending on kind of where you're at in the day. But mindfulness in threes just helps somebody start focusing on the here and now and where they are instead of focusing on whatever cognitive stuff they've got going on. Helps them get out of their mind. And during that timeout, encourage them to breathe. Some people call it relaxation breathing. Some people call it combat breathing. But you breathe in for three, hold for three, out for three. Some people do four. It doesn't matter. The big thing is you want to slow breathing because as you slow breathing, it gives your brain the cue that it's time to rest and digest. So your brain starts slowing down and secreting GABA and serotonin and all kinds of the other good happy chemicals. Other immediate strategies. Talk to a friend or journal. Extroverts will want to talk it out. Introverts may want to write it down, but getting it out of your head so it's not just bouncing around in there can help you kind of get some perspective on it. When you're doing this, try to create meaning from it. Why is this happening? What can I get out of this? Exercise. When you're stressed out, when you're angry, you've got those adrenaline going through your system and your heart's beating and it's going, we got to do something. Let's go. It's kind of like that little chihuahua that's been cooped up all day long. Take that energy and use it for something positive, like exercise. Draw it back down through those big muscles. Get rid of that adrenaline and then you can think a little more clearly. And finally, radical acceptance. It is what it is. So you get a pink slip, you get yelled at by your boss. You get in a fight with your significant other, whatever it is. And instead of just blowing up, just taking a minute and thinking, all right, it is what it is. What next? How can I improve the next moment? So those are your immediate strategies. And clients will have other immediate strategies that they use that, let's start making a list. That's great. Then move on to preventative strategies. What general things can you do to prevent or minimize vulnerabilities emotionally? So you're not already starting out, stressed out, overwhelmed or exhausted. Well, exhausted comes down physically. But emotionally, that means putting happy things in your life. It's not just the absence of anger. It's the presence of happiness. So encourage happy things in your life. Do things that make life more pleasant. Mentally, look at your cognitions. Try to cognitively restructure and, you know, look at the bright side of things. And I tell clients, you know, take a quarter, flip it. If it lands on heads, you're going to be put on your rose colored glasses and be as Pollyanna positive as you can for the entire day. You're just going to look at the optimistic side of everything. And if it lands on tails, you know, no change. Don't worry about it. And then I want you at the end of the day to describe how your day went and see if things went a little bit better on the days that you were looking at the bright side or not. And if they don't, okay, you know, that's fine. But encouraging them to do an entire day of looking at nothing but the positive and seeing how people interact with them differently, et cetera. Physically, how can you minimize vulnerabilities? Eat well, get enough sleep, exercise, you know, all those sorts of things. Deal with any chronic pain. And socially, what can you do to minimize or prevent vulnerabilities? Maybe it means avoiding certain people. And ideally, that's not going to be the end strategy. That's a stop gap until you develop better communication skills or whatever it is. But sometimes, you know, what can you do right now to prevent vulnerabilities socially? Or, you know, if you're going to a meeting that might be really, really stressful, I always went and I sat right next to my boss because my boss was great. And so I always felt a certain element of safety there when I would sit next to him. When you are vulnerable for some reason, what can you do to reduce the chances that you're going to get angry? Sometimes you may be, you know, maybe your dog passed away or your car broke down or whatever and you're just in a god-awful mood. Okay. So it is what it is. How can you prevent lashing out at somebody or getting unnecessarily angry the rest of the day? What can you do to help yourself? Because you know you're already kind of at your brink. Mentally, if you're feeling negative, what can you do to reduce the chances that you're going to get angry? Physically, you're sick. You're in pain. It's just not a good day. What can you do? Sometimes it means shutting the door and telling people, you know what? Not a good day today. Other times it may mean, you know, stretching. It may mean taking your lunch hour and actually going to lunch instead of sitting at your desk and working on your case notes or whatever. And then socially, what can you do to reduce the chances that you're going to get angry? And again, I encourage people to do more than just eliminate. Put positive things in there. Surround yourself with positive people. Do things, even if you're in a bad mood, do things that are going to help you get in a better mood. Like watch those silly cat videos or dog videos or listen to a comedian. You know, I have a little over 400 different skits on my Amazon playlist of different comedians. So I always have something I can listen to. And sometimes you just got to go out into the car, put on the Amazon playlist and it's good for a few minutes. So at the end of session four, review the anger log from last week, identify what the biggest anger trigger was. What immediate strategies could you have used to diffuse that situation? And what preventative strategies might have made a difference. So you're going back over the stuff and looking at the vulnerabilities, identifying what immediate and preventative strategies you could have used. And then develop a plan to start reducing one or two vulnerabilities each month. Because we have vulnerabilities. We have negative cognitions. We have all that stuff. So, you know, somebody may decide, you know what, I am going to start being more positive. Or I am going to start doing something every day that makes me laugh and brings joy into my life. One or two a month is plenty. If they try to do more than that, they're probably not going to be super successful. Session five, the aggression cycle. An episode of anger can be viewed as consisting of three phases. Escalation, there's the event and the responses, cues, thoughts, feelings, everything that's going on. So encourage people to identify during this escalation phase. So you notice you're angry and then it starts to build. What can you do when you start noticing these cues? What are your immediate strategies? Explosion is when somebody reacts to those urges. You know, they just, they scream at somebody. They put their fists through the wall. They do whatever. So what can you do when you have the urge to be aggressive? And you may need to make small baby steps instead of screaming at somebody, going into their room, putting their face in a pillow and screaming really loud for a second. Yes, it's not the best solution. But as an interim, as a stop gap, instead of screaming at somebody else, it's definitely a better step. And then they can take a breath and go, all right, now let's talk about this. And then post explosion is the third phase, the negative consequences, the short-term and negative, short-term and long-term negative consequences, both emotionally, cognitively, legally, socially and physically. So have them review their anger log from last week and identify the event that got the most angry or had the most negative consequences and identify what they could have done to reduce the escalation, what immediate strategies could they have used, and what could they have done to have prevented the explosion. So this is immediate strategies as well as vulnerability prevention. So I'm wanting them to see how they do have some control over their environment and they do have some control over these situations. Yes, they can't control other people, but they can control how well fortified they are to deal with any crap that comes their way. Cognitive distortions are unhelpful ways of perceiving things. Think about a time something happened and you thought it was one way, but it turned out to be wrong. So these often are cognitive distortions. Personalization is one that people use. Is all my fault that this happened or is all your fault that this happened or it's all about me. You looked at me, you had this awful look on your face, so you're angry at me. How dare you? Because I've never been anything but nice to you. You see where we can go from feeling bad to aggression really fast. So if somebody starts personalizing something and feeling like there was an air of ingratitude or whatever it was, look for three other explanations besides you that this situation might have happened. If they minimize the positive, they say, you know what? A trained monkey could have done this. I don't know why I wasn't able to do it. I get angry at myself because I'm failing at something. Asking yourself what good happened or is happening or what could come out of this that could be positive. Encourage people to look at what did you do well? What things are going well? Maybe this is an unfortunate situation. Is there any positive that could come out of it? Selective abstraction, only seeing what you want to see, mental filter. If somebody's angry, they're going to tend to see the negative side of stuff. So encouraging them to back up and look at all the facts. What are all the actual facts in the situation for and against my anger? Sounds like that worksheet, which is on the website now, by the way, the challenging questions worksheet. Try taking the other person's point of view. So get in their shoes and go, can I see it their way? Initially, people may not want to do that because then they might have to admit that they're wrong and then that gives up control and that's a whole other anger issue. But encourage them to look at some options. Exaggerating the negative or catastrophizing. You did this, so now I'm going to lose my job or the world's going to come to an end or whatever the case may be. Encourage them how likely is this to happen? Whoops. All or nothing, if they're talking in all or nothing terms, she never does this. All right, let's find the exceptions. If they have that control fallacy that they should be able to control everything, they should be able to control their spouse, their co-workers, their this and their that, that ain't going to happen. I'm just going to break it down to them like that. That ain't going to happen. What parts do you have control over? And let's focus on what you can control. So they do feel, so they don't feel like they're a fish flapping out of water. If they're overgeneralizing something, you know, whenever you grow up in a house that has a lot of violence, maybe they overgeneralize when people get loud that this is going to be violent, this is going to be dangerous, encourage them to ask how is this situation different? So maybe it's not dangerous. Arbitrary inference, you know, people use this a lot when they talk about fear of flying. They draw conclusions without having enough information. So encourage them again to look at the evidence and emotional reasoning. I feel angry about this. Therefore, there must be a threat. So look at the facts. A lot of times it comes back to looking at the facts and the big picture. So again, reviewing the anger log and identifying cognitive distortions that were in play and then talking about what cognitive distortions were or are common in your family. So you notice we didn't talk about mitigating or not mitigating but immediate and preventative strategies this time. You know, you may have already gone through all that. You may choose to go through it again. But now when we're processing the anger issue, we're going to add on to it what cognitive distortions were in play. And, you know, is this something you learn from your family? Session 6, we talk about the ABCDEs. A stands for activating event or the red flag event. B represents the beliefs about the event because it's not the event themselves that generally produce feelings of anger. It's our interpretations about beliefs and events. So if something happens, you know, you may have two different people who see the exact same thing. One gets angry and one's just like, you know, what's the big deal? The same situation. So it wasn't the situation itself. It was how each person interpreted it. C stands for the emotional consequences, which in this case is going to be some sort of anger. So D stands for dispute. This part of the model identifies unhelpful beliefs and encourages people to reframe them in alternate ways. Identify the facts for and against the belief. Make sure you're not confusing high and low probability events. You get cut off in traffic. How likely is it that you really were about to die? You know, you were going 25 miles an hour on a city street. There was a curb there or a shoulder there you could have pulled off on. How likely is it? Identify and address thinking errors and cognitive distortions. So in that D you're disputing those beliefs. E stands for evaluating your response options and choose the one that gets closer to the people and things that are important in your life. So is this worth my energy? Or what is the best way to handle this? And I encourage you somewhere in the process to have people identify what does it look like to have a happy or rich and meaningful life however they want to define it. And then every time they start to get angry they can say, alright based on my choices, what choice is going to help me get closer to a rich and meaningful life. Reveal the anger log again and identify the most intense anger episodes from the past week and apply the ABCDE model. So again going through that you're identifying the cognitive distortions. What strategy are you currently using to be more aware of cues reduce vulnerabilities and deal with anger to prevent it from escalating. So we're pulling back stuff in from the last few sessions to make sure that they're not forgetting about these things. And then we can talk about ways to integrate that into the anger control plan if they're having difficulty figuring out how to make this transition happen. Session 7 is assertiveness. The basic message of aggression is that my feelings thoughts and beliefs are very important and yours are not. The basic message of passivity is that your feelings thoughts and beliefs are important but mine are not. The basic message of assertiveness is that both of our feelings thoughts and beliefs are important. So that's awesome. So when we're being assertive we're creating a win-win. We're not saying that you're wrong and I'm right or your needs don't matter and mine do. We're saying how can we get both of our needs met and compromise. Encourage clients to talk about some of the advantages of acting assertively when trying to resolve conflicts. But also go over the drawbacks to assertiveness. Don't forget the whole motivational interviewing thing. We need to learn to look at both the benefits and the drawbacks. So whatever the drawbacks they identify are we need to help them figure out how to mitigate those drawbacks. So they're willing and somewhat motivated to be more assertive. Session 7 you go over conflict resolution. Identify the problem, the cues, the specific impact, decide whether to resolve the conflict and then address and resolve the conflict if you think it's worth resolving. So talking about that we're getting less away from learning new skills more into solidifying how to put this all together. So encourage people to review the anger log, apply the conflict resolution model to one episode and identify strategies that they're using to control their anger and to prevent vulnerabilities that seem to be helping. Session 8, we talk about anger in the family because we learn a lot about how to interpret events and cope with distress by observing our family. We watched Mom and Dad from the time we were knee-high to a grasshopper. So how was anger expressed in your family while you were growing up and how do you express it now? What did you think when it was expressed that way? What do you think when you express it that way now? How did your father express anger? How did your mother express anger? Were you ever threatened with or exposed to violence? How were other emotions such as happiness and sadness expressed in your family? Some families are only comfortable with anger so those other feelings were not okay. And likely they may have been or on the other hand they may have been okay with those other feelings and not okay with anger. And what role did you take in your family and you know were you the hero, were you the one that was always getting the varsity letters and straight people? Were you the victim? Did you just try to blend in? Were you the wallflower or were you the scapegoat for everybody's problems? We learn a lot about how to interpret events through our family. Also what messages did you receive about your father and men in general? What messages did you receive about your mother and women in general from your family of origin? Did you feel accepted and loved or did you feel like you couldn't do anything right? How did your family deal with failure? What feelings, thoughts and behaviors carry over into your relationships today? And what purpose did these behaviors serve? You know if you're acting like your dad used to act what purpose does that serve? Encourage them to review their anger management plan from the past seven weeks and identify things that have changed. Hopefully they're having a decrease in intensity and or duration. Identify what progress they've made. What still needs to change? What strategies are working well? So this is a time when you start really tuning up that anger management plan and talking about you know if somebody says well I haven't made much progress in preventing vulnerabilities or I'm still getting angry at work all the time. Then they can get feedback from the group which is pretty well established now about some techniques that might work. And then anger myths. I encourage clients to tell me you know why these are not real. Anger is inherited. Anger automatically leads to aggression. You must be aggressive to get what you want. Venting anger is always desirable. Anger is a negative emotion. It's all in your head. Venting or ignoring your anger makes it go away. Men are angrier than women. The older you get the more angry you are and anger results from human conflict. Sometimes you get angry because you're in a place and it stinks and you've got a headache and somebody says something to you and you bite their head off. And that's not ideal but did they cause the anger or were you irritable because you were uncomfortable? So it's important to be aware that anger is always human conflict that causes anger. Older people are not necessarily always angry. And that thing sometimes you were told in order to feel better you just need to vent your anger. No, research actually shows that that's not true. So I encourage them to tell me why these are myths and then if they can't come up with something then I'll throw some suggestions for themselves why these are myths and this helps me figure out if I've taught everything I needed to teach. Anger is a natural emotion it's designed to alert people that there might be a problem. When people are vulnerable or have learned maladaptive ways of dealing with anger or simply never learned healthy coping skills they can experience anger management problems. Excessive anger negatively impacts people emotionally, mentally, physically, socially, passionately, legally and spiritually. So the whole shebang anger just kind of permeates everything. Effective anger management involves preventing vulnerabilities being aware of and working on those sensitive areas or threat areas such as rejection failure, loss of control and death. Preventing anger whenever possible and developing immediate coping responses to deal with it when it occurs. Are there any questions? Right everybody, have a great day and I will see you tomorrow. If you enjoy this podcast please like and subscribe either in your podcast player or on YouTube. You can attend and participate in our live webinars with Dr. Snipes by subscribing at allceus.com slash counselor toolbox. This episode has been brought to you in part by allceus.com providing 24-7 multimedia continuing education and pre-certification training to counselors, and nurses since 2006. Use coupon code counselor toolbox to get a 20% discount off your order this month.