Cognitive-Behavioral Therapy is used all around the world to help people with many different problems like anxiety, depression, anger, relationship problems, substance use, accomplishing goals, and motivation.
We created a video to help people understand fundamental CBT tools and ideas to improve their lives.
This is a great podcast about Cognitive Behavioral Therapy done by Dr. David Burns, the author of the great self-help book “Feeling Good.”
I frequently listen to this podcast, it’s great for both clients and therapists. Here are some topics discussed:
Self-defeating beliefs
Overcoming perfectionism
The defiant child
Anxiety and Depression
Negative thoughts
Click here for a link to their webpage.
Cognitive Behavioral Therapy is the most validated form of therapy for anxiety disorders. In a huge review of studies exploring the effectiveness of CBT, the researchers found “The efficacy of CBT for anxiety disorders was consistently strong” (click here for a link to a free copy of this study). In another comprehensive review of studies exploring CBT for generalized anxiety, the authors concluded “when compared to waiting list control groups, these treatments have large effects on worrying, anxiety and depression, regardless of whether effects were measured with self-report measures or with clinician-rated instruments” (click here for a copy of this study). Many people would prefer their anxiety just went away but research suggests few people who do nothing, reduce their anxiety. As the studies above suggest, one of the things people can do to reduce their anxiety is cognitive-behavioral therapy and at the core of CBT for anxiety is exposure therapy and behavioral experiments.
Simply put, exposure therapy involves exposing the client to their feared situations in a gradual, repeated, and prolonged manner until the client becomes desensitized. For example, if a client is terrified of public speaking they may work with their therapist to create a list of anxiety provoking situations (speaking in class, watching videos about public speaking, taking a class on public speaking, imagining speaking in public, speaking in a meeting at work, talking to a cashier at a store, doing a speech at Toastmasters, etc.). The client then ranks these situations from least anxiety provoking to most anxiety provoking, this is called an anxiety hierarchy. Then starting with a situation that does evoke some anxiety but is not overwhelming, the client would repeatedly expose themselves to these situations, over and over, until they become desensitized to this situation. A useful example of this most people can relate to is learning to swim as children. Many children are afraid or at least tentative about the water, but their parents encourage them to become more comfortable over time, often enrolling them in swim classes. As the child is gradually exposed to the water over time, they become less afraid. Alternatively, the children that are terrified of the water, and refuse to ever go in the water continue fear the water.
*For more information about exposure therapy see my article “Overcoming Anxiety and Avoidance” by clicking here, or download our free anxiety workbook by clicking here.
Behavioral experiments can take a number of different forms. Similar to exposure therapy, the client and therapist may work together to create a list of anxiety provoking situations. Then the client and therapist will work together to identify the client’s fears about what could go wrong in these situations. Often these fears are exaggerated and extreme but the client sees them as perfectly reasonable. So then we create a little experiment in which the client enters the feared situation and observes to see if their fears come true. Then the client runs the experiment several times in an attempt to gather more information. Once the client has run the experiment several times, they reconvene with the therapist to discuss what they have learned about their fears and their abilities to cope.
For example, perhaps one of the situations on the client’s anxiety hierarchy is saying “no” to other people. Perhaps the fear in this situation is something like “If I say no to my mother when she asks me to do something, she will call me selfish, the rest of my family will hate me, and I won’t be able to handle that.” So then the client and therapist run an experiment in which the client talks with their mother, explains they are trying to be more assertive and wants to work on saying “no” sometimes. Then the next time their mother asks them to give them a ride to the store, the client explains they cannot help that day due to other commitments, then observes what happens. In this situation, the client’s mother may very well call the client “selfish” and their family may complain, but the client also learns they can survive being called selfish and occasionally listening to complaints. Or perhaps the client’s mother understands the client has other commitments and they schedule a plan in which the client gives their mother a ride another time, or the client’s mother finds another way to the store. See the below table for an example how I would write-up a behavioral experiment assignment with a client.
Another type of behavioral experiment involves the client identifying what they suspect other people believe then conducting a survey to assess the accuracy of the client’s assumptions. For example, the client may believe that people believe that women over a particular weight are “unattractive.” Clients may start by simply ask some trusted friends or family about this assumption. They may take photos of themselves or others to friends or family and ask people about their impressions about the people in the photos. In this example, the client ideally learns that attractiveness is not directly related to something as arbitrary and simplistic as weight.
In my experience, exposure therapy and behavioral experiments have been immensely helpful for clients. Clients usually report dramatic shifts in their anxiety in only a short period of time. In CBT we assume the client becomes less anxious in situations they are exposed to because they learn that their initial assumptions about the dangerousness of the situation is exaggerated and their beliefs about their abilities to cope with the danger posed by those situations is minimized. In other words, their cognitions change. After exposing themselves to a variety of different situations, the client learns they have a habit of exaggerating danger and minimizing their abilities to cope, and so they become less anxious in other situations they have not exposed themselves too.
For example if you are anxious about travelling but you muster the courage to go to Mexico, you might learn that Mexico isn’t as dangerous as you expected. Then if you go to Germany you might learn that Mexico and Germany are safe. Then if you go to India you might learn that Mexico, Germany, and India can be travelled to safely. Then you might learn that travelling in general can be done safely, not only to those countries you have been to in the past.
One challenge in using exposure and behavioral experiments is explaining the importance of actually facing fears to the client. Some clients have spent decades avoiding situations that make them anxious and the thought of deliberately exposing themselves to these situations is terrifying. People tend to want to avoid situations that make them anxious. Unfortunately, it is this very avoidance which perpetuates the anxiety indefinitely.
Another barrier to effective exposure and behavioral experiments is called “safety behaviors.” Safety behaviors can sometimes resemble the compulsions of someone who struggles with OCD. Safety behaviors are unnecessary, excessive, or unhelpful activities or strategies people use in anxiety provoking situations to protect them from “something going wrong.” When the client is anxious about going to a new restaurant they may excessively research the restaurant online to create a plan to prevent something “bad” from happening. In this example the excessive research is the safety behavior the client uses to keep themselves “safe.” Then when they go to the new restaurant and nothing “bad” happens they convince themselves it is because they researched prior to going. In this situation, the client has not learned that they can safely go to a variety of different restaurants, but instead they have learned they can go to a restaurant when they excessively research it in advance. Other examples include holding glasses very tightly when you’re afraid of spilling, distracting yourself with your phone when afraid of standing in lines, and never disagreeing with people when you are afraid of conflict. Research suggests it is imperative safety behaviors are identified so the client can either avoid using them or gradually reduce the use of safety behaviors over time.
Sometimes a client’s anxiety is about situations to which they cannot be exposed. For example, the client might be terrified of earth quakes, someone dying, their son being in a car accident, getting fired, or being homeless. When the client cannot be directly exposed to their feared situations, we have got to get creative. We can watch videos of these situations, we can do research, we can read stories, we can write then recite our own stories in which the client is exposed to these situations, etc. This is based on the idea that thinking about the feared situation can actually desensitize the client. Some of these interventions are called “imaginal exposure.”
Research suggests CBT is an effective treatment for anxiety disorders. Exposure therapy and behavioral experiments are core elements of CBT for anxiety. By facing fears the client learns their feared situations are not as catastrophic as originally predicted and their ability to cope is better than expected.
The AWARE strategy can be used to reduce our distress we feel when we become anxious. The five steps of this strategy are:
Anyone that has tried to wrestle anxiety into non-existence can tell you this is not an effective long-term strategy. Fighting with anxiety is like holding a beach ball under water – the harder we push it down, the stronger it wants to pop back up. So our first step to reducing our anxiety is to first accept the anxiety, even though it is uncomfortable. Do not judge the anxiety as good or bad, instead simply acknowledge the physical sensations that you feel in your body.
Pay attention to your thoughts and physical sensations in a non-judgemental manner. You can rate your anxiety on a scale from 0-100, then watch it ebb and flow.
Continue to live your life despite the anxiety. Slow down if you have to, but stay in the situation and keep doing what you are doing. Continue to breath slowly. If you run from the situation your anxiety will go down, but your fear will go up. If you stay, both your anxiety and your fear will go down eventually.
Continue to accept, watch, and act until the anxiety dissipates. This will reduce your fear and you will learn to cope with your anxiety for future situations.
When we struggle with anxiety, we often catastrophize (predict a catastrophe will occur). We can challenge these catastrophized automatic thoughts by expecting positive outcomes. Expect some anxiety but also expect that you will be able to handle it and it will go down eventually.
The AWARE strategy comes from one of the most influential therapists in history Dr. Aaron Beck, one of the founding fathers of CBT. He details this strategy in greater detail in his 15th edition of “Anxiety Disorders and Phobias: A cognitive perspective.” Click here for a video of Aaron Beck and the Dalai Lama.
Personally, I have found the AWARE model helpful in both my own life, and in the lives of my clients. It combines the non-judgemental acceptance of the present moment of mindfulness approaches with the deliberate continuing to remain in the anxiety provoking situations of exposure therapy. When I was in school I would become anxious prior to having to give class presentations. I would sweat through my shirt and my body would shake uncontrollably. By accepting my anxiety and repeatedly giving presentations, I was able to reduce my anxiety over time. Now I routinely teach classes in front of dozens of students with only minimal anxiety. When we stop fearing our anxiety and avoiding anxiety provoking situations we can learn to trust ourselves and the world a little bit more.
All counselling theories (narrative therapy, psychoanalysis, DBT, 
mindfulness based theories, CBT, etc.) all have underlying philosophies about how human beings “work”, what is “healthy”, and how people can remove barriers to become more “healthy.” People might be surprised to know there are a number of different variations of cognitive-behavioral therapy (CBT). One type of CBT is called Rational-Emotive Therapy (RET) and it was created by Albert Ellis. This article describes the underlying philosophies of RET and has been adapted from Bill Borcherdt’s book “Think Straight! Feel Great! 21 guides to Emotional Self-Control.”
RET is designed to teach people:
I suspect people will see some common themes in these recommendations. Generally, RET emphasizes personal responsibility and choice, it suggests that we are responsible for our emotional reactions and we can change our emotions, by changing what and how we think. RET also recommends we unconditionally accept our “self” while judging our emotional reactions as “appropriate” or “inappropriate”, which I think is an interesting idea. While I do not choose to use this terminology with my clients, I agree that intense emotions can interfere with our attempts to achieve our goals.
Most clients are resistant to making changes in their lives, usually for a variety of different 
reasons. People tend to want to minimize their choices and responsibility by suggesting they have no control over what they think or feel. There are several old videos of Albert Ellis working with clients on YouTube, and he has a very direct and almost confrontational style that I believe is reflected in the uncompromising philosophy of RET (click here for a classical example of RET at work). I’m not saying the advice listed above is bad advice, just that I suspect giving this advice in a way that clients could receive it non-defensively could take some tact.
People with anxiety and panic frequently tell themselves “I must do perfectly well” then ask themselves some version of “will I do perfectly well” and the answer is always “no.” After they have avoided the task, or tried and failed to meet their hopes, they then become depressed because they tell themselves they did not do as well as they “should” have done. These are some of the claims made by one of the most influential contributors to counselling psychology in history, Albert Ellis. (See here)
While, I’m not bold enough to claim that perfectionism is the core of mental illness, the majority of my clients report high levels of perfectionism. There does seem to be a real connection between anxiety, depression, and perfectionism. Therefore, this article delves into some modern research on perfectionism, how to know if you might practice unhelpful perfectionism, and what you can do if you are a perfectionist, to live a more satisfied life.
According to research, there are two dimensions to perfectionism: perfectionistic concerns and perfectionistic strivings.
While these two dimensions are related, they are not the same thing and you can have one without high levels of the other. In other words, you can have high personal standards and work to meet those standards, without over-focusing on mistakes, excessively doubting your performance, or being very concerned about what other people may think. Research shows people who report high levels of perfectionistic concerns also typically report lower life satisfaction, neuroticism, low self-esteem, negative affect, anxiety, depression, and suicidal ideation. While people who report high levels of perfectionistic strivings, without high levels of perfectionistic concerns, report higher levels of conscientiousness, positive affect (they are generally happier), endurance, and academic performance (Stoeber & Otto, 2006).
When working with clients, I often hear rationalizations like “my perfectionism motivates me to work harder” or “I have to be a perfectionist or something really bad might happen.” The research described above does suggest that there are a number of benefits to having high personal standards and working hard to achieve those standards. However, when we are overly focused on making mistakes, doubting our actions, and focusing on what others think, we lose the positive benefits of our perfectionism. For the remainder of this article, I’ll refer to being overly concerned about mistakes, doubting ourselves, and being focused on how others might evaluate our performance (perfectionistic concerns) as “unhelpful perfectionism.”
Interestingly, unhelpful perfectionism is a recipe for low life satisfaction regardless of how well we actually do. In a study from Pennsylvania State University, 273 students reported engaging in unhelpful perfectionism led to less satisfaction with grades, regardless of how well they did (Grzegorek, Slaney, Franze, & Rice, 2004). In other words, even if they met their high personal standards, they were still unsatisfied if they were overly focused on making concerns, doubting their actions, and focusing on what others think.
How to know if you might practice unhelpful perfectionism
People that practice unhelpful perfectionism might claim:
These are items from two measures of perfectionism, the Frost Multidimensional Perfectionism Scale (Frost et al., 1990) and the Multidimensional Perfectionism Scale (Hewitt & Flett, 2004) and they reflect concern about mistakes, doubts about actions, and concern about other people’s evaluations. Beliefs and behaviors like these tend to interfere with a person being satisfied in life.
In 2011, two researchers from the University of Kent, Joachim Stober and Dirk P. Janssen, wanted to better understand the relationship between perfectionism, how people typically coped with stresses in their lives, and the amount of satisfaction they generally felt at the end of the day. They found people reporting high levels of unhelpful perfectionism seemed to cope with stressors in their lives in similar ways, and these coping mechanisms were contributing to lower satisfaction. People who reported a lot of unhelpful perfectionism reported typically trying to cope with stresses by criticizing themselves or blaming themselves for the “bad things” that happen to them. Unsurprisingly, self-criticism was associated with diminished satisfaction.
Alternatively, people who reported high levels of unhelpful perfectionism reported more satisfaction when they used a coping mechanism “positive reframing” (aka “positive reinterpretation”). These people attempted to cope with challenges by “trying to see it in a different light, to make it seem more positive” or “looking for something good in what is happening” (Carver, 1997).
Two other ways of trying to cope with perceived failures were related to high levels of satisfaction, acceptance (“accepting the reality of the fact that it has happened”) and humor (“making fun of the situation”). Although, these coping mechanisms seemed to be less effective for people reporting high levels of unhelpful perfectionism.
Positive reframing has been explored in great detail in a multitude of studies over the last 30 years. Back in 1984 Lazarus and Folkam explained that positive reframing allowed people to manage their distress when challenged so they could continue with effective problem solving. This combination of positive reframing and actively trying to deal with stressors in an effective way can be an incredibly useful way to handle challenging situations in life.
We can have high personal standards and work hard to achieve these standards without over-focusing on our mistakes, excessively doubting your performance, or being very concerned about what other people may think. Indeed having high personal standards is associated with better life satisfaction. However, when we engage in unhelpful perfectionism it leads to reduced life satisfaction, neuroticism, low self-esteem, negative affect, anxiety, depression, and suicidal ideation.
Examples of unhelpful perfectionism include claiming things like:
However, even if we engage in unhelpful perfectionism we can experience greater satisfaction in life, by attempting to cope with challenges by seeing challenges as opportunities, focusing on what we learned from challenging experiences, and looking for something good in what has happened. By thinking about problems in this proactive way, we are better able to engage in effective problem solving.
Although this will likely reduce the number of “likes” I get for this post, I believe it is important to begin with some honesty. Overcoming anxiety is hard work. Most people want a simple and easy answer that can make all of their suffering go away. However, for every complicated and messy problem there are many simple and easy answers that are ineffective. For example, in Canada the use of antidepressants increased over 450% between 1981 and 2000, but the demand for mental health services has never been higher. This post is not an “8 easy steps to being less anxious” kind of post, it is more of a “if you work really hard, stay determined despite set-backs, and keep an open-mind about trying new things you may be able to make some real improvements to your life” kind of post.
Anxiety is a normal reaction to perceived threats. However, when we have a tendency to focus on threatening situations, the problems in our lives, we are fueling excessive amount of anxiety. One way we attempt to reduce the amount of anxiety we experience is by avoiding challenging situations. However, avoidance prevents us from overcoming our fears. Furthermore, as we avoid more and more things, our lives become more and more restricted.
For example, if you had social anxiety and were terrified of 
talking to authority figures, you would likely experience anticipatory anxiety before you spoke to people of authority, then when you did have to talk to someone of authority (exposing yourself to the feared situation) your anxiety would likely spike. Then when you avoid the situation by promptly leaving, your anxiety will naturally go down. Unfortunately, when we cope with anxiety by avoiding challenging situations we cannot challenge our assumptions that the situation is dangerous, we cannot challenge our assumptions that we cannot handle the stressful situation, nor can we learn how to handle the situation more effectively. So then the next time we exposure ourselves to the stressful situation we experience a similar amount of anxiety.
Overcoming anxiety can be accomplished a number of ways. However, research strongly suggests that one of the most effective strategies for overcoming anxiety is something called “exposure therapy.” Exposure therapy rests on the premise that if we can expose ourselves to our anxiety provoking situations in a certain way, we can learn: the situation isn’t as dangerous as we assume, we can handle the challenging situation, and we can practice skills to better handle similar situations in the future.
Exposure therapy
By exposing ourselves to anxiety provoking situations appropriately, we are able to reduce the amount of anxiety experienced when we face similar situations in the future.
Some notes about exposure therapy:
Exposure therapy can be immensely effective for anxiety created by many different situations. Personally, I have seen clients make radical changes in only a small number of sessions when they are committed to their exposure plan. However, it is important to remember than some situations are actually dangerous and we are not always exaggerating the danger in our minds. Therefore, I do not encourage people to behave recklessly, for example standing in a busy highway, going down dark alleys at night, or committing any crimes. Also, this article only describes one type of exposure therapy, something called “in vivo” exposure therapy and this type of exposure therapy cannot be used to overcome some anxiety provoking situations. Obviously, we cannot expose ourselves to our fear of our own death (at least not more than once), to fears of loved ones dying, or to fears of natural disasters. For these types of hypothetical fears, we may need to practice something called “imaginal exposure” which is not described in this article.
Some notes for therapists:
Many clients struggle with creating the motivation to engage with exposure therapy. When we are distressed we often resort to coping mechanisms that are familiar to us, even if they are not helpful. It can be useful to go slow with clients and discuss the costs and benefits of avoidance. Encourage the client to consider what their life may be like if they continue to avoid anxiety provoking situations indefinitely and/or consider the opportunities their avoidance may have already cost them. Remember, it is not our job to convince the client to do anything. Instead we are there to help them make informed decisions. If the client chooses to continue to avoid, while knowing the consequences of this decision, that is their choice and that should be respected.
Processing what the client has learned from exposing themselves is just as important as collaborating with the client to design the exposure activity. “what did you learn from exposing yourself to this situation?”, “what did you learn about your ability to cope with the situation?”, “what did you learn about your anxiety in general?” “what did you learn about your fears?” – Questions like these can be very helpful.
There are two workbooks you can now access in our “self-help” section for free.
The Making Changes workbook can help you learn about Cognitive Behavioral Therapy principles and how to apply them to your life. It can help you improve your living habits, set goals, and change your thinking.
The new Anxiety workbook can teach you about anxiety, skills to manage anxiety, and steps you can take to reduce your anxiety over time. Here is an portion from that workbook:
SUMMARY
· Anxiety is a normal human response to perceived danger.
· The more we worry, the more we are thinking about potential dangers, this then triggers the anxiety response.
· We can practice skills like box breathing, 5-4-3-2-1 sensory grounding, and progress muscle relaxation to cope with extreme anxiety.
· Cognitive behavioral therapy can help use reduce our anxiety.
· Our thoughts cause our emotions and behaviors, not situations. Therefore, our anxiety is being created by the story in our head, not the situation we are in.
· When we experience excessive anxiety we are usually engaging in unhelpful thinking styles.
· CBT teaches us to recognize our unhelpful thinking and then dispute irrational thoughts, replacing them with more helpful thoughts.
· Excessive worry fuels excessive anxiety. Sometimes we believe excessive worry can be a good thing, but these beliefs maintain worry.
· When we believe (1) “problems are threatening”, (2) “I can’t handle problems effectively”, and (3) “problems will turn out badly regardless of what I do” we are preventing effective problem solving. We can solve this by recognizing problems as a normal part of life and seeing the opportunities presented by our problems.
· A problem solving model can be used to help us effectively cope with challenges we can reasonably do something about.
· Graded exposure can be used to decrease the amount of anxiety we experience in situations. Graded exposure is a process by which we practice exposing ourselves to anxiety provoking situations, practicing and developing our skills, and gradually learning situations are not as threatening as our minds make them.
· We can improve our abilities to cope with stressors by maintaining a healthy self-care plan which includes diet, exercise, sleep, relaxation, work , socializing, thinking helpful thoughts, and goal setting.
You should do breathing exercises. Maybe do yoga a few times a week and you’ll feel better. Go for a walk daily. Start your day off with a 10 minute meditation.
I cannot count the number of times people have given me advice like this to me. These are probably good suggestions and they do indeed have a reasonable amount of research supporting them, but I believe they are insufficient for promoting lasting composure. I do see a lot of value in maintaining a relaxed, composed state of mind while going through my day. When we are calm our brains function differently, we have superior reasoning and problem solving abilities. I think many people can relate to the experience of reacting inappropriately when distressed. How can 10 minutes of meditation in the morning, a walk, or yoga a couple of times a week maintain my composure throughout the day? I do not believe it can. Instead, perhaps I need a tool I can easily use throughout the day to maintain my composure. For me, this tool is practicing mindfulness.
Mindfulness refers to paying attention to the present moment, without judgement. Practicing mindfulness is simple and incredibly effective for regulating my emot
ions throughout my day. What does practicing mindfulness look like? Take a breath, notice the air filling your lungs, notice your rib cage expanding, notice your heart beat, just notice how it feels. Focus on those things, and without judgment (“It should be deeper”, “it should be slower”, “it should be…”), just notice the way it is. Congratulations, you have just practiced mindfulness. It’s that simple.
Paying attention to your breath can be convenient because we always have our breath, even in a completely dark room, late at night but we do not have to pay attention to our breathing to practice mindfulness. We can be focused on anything in the present moment without judgement to practice mindfulness. By “judgment” I mean assigning interpretations like “good”, “bad”, “better”, “worse”, etc. For instance I often look at a tree outside my office window. I watch how the sun hits each leaf, I look at the shades of green and grey, I watch it move in the wind. Instead of thinking “that is a beautiful tree” or “that tree should be bigger” I just notice and accept how it is in the present moment.
I direct my attention to the present moment hundreds of times a day. As the people in my life can attest (with some frustration occasionally) I do very little worrying about the future. I also try and rarely think about the past, besides considering what I can learn from it and moving on. My paying attention to the present allows me to avoid much of the anxiety and depression that is associated with worrying about the future and regretting the past.
But I need to problem-solve and plan! I can’t just be sitting around looking at trees all day! I agree, that is impractical. However, I would argue that many people do far more worrying and regretting than are truly necessary. How many times have you lay in bed and lost sleep because you were trying to worry your way out of a problem? So we problem solve and plan when we must, and we stay in the present as often as we can. This way when we do have to problem we are composed, and our thinking is productive.
Okay, so what happens when I’m paying attention to the present moment and my mind just naturally thinks about the future or the past? It takes practice to stay in the present moment for any extended amount of time but while we are training our minds we want to be compassionate with ourselves. Like training a puppy, we want to be consistent, reliable, and gentle. So when our minds wander to a place they don’t need to be, we gently guide it back to the present.
I find practicing mindfulness to be most helpful in distressing situations. For example, when talking in-front of people I find it very helpful to just take a deep breath and just for a moment notice the air filling my lungs and my ribs expanding. This relaxes me immediately. Or after a stressful experience I will take a breath and just ask myself “what is going on in my mind right now?”, “what am I feeling?”, and “where are these emotions coming from?” I find this to be much more helpful for regulating my emotions than thinking “stop getting angry”, “I shouldn’t (judgement) worry about this”, or “I’m being too dramatic (judgment).”
You never listen to me. I fell like you are overreacting. I can’t do anything right, I’m always the bad guy. Don’t get upset. You always do this. You’re an asshole. Why do you have to be such a bitch? This is why this shit always happens to you.
Have you ever been hanging out with friends and have the displeasure of watching another couple’s argument turn into a full-blown fight? Have you ever been shocked by the devastatingly hurtful things family members say to each other? I’ve both been the shocked observer and I reluctantly admit to having been one of the people saying the hurtful things. On the surface, these statements appear to be motivated by anger. However, anger is described as a “surface emotion” and underneath anger there is usually a more vulnerable emotion like hurt, sadness, embarrassment, grief, etc.
Our angry behavior (yelling, intimidating, saying hurtful things) can be a way of communicating more vulnerable emotions. Unfortunately, communicating in this way is inherently manipulative because we are not communicating directly about what is going on for us. Instead of using the words “when you said I was lazy, I felt hurt because I really value your opinion. I also felt afraid because I was concerned you might not want to be in a relationship with someone you think is lazy”, we hope they get some form of this message through our angry behavior.
Our anger can also serve as a tool to teach another person about what we want. People learn through processes like reinforcement, punishment, and extinction. When another person does something we don’t like, we can use anger to punish them, in hopes they will not replicate this behavior in the future. For example, when Person A says something hurtful (you’re lazy), Person B may retaliate to punish the other person to reduce the probability of future hurtful comments. However, when we are in a relationship with a person and they are continuously punishing us we are likely going to develop resentment because, by definition, people don’t like being punished. So while anger can be a powerful form of punishment, it can seriously poison a relationship.
One of the best examples of these two concepts is when we get angry about another person getting angry. Getting angry at another person for getting angry at you is like trying to put out a camp fire with gasoline. Person A gets mad, then Person B thinks something like “I don’t deserve to be treated like this!” and gets angry to punish Person A. In addition to feeling anger, Person B is also probably feeling fear, hurt, and maybe even embarrassment.
If you have the goal of intimidating someone, expressing anger in an aggressive way may move you closer to achieving your goal. However, if you have the goal of having a good relationship with the other person, expressing anger in an aggressive way will be less helpful.
Reducing the likelihood of getting extremely angry. CBT recommends we begin by identifying our “triggers” and times when we are more likely to become triggered. “Triggers” are things (people, comments, situations, etc.) that rapidly increase our emotional responses. For example, if you are triggered by criticism, you are likely to have an extreme emotional response to being criticized. Common triggers include perceived rejection, failure, abandonment, and loss. Identifying your triggers in advance is a form of exposing yourself to your triggers through the use of your imagination. This “imaginal exposure” actually can reduce how distressing these triggers will be when you are exposed to them in real life. Furthermore, identifying your triggers in advance allows you to plan how you want to respond when faced with this trigger.
We are more likely to be triggered in certain circumstances. For example, I am more likely to be triggered when I am tired, hungry, or while drinking alcohol. So I make reasonable attempts to avoid situations that may trigger me during times when I’m more likely to become triggered. For example, if I have to talk to a friend about a sensitive topic, I do so when I’m rested, fed, and sober.
These two principles of identifying triggers in advance and considering times when we are more likely to become triggered can be useful for managing all extreme emotions, not simply anger.
Regardless of whether or not we identify triggers and times we are more likely to be triggered, we may still get triggered unexpectantly. While there are a ton of relaxation skills out there, some are more effective than others. These are the ones I recommend to people managing intense anger.
Minimize risk. Stop yourself from the “knee-jerk” reaction that often accompanies anger. Then I recommend you remove yourself from the situation if it is reasonably possible, it may also be useful to say something like “I don’t mean to be rude but I have to go calm down for a moment” and go for a walk.
Relax the body. Then cool off by splashing cold water on your face, taking a cold cloth and putting it on your face or the back of your neck, or taking a cold shower. You’ll learn that it is really difficult to stay mad when your face is frozen. Take some breaths, one useful breathing exercise is the 4-7-8 breath where you breath in for 4 seconds, hold your breath for 7 seconds, and breath out slowly for 8 seconds. Intense exercise and something called “progressive muscle relaxation” also can be very effective for calming our bodies.
According to Baranowsky, Gentry, and Schultz (2011, p. 127), when our fight/flight/freeze response is activated we are using our “sympathetic nervous system” and when we are calm we are using our “parasympathetic nervous system.” When the sympathetic nervous system parts of our brain are dominant our thinking is reactive, we have an increased threat perception, and we have diminished brain functioning. By contrast when the parasympathetic nervous system parts of our brain are dominant, we are more capable of creative problem solving, we have better decision making, and we are better at regulating our emotions. By relaxing our bodies we can shift from sympathetic nervous system dominance to parasympathetic dominance.
Calm down the mind. Once our bodies are calm, we are more capable of communicating and problem-solving. We can use cognitive-restructuring strategies to identify the thoughts causing our intense emotional reactions, challenge the validity of these thoughts, and replace them with more realistic thoughts. The automatic thoughts commonly associated with intense anger include thoughts about fairness (How dare you call me a jerk after all I do for you! I don’t deserve this!) and about how we want people to behave (You shouldn’t be acting like this! I should better at this! You should take out the trash!).
We can also use mindfulness skills to calm our mind. Put simply, when using mindfulness we are paying attention to what is going on in our mind, without judgement. We notice, accept, and let go of our anger inducing thoughts. It sounds simple but it takes practice.
Communicate. Once our bodies and our minds are calmer we may choose to communicate. Some good skills for communicating assertively include “I-messages” and the “assertive message format.”
I-messages typically include a description of how we feel, explaining the reasons for this emotional response, and clearly describing what you want. Some examples:
I felt angry when you said that I never listen to you, I’d like to talk about this.
I felt concerned when you raised your voice earlier, I’d appreciate if you could avoid doing that in the future.
I felt sad and surprised when you said my family is crazy, I’d like to understand where that comment came from.
The assertive message format includes: a description of behavior, an interpretation, describing your emotions, consequences, and your intention/position. These components can be combined in any order.
You were running behind yesterday and (behavioral description), as a result we were late to meet up with everyone (Consequence), I’m sure you didn’t mean to be late but (interpretation), and honestly, I was feeling a little annoyed and frustrated (feelings), next time, I would appreciate it if you could toss me a text if you’re running behind (intention/position).
― Melody Beattie
Both I-messages and the assertive message format are designed to open a dialogue with the other person, while reducing the probability they will respond defensively. When using these skills it is important to avoid blaming (you are responsible for your own emotional reactions), generalizing (“You’re always late”), or name calling. I’ll revisit more communication skills in future posts.
To summarize, anger is a surface emotion, usually with more vulnerable emotions underneath. Anger can be used to communicate more vulnerable emotions as well as punish other people to behave in ways that we want. We can reduce the likelihood of becoming extremely angry by identifying our triggers and times when we are more likely to become triggered. When we do become angry, we can manage our anger by reducing the risk, calming our bodies, calming our minds, and communicating effectively in a respectful and compassionate way.
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