CBT

Improve your Relationships by Understanding and Managing Anger

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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.

anger

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.

Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else; you are the one who gets burned. – Buddha

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.

So how do we reduce the likelihood we will get extremely angry and how do we communicate better when we are angry?

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).

“We can say what we need to say. We can gently, but assertively, speak our mind. We do not need to be judgmental, tactless, blaming or cruel when we speak our truths”

― 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.

Improve your approach to dealing with problems in life (Part 1)

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The Jewish psychiatrist Viktor Frankl remembers the day he entered the camps:

Then the train shunted, obviously nearing a main station. Suddenly a cry broke from the ranks of anxious passengers, “there is a sign, Auschwitz!” Everyone’s heart missed a beat at that moment. Auschwitz – the very name stood for all that was horrible: gas chambers, crematoriums, massacres. Slowly, almost hesitatingly, the train moved on as if it wanted to spare its passengers the dreadful realization as long as possible: Aushwitz!

His book Man’s Search for Meaning tells a harrowing tale of some of the worst conditions humans have been exposed to in modern history. As I read this book for the first time, several years ago, I was mesmerized by Dr. Frankl’s seemingly endless ability to recognize the opportunities within his experiences. His beliefs about problems and suffering were infectious.

Negative Problem Orientation

Put simply, a person’s problem orientation refers to their beliefs about problems and their ability to solve problems. People with a negative problem orientation are more likely to view problems as excessively threatening, they typically doubt their ability to solve problems, and they believe negative outcomes will occur regardless of how much effort they put in to solve them. As a result of these beliefs, researchers Dugas and Robichaud suggest people with a particularly negative problem orientation are more likely to be frustrated, irritated, anxious, or depressed when they face a problem. Behaviorally, people with a negative problem orientation are more likely to procrastinate and/or avoid problem solving. As a result, they can make new problems for themselves and increase worries.

Perhaps unsurprisingly, negative problem orientation has been connected with a wide variety of mental health difficulties including generalized anxiety disorder, depression, pathological gambling, and post-traumatic stress disorder (Robichaud & Dugas, 2005).

Locus of Control

In my opinion, a person’s problem orientation plays a massive role in how they approach the world. There seems to be a large overlap between problem orientation and something, in psychology, we call “locus of control.”  Our locus of control can be described as our beliefs about how much we influence what happens in our lives. People with an “internal locus of control” typically believe they greatly influence their destiny. While people with an “external locus of control” typically believe that what happens in their lives is largely controlled by forces outside of them. Research over the last 65 years has suggested that people with an internal locus of control have greater academic success, are more motivated, are more socially mature, have less stress and depression, and live longer. They “earn more money, have more friends, stay married longer, and report greater professional success and satisfaction” (Duhigg, 2016, p. 24). So to summarize, people with an internal locus of control will usually be less threatened by problems, work harder to solve problems, and believe they can mitigate negative outcomes through effective problem solving. In other words, they have a more positive problem orientation.

locus of control

So if a negative problem orientation and an external locus of control are typically unhelpful for promoting health and wellbeing, what can we do to change?

Luckily, research suggests there are a few things we can do to improve our problem orientation and our beliefs about locus of control. Dugas and Robichaud suggest we first have to learn how to identify problems. Many clients enter therapy and believe that their emotions are the problem, they just want to be happy. However, emotions are not the problem. Emotions are data, they are just information giving you clues something is or is not working for you in life. The problem is not that you are depressed, the problem may be you are stuck in a relationship that is not good for you, it could be that your habits are not particularly healthy, it might be that you are stuck in depressive thinking habits, perhaps the problem is that you are in a concentration camp, etc. Once we can see our emotions as information, this can help you identify appropriate solutions to the real problems.

The belief that we are exceptional because we experience problems can keep us stuck. Why does this keep happening to me? Why was I the one who was dealt a bad hand in life? We can improve our problem orientations by challenging these kinds of beliefs and recognizing that experiencing problems in life is normal. Suffering is an important part of life, it is times when we suffer the most that we are motivated to adapt and grow the most.

Challenge filtering and overgeneralizing (see our cognitive distortions list). An internal locus of control and/or a negative problem orientation occurs because we are not paying enough attention to all the times your effort and practice have influenced outcomes. We conclude because we could not have possibly prevented ____________ from happening in the past, why bother trying in the future? While there is a lot in life that you cannot control, there is a massive amount that you can. By just focusing on the things we cannot control, we are underestimating the number of choices we have. When we underestimate the choices we have, we are reinforcing the belief that we are not responsible for what happens to us and this can be a very comfortable delusion to live in. However, this short term comfort comes with a price, it disempowers us and maintains a victim mentality.

Lastly, and perhaps most importantly, we can improve our problem orientation by recognizing the opportunities that are within all of the problems we experience. Every problem has opportunities associated with it. Few people illustrate this better than Viktor Frankl. While in the camps, he became very sick, and with the sickness came a far greater likelihood of being “selected” to go to the gas chambers. Despite his sickness he remembers:

We were sick and I did not have to go on parade. We could lie all day in our little corner in the hut and doze and wait for the daily distribution of bread (which, of course was reduced for the sick) and for a daily helping of soup (watered down and also decreased in quantity). But how content we were; happy in spite of everything.”

This sickness gave him the opportunity to rest. More generally, by being a prisoner within the camp, Frankl recognized he was given the opportunity to study what happens to a human under such circumstances. He was given the opportunity to understand how people find meaning and purpose even in the worst of conditions. Gordon Allport describes Frankl’s conclusions beautifully in his preface:

In the concentration camp every circumstance conspires to make the prisoner lose his hold. All the familiar goals in life are snatched away. What alone remains is “the last of human freedoms” – the ability to “choose one’s attitude in a given set of circumstances.”

Being in the camp presented many, very real and horrifying, problems. However, Frankl was also given the opportunity to choose how he was going to cope with these problems. He was given the opportunity to search for answers to some very fundamental human questions – what prevents some men from committing suicide in such horrible conditions? Why choose to live when one can simple run to the electric fences at any time? What motivates a man to treat prisoners a particular way? Etc.

When your partner says something you don’t agree with, you are being given the opportunity to practice your non-defensive communication skills. When you lose a relationship you have the opportunity to be a kind, loving, and respectful person even when things do not go your way. When you get lost, you have the opportunity to become familiar with somewhere new. When you are in a concentration camp, you have the opportunity to study how humans adapt to such horrible conditions and find meaning and purpose despite great suffering.

If you have children, it is likely they will experience their own challenges in life (divorce, trauma, accidents, health problems, etc.) and every time you experience these things, you are being given the opportunity to teach your kids how to effectively face these problems in their own lives. By recognizing the opportunities within the problems we face, we are going to be more likely to accept when problems occur and we will be more motivated to engage with our problems in a helpful way.

Duhigg, C. (2016). Smarter, faster, better: The secrets of being productive in life and business. Doubleday Canada.

Frankl, V. E. (1959). Man’s search for meaning: An introduction to logotherapy. Washington Square Press, New York.

Robichaud, M., Dugas, M. (2005). Negative problem orientation (part I): Psychometric properties of a new measure. Behavior Research and Therapy (43)3, 391-401.

An introduction to unhelpful thinking styles

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I’ll never find anyone as good. I’ll never meet someone else, never have my own family. I can’t handle this. This isn’t fair. I’m unlovable. Everything is awful.

 Most people are familiar with thoughts like these. When under intense stress, like the loss of a significant relationship, our minds often go to those dark places. Sometimes our thoughts are irrational and since these thoughts are extreme, the emotions they evoke are also irrational. I tell clients all the time that I do not want them to be an unfeeling robot. If we suffer a significant loss we should feel some grief, if we are treated unfairly it is normal to feel angry, and it is okay to be sad sometimes. However, sometimes we have emotional reactions which are disproportionate to the situation. It is these intense emotional reactions which usually lead to behavior that is inconsistent with our values and goals. Since we know emotions are caused by thinking, we can reduce the intensity of irrational emotional responses by changing the irrational thinking evoking them.

 

“There are no facts, only interpretations.”

― Friedrich Nietzsche

 Dr. Aaron Beck is widely considered the father of Cognitive Therapy. He was trained in the classical forms of therapy pioneered by Sigmund Freud (Psychodynamic Therapy). Psychodynamic Theory suggests that our thoughts are the product of unconscious or subconscious forces within our psyche. In other words, this theory suggests that our thoughts mean something about us. While at a dinner party, Dr. Beck met a woman and this interaction would change psychotherapy forever. The story is that this woman explained she was depressed and she believed that no one loved her/she was unlovable. Instead of going down the usual therapeutic road, Dr. Beck decided to try something different. He asked her to evaluate the evidence for her beliefs. To her surprise, the woman was able to recognize that there were several people in her life that loved her and when she focused on this, her sadness dissipated (listen to this great podcast for more information). While working with severely depressed patients in his clinic, he noticed several common thinking errors within the thoughts of his patients. Today these thinking errors are called “cognitive distortions.” By identifying and challenging cognitive distortions, our thinking can become more rational and as a result our emotions will also become more rational.

rational thoughts and feelings

In the following table I demonstrate how the “three column technique” can be used to challenge cognitively distorted thoughts. In this exercise you identify your distressing thoughts, identify cognitive distortions taking place, and try and come up with more rational thoughts.

Cog distortions example

While a full description of all of the common cognitive distortions is beyond the scope of a single blog post, I will post a worksheet I use with clients on the self-help resources page that goes over them in greater detail.

When I work with clients, I typically go over a list of some common cognitive distortions. The vast majority of clients are able to recognize that they have many thoughts consistent with these unhelpful thinking styles. Clients struggling with depression usually filter out all of the good things in life, those struggling with anxiety are often plagued with catastrophizing, and people overwhelmed with anger desperately want the world to work the way they want (should/musts and the fallacy of fairness). We all think cognitively distorted thoughts sometimes, it is normal. The refreshing thing about thinking habits is that they can be changed. The first step to changing our thinking is building our awareness of our thoughts. Simply reading this post and the list of common cognitive distortions on the self-help page can help you with becoming more aware of your unhelpful thinking patterns.

Personally, learning about cognitive distortions has changed my life. Challenging my unhelpful thoughts insulates me from distress that comes with being a human being. When I am irrationally frustrated about something (like a hockey game) I pull out my journal and practice these skills. When I go through a more significant challenge (bereavement, financial concerns, trauma, etc.) I use the same skills. Before learning these theories and techniques, I would stay up for hours on end, just laying in bed ruminating about things. Now I am able to process what is going on for me and let it go. Hopefully with some practice, you will be able to do the same.