Anger Management: 10 Session Cognitive Behavioral Therapy Protocol

Hey there everybody, and welcome to this counseling continuing education presentation on a 10 session anger management protocol. I'm your host, Dr. Donnellice Snipes. In this presentation, you're going to learn about anger and its functions. Explore early warning signs, figure out how to develop an anger control plan, learn about the aggression cycle and how to change it. Review the ABCDEs and explore how prior learning influences current anger triggers. Session one. In session one, you're gonna learn about anger. Anger is an emotion triggered by a threat that prompts the fight or flight reaction. This is what we call the HPA axis, or what I call the threat response system. And when this happens, your body dumps adrenaline, it dumps cortisol, it dumps glutamate, it dumps all these chemicals and hormones that are designed to give you the energy to check out if there's a problem and if necessary, fight or flee. Just like a smoke alarm tells you that, hey, there might be a fire, your threat response system tells you, hey, there might be a threat. It's not saying there is, it's saying there might be. And here's a bunch of energy so you can get up and figure out if there is a threat and respond if needed. Hostility refers to a set of attitudes, thoughts and judgments that motivate aggressive behaviors. Aggression is a behavior that's intended to protect oneself by causing harm or energy to another person or damage to property. What's the benefit of aggression? Well, if we're feeling threatened and we want to fight or flee, and in this case fight, then the goal is to regain control, to regain power in the situation. So aggression serves to forcibly take back power. Many times what we initially perceive as a threat is actually not currently one. But our reaction is based on outdated schema. And schema are our brain's Cliffs Notes, if you will. Every time we have an experience, our brain notes what happened. You know, just very short, quick little summaries of what happened and that helps us predict the future. We have schemas about going to work, we have schemas about stoplights, we have schemas about going to the doctor. That way, when we are getting ready to encounter one of those situations, we know what to expect. And our brain tells us, okay, been here, done that. This is what we expect. Unfortunately, schema are only based on prior experiences. So if this experience is different, the schema is not going to be effective, it's not going to work for you, and that can cause you problems. The cognitive triangle is a concept that we use in cognitive behavioral therapy that points out that our thoughts, feelings, and behaviors are all interrelated. If you're having angry thoughts, you're probably going to respond with irritability, and you may have, obviously, feelings of anger. If you are having feelings of anger or anxiety, then you're probably going to have thoughts that support that. You're going to be telling yourself that there's a threat of some sort, and you're going to respond accordingly. Inaccurate schema and misperceptions are very common. And the reason we have them is because, as I said, the brain does not integrate often the present moment, it just kind of goes on autopilot going, okay, been here, done that. This is what to expect. We need to actually disengage from our autopilot and recognize what's going on in the present moment and evaluate whether the space schema are accurate or not. I already talked about the fire alarm. When the fire alarm goes off, it doesn't always mean there's a fire. It means there might be someone. Not returning a text is another thing that triggers anger in people sometimes because they may feel that the person is being disrespectful or rude or rejecting them in some way. We don't know, though. We're assuming. Assuming, as they say, makes an ass out of you and me because we don't have the facts in the current context. My dog, Brewster, was a foster dog, and I have no idea what happened to him before he came to us. But there was one day that my son and his best friend were out practicing martial arts in the yard. And Brewster saw them, and he didn't realize that they were playing. I mean, they were practicing martial arts. They weren't actually attacking each other aggressively. But Brewster didn't understand that. So he formed a schema about Elias that said, this. This dude's no good. And it took multiple exposures of Brewster to Elias and Sean after that for Brewster's schema, his understanding of the situation to change literally months before Elias could come in, and Brewster wouldn't get his hackles all up on his back. If somebody has a history of abandonment, then when they experience similar situations, whether it's the way somebody acts or the way somebody talks to them, or even different microaggressions, they may interpret as that they're getting ready to be abandoned. And it can trigger feelings of anger. People who've been victims of crime, and I use crime very broadly here, when people experience trauma, it strips their sense of safety and personal power or control. So in the future, when they feel like they are not in Control of things. When they feel like they are lacking power or they're unsafe in some way, it will trigger anger a lot more intensely because they're reacting from oftentimes from that place in the past when they were victims, and so they're trying not to be one again. Anger initially has apparent payoffs, like releasing tension, controlling people, getting your own way. But in the long term, these payoffs often lead to negative consequences. What benefits or payoffs does anger have for you? Now, we don't do things unless there's a benefit. So it's important to recognize what benefits anger has in order to figure out, is this a benefit that I need or that I want or that I want to get this way? And is there another way of getting that benefit, such as feeling safe? Is there another way to feel safe besides having to be angry and aggressive all the time? When you get angry, what are your responses? What behaviors do you use? What thoughts do you have? What feelings do you have? Sometimes a lot of time, people, when they get angry, underneath, there's also a feeling of anxiety or hopelessness, and the anger is protecting them from those fears. Anger is a natural, normal emotion that's designed to help us survive. It becomes a problem when it's felt too intensely, too frequently or expressed inappropriately. Think about how anger affects you. Remember I said anger indicates that our threat response system has been triggered. So our body's dumping cortisol and adrenaline and all these stimulants into our system. When we're angry and we have these stimulants circulating through our system, it's going to make it darn near impossible to get good quality sleep. It can increase pain not only because of the muscle tension that we have when we're angry, but but also because it alters our neurochemicals that are responsible for our pain threshold, and we actually may start feeling more pain. Our gastrointestinal system can get disrupted. When you are in fight or flea mode, your body is saying, yeah, not going to devote energy to digestion, so let's just clear everything out of there. Additionally, the stress response, when it goes on for too long, will impair immunity, and it can also trigger autoimmune disease, flare, ups, crohn's disease, those sorts of things affectively or emotionally. After people have an anger outburst, they may also end up feeling regret or guilt or. Or even helplessness because they're trying to control their anger, but they can't figure out how to actually do it cognitively. When your brain is flooded with all those stimulating neurochemicals and you're in fight or flee mode. You're not using your higher order thinking, your prefrontal cortex. You are in a very primitive, reactive state. Linehan talks about that as the emotional mind. And in order to make effective decisions and respond in a different way, it's important to get into your wise mind, which means de escalating until you can think more clearly. Additionally, when you are revved up, when you are angry, when you're in an unpleasant mood, you're going to notice the threats in the environment and the negative things a lot more easily than you're going to notice anything positive. I mean, think about when you're in a bad mood. Do you notice the birds and the little bunny rabbits and the things that would make you smile, or do you tend to just notice all the stuff that supports your current mood environmentally, when people are angry, you know, how, what, how does it affect your environment? Do you break stuff, put holes in walls, throw out things impulsively? I remember back before computers, we used to have pictures, and it wasn't uncommon for people to tear up pictures impulsively when they got mad and then regret it later. Relationally, when somebody is angry, it creates an environment where other people may fear being around them. They're walking on eggsh because they don't want to trigger this person's anger. So instead of being a relationship that's based on respect and desire to support one another, it's a relationship based on fear where that person is just trying to keep you from exploding. And this can negatively impact relationships for obvious reasons. Changing how you respond to anger triggers takes a lot of work and energy. And it's important to figure out, why do I really want to do this? Define your rich and meaningful life. You know, if you woke up tomorrow and you had this rich and meaningful life, what people would be in it? What would those relationships be like? What things would you have? What experiences or activities would you be using your energy for? Every time you get angry angry, it uses your energy. So you've got to decide, do I want to use my energy for being angry about this, or do I want to use my energy to work towards something that's important in my life? And you may find a lot of people find that they waste a lot of energy being angry and nurturing grudges when they could use it instead to nurture and enhance positive things in their life. How does anger keep you from moving toward the things that are important in your rich and meaningful life? And what thoughts, feelings and behaviors would be a better use of your energy. At the end of session one, we want to talk real quick about quick skills, because when you experience anger, I talked about getting out of the emotional mind into the wise mind. That means figuring out something you can do to help slow your heart rate. Slow your breathing. The first one is what we call square breathing. Breathe in for four, hold for four, exhale for four, hold for four. When you do that 16 count breathing, or the four square breathing, it actually forces your heart rate to slow down. You're manually overriding your nervous system. Some people prefer to go to the opposite end, and instead of slowing their breathing, they prefer to engage in something physically active. So they're body movement matches their heart rate. And then when they start cooling down from whatever that activity is, walking, running, sit ups, push ups, whatever it is, then the heart rate starts to go down. I encourage you to also develop a personal mantra when you're angry. Have a little, little bit of what Linehan calls a half smile and repeat the mantra to yourself in order to help you get through that initial 90 seconds, five minutes where you're in that adrenaline haze. For me, my mantra is it's all good. It's all good. And I may even say it out loud when my family hears me going, all right, it's all good. They noticed. Give me a few minutes because I've gotten upset about something and I'll come back and tell them about it later. But that helps me not only down regulate my stress response, but it also helps me block a lot of those other thoughts that would be contributing to fueling and stoking my anger. You can't have two thoughts at the exact same time. So if you keep focusing on your mantra, it's all good, then you can't hear those other thoughts. And that allows you to calm down a little bit so you can get into your wise mind. And finally, unhooking. And this is a technique from acceptance and commitment therapy. But unhooking means taking that feeling, taking those thoughts and putting them out. Here I'm having the feeling that I'm angry, okay? Envision it as a bubble or a rock or whatever you want to envision it as, but it's not part of you. You're having a feeling, you're having a thought. What do you want to do with it? Do you want to hold it? Do you want to nurture it? And if it's a negative feeling like anger, you may even envision it like a hot potato. You know, do you really want to sit there and hold this hot potato. What do you want to do with it? You want to get rid of it so but envisioning it as something separate from you, then you can decide what to do with it. When you start saying it's part of me, then it's harder to figure out how to get rid of it Homework for Week one Keep a log of your anger intensity over the week. Keeping a log helps you become more aware of your triggers and see your progress on the top of each page. Put the date and use a different sheet each day. I encourage you to use paper on a landscape orientation because we are going to add additional columns over the coming weeks. Make four columns with the following Episode intensity, duration and anger control strategy. For the episode, you're going to describe briefly what happened. The intensity scale from 1 to 4 mildly irritated, moderately irritated, angry or enraged. The duration a1. It was brief, just a minute or two a2 it was less than an hour but it still lingered for a bit. 3. You felt that anger or irritation for a couple of hours or four it ruined your day. And the fourth column what strategy did you use to try to respond to that anger to try to control that anger? Session 2 Every session starts out with a review of the homework from the prior week. So reviewing the homework from last week, what was the highest number that you reached? What triggered the most intense anger episode? What strategies did you use to avoid reaching a 4 on that anger meter? To avoid reaching the level where you were enraged? This week we're going to start thinking about anger in terms of a habit, a habitual response, an autopilot response. Habits are things we do almost automatically. In what ways is anger a habit for you? And when something happens that triggers your anger, do you stop and think, I'm going to react with anger or do you just automatically do it? Just autopilot. What other habits have you had? Biting your nails? Shaking your foot? Tapping the table? Whatever habits you've had, how have you tried to break those? What has helped you break those habits? And I'll give you a hint. Becoming aware of the habit is the first step to doing it. Review your anger log from last week. When you got angry, did you consider other response options or did you just respond out of habit? Was it a knee jerk response? How can you use mindfulness to start to break your anger habit? And I use the mnemonic beta or beta testing to help you remember what to do in order to start breaking a habit. So B stands for breathe. The first thing you need to do practice that 4. Square breathing in order to get into your wise mind. So start to slow your breathing. When you notice your anger starting to ramp up. When you notice you're starting to get a little bit frustrated or irritable, start breathing. Then don't wait until you are enraged before you try to calm the system down. E stands for explore the situation mindfully and non judgmentally. Acknowledge I'm angry. Okay, what is the cause? Just be curious about what's going on. Is this actually a threat to me at this time? And in this context? Do I know this for a fact to be a threat, an imminent threat to me at this time? And in this context, if it's not an imminent threat, then you've got time to figure out the best way to respond. Think. T stands for think about the best response in a situation to help you achieve those goals in your rich and meaningful life. You can hold on to the anger and nurture it and dwell on it and just keep dumping energy into it. You can do that. That is a valid choice. You can let it go because it's not worth your energy. That person's not worth your energy. That situation's not worth your energy. You can take constructive steps to change the situation, whatever's making you angry. So for example, if you get really irritable or angry in traffic, you can take constructive steps and say, all right, maybe I'm not going to take the main roads to get to work, I'm going to take the back roads so I don't have to deal with, you know, nearly as much traffic. Or are you going to change the way you react to the situation? And that can be easier said than done. And then a is act tentatively. Choose how you're going to respond to this situation. And once you start responding, if you get into it a little ways and it doesn't seem like it's working for you, you can always back up and choose a different strategy. That's why we say act tentatively. But a lot of times, by the time you get down to this point, you've gotten into your wise mind and you usually will make a much better choice for responding. Identify anger control strategies you've used in the past. Strength based approaches encourage you to build on what's worked for you in the past. So think about anger control strategies you've used, which ones didn't work, and why you don't want to keep trying to do something that doesn't work. A definition of an insanity is doing something over and over again and expecting different results. If it doesn't work for you, that's fine. What are you going to do instead? Not every technique works for every person. Likewise, which strategies have you used that have worked, at least in some situations or to help reduce the intensity of the anger? Maybe they weren't perfect, but they helped Envision one of your anger situations from last week. If you had used a different strategy instead of automatically getting angry and erupting, how might the situation have gone differently and actually walk through in your mind's eye? Or if you're doing this in group, actually discuss or explain what happened and how it might have gone differently had you used this different tool. Envision yourself in a similar situation next week and describe yourself using your hopeful skill to get through that situation. So if road rage is one of your triggers, you're going to envision a road road rage incident from last week and describe how the situation may have gone differently had you used this different technique to handle your anger. And then you're going to envision being in traffic next week and having your road rage triggered and see yourself using your helpful skill. How do you deal with it in a more effective way so you can conserve that energy for things that are more important to you? Week two Homework Very simple. Just continue your anger control log. You're still getting to know what your triggers are and get a good picture. You're still compiling a good picture of your anger. Session 3 Homework from last week. What was the highest number that you reached on your anger control log? What triggered that anger episode? What strategies did you use to avoid reaching a 4 on the anger meter? Have you noticed a change in the frequency or how often you get angry or the intensity? How intense your anger episodes are or the duration of your anger? Instead of ruining your whole day, maybe it only lasts for a couple of hours. When you get angry, it's because you've encountered something that's made you feel threatened. Anger is the fight part of the fight or flight response. What are some general situations that make you irritable, angry or enraged? Just make a list of them. Jot them down. Other examples to consider that I've compiled Doing anger management groups for about 20 years long waits at the doctor traffic jokes about a sensitive topic. A friend not paying back money. Being wrongly accused of something by your spouse or your boss? Having to clean up after somebody like a roommate or your children. A loud neighbor being placed on hold forever. Rumors being spread about you having something stolen. Ingratitude. Somebody openly contradicting you. Not getting a promotion you expected that you were going to get or getting criticized. Many times specific events touch on what we call sensitive areas. These sensitive areas usually refer to long standing issues that can easily lead to anger. It's triggering those memories of distress from the past which brings up that fight or flight response in you in the present. Four main themes or fears that are associated with anger loss of control or powerlessness, rejection or isolation, death or loss of something that you care about and failure. Think about why each of these sensitive areas may make you feel threatened or trigger your anger. And in what ways does anger help you feel safer or more in control? For each common trigger that you have and that list of triggers, what memories, if any, is the reaction related to? What fears? Rejection, loss of control, failure or loss? What fears is your reaction related to? Maybe when somebody your roommate doesn't clean up after themselves and you have to do it, it makes you feel rejected and disrespected and that triggers your anger. Is there an actual threat in the current context? And remember, there can be things that are disrespectful or unpleasant or are problematic. But is there an imminent threat in the current context and if so, what is it? And identify at least two alternate ways of responding, for example, the roommate who doesn't clean up after themselves. It may not be because they intentionally are trying to disrespect you. They may just never have developed good personal hygiene habits and they may not have the skills or really understand the impact it's having on you. Homework Continue keeping your anger control log. Add a column this week for fears, rejection, loss of control, failure, or loss. So you're going to continue using that chart that you've been using every day. But you're going to add this additional column for your fears because we're going to start looking for themes. A lot of people have anger management issues that revolve around one or more of these fears. And practice using beta testing or another strategy to respond to your anger. Session 4 Again, review your homework from last week. What was the highest number you reached? What triggered that anger episode? Is your anger often related to common memories or themes? What strategies did you use to avoid reaching a 4 on the anger meter? And have you noticed a change in the frequency, intensity or duration of your anger? Now we've talked about anger in general. We've talked about anger triggers. Now we're going to talk about early warning signs. Early warning signs are indicators that you are getting angry. They can be broken down into four categories. Physical early warning signs are how your body responds with an increased heart rate, tightness in your chest feel, feeling hot or flushed? Behavioral early warning signs are what you do, like clenching your fists or clenching your teeth, raising your voice, glaring at others. What behaviors do you do where you're posturing? Emotional early warning signs can include other feelings that may occur along with anger, including fear, hurt, jealousy or disrespect. And cognitive early warning signs are what you think about in response to the event, like hostile self talk, I'll fix her little red wagon or she won't get the best of me, or even having images of aggression or revenge. Review your anger log from last week and identify your common early warning signs. Now you weren't charting those. You're just going to think back and think, what were my early warning signs before I actually had the explosion? What strategies can you use to become more aware of and deal with these early warning signs as soon as they begin to appear? Hourly mindfulness can be helpful. Set a alarm on your mobile device to remind you at the beginning top of every hour to just check in, how am I feeling? What am I thinking? What am I needing? Another technique that I really like is getting a heart rate monitor and set it to alert when your heart rate goes above a certain level. When we get stressed, our heart rate increases. Now obviously when you get up, if you're going up and down stairs, you might erroneously set it off. But having it set so it goes off when your heart rate increases 10 or more beats a minute, for example, over your standard resting heart rate can help you notice earlier on when you're starting to get stressed so you can intervene. I also on my Garmin and I think a lot of the other fitness trackers have it. It notices when it thinks I'm quote stressed and it reminds me to breathe. Continue keeping your anger log and pick one early warning sign that you have. Maybe you know, for me I grit my teeth. Pay attention to this throughout the week so you start becoming more aware of when you're gritting your teeth earlier on so you can respond before you're in a full fledged anger outburst session. 5 Review your homework from last week. What was the highest number reached? What triggered that episode? What were the early warning signs associated with the behavior? Physical warning signs, behavioral, affective and cognitive. We want to start tracing it back so you can become more sensitive to when you are starting to get angry so you can intervene earlier. Just like getting a cold, it's a lot easier to get better or to intervene if you notice the signs early as opposed to if you wait till you've got full scale pneumonia. How effective were you at modifying your target early warning sign? For me, I said grinding my teeth. How effective was I at noticing when I was starting to grind my teeth and addressing that? What strategies did you use to avoid reaching a 4 on the anger meter? And are there particular threat themes that are emerging? Remember failure, loss of control, rejection, isolation, and loss. This week we're talking about vulnerabilities. They're a little bit different than early warning signs. Vulnerabilities are situations that make you more likely to respond with anger or irritability physically. If your blood sugar is low, if you're under the influence of alcohol, you've had too much caffeine, you're in pain, you're sick, or you're exhausted, those are big vulnerabilities. For a lot of people to respond more impulsively and feel angry easier affectively if you're overwhelmed, if you're irritable about something else, if you're stressed out or feeling sensitive or vulnerable in some way, then you may be more likely to respond with a stronger anger response cognitively. If you're expecting a negative outcome from a situation, person or meeting, or you've just got a negative attitude, you're more likely going to see the glass as half empty and respond with anger. Environmentally stressful environments and that can include a lot of things. For me, I don't like lots of noise, and I don't like sudden loud noises or being interrupted a lot. So if I'm feeling irritable, if I'm feeling tired, I will shut my door. That way I don't have people popping in constantly and interrupting my workflow, which tends to make me more irritable relationally. Being in situations that make you feel more on edge or around people that trigger anger or tend to be more negative themselves can also make you more vulnerable to anger. If you're around somebody that's going to feed your anger, then it's going to make it more likely that you're going to be angrier. What are your particular vulnerabilities and how can you best prevent them? And when you can't prevent them, how can you best mitigate them or deal with them? Like I said, when I haven't slept well for some reason, can't always sleep well. But when I haven't, one of the things that I always do is shut my door because I know that that is a vulnerability for me. If I'm overtired, I tend to be a little bit more irritable. Continue keeping your anger log and add a sixth column where you're going to begin identifying your vulnerabilities. You want to start looking for trends and themes and patterns here, but just add that sixth column to start identifying vulnerabilities. Session 6 Review your homework from the last week. What was the highest number you reached? Hopefully this number is going down. What triggered that anger episode? What were the early warning signs associated with the behavior? How effective have you been at noticing your early warning signs? What strategies did you use to avoid reaching a 4 on the anger meter? And what vulnerabilities contributed to your anger? This week we're going to talk about creating an anger control plan. An effective plan should include both immediate and preventative strategies. So you want to prevent the vulnerabilities, prevent the anger, but also have a crisis response, so to speak. Immediate strategies Timeout when might you use it and how might you do it? And it's important if you're having difficulty, if you're A lot of your anger is triggered by interpersonal interactions that you are clear with the other person that when you need a timeout that you will be back in 10, 15 minutes, whatever it is that you need. But it's important that they respect your boundaries and allow you to take that time out to get into your wise mind you during your time out you can distract yourself with activities like doing something different, going on a walk, listening to music, or even using guided imagery just to go to a mental vacation. You can block the situation from your mind temporarily with thought stopping. Having alternate thoughts. You can't have two thoughts at the same time, so you can use your mantra for thought stopping. You can also use positive or what we call distress tolerant thoughts where you're telling yourself I can get through this, I'm not in danger right now. Whatever script you want to use and I recommend that you write it down and you have it on a file on your mobile device so you can just read it when you start feeling stressed and you don't have to think about something. Practice mindfulness in threes. What are three things that you see, three things that you smell, three things that you feel, three things that you hear and practice that four quadrant or four breathing in force Talk to a friend or journal. You know maybe you need to just call somebody call a friend. Exercise and or radically accept and just saying it is what it is or it's all good encourages you to radically accept the moment. That means accepting the good parts of what's going on or life with the fact that this part right now sucks. Preventative strategies what general things can you do to prevent or minimize vulnerabilities? Emotionally, what can you do? What can you do to increase happiness and decrease distress? Mentally, what can you do to minimize those vulnerabilities? Can you and one of the things that can be helpful is spending 20 minutes a day focusing on what went right that day. The other 23 hours and 40 minutes you can focus on whatever you want. But 20 minutes a day focusing just on what went right. And a lot of times I encourage people to do this at dinner with their family. That way they feel during the meal is a time where they can be relaxed together. Physically, what can you do to prevent or minimize vulnerabilities? Healthy nutrition, minimize stimulants, get enough sleep, all that stuff. And socially, what can you do to prevent or minimize vulnerabilities? How can you set and maintain healthy boundaries? How can you practice assertiveness? How can you nurture your supportive relationships when you are vulnerable for some reason? What can you do to reduce the chances that you will get unnecessarily angry? Review your anger log from last week. What immediate strategies could you have used to help you take a timeout? To help you get into your wise mind? What preventative strategies could you have used? What could you have done to prevent the vulnerabilities that might have made a difference. This week? For homework, maintain your anchor log and develop a plan to start reducing one or two of your vulnerabilities each month. Now that's realistic. One or two a month you can do. The more vulnerabilities that you eliminate, the less things that you've got to worry about preventing or guarding against. Session 7 Review your homework from last week. What was the highest number you reached? What triggered that anger? What were the early warning signs that were associated? How effective were you at noticing your early warning signs? What strategies did you use to avoid reaching a 4 on the anger meter? What vulnerabilities contribute to your anger and how effective have you been at reducing your target vulnerability? An episode of anger can be viewed as consisting of three phases escalation, exposure, explosion, and post explosion. During escalation, the event and responses or early warning signs are happening. You know something happens and you start to get angry. During the explosion phase, the verbal or physical aggression emerges. What can you do when you have the urge to be aggressive and that goes into those immediate strategies. Post explosion, this is when you are starting to experience the negative consequences of the anger emotional, cognitive, legal relationships, or even physical health. Review your anger log from last week and identify the event that got you most Angry or had the most negative consequences and identify what you could have done to prevent it. To reduce the escalation or prevent the explosion. 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 completely wrong. There are a variety of cognitive distortions and I'm going to go over some of the most common ones. Personalization is taking things or interpreting things as all your fault or all about you. Somebody looks at you cross eyed, you think that they are angry with you. What are three other explanations for why they may have looked at you that way? Were they even looking at you? Minimization of the positive. Identify what good things have happened. What is happening that's good, or what good could come out of this and the mental filter or only seeing what you expect to see. It's important to look at all the facts. If you expect to see negative, you're going to see negative. But there's also positive that you're probably just overlooking. So what are all of the facts? Sometimes it can be easier to do this by taking somebody else's point of view. Exaggeration of the negative or catastrophizing is another cognitive distortion. You assume the worst or you assume that the sky is going to fall. It's important to really ask yourself, how likely is this to happen? How likely is it that this mistake I made is going to result in me getting fired? Or that this person's behavior is going to result in something negative for me? All or nothing thinking you always do this or you never do this, or I always do this. It's important to find the exceptions. Let's take that sloppy roommate, for example. You always leave your dishes in the sink. Well, are there exceptions to that? Finding the exceptions can be helpful because then you can reward the exceptions. When they leave a clean kitchen and you see it in the morning and there's no dishes in the sink, you thank them profusely. It's more likely that they'll do that again if they see that there's a benefit to them. They may not consciously know this, but subconsciously we do things that are more rewarding. The control fallacy. A lot of times we feel like we have control or should have control over more than is realistic. So what parts of the situation that are triggering your anger? What parts do you actually have control over? What parts do you need to figure out how to accept or cope with? And over generalization? Sometimes we expect that since we've been in similar situations, that this situation is going to work out the exact same way. We assume that what happened once is going to happen again. It's important to explore not only how is this situation similar to the past situation, but how is it different? Arbitrary inference is another cognitive distortion where we assume that something is dangerous or fearsome because of one particular piece of information. The news broadcasts a lot when there's a plane crash, it never gives us news stories about the 20,000 flights a day that take off and land successfully. So if we assume that flying is dangerous because we saw a news story at some point about a plane crashing, we're not using all of the facts to make our judgment and emotional reasoning. I feel angry. Therefore, there must be a threat. Not always. Sometimes something can happen. A smell, a sight, a sound that triggers a memory. We may not remember the memory, but it triggers that reaction. And Bessel van der Kolk talks about how trauma is often remembered as a reaction, not an actual memory. So it's important when we feel angry, remember, that's our smoke alarm. Now we've got the energy. We need to check and see. Is there a threat right now? One model for dealing with our cognitive distortions is called the abcde. Model A stands for the activating event. What happened B represents our beliefs about the event. It's not the event itself that often produces feelings like anger. It's our interpretation and beliefs about the event. That's why two people can be driving and experience the same rude driver. One gets angry and develops road rage, and the other one hardly notices it because they interpreted the situation differently. They had different beliefs about the event. C stands for the reaction or consequences as a result of your interpretations and beliefs. So the person who perceived it as a threat got angry. The person who just saw it as an inconsiderate driver, they didn't get angry. So the consequence of the same situation was different for these two people based on their beliefs. D stands for dispute. Identify any unhelpful beliefs and reframe them in alternate ways. Identify the facts for and against your belief, and we'll stick with road rage. This person is being rude. They're being disrespectful to me. They have no respect for anybody else. They could have killed me. Well, how many of those are actually accurate? Maybe the person you were in their blind spot and they just didn't even see you. Or they were distracted with something else and it wasn't about you. They weren't trying to be disrespectful to you. They just didn't notice. Make sure you're not confusing high and low probability events and identify and address thinking errors and cognitive distortions. So you're going to go through that list of cognitive distortions, the personalization, minimization, all that stuff that we just talked about. Identify if any of your beliefs about the situation may be skewed in one direction or another. E stands for evaluate your response and choose the response option that gets you closer to those people and things that are important in your life. So E basically is saying, ask yourself, is this worth my energy? What is the best way to handle this? And use my energy to move quickly towards the things that are important in my rich and meaningful life. Reviewing your anger log Identify the most intense anger episode from last week and apply the ABCDE model. Review your anger log and identify the cognitive distortions that were in play and what common cognitive distortion or what cognitive distortions are common in your family? Cognitive distortions don't usually come out of thin air. We often learn them. We hear our family using all or nothing language, for example, or personalizing being overly responsible for things. So what cognitive distortions did you learn from your family? Homework Continue keeping your anger control log. Add another column for cognitive distortions and the rebuttal. So remember finding the facts, Looking for exceptions, etc. Session 8 Review your homework from last week. And then start learning about assertiveness. The basic message of aggression is that my feelings, thoughts and beliefs are very important. More important than yours, and your feelings, thoughts and beliefs are unimportant. The basic message of being passive, the opposite of aggression, is that your feelings, thoughts and beliefs are very important, but my feelings, thoughts and beliefs are not. Assertiveness, on the other hand, says that my feelings, thoughts and beliefs are just as important as your feelings, thoughts and beliefs. Communicating assertively starts with validating the other person's thoughts and feelings. I can see that you're very angry about this situation right now. Or what I'm hearing is that your perception of this situation is xyz. So you're paraphrasing what you hear or see from the person. You're validating where they are so they feel understood. And then you communicate in a way that ideally creates a win win. You know, how can this situation be solved in a way that both of you get your feelings, thoughts and needs validated and met in the best way possible? What are some advantages of acting assertively when trying to resolve conflicts? What might some of the drawbacks to assertiveness be? And I'll give you a hint when you're assertive and not aggressive sometimes you don't always get your 100% your own way. The Conflict Resolution Model get into your wise mind. Remember, de escalate. Use your breathing. Identify the problem. Identify your beliefs about the problem. Find the facts for and against your beliefs. Decide whether it's worth your energy to even worry about resolving the conflict. If it is, then address and resolve the conflict assertively by validating communicating assertively your thoughts, wants and needs in the situation and then determining the course of action. Review your anger log for the last week and apply the conflict resolution model to at least one anger episode. Continue keeping your anger control log and actively practice being assertive and even when you're not angry. So actively practice stating your thoughts, wants and needs and asking people about theirs and paraphrasing theirs so you're more effectively communicating and you stop assuming and mind reading or assuming you know what the other person's thinking. Session 9 Review the homework from last week. The highest number you reached. What triggered that anger? Your early warning signs, strategies you used to avoid reaching a 4, the vulnerabilities that contributed and your most common cognitive distortions and the restatements or rebuttals to them. We learned a lot about how to interpret events and cope with distress by observing our family. How was anger expressed in your family when you were growing up? How'd your father express it? How'd your mother express it? Were you ever threatened with or exposed to physical violence? How were other people's emotions, such as happiness and sadness expressed in your family, or were they not even allowed? Was emotional expression limited to feelings of anger and frustration, or were many different kinds of emotions expressed? What role did you take in your family? In the addicted family, we've got different roles that actually have labels like hero. This is the person who's always getting the A's and making the team. The rescuer, the victim, the wallflower who just kind of blends into everything, or the scapegoat, the one that gets blamed for all the problems in the family. So what role did you take in your family? What messages did you receive about your father and men in general? What messages did you receive about your mother and women in general? Did you feel accepted and loved, or did you feel like you couldn't do anything right and you were constantly being either rejected or criticized or or threatened with abandonment? How did your family deal with failure? What feelings, thoughts and behaviors carry over into your relationships today? The ones that you learned from your family of origin? What purpose do these behaviors serve today? And are there alternate behaviors that might serve the same purpose but but be more helpful? Review your anger management plan from the past 7 weeks 8 weeks what progress have you made? What still needs to change? What strategies are working well? And session 10 review your homework from last week. This is the last week that you have to do this. What was the highest number you reached? What triggered that episode? What were the early warning signs associated with it? How effective have you become at noticing your early warning signs? What strategies are you finding most helpful to keep you from reaching a level four or even a level three? Hopefully by this point on the anger meter? What vulnerabilities are still contributing to your anger? How effective have you been at reducing your vulnerabilities? And what are your most common cognitive distortions and rebuttals using what you've learned over the past 10 weeks? Dispute these anger myths. 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. Anger is all in your head. Venting or ignoring your anger makes it go away. And men are angrier than women. It's important to remember that men and women get angry over different things and often express it differently. The older you get, the more angry you are. The data, however, shows that the angriest people tend to be 14 year old boys. Anger always results from human conflict. Sometimes yes, sometimes no. People can also get irritable or angry from being exposed to stressful environments. Remember we talked about all those different triggers? Foul odors, pain, hot temperatures. None of those things necessarily involve the action of another person. You can be all by yourself and get angry. 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, occupationally, sometimes legally and spiritually. Effective anger management involves preventing vulnerabilities, being aware of and working on those sensitive areas or threat areas, preventing anger and vulnerabilities whenever possible, and developing immediate coping responses to deal with anger when it does occur.