Individual and Group Therapy Activities for Anger and Anxiety

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I'd like to welcome everybody to today's presentation on individual and.

Group exercises for anger and anxiety. Now, I'm Dr. Donnelly Snipes, your host.

Most of us have worked with clients.

Who have anger or anxiety issues over the years, and I'm not going to spend a whole lot of time really talking about the fight or flight stuff or what anger or anxiety is. We're going to spend a little bit of time.

I really want to focus more on.

What are some creative interventions that we can use in group or individual session instead of just lecturing to people or giving them a handout to read.

So we're going to briefly explore the.

Purpose and effects of anger and anxiety and then identify a group and individual.

Activities to help people really start addressing it. Remember that anger and anxiety are flip.

Sides of the fight or flee response that we experience that protects us from perceived threats by alerting us that there might be a problem. And you remember last week I used the fire alarm analogy.

In our house, the smoke alarm periodically goes off.

It could be because the windows are open. I don't know why that triggers them. It could be because something overflowed in the oven and it's getting smoky in there, but there is no fire. The smoke alarm, much like our HPA axis or our threat response system, is there to tell us, hey, there might be a threat. You need to check it out.

Think about times that you've gotten angry or stressed about something just to find.

Out it wasn't a big deal. You know, you were really worried. I had the doctor's office call me the other day after my physical and and she left this ambiguous message on my phone instead of saying, you know, no problems. She's like, this is so and so from the doctor's office. We got your lab results back. We need you to call us at the office. And I was just like, oh my gosh, you know, why? What is so bad? They can't even leave a message about it. So I got all freaked out about it and you know, I was trying to call and of course I couldn't get through because the line was busy and yada yada, you know, doctor's offices.

And finally I got through and she's like, oh, your results were fine, your.

Cholesterol was a little high.

I was like, you couldn't have just Left that on my machine. So I got myself all fired up.

Over something thinking that, oh my gosh, you know, the sky is faulting. And it wasn't. So my anxiety kind of went through the roof.

Some of the problems with our anger.

And anxiety, it's not feeling it. Feeling it is a natural emotion that is our body's way of protecting us. It's what we do with it.

And sometimes we misinterpret what's going on.

Based on prior learning experiences such as, you know, maybe in the past you were victimized when you were walking to your car in a parking garage or somebody snuck up on you and scared you and. And you know, other people have been victimized in parking garages. And so that caused you to be afraid of walking to your car at night in parking garages.

Now, you know, you're in this parking.

Garage and it's got, you know, all kinds of security, let's say. So it's not an unsafe situation. It's much safer than other parking garages. But you still may feel anxiety because you're remembering prior situations instead of really looking at the facts. You know, it's the middle of the day. This is, you know, they've got cameras everywhere, they've got security guards on patrol, yada yada.

Sometimes we will experience anger or anxiety.

Because something's happening and we're afraid that it's going to mean that we won't get somebody's approval.

Other times we may experience anger or.

Anxiety that's over generalized. You know, when dogs are barking. If dogs barking before have indicated a threat to you, either that a dog was charging and might attack you, or the dogs were barking to alert you that an intruder was trying to get into the house. Something like that could make you associate barking dogs with danger. Now you have dogs, and every time they bark, your anxiety goes through the roof because that schema hasn't been addressed. You haven't really looked at it and looked at the facts of the current situation and said, okay back then, whatever that situation was that happened, that was unfortunate. This situation is different. So we do need to figure out ways to address overgeneralization.

Other things that may cause problems with our anger and anxiety include transference.

You know, we could experience anxiety in relationships with someone who reminds us of somebody we've been in a relationship with in the past, and that person abandoned us or caused us, did something that caused us to feel anger or anxiety. So now when we get into those kinds of relationships, those intimate types of relationships, we may feel abandonment Anxiety because we're afraid it's going to happen again. Instead of looking at what are the facts with this situation and this person, how am I different now? And how is this situation different than. Than back then?

And sometimes our perceptions may simply be inaccurate.

You could be in the middle of, you know, the city and hear a.

Car backfire, and all of a sudden.

You get stressed out. You think, oh, my gosh, that somebody's firing a gun.

Well, your perception was inaccurate.

It doesn't mean that it was wrong to have that initial thought, but it's what you do with that feeling. Do you get terrified and panicked and go, okay, I can't go back into that city because, you know, people are shooting guns. Or do you examine the facts? My son, when he was about 6, he was going through a orthodontia procedure that used a palate spacer. And it sounds really barbaric, and it sounded like it should have felt barbaric, but apparently it wasn't bad.

But he had this thing in his.

Mouth, and we had to tighten it once a week, just a little tiny increment, in order to help space his palate out so his teeth could grow in. And, you know, sounds awful. Anyway, one day after doing that, you know, I was busy folding laundry and whatever in the back, and he had toddled off somewhere, and all of a sudden he comes back and he's banging on our door. And I open the door, and he is coming covered in blood. Okay? So my first thought is, I tightened it too much, I broke his palate, and he's hemorrhaging from the inside. Because, of course, I go to the worst possible scenario.

Anyway, long story short, he was playing.

In one of the laundry hampers, and he fell over, smacked his nose on the ground, and gave himself a bloody nose. But, you know, when he came to the door, he's like, I'm sorry, Mommy.

I got paint all over the floor.

And he's just, like, gushing bl. Either way, my perception of the situation was inaccurate. I thought that, you know, I had broken my son, and it was this huge medical crisis. When in reality, once we got things cleaned up a little bit, he had just gotten a bloody nose. Those are things that we need to help clients really be able to stop, take a breath, and check the facts, you know, see what that fire alarm is telling them.

Encourage people to examine how anger or.

Anxiety affects them, because this will help them increase their motivation to change physically. When you are angry, when you are.

Stressed, when you are resentful.

Resentful and remember, anger has all those permutations. Envy, jealousy, guilt is self anger or resentment. There are lots of different shades of anger. But when you feel those feelings, how.

Does it affect your sleep?

Are you able to lay your head down on your pillow and relax and go, it's been a good day, and drift off to dreamland? Probably not if you're nurturing that anger. Now remember, if you just feel it for a second and say, okay, I'm angry, how can I improve the next moment? That's totally, you know, awesome. That's good. I feel angry. Let me check the facts and figure out how to improve the next moment. That's what we want. But when people feel anger or anxiety and they just hold onto it, they ruminate on those thoughts that are making them feel anxious or angry. Then it can cause problems. It can interrupt their sleep. It can keep their HPA axis elevated so they are not able to get relaxing sleep. Their mind is constantly wandering. If I wouldn't have gotten hold of the doctor that day, I can tell.

You, based on my family history, I.

Probably would have been laying in bed that night fretting about what the results were going to be. Now, is that helpful?

No.

Is that going to change anything?

No.

However, that would probably be one of my reactions that I would have to work to address and stop that monkey mind so I could go to sleep.

When people have high levels of anger or anxiety, they tend to clench their.

Fists and clench their, well, clench their.

Fists, clench their jaw, and tighten their.

Muscles, especially in their neck and back, which can increase pain. And additionally, when that HPA axis is activated, serotonin levels go down, which means pain threshold goes down. Another reason that anger or anxiety, nurturing it is not helpful for us.

When we're angry or anxious, it tends.

To upset our stomach. We tend to get that GI upset. Why?

Because when our body perceives that there's a threat, what is it wanting to do? It's wanting to clear out anything in.

There so it can get away from digestion and focus on fleeing or fighting the threat. It's a natural reaction for our body to speed up a little bit. And our immunity tends to go down when we are angry or anxious a lot. Because we're not getting quality sleep and because when our GI system is in overdrive, we're not absorbing as many of the nutrients as we normally would from our food.

Emotionally, when we are angry or anxious.

People may also experience regrets, guilt, senses of feelings of hopelessness. You know, I'm always going to feel this way Everybody's against me, yada, yada, yada. Feeling very defeated. Socially, people may struggle because when they.

Feel angry at others, they may not.

Want to get close to others. When they feel anxious about abandonment, they may be afraid to let people out.

Of their sight or afraid to get.

Close because they're like, if I get close, you're going to leave me, so why bother?

Depending on the person, we need to.

Examine what is causing their anger or anxiety at work.

Anger and anxiety can really impact your ability to, for lack of a better term, play nice in the sandbox. If you are cranky, if you are.

Irritable, if you are stressed out, a.

Lot of times it is hard to work with people that are in that.

Mindset because they are just oozing stress or oozing negativity, and most colleagues don't.

Want to be around that. Spiritually, anger and anxiety can impact our sense of connectedness to an impact within the world. If we are in a bad mood.

If we are angry, think about a day and we've all had them where.

You get up, you're on the wrong.

Side of the bed, you just, you drudge out to work, you don't want to go to work, you're in a bad, God awful mood all day long. How does that impact your productivity? Your relationship with others? How does that impact your impact on the world? When you feel that way, what does.

That do to others?

What kind of energy is that sending out? And what effect does that have on your little corner of the universe? You know, if you exude positivity, then people will probably similarly exude positivity. It's contagious. If you exude negativity, then people will either scatter or it will attract others who are similarly negative. Unlike magnets, where opposites attract, a lot of times moods similarities attract.

And environmentally, when we're angry or anxious.

Especially angry, you may break stuff, put holes in walls, or throw out things impulsively. It's like, this person gave me this knickknack, I don't want to see it anymore. There are a lot of impulsive things when we do, when we're angry, encouraging people to look at what their behaviors are.

Since anger protects people and it often.

Results from application of prior knowledge or experiences, then we can assume that people with a lot of anger may have been exposed to significant threats or traumas in their past. A lot of times, people who tend.

To be angrier tend to be more.

Guarded because of their prior experiences, and.

They have felt helpless, they have felt.

Hopeless, when you are growing up in a situation like that, which threat after threat after threat, and you know, this person was harmful, this person was negative, this bad thing happened that every problem or every event starts to look like a problem. You know, you have a hammer and everything that happens starts to look like a nail. You start looking for the negative in it. This person did something nice for me, so what is it that they want? Or how are they using me? Or this good thing happened. When is the other shoe going to drop? Have a friend that's like that, bless his heart, he's just. Anytime anything good happens, he's always waiting for, yeah, that was good. I'm just waiting to see what the other shoe holds for me.

Anger and anxiety triggers. One thing that you can do with.

Clients that I enjoy, you know, and it can be a fun activity, is even for adults, is the Alphabet list. And you can do it where you're passing a hot potato around, or not a hot potato actually, but like a beach ball, or you're just going around and doing the clapping game, or just going from person to person and going down the Alphabet. So the first person has the letter A. So what triggers your anger or anxiety in other people? And somebody may say, well, when somebody else has a bad attitude, okay. Or when somebody else is angry at me, it triggers my feeling. B is for bullying. C is for creating drama. When people create drama, it really stresses me out because that's what my family of origin was like. Or it really makes me angry because I hate being in the middle of all the drama.

Once we start identifying what the triggers.

Are, then we can start examining the whys. You know, why is that creating drama makes you feel angry or anxious? Now, why is it when somebody disagrees with you, it makes you feel angry or anxious? Now where does that. Where does that come from?

We want to recognize anger and anxiety as protective responses based on people's experiences and worldview.

I know I've said this in, like, six different ways. I could be a politician today. Anger and anxiety are good. They are not good when we nurture them and hold on to them and ruminate on them. But they are good in terms of. They are natural emotions that warn us. Have people examine when they feel angry or anxious.

In what way does this situation make me feel unsafe?

Emotionally, interpersonally, or physically? Or remind me of a time when I was unsafe? You know, that's one of those questions that they can ponder.

And safe may not be the right word.

We may have to massage that a little bit. For example, If I get angry when someone disagrees with me, in my mind, that may mean I am being disapproved of. So in what way does that remind me of a person? Prior time when I was disapproved of, when I was seeking approval and didn't get it, that felt threatening to me. That triggered my abandonment anxiety.

So we need to help people expand.

Their concept of safe a little bit because when things happen to us as children, a lot of things can make us feel anxious as children because we know somewhere in the back of our four year old minds that we cannot survive without our parents. So if we fear abandonment, if we fear criticism or rejection from them, then that can make us feel self conscious or, you know, unsafe.

Basically another question for people to ask themselves when they feel anger or anxiety, what emotions were triggered by this event.

And what vulnerabilities or skill deficits contributed to the event? And that there's a lot there and you know, there's other classes that we have on our YouTube channel about vulnerabilities.

Basically we want people to do some.

Real quick backward chaining and say this event happened. What emotions were triggered? All right, I felt angry, I felt anxious. That abandonment anxiety came up, whatever it was. Now what vulnerabilities contributed to that? Have I gotten enough sleep? You know, am I feeling worn down and exhausted and like I can't tolerate one more thing, Like I need other people's help right now. And that situation made me fear that I was going to lose that support.

You know, encourage them to look at.

Things that make them feel more vulnerable and or less able to deal with life on life's terms and what skill deficits contributed to the event. And this is a hard one sometimes because sometimes you don't know that you have, you don't know what skills you don't have until you figure out that, oh, well, there's a skill there that might have helped. For example, when people are in relationships, a lot of times, anger and anxiety can be triggered by poor communication skills. And if people recognize that, okay, my assertiveness skills were a little bit lacking in this situation, or I was engaging in mind reading, which contributed to my fear in this situation, helping them understand what happened and what things they may need to do differently in order to respond differently the next time.

In what way did the situation trigger.

A sense or memory of a loss? Sometimes it triggers this sense of being alone, or it triggers a memory of a relationship that ended or something that happened in the past.

And how does this experience alter my future? Looking at it because sometimes we get stressed out over things that really have.

No consequence or virtually no consequence in our future. We can get angry about something that happens on Facebook. Maybe you posted something and you got put in Facebook jail and that made you feel angry. I think just about everybody's gone to Facebook jail at least once.

When that happens. Examining, does this alter my future?

Does me being put in Facebook timeout really have any notable effect on my ability to live a rich and meaningful Life?

And for 99% of people, I think they're going to say no, you know.

It really does not have any long term consequence for my life. So then they go back to examining. All right, how effective is it for me to use my energy and ruminate on the fact that Facebook seemed to, you know, single handedly put me in timeout?

The Alphabet list again, you know, this is a real easy one that you can use.

You don't need any props, but you can do a lot of different types of activities. You can have, have a box or a hat that people draw cards out of that have different letters on them, whatever you want to do, just to encourage them to use their mind to get past the real simple, easy ones.

Because some of the triggers are really.

Easy and some of the interventions are really easy to come up with. And others like cue, you know, what kind of intervention can you come up with for cue? Well, the answer is quiet time, but.

It encourages people to really dig through.

And think about, all right, what type of intervention would begin with this letter?

So anxiety and anger interventions, acceptance, breathing.

Compassion, disputing, distracting, distress, tolerance. You see where we're going here.

There are a lot of different interventions.

That can be used and you can.

Use it, like Lindsay says, as a place to start.

You know, this is not going to put forth a really intensive, you know, aha, moment type of group, but it is going to start prompting discussion. And you can even go around the group and have everybody identify an A and then everybody identify the B. A, B, depending on how many people are in your group. But if you've only got six to eight people, that can be interesting too, because then they do have to think of something else that begins with that letter that nobody else has said. Yet.

Another activity. Identify two ways you could deal with.

The following symptoms, and we'll get to those in a minute.

Why they might occur and why it's.

Important to your recovery.

Now that's a lot.

So I usually write that on the board. Two ways to deal with it, why.

The symptom might occur and why it's.

Important to deal with that symptom in recovery.

And there are multiple ways to do it.

My favorite is the beach ball, just because it's easy. You can get really cheap beach balls at the dollar store, you know, the inflatable ones. And on each color of the beach ball, you can write a different symptom.

And when you pass it around, whatever.

Symptom is facing up when they catch the ball is the one they've got to talk about. So it's a little bit more active than others. You can do Jenga when you have three to four different colors of Jenga blocks making your Jenga tower. And whatever color block they pull, they've got to pick from that stack of cards. And you know, each stack has a different. What's the word symptom on it or a hat draw. You know, sometimes you just have them draw a card and it will have a symptom on it. And then they've got to identify the associated information.

So let's go back to the beach.

Ball, just because I like that one. It's more active and entertaining to me.

So you write all the symptoms on a beach ball. You pass it to Sally, Sally catches.

It, she looks down and it says insomnia.

And she identifies two ways she could.

Deal with her insomnia. Thought stopping and meditation. Okay.

She identifies why her insomnia might occur because she is perseverating.

She is thinking over and over again about something that stresses her out and it's keeping her threat response system activated. Okay. And why is it important to address insomnia in recovery?

Because.

And this could be from anger, anxiety, depression, whatever. It's important to address insomnia because lack of sleep is going to make you feel more foggy headed, make it more difficult to deal with life on life's terms and reduce your energy, increase your fatigue. You know, those are some things that they might come up with.

You can have an anger or anxiety graphic novel or skit.

If you're doing individuals, you can have them do it in a graphic novel. You can also break a group, a big group up into little groups and they can either draw their own little graphic novel. It doesn't have to be super artistic. I'm the stick figure person. Or they can develop a skit that talks about something that they got angry about and ways that how they handled it and then how they could have handled it.

You could do anger or anxiety says.

And they talk about a particular situation. You know, they've identified their different triggers in the earlier, you know, the ABCs. And so we'll say creating chaos. And you identify one of their triggers as the group leader. You say creating chaos. What does anger or anxiety say? What is it telling you? And if they say anxiety is telling me I'm not safe, anxiety is telling me that or reminding me of a situation. You know, when there was chaos, it usually preceded a domestic violence incident. Anger or anxiety is telling me this, okay?

Anger or anxiety is telling you that.

There might be a threat and we need to identify what that threat might be in order to check to see if it exists.

You can also use those triggers and.

Have them identify evidence for and against. And that's one of my favorite to help them get into fact based as opposed to emotion based reasoning.

When somebody disagrees with you and it.

Makes you feel angry or anxious, figuring out the evidence for and against, what does that mean to you? What is the evidence for your thought? You know, you get angry that somebody disagreed with you because it feels like they don't respect you or they're rejecting you. Alright, so let's look at the evidence for and against that.

You can have them use the anger or anxiety thermometer and they can talk.

About situations they've experienced in the past week. And they can use this, keep this with them mentally throughout the week.

And when they feel angry or anxious.

Have them rate their anxiety and then have them be mindful and pay attention as that anxiety thermometer goes down into the blue. So if they experience something and they feel very scared or very angry, they're at an 8. They can envision themselves as red like on that thermometer and then envision, you know, close their eyes. If they can envision that red draining out and turning to that cool blue and feeling the cool blue wash over.

Them, you can use vulnerability predictor or prevention.

This is another great intervention that you can do with people.

Have them look back over their past. Think of three times that you got.

Really angry or really anxious over the past week or two weeks. And what are some commonalities? What are some common vulnerabilities that may have contributed to that? And it could be, you know, they're not getting enough sleep. It could be they're feeling overwhelmed because they've got too much going on and they're poor time management. Encouraging them to look at what factors make it more likely for them to get excessively upset over things.

You can role play, especially handling criticism.

You know, it's hard for a lot of people to handle criticism. Worry stones or beads are another thing that people can do. Sometimes when they're anxious, it helps to hold a worry stone.

And.

And I know a lot of times I don't even know where mine is right now. Oh, here it is. I've got my little worry stone. I either do that or I pick my nails. I tend to be a little bit high strung, so if I have to sit still, you know, I do better if I have something that I can fidget with.

And it's not necessarily anxiety.

It may be a little bit of.

Nervous energy, but letting people know that that's fine. Give yourself something to work with.

Rosary beads or meditation beads, they don't have to be. Rosary beads can also be helpful because it can help people get mindful. I encourage people, if they're not using rosary beads, to, you know, they can create their own string using beads of different shapes, different textures, different materials that will help them stay more mindful. So when they're feeling those beads, they feel the one that's sharp, that's, you know, a shell. They feel one that's soft and smooth, that's a polished stone. They can focus on what they're feeling. Why? Because that helps them urge, surf however you want to identify it. Get from their emotional mind into their wise mind. It gives them something to focus on, get grounded, become mindful, until that adrenaline bleeds off and they can focus more cognitively on what's going on.

A worry box or even an anger box.

You know, you can use boxes for anything that you want to unload, so to speak.

Sometimes people just need to get stuff.

Out and they need to feel heard or whatever. And writing that stuff down can sometimes be really helpful. And they can write down whatever they're worried about and put it in this worry box.

That way they don't have to worry.

About forgetting about it, but they don't have to carry it with them all the time. They know they can come back and they can worry about it. And I like to set aside with clients who tend to have a lot of perseveration on their worry, and they feel like if they're not worried that something's wrong. I'm like, okay, if you want to revisit those things, if you feel a need to revisit or if you're feeling anxious, that's okay.

Let's set aside a time each day.

That is your worry time. And if you want to worry during.

That time, that's great.

More power to you. But if you don't want to worry.

During that time, that's cool too.

However, that time is bracketed. So when that time is up, it's time to stop worrying, put your worries back in the box, shut it, and figure out how to move on.

And a lot of times when we.

Work with a worry box, there's that second step. After you put your worry in the box, what do you do? How do you switch gears to not worrying? And it's important for clients to make a plan for how they're going to do that. Some people in substance abuse treatment and in some Christian based treatments, they may call it a God box, where they put their worries or their angers or their hurts into that box and they're giving it to their higher power.

In a more secular approach, we talk.

About God in terms of good, orderly direction. What is it that I want to accomplish with my life? And if this isn't something that's important for me to accomplish with my life, I'm going to put it over here so I don't have to carry it and use my energy for it. But whatever.

Sometimes people just want to put it.

In a box, other times it's not even a box. People can write their worries down and this works even better with grief. But when people deal with anger or anxiety and they write something down and they tell their story and they tell what they're worried about. I had a client one time that was getting ready to go to court and was facing some pretty significant jail time if things didn't go her way in court. And she was terrified her kids were going to go into foster care. You know, there was a lot of stuff. And so she wrote it all down and we took that letter and we went outside, obviously, and used a metal trash can. She burned it. She just let it go up in smoke and she watched that worry disappear and tried to remind herself that holding on to that anxiety wasn't going to help her in court.

Positive writing, this isn't to say, not.

To deal with the anger or anxiety. We want to help people recognize any threats and deal with them. So sometimes people get stuck in that anger and anxiety loop where everything they're seeing, perceiving, is making them angry or stressed out or anxious.

Sometimes it's important to encourage people to.

Spend 20 minutes writing or reflecting. Not everybody likes to write on what is going right, what is positive in their world that day.

20 minutes after that 20 minutes, they.

Can go back to wherever their head wants to take them or needs to take them. You know, that gives people a little bit more control. If you say, all right, after the 20 minutes, you know Just take a breath and resume your daily life.

But research has found that positive writing.

As little or reflection as little as 20 minutes a day has significant impacts on increasing people's sense of hope and optimism. Interesting.

And you can talk about the anger onion.

This is one of my favorites because I love onions. We rarely feel uni dimensional feelings. You don't. Most people, when they get angry, don't feel just anger. They may feel angry, they may feel rejection, they may feel hurt, they may feel scared, they may feel frustrated that they're angry, they may feel guilty that they're feeling angry because they don't think they should feel angry about that. Helping people identify what the emotions are.

Generally with an anger onion, anger is.

The outside layer because it's protecting us. What is it protecting us from? What is that soft inner core that it is protecting us from? Those feelings that we are more afraid to feel? Rejection, isolation, disappointment. You know, those can be more devastating. Sometimes anger is a power play.

A hidden heart activity. Have people fill a Ziploc baggie with slips that tell about all of their hurts or anger.

This is their heart and this is the heart that they've got within them that has all the hurt.

Put the little bag inside of a paper lunch bag. Write on the outside all of the ways that they present themselves to the.

World to hide what is hidden on the inside. And then talk about this hidden heart, helping them visualize how they are using some of their behaviors as masks to protect themselves from the world and to protect others from seeing the ways that they feel hurt inside.

For kids, you can do an anger tornado.

And you know how you get the 2 liter bottles and you swirl them around and you create a tornado and you help them think about.

How anger.

Is like that tornado. Initially, it gets them really wound up and they feel like they're kind of swirling when all that adrenaline is going through their mind. But if they don't keep shaking the bottle, if they don't keep feeding it energy, that tornado turns into just a bottle of water. Same thing with our anger. If we don't keep feeding it, if we don't keep stirring it up by thinking about the same things and ruminating on it, then that adrenaline will dissipate so we can think more clearly about what the next step is.

A relax jar is another activity that's.

A little bit more fun.

Use beads with the letters R E.

L A X and other small beads in sequins. And fill a small jar with rice or perlite or whatever you want to. Rice is usually cheap and available.

Leave a little air at the top.

So as it's rotated, the rice will slide around inside revealing the letter beads and sequins.

When the person gets angry or anxious, he or she can turn the jar.

Until they find all the letters that spell relax.

That focuses their attention again.

This is one of those distress tolerance activities. It's not solving whatever triggered the anger or anxiety, but it's helping them get to where they're in their wise mind so they can make choices that are more in line with their goals and values and authentic.

Ask people how they can use mindfulness.

To start to break the habit of anger or anxiety.

If the person says I'm angry or.

Anxious, okay, so they notice. That's that mindful awareness. I notice I'm angry or anxious. Alright, so let me take the place that fly on the wall. What am I feeling angry or anxious about? What in the world is my problem? And you know, I woke up this.

Morning for some unknown reason.

I woke up anxious and I have no to this moment. I still have no idea why. And sometimes that's even more frustrating. But I noticed I'm angry or actually this morning I noticed I was anxious and I asked myself, you know, what in the world am I anxious about? I started thinking about the dreams I had and what I had to do today and I was like, no, nothing's checking the block. I'm not sure, you know, maybe it was just a fluke.

Is this actually a threat to me.

In the present moment? Well, this morning I couldn't even figure.

Out what I was anxious about.

So no, not thinking there's a threat to me in the present moment. You know, everybody's fine, the dogs are fine, microwave's still working, we're good.

What is the best response in this.

Situation to help me achieve my goals?

I could have sat there and perseverated.

Over what am I anxious about? And been frustrated that I woke up with heart palpitations and whatever.

You know, in reality it was probably.

Just hormones and you know, because when you're in. When women go through menopause as their estrogen fluctuates, their heart rate can fluctuate up to 20 or 30 beats a minute sometimes.

And you know, so I chalked it up to that and I said that's the best response in this situation because.

I can't think of anything else to be worried about. Now if I keep looking and poking the bear, sure I'll find something to be worried about.

But superficially I got up, it's 4:30 in the morning I'm thinking there's really.

Nothing going on, and so it must be something else. So I was checking the facts. You know, that fire alarm went off.

I'm looking around, all the animals are.

Fine, the kids are fine, husband's fine, house is fine. Nothing to be worried about. So the best response in this situation is to just let it go. And we want to encourage people to start using mindfulness.

If there is a threat, that's okay. You know, it happens. There are things sometimes that are a threat.

Why am I anxious? You know, getting ready to go into a job interview even if you know.

You'Ve already got a job?

A lot of us get anxious before we go into a job interview. Why am I feeling this way? Well, because I want to be accepted, because I applied for the job, because it's something I want. Because, you know, there's a certain amount of impression management. There's a bunch of reasons that we get. We may get nervous before a job interview. So that helps me identify what I'm anxious about. Is this a threat to me in the present moment? Well, if I'm unemployed and I need this job in order to put food on my table, it may be. So I need to figure out how to practice my breathing and recognize that, you know, making a good impression is really important right now. So going in, you know, totally flummoxed with anxiety probably isn't going to be the best response in this situation. So taking a deep breath and putting my best face forward and doing the best that I can is probably the best response in this situation.

Going through multiple scenarios like that.

Have people look back over their past week and identify, you know, what was.

Something that triggered your anger or anxiety.

In the past week and then apply it. So you felt anxious. All right, what specifically were you anxious about? Okay, we know that. Was it actually a threat in the present moment? And what did you do? But ultimately, what would have been the best response in that situation based on how you define your goals and values?

Anger and anxiety are excitatory emotions. They get us revved up. Ok, so what can we do to prevent false positives?

What can we do to prevent that fire alarm from going off unnecessarily? Reduce stimulants. That's, you know, a big one.

And being aware of, you know, if you are. If you've got a cold and you're taking decongestants.

Decongestants are stimulants. Therefore, you may be more irritable or edgy when you're taking decongestants.

Not saying not to take them if.

You need them, but recognizing that, okay, I'm taking decongestants today, so I know that I may tend to feel a little bit more anxious or edgy or whatever word you want to use throughout the day because that is going. Decongestants will keep people's blood pressure and their heart rate elevated over what it normally would be, which is one of those first signs, those physiological signs of anxiety.

Get enough rest. It is easier to deal with life.

On life's terms when we are not exhausted, when we are able to think clearly.

Additionally, if we've got enough rest, then.

We'Re probably not living on caffeine, which is a stimulant in order to get us through the day. So rest is a good thing.

Strive for work life balance, which, you.

Know, is so easy to say, so hard to do, unless you make it a purposeful choice. Deciding, okay, I'm leaving the office right now. I am not checking my office email when I'm at home. I am not doing this when I'm at home. When I am at home, that is my home time. And recognizing that when I used to work in Gainesville, I had about a 30 minute drive to and from work.

And that 30 minute drive was my.

Time to decompress and get it all out. Because when I got home, you know, I had two little munchkins at home and I didn't want to be thinking. I didn't want to still be ruminating and thinking about things that happened at the office and even the good things like excitement about the new program we're starting or something. I wanted to be able to train myself to leave work at work.

Keep your blood sugar stable. When our blood sugar gets low, our.

HPA access kits kicks off our threat.

Response system that causes cortisol to be released.

When cortisol is released, it causes blood sugar to be released.

Our body's response to low blood sugar is to ramp up that threat response system.

So people may start feeling shaky and irritable and agitated. That is the body trying to, you know, fuel itself.

If you keep your blood sugar stable.

Then you can prevent that from triggering anxiety.

Hey, be aware of your triggers. Who knew?

Know what your environmental triggers are for anxiety or anger? If there is, you know, if there are certain TV commercials or news or.

People or colors or whatever it is.

That reminds you of things that you get angry about or that trigger your anger, figure out how to deal with them.

Bad traffic.

Some people hate driving in heavy traffic, and that is a Trigger. And every morning they drive to work in heavy traffic and they're angry and.

Irritable by the time they get to work.

And my thought is, why don't you.

Leave a little earlier?

You know, easier said than done. Sometimes if you've got to drop kids.

Off at school or take a different.

Route, you know, it may be a.

Little bit longer to get to work.

If you're taking the back roads, but you're not stuck in super heavy bumper to bumper traffic getting irritable.

Talk to your boss about switching your.

Schedule so you come in after rush hour and then leave after rush hour.

Whatever it is, it can't hurt to explore creative solutions. Being aware of situational or interpersonal triggers.

For anxiety or anger.

Remembering that transference.

Can happen. Or just things in relationships and interactions with people that trigger your threat response system. And becoming aware of why it triggers your threat response system. Are you needing approval? Do you have enough self approval? Is your self esteem high enough? Are you relying on them for approval? Are you having a transference reaction? Maybe you are viewing this person who is now your boss as a father figure and you're trying to get approval from your father figure repeatedly. Now you're trying to recreate that family of origin.

There are a lot of reasons, but being aware of why you react to.

Certain people in certain ways is really important.

Have a plan. There are going to be days that you wake up, you're Grumpy, you are 20 yards back from the 50 yard.

Line and it's going to be a long haul. Know that. Be aware that you are not feeling well or you're tired or grumpy or whatever the case may be. And know how you're going to prevent as much irritation as possible.

That may mean, for example, not going.

Down to the lunchroom to eat or where people are going to come up and talk to you. And you may just not even have the energy to deal with them.

Or taking a power nap at lunch.

Instead of going to the gym or whatever. You usually do have a plan for the best way to mitigate and prevent.

Any further distress and get support. Sometimes we just need to call somebody.

And say, you know what, let me tell you. And we need to feel. Some people need to feel validated, like they're not crazy. You know, let me tell you what happened today.

You get it out, your friend says.

Wow, that really sounds like it was a trying day. Or whatever they say that's super supportive.

And you're like, yeah, and then it's fine. Sometimes just validating or Being validated can.

Help us feel like we're okay. It can help us get regrounded and take that next step.

Emergency planning for when people feel terrified, when people feel enraged.

How can you get safe?

If that threat response system goes off.

And you feel like there is some sort of current threat, how can you get safe? Now it may be, you know, your past is being triggered and you're having flashbacks. That could be. There could be a lot of reasons.

But if that anger or anxiety feels.

Like it's uncontrollable for some reason right now, how can you get safe? Where can you go where you can decompress for a few minutes?

Who can you call or text? What strategies can you use to help.

You get into your wise mind? And y' all know I love Linehan's mnemonics for accepts and improves. I encourage clients to make a list of distress tolerance activities that they can do that they can keep with them.

When they are in the throes of rage or fear or terror, they're not.

Thinking, alright, you know, what is that.

Distress tolerance activity that I thought might be helpful? No, that's not where their brain is.

At that point, their brain is on survival. If they have a list that's easily accessible, they're going to be more likely to at least try to access that.

And why is it important to you.

To manage these feelings? Helping people recognize again that.

Anger and.

Anxiety are natural, they are protective.

That's our body's cue, that, hey, we want to survive.

How cool is that? What we do with them can either help us move towards a rich and meaningful life, or it can use a lot of energy that actually moves us away from those things that are important to us. So it's important to manage these feelings so we can use that energy in ways that are purposeful to help us draw towards those things that are important.

Another activity that Maribel suggested is using.

The iceberg instead of the onion. Might be recognizing the ice. The tip of the iceberg is that emotion that you let everybody see. And then what's underneath the water, which is the bulk of the iceberg, is the stuff that you are keeping under wraps, so to speak, which whatever metaphor works for your clients is really awesome. Just helping them understand that there's generally a lot of emotions involved when we feel anything.

Anger and anxiety are normal emotions that help people survive. Answers can often be found by asking.

What happened to me that would trigger this reaction? What experiences have I had that would tell me that this is a dangerous situation? You know, back when we lived in Florida. Lots of hurricanes hit Florida. We were in the middle of the. In the middle of the state. Never had problems with hurricanes. You know, they were category one or two by the time they came to Gainesville.

So storms never bothered me.

I rather enjoyed watching the wind blow, the trees and the. And the lightning and hearing the thunder.

And, you know, that was kind of.

Romantic in some weird way. Not a hurricane, but just a regular old storm. We moved to Tennessee, and we are up on a ridge right now.

And there was one time about four.

Years ago, after a particularly beautiful storm, that we walked outside and about 400ft.

Of our fence was lying flat.

The storm had, you know, obliterated our fence, which was, you know, six by six wood posts and everything. Didn't think anything could happen to it, and part of our roof was gone. And it was, you know, kind of startling because I was like, how are we going to get all this fencing back up to keep the donkeys and everybody in?

So that was a stressful experience.

And after that, there were a couple more storms where a couple more hundred feet of fencing fell down. So now when there's a storm and the wind starts blowing, guess what? I have this stress reaction that I know that my first thought is, I hope the fence is not going to fall.

And then I have to go through.

My cognitive stuff about, okay, we've, you know, completely redone the fence, and we haven't had any problems with that in two years. So, you know, everything's fine, and if it falls down, you know, we'll put it back up because our donkeys don't seem inclined to go anywhere. That's the process that I go through.

But that's how my perception of a.

Storm went from being something that I.

Just love to watch to something I.

Really hate when it comes around. And understanding that there were events that triggered that reaction that I need to cognitively address when those feelings come up and check myself and go, all right, is there really a problem? No. Okay, moving on.

Situations that trigger anger and anxiety often.

Involve a sense of being unsafe, a loss of something, emotions that are unable to be handled effectively, or an alteration of how that person envisions the future.

Problems arise when anger and anxiety are misinterpreted or we don't have the skills to deal with the problem.

Something happens and we're like. Like, when the fence fell down, I don't have the skills to put a fence back up. Thankfully, my husband was home that week and was able to help us, you know, get the fence back up and teach me what I needed to know so I could repair it. Repair it henceforth and forevermore.

Anger is not a simple emotion. It often covers up shame, embarrassment, guilt, or anxiety. By helping people identify the roots of their anger and more effective strategies to.

Use, they can be empowered to reduce the frequency and intensity of these emotions and more effectively cope when they do arise.

Between writing notes, filing insurance claims, and scheduling with clients, it can be hard to stay organized. That's why I recommend Therapy Notes.

Their easy to use platform lets you.

Manage your practice securely and efficiently. Visit therapynotes.com to get two free months of TherapyNotes by just using the promo code CEU when you sign up for a free trial at therapynotes.com.

If this podcast helps you help your.

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