Anger, What s Up and What to Do About It Buck Black MSW

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Anger, Whats Up and What to Do About It

• Buck Black MSW, LCSW, LCAC
• BuckBlack.com
• TruckerTherapy.com
• 765-807-6778

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Disclosures

• I am in in private practice at Heartland Clinic
• I am a board member at Mental Health America

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Healthy Anger

• Anger is healthy when controlled
• Good that has come from anger
• Work harder to reach your goals
• Stand up for yourself
• Womens right to vote
• Civil rights
• Self defense

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Causes of anger

• Anger is a secondary emotion
• What feeling is behind anger
• Sadness
• Fear
• Mr. Macho
• Protecting self from being emotionally hurt
• Is there anger in the home life when growing up?
• Anger is largely learned
• Are there secondary gains for anger?

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Is anger simply the symptom?

• Is there a head injury?
• Damage to prefrontal cortex
• Substance abuse?
• Mental illness?
• Depression, Bipolar, Anxiety
• Look for domestic violence

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Medication or Therapy?

• My bias
• Therapy first!
• Therapy helps to
• Change thinking patterns (CBT)
• Teach parenting skills
• Find reasons for angry behavior

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Consider Medication When

• Clients condition worsens during therapy
• Client shows little change after several sessions
• It is obvious that client has another diagnosis
  that needs to be treated with medication

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Often the Best Combination

• Medication and therapy are often a great
  combination.
• Relying too heavily on one or the other may not
  yield the best results.

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Anger Management is NOT

• Domestic violence program
• Substance abuse program
• Simply education
• Clients often tell me that anger management
  classes (without a therapy component) are often
  ineffective.

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Anger and Logic

• The angrier you get, the dumber you get!
• Frontal lobes practically shut down

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Motivational Interviewing

• Motivational Interviewing is a necessity for
  approaching anger.
• I am not angry!!!
• My parents forced me to see you!!!
• My kid is the one with the problem, not me!
• Avoid power struggles with client

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MI Techniques

• Let client decide if the anger is worth it
• What are the pros and the cons of anger
• Let the client be angry
• Avoid direct confrontation
• Avoid lecturing
• Let the client figure it out

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MI Techniques

• People will have anger relapses
• Did anyone get hurt?
• Did you do anything you regretted?
• How did you stop yourself?
• Was this time better than the usual anger
  outburst?
• What would it take
• What will be different next time?

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Choice Theory

• Focus on persons choice
• External control does not work
• ActionConsequence

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How many volcanoes?

• Have client measure anger in volcanoes.
• Keep a daily log of the volcanoes and triggers.
• Make it a maximum of 100 volcanoes.

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Triggers

• Stop anger before it is a 100
• Intervene when anger is a 20
• Indicators of anger
• Behavioral
• Cognitive
• Somatic

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CBT

• Will it matter next week, next month, next year?
• What right do I have that is being violated?
• Visualize getting along, walking away
• Sports psychology
• Look at it as a test
• Positive self talk

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CBT

• Keep palms open
• Press open palms against legs if needed
• Relax jaw and other muscles
• Change environment
• Timeout

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Practicing Anger

• It might feel better at the time, but these
  maintain anger
• Punching bag
• Boxing ring
• Breaking things
• Violent video games
• Angry music
• Substance abuse

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Focus on something positive

• Focus on something else
• Focusing on anger symptoms will make them worse
• Dont think of a pink elephant

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Anger Reducers

• Exercise
• Hobbies
• Learning Communication Skills
• Life Saver technique
• Journaling (most guys dont like this)

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Relaxation

• Deep breathing and muscle relaxation is all well
  and good, but dont over do it!
• Young men often do not buy into these relaxation
  techniques. Do not force it on them. Remember
  to meet the client where he/she is!

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Humor ?

• Laugh!
• More importantly, laugh at yourself
• Keep a journal of absurdities
• Find the comedies in the tragedies

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Suicide/Homicide

• Angry people are often impulsive.
• Watch for suicidal/homicidal ideation.
• Remember the duty to warn
• A referral for therapy is needed.
• Bring client in for emergency assessment if a
  danger to self or others

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De-escalation

• Take inventory of your own feelings
• Keep a calm voice
• Show relaxed body language
• Place yourself by the door
• Dont take anger personally
• Use active listening
• Wrestle client as last resort

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Contact InformationBuck Black

• BuckBlack.com
• TruckerTherapy.com
• Follow me on Twitter
• _at_BuckBlack
• _at_TruckerTherapy
• 765-807-6778
• Heartland Clinic
• 2201 Ferry St, Lafayette, IN

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Take Home Points

• Anger is healthy with controlled
• If anger is causing a problem, it is a problem
• Angry is the symptom
• People with anger often have depression, anxiety,
  and/or substance abuse problems
• Seek consultation if concerned about an angry
  patient