Understanding and Resolving Problems with Anger and Impulse Control

1. Understanding and Resolving Problems with Anger and Impulse Control NASW MI 2010 Annual Conference Bob Van Oosterhout, MA, LMSW, LLP An updated version of this handout along with other information and video links are available at www.bobvanoosterhout.com

2. Problems with Anger and Impulse Control are Distortions of Nature • I do not believe that humans are naturally aggressive or self-centered • Aggression is a response to conditions and history • Rifkin – evidence human nature is empathic • We are working with nature when helping to resolve problems with anger/impulse control

3. The Nature of Human Emotion • Universal Human experience • Means of connecting with others • Different than thought • Few connections between limbic system and cortex • Different developmental process • Response to perception of the moment • involves proprioception (muscle movement) • tension blocks full experience • resistance builds tension

4. The Nature of Human Emotion (cont.) • Regulates energy • Anger, fear increase energy to deal with threat • Sadness, hurt slow us down to facilitate recovery • Tension increases intensity of reaction (sunburn metaphor) • Provides useful information but is only a part of the picture • Easily distorted by emotional tension (interpret current situation based on emotions from the past) • Experience is different than expression

5. Common Myths About Anger • The truth comes out when we are angry • We need to express anger in order to “let it go” • Hitting or throwing things discharges anger • Playing violent games discharges anger • Anger increases performance in competitive environments

6. The Nature of Anger • Response to a perceived threat • Function is to push away • When level of anger exceeds the threat, it is the result of built-up of tension (spring metaphor) • Anger is a secondary emotion –reaction to fear, hurt, frustration, embarrassment • Interferes with problem solving by narrowing focus and blocking receptivity

7. There is No Long-Term Resolution Through Anger • Anger tends to create defensiveness and anger in others which in turn increases the likelihood that they become more threatening • Problems solved through anger produce resentment and mistrust which undermines lasting solutions • Helpful advice regarding anger in relationships • Don’t speak when angry • Don’t listen to what is said in anger

8. The Nature of TensionTension involves resistance • Physical • muscles working without moving • develops into habitual patterns structured into body • Mental • narrowing and fixing of perceptions • patterns of negative thinking that create physical tension • Emotional • resisting the full experience of emotions through breath-holding and patterns of physical tension

9. Physical Tension Regulated by Autonomic Nervous System (ANS) Sympathetic Nervous System (SNS -required for activity) becomes over stimulated while the Parasympathetic (PNS - required for health maintenance) is suppressed (Fight or Flight) High level or intensity of tension stimulates release of stress hormones which boosts SNS and suppresses PNS Creates a self-escalating process when more stress hormones are released as tension builds, thus stimulating the release of more stress hormones.

10. Mental Tension • The build up of physical tension is interpreted as an indication of a threat, which • Narrows focus and perception • Leads the mind to ask “what’s wrong” • Thoughts create physical tension when they indicate a need for action but don’t result in purposeful activity • Asking “what’s wrong” from a narrow focus builds tension, which further narrows focus on “what’s wrong” creating a self-escalating process

11. Emotional Tension Specific muscle movements are associated with different emotions Facial expressions are obvious but other muscle groups move in response to specific emotions Resisting emotions involves restricting muscle movement which creates physical tension Tension increases reactivity while decreasing responsiveness Not necessarily linked with specific memories (soup metaphor)

12. Resolving and Preventing Problems with Anger Balance and Clarify • Body • Resolving tension provides time to make informed choices • Mind • See the larger picture more clearly • Any conflict, misunderstanding or slight can be attributed to one or more parties not seeing clearly • Let go of patterns of thinking that build tension • Emotion • Able to respond rather than react

13. Resolving and Preventing Physical Tension Requires more than relaxation. Balance must be restored to the ANS Rhythmic diaphragmatic breathing stimulates the PNS and suppresses the SNS Precise rhythmic movement of the diaphragm stimulates the right vagus nerve activating the PNS (proper rhythm is critical) Regular PNS activation over time allows liver to remove stress hormones from bloodstream restoring balance to ANS Grounding reverses patterns of tension while developing awareness of tension habits.

14. Teaching Diaphragmatic Breathing • Explain how and why it works • Opposing parts of ANS prepare the body for activity or maintenance • Movement of diaphragm stimulates right vagus nerve which activates internal organs and stops build up of tension • Demonstrate slow, rhythmic, effortless movement of diaphragm with hand on abdomen • Fingers move out • Watch for obstacles to diaphragmatic rhythm • No diaphragmatic movement – use positioning, metaphors • Inability to bring air to bottom of lungs –deep exhale • Trying too hard – pair with rhythm phrase

15. Teaching Grounding • Describe need for balance between opposing muscle groups and how to achieve “neutral” • Feet width of hips apart, pointing straight • Pelvis over feet (weight over ball of feet) • Knees bent (explain “tensing up”) • Observe from side, check that weight is supported by skeleton • Observe and correct for deviations from neutral in head and shoulder positioning • Sitting – make sure pelvis is back in chair and forms a base to support the spine – feet flat on floor pointing straight ahead, head supported by spine

16. Patterns of Physical Tension Evident in Restrained Anger • Common terms describe patterns of tension • “Pulled up” • “Up in arms” • “Get your back up” • Need to “Settle down” • Discovering natural neutral positions resolves tension and increases awareness of when it starts to build

17. Resolving and Preventing Mental Tension Clarify thoughts, perceptions, and effects of behavior Identify nature of immediate threat separate short from long term issues “Rhythm phrase” & labeling block and redirect negative mental habits Regular meditation develops mental discipline and perceptual flexibility

18. Perceptions that WorkWays of viewing others that prevents anger • Compassion • Hope • Personal Responsibility • Humility

19. Resolving and Preventing Emotional Tension Accept emotion without resistance Let go of patterns of tension which restrict emotion Respond appropriately to secondary emotion Fear – clarify nature and risk Frustration – clarify expectation Hurt – accept, mourn, assess risk and options Embarrassment – accept, clarify options, don’t escalate

20. What Works When Dealing with an Angry Person • Calm undermines anger (removes threat) • Clarify control issue (perceived lack of control increases perception of threat) • Empathize with secondary emotion • Expand perceptual frame • Present realistic options

21. Demeanor and Focus when Defusing Anger • Must be grounded • Safe but not aggressive or assertive • Non-threatening • Maintain calm • Able to provide full receptive attention with intact peripheral vision • Able to understand views and perceptions • Able to think creatively

22. Problems with Impulse Control have Roots Similar to Anger • Built-up physical, mental and emotional tension • Narrowed perceptions • Emotionally based decision making • Perception of lack of self-control • Habitual response pattern • Distorted self-image

23. Effectively Dealing with Problems with Impulse Control Balance and Clarify • Resolve physical tension – • diaphragmatic breathing / grounding • Provide tools to break up patterns of mental tension • rhythm phrase, labeling, clarifying, meditation • Facilitate acceptance of emotion without tension

24. Effectively Dealing with Problems with Impulse Control (cont.) • Set up temporary obstacles to obstruct habitual patterns • Clarify strengths, potential, opportunities, • Clarify long-term goals and current direction • Clarify what works over the long term

25. Summary: ABC Principles • Three principles remove tension from situation and get things moving in a positive direction • Accept – reality and person • Balance – resolve tension and imbalance • Clarify – what is true and important from a larger perspective • Usually easiest to start with Balance

26. Hypotheses on Anger • Anger is a natural emotion experienced both by humans and many higher level mammals. • Anger is a response to a perceived threat. • The function of anger is to push away. • If the level of anger exceeds the level of the threat, the increased anger is caused by a build up of physical, mental, and emotional tension. • Anger resulting from the build-up of tension is a secondary emotion. It is stimulated by another primary emotion such as fear, hurt, frustration or embarrassment.

27. Hypotheses on Anger (cont.) 6. Tension involves resistance. Physical tension is a continuous contraction of groups of muscles that tends to form patterns outside of normal awareness. Mental tension results from patterns of thinking and perceiving that create narrow, inflexible and distorted perceptions and mental habits that create physical tension. Emotional tension results from attempting to restrict the experience of emotion through muscle contraction and breath holding. There tend to be consistent patterns of physical tension that are associated with resistance to specific emotions.

28. Hypotheses on Anger (cont.) • Physical tension limits perceptual flexibility, receptivity, and the ability to experience emotion while limiting awareness and the capacity for reflective thought. It leads to non-productive negative thinking which builds additional physical tension contributing to a self-escalating process. • When tension builds, it creates an imbalance in the Autonomic Nervous System (ANS) where the Sympathetic Nervous System (SNS), which stimulates muscle effort is over-activated while the Parasympathetic Nervous System (PNS) which stimulates health maintenance and recovery is suppressed.

29. Hypotheses on Anger (cont.) • The build-up of tension triggers the release of stress hormones which, in turn, increase tension levels while limiting the ability to recover, creating another self-escalating process. • Patterns of tension form habits of posture and movement which build additional tension on an ongoing basis.

30. Hypotheses on Anger (cont.) 11. Full recovery from built-up tension requires restoration of balance to the Autonomic Nervous System as well as the ability to accept emotions without resistance, shift and reframe perceptions and redirect and clarify negative thoughts.

31. Hypotheses on Anger (cont.) 12. The clinician’s role in the recovery process involves: 1) Creating an atmosphere where the client feels understood, that their symptoms make sense, and their emotions are a normal response to perceptions of their experiences. 2) Identifying obstacles to recovery including stress, relationship or health issues, addictions, problems, and conflicts while assisting in the process of removing them; 3) Timing interventions to match the readiness of the client to understand and act upon them.

32. Hypotheses on Anger (cont.) 13. Effectiveness of the clinician requires 1) Balance, defined as the absence of tension, a state of relaxed receptivity and perceptual flexibility; 2) Emotional openness indicated by an ability to feel and let go of emotions experienced by the client without resistance or tension; 3) Receptivity to the perceptions and emotions, and experience of the client that is not blocked by ego, attachment, judgment, or preconceptions.