therapy

{Monterey, California}

Up until I graduated medical school, I used to be irritable and impatient on a regular basis.  Not many people would think I had anger issues (particularly due to the way my anger manifested, which was mostly unassertive and passive, see below) except for those who received the brunt of it, which is often the case for most people.  I also used to feel guilt and shame for having an angry temperament as a child, until I opened up about the issue during individual and group psychotherapy.  It was quite therapeutic to hear that several group members (whom I least expected given their present demeanor) reported being angry during childhood as well, and even more helpful to gain the insight needed to identify triggers for my anger, in addition to more productive ways to express and cope with it.

We’ve all experienced anger before, and there’s various ways it can present itself.  The spectrum of anger can manifest as brief, subtle annoyance to full-fledged rage.  Though anger can be constructive (ie, used as motivation to create change or solve a problem), the more problematic expressions of anger are more outward via yelling, physical aggression (punching and throwing things, etc), or violence.  Others may also express anger in an unassertive way (which can also be quite volatile) by isolating, holding it in, and not expressing the anger at all which often leads to more passive-aggressive and pathological forms of coping such as taking it out on others via hurtful comments, putting people down, being vengeful by indirectly trying to get back at people without communicating the reason why, etc.

Developing healthier ways to express anger has many benefits, which include health (anger is known to be associated with increased risk of having a heart attack, hypertension, diabetes, migraines, self-medicating with substances such as alcohol, etc), improved communication in relationships, and a gained sense of control over your emotions.  Though the origin and persistence of your anger can be quite complex to fully understand (I tend to formulate my patients’ issues psychoanalytically, which can be theoretically confusing to many (including myself) except Sigmund Freud, who first laid out the theory), the following are some concrete strategies that can help keep your anger in check, which I also teach my patients and use on myself:

1. When your anger gets triggered, slow your response rather than reacting on impulse.

When anger gets triggered, our brain perceives the situation as a threat and automatically reacts by going into fight or flight mode and the response is believed to last less than 2 seconds.  Therefore, since we can go into a rage from 0 to 100 instantly, we can take control of our behavioral response by using tactics that allow us to regroup and think through how to respond.  Some tactics include the following: take a couple of deep breaths, count to 10, step away and excuse yourself briefly, grab a drink of water, etc.

Another similar example/situation — Have you ever received an email or text message that was so upsetting that you immediately started aggressively typing a hostile reply?  I’ve reacted this way many times (and have also typed blogpost drafts out of anger), yet the rule of thumb is do not send content that is typed in a heated, angry state of mind, but rather to wait and respond when you’ve cooled down because you might send something you’ll regret (and an email/text message is a permanent record that you can’t take back).

2. Recognize your initial signs of anger.

I often ask my patients to identify the initial signs they experience when anger gets triggered because being mindful can put a stop to the progression to an outburst or response they might regret.  Utilizing Tip #1 above is even more useful if we can quickly recognize our body’s initial response to anger.

To give an example, the following is my usual pattern of response that occurs when my anger gets triggered: eyes get wide, chest tightens, heart races, facial muscles tense, fists tighten.

I’ve practiced this technique numerous times and have become far more mindful and self-aware in the last few years (therapy and yoga helped) to the extent that once I notice my chest tighten and heart race, I quickly take deep breaths to calm down.  So next time you get angered, pay attention to how your body responds.

3. Once you’re in a calm state of mind, express your anger.

When people hold in and suppress their anger, it often becomes internalized (and may experience depression by directing the anger inward) or builds up to the point that it leads to an eventual huge, uncontrollable outburst.  I used to cope this way with anger as well where I’d yell and scream hurtful things and bring up anything and everything that upset me in the last few months.  Once you’ve calmed down in the moment, try to assert and state your concerns in a clear, direct way rather than waiting until you’ve reached your boiling point.

I admit that I used to also react by either saying nothing or passively turning to someone next to me and saying mean, hurtful things that were loud enough for the person who upset me to hear (yes, I know this response is sooo high school circa Rachel McAdams in Mean Girls), so I felt awkward at first when practicing to be more direct at communicating my anger.  However, just like with anything in life, you have to keep practicing and eventually you’ll learn to successfully express yourself and get your point across in order to feel understood and heard.

4. Identify the underlying cause of your anger in the moment, and if the issue is minutiae, let it go.

Numerous things can trigger anger (a negative comment, criticism, lack of sleep, not getting your coffee fix, drugs, depression, medications, anxiety, stress, grief, kids not doing their chores, your sports team losing, bad luck with fantasy football picks, a friend wearing the same outfit as you, a pimple, tardiness, misinterpretation of a text message, someone lying to you, PMS, delayed flight, someone cut you off on the freeway, etc, etc — I think you get the point).  If the trigger is something small and trivial (ie, getting cut off in traffic), recognize that reacting in anger won’t solve the issue (that’s right — stepping on the gas and tail-gaiting the SOB will not make the situation any better…I only know this through experience) and expends so much energy that can be more productively utilized elsewhere.  However, if the underlying cause might be a major issue you’ve struggled with throughout your life (for example, having social phobia and being extremely sensitive to judgment and criticism) then please refer to #6 below.

5.  Diffuse your anger by getting some exercise or channeling that energy into a workout.

This point is pretty straightforward — anger triggers increased stress and exercise is always a good way to lower stress and expel the anger from your system.

6. Seek professional help.

If your anger is causing substantial impairment in your life (work, relationships, etc), then don’t be afraid to seek help from a professional (psychotherapist, your regular medical doctor, psychiatrist, anger management, etc).  I mention numerous times in my blog how much psychotherapy has helped me personally and those I’m closest to can vouch for the noticeable improvement in the way I manage stress and anger.