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Anger management
- 1. ANGERANGER AGGRESSIONAGGRESSION JEELANIJEELANI SAIMA HABEEBSAIMA HABEEB Lecturer (CON) BGSBULecturer (CON) BGSBU
- 2. Does everybody experience anger?Does everybody experience anger? ď§ Everybody gets angry. That is okay. YouâreEverybody gets angry. That is okay. Youâre going to feel how you feel. BUT: how yougoing to feel how you feel. BUT: how you act is up to you. And that matters, becauseact is up to you. And that matters, because how you act leads to consequences.how you act leads to consequences.
- 3. INTRODUCTIONINTRODUCTION Most of us have probably become angryMost of us have probably become angry on occasion. Let us hope the momenton occasion. Let us hope the moment passed quickly, we apologized and movedpassed quickly, we apologized and moved on. However, anger that is not underon. However, anger that is not under control can be extremely harmful, evencontrol can be extremely harmful, even lethal. It is vital to learn early how tolethal. It is vital to learn early how to control this emotion.control this emotion.
- 4. ANGERANGER THE EMOTION MOST HARMFULTHE EMOTION MOST HARMFUL TO RELATIONSHIPSTO RELATIONSHIPS ââDo not be quickly provoked in yourDo not be quickly provoked in your spirit, for anger resides in the lap ofspirit, for anger resides in the lap of foolsâfoolsâ Ecclesiastes 7: 9Ecclesiastes 7: 9 ââIf you are patient in one moment ofIf you are patient in one moment of anger, you will escape one hundredanger, you will escape one hundred days of sorrowâdays of sorrowâ Chinese ProverbChinese Proverb
- 5. 55 ď§ Know the difference betweenKnow the difference between ANGERANGER andand AGGRESSIONAGGRESSION.. ď§ AngerAnger is an emotion. It is ok to beis an emotion. It is ok to be angry.angry. ď§ AggressionAggression is acting outis acting out inappropriately and is not ok. Learn toinappropriately and is not ok. Learn to check your aggression and express yourcheck your aggression and express your anger appropriately.anger appropriately. ANGER ANDANGER AND AGGRESSSION:AGGRESSSION:
- 6. ANGERANGER ď§ Angeris a normal human emotion that, whenAngeris a normal human emotion that, when handled appropriately and expressedhandled appropriately and expressed assertively, can provide an individual with aassertively, can provide an individual with a positive force to solve problems and makepositive force to solve problems and make decisions concerning life situations.decisions concerning life situations. ď§ Angerbecomes a problem when it is notAngerbecomes a problem when it is not expressed and when it is expressedexpressed and when it is expressed aggressively.aggressively. ď§ Angeris an emotional state that varies inAngeris an emotional state that varies in intensity from mild irritation to intenseintensity from mild irritation to intense fury and rage.fury and rage.
- 7. AGGRESSIONAGGRESSION ď§ Is a behavior that is intended toIs a behavior that is intended to threaten or injure the victimâs securitythreaten or injure the victimâs security or self-esteemor self-esteem ď§ Can cause damage with words, fists,Can cause damage with words, fists, or weapons, but it is virtually alwaysor weapons, but it is virtually always designed to punish.designed to punish. ď§ Human aggression is any behaviorHuman aggression is any behavior directed towards anotherindividual thatdirected towards anotherindividual that is carried out with the proximate intentis carried out with the proximate intent to cause harm.to cause harm.
- 8. CAUSES OF ANGER & AGGRESSION
- 9. The Cycle of AngerThe Cycle of Anger
- 10. Anger â physical responses: increased heart rate and blood pressure, sweating, muscle tension, clenched jaw Anger â psychological responses: feelings of frustration, feelings of rejection, feelings of mistreatment, hostility towards some people Aggression: shouting at people (e.g. family, colleagues, strangers, physical violence (e.g. hitting, punching people ), ignoring or socially Symptoms of Anger & Aggression
- 11. ANGER CUESANGER CUES ď§ Your bodyYour body sends yousends you signals,signals, whenwhen youâreyouâre gettinggetting angry.angry. Clenched fist Loud voice Sweat Red face Racing & pounding heartbeat Upset stomach
- 12. ď§ What are your anger cues?What are your anger cues?
- 13. DEALING WITHDEALING WITH ANGERANGER ď§ When you find yourself angry,When you find yourself angry, REMEMBERREMEMBER the only behaviorthe only behavior you can manage is YOURyou can manage is YOUR own!!!own!!! ď§ So, pay attention to your angerSo, pay attention to your anger cues.cues. ď§ And, if you feel like youâreAnd, if you feel like youâre going to lose itâŚgoing to lose itâŚ
- 14. Using Coping ThoughUsing Coping Though
- 16. The TripleThe Triple AA ApproachApproach ď§ Angeris exacerbated by aAngeris exacerbated by a feeling of victimization andfeeling of victimization and helplessness. It helps to knowhelplessness. It helps to know then that we always have atthen that we always have at least three options whenleast three options when dealing with an anger-dealing with an anger- provoking situation: you canprovoking situation: you can alter, avoid oraccept.alter, avoid oraccept. In the long run, we shape our lives, and we shape ourselves. The process never ends until we die. And the choices we make are ultimately our own responsibility. Eleanor Roosevelt
- 17. AlterAlter
- 18. AvoidAvoid
- 19. AcceptAccept
- 21. Management of aggressiveManagement of aggressive patientâspatientâs ď§ The safety of patient, clinician, staff,The safety of patient, clinician, staff, otherpatients and potential intendedotherpatients and potential intended victims is of most importance whilevictims is of most importance while looking afteraggressive patients.looking afteraggressive patients. ď§ while working with impulsivelywhile working with impulsively aggressive orviolent patients in anyaggressive orviolent patients in any setting one must take care to reducesetting one must take care to reduce accessibility to patients of movableaccessibility to patients of movable objects.objects.
- 22. ContdâŚContdâŚ ď§ Adequate caregivertraining and theAdequate caregivertraining and the availability of appropriate supervision areavailability of appropriate supervision are critical safeguards in the treatment ofcritical safeguards in the treatment of potentially dangerous patients.potentially dangerous patients. ď§ The caregivermay choose to present a fewThe caregivermay choose to present a few key observations in a calm and firm butkey observations in a calm and firm but respectful manner, putting space betweenrespectful manner, putting space between self and patient; avoiding physical orverbal self and patient; avoiding physical orverbal threats, false promises and build rapport withthreats, false promises and build rapport with client.client. ď§ Forcaregivers  treating patients with a highForcaregivers  treating patients with a high
- 23. NURSING PROCESS:NURSING PROCESS: Nursing assessmentNursing assessment â˘A violence assessment tool can help the nurse. â˘Establish a therapeutic alliance with the patient. â˘Assess patientâs potential for violence. â˘Notify co-workers â˘Obtain additional security if needed â˘Assess the environment and make necessary changes. â˘Notify the physician and assess the need forprn medications.
- 24. Nursing InterventionsNursing Interventions 1.Self awareness1.Self awareness ď§ The most valuable resource of a nurse is the ability toThe most valuable resource of a nurse is the ability to assess oneâs self to help others .to ensure the mostassess oneâs self to help others .to ensure the most effective use of self , it is important to know abouteffective use of self , it is important to know about personal stress that can interfere in oneâs ability topersonal stress that can interfere in oneâs ability to communicate with patients.communicate with patients. 2.Patient education2.Patient education ď§ Teaching patients about communication and theTeaching patients about communication and the appropriate way to express angercan be one of theappropriate way to express angercan be one of the most successful interventions in preventing aggressivemost successful interventions in preventing aggressive behavior.behavior. Teaching patients that feelings are not right orwrongTeaching patients that feelings are not right orwrong
- 25. 3.Assertiveness training3.Assertiveness training ď§ Communicating directly with anotherperson.Communicating directly with anotherperson. ď§ say no to unreasonable requestssay no to unreasonable requests ď§ Being able to state complaints.Being able to state complaints. ď§ Patients with few assertive skills can learnPatients with few assertive skills can learn them by participating in structured groups andthem by participating in structured groups and programmes .In these settings patients canprogrammes .In these settings patients can watch demonstrate specific skills and then rolewatch demonstrate specific skills and then role play the skills themselves.play the skills themselves. ď§ Staff can provide feedback to patients onStaff can provide feedback to patients on appropriateness and effectiveness on theirappropriateness and effectiveness on their
- 26. 4.4.Behavioral strategies:Behavioral strategies: a)a) Limit settingLimit setting :Limit setting is a non punitive:Limit setting is a non punitive non manipulative act in which patient is toldnon manipulative act in which patient is told what behaviouris acceptable and what is notwhat behaviouris acceptable and what is not acceptable , and the consequences ofacceptable , and the consequences of behaviourunacceptably.behaviourunacceptably. b)Behavioral contractsb)Behavioral contracts :If the patient uses:If the patient uses violence to win control and make personalviolence to win control and make personal gains, the nursing care must be planned togains, the nursing care must be planned to eliminate the rewards patient receives whileeliminate the rewards patient receives while still allowing the patient to assume as muchstill allowing the patient to assume as much
- 27. EVERYBODY GETSEVERYBODY GETS ANGRYANGRY ď§ Thatâs just how it is.Thatâs just how it is. ď§ The difference comes in what you doThe difference comes in what you do about it.about it. SO: GET A GRIP!!!
- 29. 2929 1 â Go inside1 â Go inside your shellyour shell ď§ THINK before you ACTTHINK before you ACT ď§ Take a âTime OutâTake a âTime Outâ
- 30. 3030 ď§ Time toTime to RELAXRELAX ď§ Calm yourself downCalm yourself down 2 â Take 3 Deep Breaths
- 31. 3131 ď§ Think of a good solutionThink of a good solution 3 â Walk Away
- 32. CONCLUSIONCONCLUSION ď§ Angeris a normal human emotion that is crucial forAngeris a normal human emotion that is crucial for individualâs growth. When channeled inappropriatelyindividualâs growth. When channeled inappropriately and expressed as verbal aggression orphysicaland expressed as verbal aggression orphysical aggression.aggression. ď§ Patients admitted to an inpatient psychiatric unit arePatients admitted to an inpatient psychiatric unit are usually in crisis, so theircoping skills are even lessusually in crisis, so theircoping skills are even less effective. During these times of stress acts of physicaleffective. During these times of stress acts of physical aggression orviolence can occur. Nurses spends moreaggression orviolence can occur. Nurses spends more time in the inpatient unit than any otherdisciplines,time in the inpatient unit than any otherdisciplines, so they are more at risk of being victims of acts ofso they are more at risk of being victims of acts of violence by patients. Forthese reasons, it is criticalviolence by patients. Forthese reasons, it is critical that psychiatric nurses be able to assess patients atthat psychiatric nurses be able to assess patients at
Editor's Notes
- Anger is a natural emotion that usually stems from perceived threat or loss. Itâs a pervasive emotion; it affects our body, thoughts, feelings and behavior. Anger is often described in terms of its intensity, frequency, duration, threshold and expression. Anger typically follows a predictable pattern: a cycle. Understanding the cycle of anger can help us understand our own anger reactions, and those of others. It can also help us in considering the most appropriate response. The Trigger Phase The trigger phase happens when we perceive a threat or loss, and our body prepares to respond. In this phase, there is a subtle change from an individualâs normal/ adaptive state into his stressed state. Anger triggers differ from person to person, and can come from both the environment or from our thought processes. Â The Escalation Phase In the escalation phase, there is the progressive appearance of the anger response. In this phase, our body prepares for a crisis after perceiving the trigger. This preparation is mostly physical, and is manifested through symptoms like rapid breathing, increased heart rate and raised blood pressure. Once the escalation phase is reached there is less chance of calming down, as this is the phase where the body prepares for fight or flight (to be discussed later). Â The Crisis Phase As previously mentioned, the escalation phase is progressive, and it is in the crisis phase that the anger reaction reaches its peak. In the crisis phase our body is on full alert, prepared to take action in response to the trigger. During this phase, logic and rationality may be limited, if not impaired because the anger instinct takes over. In extreme cases, the crisis phase means that a person may be a serious danger to himself or to other people. Â The Recovery Phase The recovery phase happens when the anger has been spent, or at least controlled, and there is now a steady return to a personâs normal/ adaptive state. In this stage, reasoning and awareness of oneâs self returns. If the right intervention is applied, the return to normalcy progresses smoothly. However, an inappropriate intervention can re-ignite the anger and serve as a new trigger. Â The Depression Phase The depression phase marks a return to a personâs normal/ adaptive ways. Physically, this stage marks below normal vital signs, such as heart rate, so that the body can recover equilibrium. A personâs full use of his faculties return at this point, and the new awareness helps a person assess what just occurred. Consequently, this stage may be marked by embarrassment, guilt, regret and/ or depression.
- Once you realize that you are angry, or that youâre about to get angry, you can start calming yourself mentally. The following are just a few mental scripts you can use to keep your anger under control. 1.Calm down first, and think this through. 2.This may not be as bad as it seems. 3.This is just one incident --- it doesnât define my life. 4.I am capable of managing this situation. 5.Itâs alright to be upset. / I have the right to be upset in this situation. / I am angry. 6.What needs to be done immediately? (damage control/ solution-focused mode). 7.Bad things/ Mistakes do happen/ Nothings says that things will go right all the time. 8.There is no need to feel threatened here. 9.I have no control over other people and their feelings. But I have control over myself. 10.I have managed anger successfully before and I will again.
- Relaxation techniques that you can do include: Breathing Exercises Deliberately controlling your breathing can help a person calm down. Ways to do this include: breathing through oneâs nose and exhaling through oneâs mouth, breathing from oneâs diagram, and breathing rhythmically. Meditation Meditation is a way of exercising mental discipline. Most meditation techniques involve increasing self-awareness, monitoring thoughts, and focusing. Meditation techniques include prayer, the repetition of a mantra, and relaxing movement or postures. Progressive Muscle Relaxation (PMR) PMR is a technique of stress management that involves mentally inducing your muscles to tense and relax. PMR usually focuses on areas of the body where tension is commonly felt, such as the head, shoulders and chest area. Itâs a way to exercise the power of the mind over the body. Visualization Visualization is the use of mental imagery to induce relaxation. Some visualization exercise involves picturing a place of serenity and comfort, such as a beach or a garden. Other visualization exercises involve imagining the release of anger in a metaphorical form. An example of this latter kind of visualization is imagining oneâs anger as a ball to be released to space. Music Some people find listening to music as very relaxing. The kind of music thatâs calming differs from person to person; traditional relaxation music includes classical pieces, acoustic sounds and even ambient noises. Art and Crafts There are people who find working with their hands as a good way to relax. This is especially true for people who feel their tensions in their hands. Drawing pictures, paper construction and sculpting are just some of the ways to de-stress when faced with an anger trigger. Arts and crafts are helpful because it keeps a person from obsessing on the anger while he or she is still in the recovery phase of the anger cycle.
- You are not a victim of your situation; you always have the option of taking a deliberate and well-thought out response to an anger-provoking situation. Your options typically fall into three categories: alter, avoid or accept. Alter means that you initiate change. You can change things in your environment that are within your control. You can also initiate changes within yourself. The following are ways that you can change to deal with anger more effectively. Change non-productive habits. If you know that you have a particular way of doing things that often result into an anger situation, perhaps itâs time to break the pattern. For example, if you know that mediating a family quarrel while your mind is tired from work often leads to blow-ups, then re-schedule family meetings to times when youâre more relaxed. Respectfully ask others to change their behavior and be willing to do the same. You canât control other peopleâs thoughts, feelings and behavior. You can, however, let them know that youâd appreciate a change. Waiting for lightning to strike people with habits that irritate you will never get you anywhere, perhaps proactive communication can. Change the way you view a situation. Sometimes, itâs our interpretation of a situation that makes us angry, rather than the situation itself. What you can do is change your way of thinking. For example, irrational thoughts like âI have to be perfect at all timesâ usually result in anger directed at oneâs self when failures happen. Maybe if you start thinking âItâs alright to fail now and then,â things would get easier. Change the way you react to a situation. You can also deliberately change the way you respond. Anger usually begets anger; we raise our voice when someone raises their voice to us. But if you take a moment and find other ways to respond, then maybe you can manage your anger better.
- Avoid means steering clear of situations that can make you angry. The following are âavoidâ ways that you can do to deal with anger more effectively. Steer clear of people who make you upset. Anger is often triggered by interactions with difficult people, or people who just ârub you the wrong way.â If you know that a person is eliciting an intense anger reaction in you, and you feel that you canât control it, then perhaps itâs best that you just take action to avoid this individual. Steer clear of your âhot buttons.â One of the advantages of knowing your hot buttons is that it enables you to structure your day in such a way that avoids them. For example, if too many deadlines make you angry and stressed, then learn time management --- or donât take more projects than you can handle. Saying ânoâ is a good avoid response. Remove yourself from a stressful situation immediately. Another avoid interventions is immediately taking yourself away from a situation that might escalate your anger. For example, if a peer provokes your anger, you donât have to stay around to listen to what he has to stay. You can opt to walk away and address the issue another day.
- De-escalation techniques are skilled interventions designed to facilitate a personâs cooling down process, reduce the possibility of getting verbally or physically hurt, and gain control of the situation. The following are examples of de-escalation techniques: Â PRACTICE ACTIVE LISTENING. MOST OF THE TIME, ALL AN ANGRY PERSON NEEDS IS AN OPPORTUNITY TO TELL SOMEONE HOW THEY FEEL, AND HAVE THEIR ANGER ACKNOWLEDGED. SEEING THAT YOU ARE GENUINELY LISTENING TO THEIR GRIEVANCE CAN HELP LESSEN THE INTENSITY OF THEIR ANGRY REACTION. THE FOLLOWING ARE SOME HELPFUL COMPONENTS OF ACTIVE LISTENING: a. Show non-verbally that you are listening. Make sure that your posture shows openness. Establish eye contact. Speak in a soft, well-modulated, non-threatening tone of voice. Â b. Reflect. Re-state what you hear from the person. Example: âThis is what I heard from you: You are mad because the package did not arrive on time.â You can also mirror back their body language in a tentative but objective, non-judgmental fashion. Example: âI can see that youâre really upset. You are clasping the desk very tightly.â Â c. Clarify. Help the person make sense of their garbled, confusing and/ or illogical statements. âCould you help me explain to me a bit more about what happened in the cafeteria? What do you mean by âhe bullied youâ? Â INCREASE PERSONAL SPACE. Anger can escalate if a person feels that he is being stifled. Make sure your body language is non-threatening. Create distance between you and the person. Â HELP THE PERSON RECOVER A SENSE OF CONTROL. Angry people may feel victimized by a situation, and may need to recover even a small sense of control. You can help do this by: a. Giving them choices. Example: âWould you like to move to a different area and talk?â b. Seeking their permission to speak. Example: May I tell what I think about what just happened? c. Focusing on immediate solutions. Example: âWhat do you think we can do today to help solve this issue?â Â ORIENT THEM TO IMMEDIACY. People temporarily loses track of their immediate surroundings at the height of getting overwhelmed. Orienting the person to the time, his location, and who he is with can help de-escalate a person. It helps a person feel less threatened if he knows where he is and how he got there. The goal also is to shift him from attending to his overwhelming feelings to recovering rationality. Â INVITE CRITICISM Ask the angry person to voice his or her criticism of yourself or the situation more fully. You might say something like, "Go ahead. Tell me everything that has you upset. Don't hold anything back. I want to hear all you have to say." Â AGREE IF POSSIBLE. IF NOT, AGREE TO DISAGREE. There are cases when anger is triggered by a legitimate grievance. In these cases, it can help a person lose steam by hearing someone validate the presence of injustice. At the very least, agreeing that a person has a right to the opinion they have can help de-escalate anger. Â REITERATE YOUR SUPPORT. Emphasize your willingness to help. Example: âOkay. I donât know how this thing could have happened, but you have my assurance that Iâll stay with you until we figure it out.â Â SET LIMITS. Tell the person that you are willing to listen, but youâd appreciate that the tones down the expression of his anger. Example is: âIâm listening right now. Iâd like to talk, but without the shouting. When you shout it is distracting, and if this issue is important to you, then I want to be able to concentrate without hearing you raise your voice. Can we start again? How did I upset you? â