ANGER

When I went to a CBT conference hosted by David Burns, I was surprised by the fact that he kept bringing up anger.  It was a conference about combating anxiety, yet he continually found that anxiety was usually secondary to anger, because we live in a "nice" culture where it's not OK to express your anger.  In fact, one of his techniques to "untwist your thinking" revolved entirely around the idea that you may be holding in something upsetting and your brain has converted this anger into a safer emotion (anxiety).

The Hidden Emotion Model: This technique is based on the idea that when you're anxious, you may be avoiding a personal problem that you don't want to face. Bringing this problem to conscious awareness and expressing your feelings will often eliminate your anxiety. Ask yourself, "Am I focusing on my anxiety to avoid dealing with something upsetting? What's the real problem that's bothering me? Do I secretly resent my spouse or my job? Am I unhappy about being in school? How do I really feel?"  (from David Burns 50 ways to untwist your thinking)

That was different from what I heard in my substance abuse classes; there I learned that anger is a secondary emotion and that there is usually something behind the anger, like feeling inferior, that people won't let themselves be vulnerable enough with to express, so instead they take it out on the people around them with anger.   

Which comes first the anxiety or the anger?  I think it depends on which population you work with. If you worked with drug addicts all day, you may see a lot of angry clients and see that the real reason they express that emotion is they are experiencing pain from cravings and withdrawal, pain from abuse and neglect, and sorrow from past mistakes. If you are working with anxious clients, you will see that the hidden emotion is unexpressed anger and they have learned to quickly suppress it because its "not OK to be angry." For example, a client may be really angry they had to work a late shift again but was too nice to tell his boss how mad he was, and may feel he doesn't deserve to be angry anyway and should be grateful he even has the job, so instead he just develops anxiety about going to work, or may have the urge to throw up every time his boss comes around. 

In either scenario, managing anger becomes an important aspect of recovery. Anger has gotten a bad rap because we associate anger with being out of control. Many people get uncomfortable at the least and at worst hurt when anger rears its ugly head. However, anger is an emotion we all will experience and simply having some anger does not make you out of control, any more than having some sadness makes you depressed.  It can actually be quite useful anger, it can defend us when we are in danger and can warn us when something isn't right, and helps us keep healthy boundaries, so we don't want to eliminate or suppress it completely.

So what do we do with it?  There are two options, you can 1. lower your expectations or 2. learn to express your anger in a healthy manner. 
The latter, learning to express your anger assertively but not hurtfully, is by far the optimal decision for your mental health. However, it takes practice, courage and vulnerability to be able to learn how to simply and assertively express that you are upset about something without hidden vindictive intentions.  We first have to identify what is making us upset, and sometimes that alone is very difficult because we've spent a lifetime suppressing or avoiding the emotional pain of anger. Once the source of the anger is pinpointed, we must have the courage to say in a calm voice, "I feel upset about that" without criticism, contempt, defensiveness, or revenge.  (Or "please don't do that" or "I don't feel right about that" or even "I'm so angry I can't see straight.")

If you are not sure that expressing your anger is an option for you right now, you can try to lower your expectations.  Anger generally comes from frustration about something you expected to happen or thought should happen but did not.   The man yelling at his computer obviously thought some technical program should be easier to navigate than it was or doing something that it was not. A wife  cannot be angry with her spouse if there was not some expectation in her mind that he did not meet.  It stands to reason that if you lower your expectations you will lower your frequency of angry moments.  Trying to lower expectations can help you at least start to identify the source of your anger so that you can decide if its worth being angry about, and if it is, explore ways of how to express that.

"Peace comes from learning to process life as it is, rather than as you think it should be."

Addiction

Last thing I remember, I was
Running for the door
I had to find the passage back
To the place I was before
"Relax, " said the night man,
"We are programmed to receive.
You can check-out any time you like,
But you can never leave!
--Eagles

We all do things to try and alter our conscious awareness at times. Whether it be food, botanicals, or entheogens, humans have long been taking in substances (or engaging in behaviors) that change the chemicals in the brain to promote a sense of well being.  You may be doing it too, without realizing it.  For example, bread or other carbohydrates make us feel calm and stimulate serotonin levels, and you don't realize how much you "need" refined carbohydrates until you try to eliminate them completely from your diet. Most people who engage in behaviors that promote their sense of well being will continue to do so until it causes more pain than relief, or too many disadvantages to ignore any longer.  So ask yourself, is what you are doing working for you?
Maybe you do realize you are trying to alter your conscious awareness, and it's causing you some problems, but you don't know what to do about it. When the neruotransmitter dopamine gets a surge and the pleasure centers of the brain become accustomed to a certain substance or behavior, the ability to choose becomes compromised. Your brain will push you towards more of that substance to the point of feeling you need it to keep going, to keep living, to survive.  When a substance becomes one of the primary survival needs it is very difficult to reverse that process, because the brain itself becomes programed to protect itself from ever losing its source of pleasure and survival.
Contrary to what the popular Eagles lyrics suggest, there is hope. The human brain can cause a lot of problems, but the mind can overcome the brain if given the proper tools. Have you ever looked at a large dam?  At the bottom of every dam there is a little river of water.  The flow of that river of water increases or decreases depending on the pressure building up on the other side of the dam. More pressure, more water let out. It is the same things with our life. Willpower alone will probably not get you far in overcoming addition, but willpower combined with positive negative outlets such as therapy, group support, journal writing, writing your story, exercise, pursuit of hobbies and goals, and telling your story to family and friends, may help your brain little by little find other ways to cope with discomforts in life without the addictive substance.  The key is to find positive coping outlets, if you deal with negative experiences in life by numbing the pain instead of letting them out, your will become internally as toxic as the Dead Sea.  You need an outlet!  Negative thoughts, feelings, and experiences will continue to come, but there is much in life worth living for if you know how to let the negative out in a positive way.
It will take time and courage and vulnerability, and will not be easy, but if you "hold the vision and trust the process" your mind can help change your brain that has been trapped in the dopamine surge of addiction. Please seek help, talking to someone about it is a first great step.

"Whatever the mind can conceive, it can achieve." --W. Clement Stone
"Where there's hope, there's life; it gives us fresh courage and makes us strong again." Anne Frank

Agenda Setting

Part of any therapy process needs to include setting the agenda with the client. This means the client chooses how much change, if any, he or she will make in treatment and the therapist goes at the client's pace.  This is important for a number of reasons, two reasons are 1. because the therapist can't work any harder than his or her client, and 2. because self determination and agency of the client are vital in successful treatment outcomes. So how badly do you want to change?

When setting the agenda, it's helpful to include a cost/benefit analysis of what you are experiencing so that you can foresee what process and outcome resistance might come up for you. For example, if you're focus of treatment is conflict with your spouse and you are miserable in your relationship, but really don't want to divorce your spouse, you will be faced with needing to change some things about yourself in order to change the situation in your relationship.

But why should you change? Why can't they change? Its easy to see how much easier your life would be if only they would change. It's hard to be the one to say "I'd rather be married than be right" and make some adjustments.  In fact, some people would rather live in misery than do the work necessary to change. That is generally because there are some benefits to staying the way you are.

It helps to know what you are up against, and doing a cost benefit analysis will help you know. Pick one of the scenarios that closely applies to you and fill out the advantages/disadvantages lines.

Attitude or emotion: "It's not me who needs to change, its his/her fault things are a mess"
Advantages to holding to this belief:
Disadvantages to holding to this belief:

Attitude or emotion: "I'm the victim here, I'm not doing anything wrong."
Advantages to holding to this belief:
Disadvantages to holding to this belief:

Attitude or emotion: "I feel like I've already tried everything in my power to improve things."
Advantages to holding to this belief:
Disadvantages to holding to this belief:

Attitude or emotion: "Nobody understands how hard it is, I can't do it."
Advantages to holding to this belief:
Disadvantages to holding to this belief:

What were your answers like?  Did they sound anything like the following?
Advantages to holding to this belief: You don't have to communicate your needs; you can justify feeling hurt; your don't have to forgive; it's safer to be guarded than being vulnerable with someone who can hurt you again; its easier to do what I'm used to.
Disadvantages to holding to this belief: You don't have an emotional connection; trust is broken; you actually don't feel safe you feel the need to guard yourself; everything is more complicated because your upset about being at odds with someone you love; you are unhappy.

The answers will vary because no two people are the same, what's serving one will not necessarily serve another, neither will the what's hurting one hurt another. But knowing the advantages and disadvantages can help you really see which side is more important. Is it more important to you to feel safe and guarded, or vulnerable and connected? Which is serving you in the interest of you goal?  How important is it to you to change? How hard are you willing to work in order to get rid of those disadvantages, or maybe you aren't really interested in getting rid of them at all?   

Mental Filter

If you suffer from shyness, anxiety about going into something new, or fear of not knowing what you are doing, or have any social phobia of any kind, you may be buying into the cognitive distortion which is a sub type of All or Nothing thinking, the "Mental Filter."  Mental filtering is when we pay especial attention to our limitations and weaknesses or outright flaws, and filter out the positive qualities we have.  This makes us feel vulnerable and saps our confidence, and the thought of facing situations where we don't know what to expect will cause massive amounts of anxiety.

Do you ever tell yourself any of the following?

"I won't know what I'm doing."
"Everyone will think I'm weird or stupid."
"I can't do, that I already tried and couldn't do it."
"I made a mistake, I'm a loser."
"Everyone else seems to have it together, what's wrong with me?"
"That would be too [hard, humiliating, scary, embarrassing]"

Coupled with some other cognitive distortions, the Mental Filter is present in all of these statements.  Assuming that because you aren't the expert in a situation so you won't be able to handle it turns out to be self fulfilling prophecy; either you don't try so you never find out, or if you do try your hesitation and holding back will suggest to people that you truly can't handle it. Either way you get to avoid what you feel you can't do, and this only gives you another layer to add to the negative attributes list that you are holding in the mental filter sieve.

You owe it to yourself to stop filtering out all your positive qualities!  People are more than their negative attributes, much more. If your negative attributes count, so do your positive attributes.


It may take years to understand that you can be weak and its OK, but it will be revolutionary once you get it. It doesn't have to be one or the other, it can be both! Combat the mental filter with a combination of self defense and acceptance. Examples include:

Its true I'll never get everything done in a day that needs to be done. (acceptance)

I'll never be "good enough" but I am enough (acceptance and self defense)

I'm not able to completely control my emotions. (acceptance)

I'll make mistakes every day. (acceptance)

There will always be people who don't value me, judge me, and maybe even dislike me. (acceptance)

Some things are in my control, some are not, that is normal. (acceptance)

Some days I won't live up to my own standards and values. (acceptance)

I won't know all the answers. (acceptance)

I'll experience humiliation shame and fear. (acceptance)

I can accept these because it's OK, what we’re here for is to learn. (self defense)

Every day I can get up and try again. (self defense)

Every day I can be thankful for something. (self defense)

Every day I can step a little closer to my goals. (self defense)

I can endure, and save myself for days of happiness. (self defense)

I'm not an expert on everything but I have many strengths and talents. (acceptance and self defense)

I can use the strengths I have and apply them in situations I feel weak. (self defense)

I'll never give up holding to my standards and values. (self defense)

Where it truly matters to me, I excel. (self defense)

My favorite combination of acceptance and self defense sounds like this: "I'm weak and I'm strong. I'll never be 100% good or 100% bad. I'm capable and I'm limited, I fail and I succeed. There's no one like me out there so there's no one I'd rather be than me." 

These will help you will cure yourself of Mental Filter so you will be able to build the confidence you need to move in the direction you desire.

I think, therefore I fear

Anxiety. One among many of the wide range of emotions we will experience during our life. Depending on its intensity anxiety can range from mild nervousness or anticipation to terror or panic.  Many clients come with the goal of not being "so anxious" or eliminating anxiety altogether.  Is it unnecessary to be anxious?  What constitutes a healthy amount of anxiety?

We need some anxiety, it keeps us from getting into goal-hampering or dangerous situations. For example, its anxiety that keeps us safe on the road, we pay attention to other drivers and don't wander into the oncoming traffic due to fear of getting in an accident. But too much of it and you become a road hazard; heightened anxiety can cause you to be paralyzed by fear, hyperventilate due to panic, or cry in fear, or become too terrified to get in a vehicle altogether.

Where are you on the anxiety spectrum?  If zero were "feeling completely calm and safe" and ten were "full blown panic attack," in what situations do you find yourself at a 3? a 9?  Perhaps when you are driving you are only at a 2, but going into the grocery store anxiety levels reach a 7? Perhaps at home you are a 0, but when someone knocks on the door you jump to a 10? It is different for every person because of differences in biology, psychology, and environment. Understanding how each domain influences anxiety can help you keep your anxiety at manageable levels.

In the psychological realm, our thoughts affect our anxiety levels. If you are afraid, its assumed that you must be anticipating bad things will happen, otherwise the fear would not be there.  What are you anticipating bad will happen?  What are you telling yourself when you are in the anxiety-provoking situation? Changing your thoughts to be free of distortions or self defeating beliefs can help decrease your fear of what might happen. This is hard to do because thoughts are so automatic and shaped over years of development.

In the biological realm, our sleep, diet, and exercise regime affect our anxiety levels. High intake of caffeine and sugar will affect mood swings and may created a heightened sense of anticipation. Not eating regularly can cause low blood sugar which may make you vulnerable to feelings of fear. Exercise helps regulate chemical flow in the brain and will give you an increased sense of control. Sleep restores the brain function and allows for more ability to think clearly.  Many are the benefits of a balance in healthy eating, active lifestyle, and sleep and rest; lowered anxiety is one of the benefits.

In the environmental realm, stress levels affect anxiety. Depending on your stage of life and circumstances you may or may not have a lot of control over your environment. Be that as it may, high stress levels increase cortisol production, which is the "stress hormone" that moves you to action and can cause influx of adreneline to be secreted unnecessarily. High amounts of cortisol are toxic to our brains and will decrease our ability to maintain healthy levels of anxiety.

All of these domains are affected by each other. For example, if you are experiencing high levels of stress in your environment, it may be due to the fact that psychologically you are telling yourself that your productivity level is tied to your self worth, which makes it feel impossible to decrease your work load. This can affect your time to rest and exercise, and even may negatively affect your eating patterns.  A good place to start in managing your anxiety is by monitoring your thoughts, which is why therapy can be so helpful.  We think, therefore we fear.  Grab whatever courage you can, and seek guidance to make sure your thoughts are not exacerbating emotional pain due to anxiety.

Book Review: Gifts of Imperfection by Brene Brown

Brene Brown does a thorough job in her book "Gifts of Imperfection" helping readers to learn the CBT acceptance paradox technique ("The Acceptance Paradox...is arguably the most powerful and important CBT technique of all. Patients tell themselves, 'I'm no good. I'm defective. There must be something wrong with me.' When patients try to argue with these thoughts, that rob them of self-esteem, they often end up feeling even worse. Instead, you can show patients how to defeat or transcend their defectiveness by accepting it. Although this is very simple, it is incredibly difficult, because patients cannot readily distinguish healthy acceptance from unhealthy acceptance, which are radically different." David Burns). Brown helps her readers learn a healthy acceptance. Her premise-- shame doesn't make people better, compassion authenticity and courage make people better--along with tools and tips on how to live a "whole-hearted" life provide valuable insight to readers and inspiration to help them move forward despite limitations.  Her work as a researcher and her personal experience gives her assertions a truthful groundwork and a sensitive approach, and there's lots of tidbits of inspiration throughout.

Brown warns: "There are too many books that make promises they can't keep or make change sound so much easier than it is. The truth is that meaningful change is a process. It can be uncomfortable and is often risky, especially when we're talking about embracing our imperfections, cultivating authenticity, and looking the world in the eye and saying 'I am enough.'"

Personalization

When I was a freshman in college I took a Calculus class at the suggestion of a guidance counselor at the university. I failed the class, and after the last test I went home and cried and thought "Its all my fault! I'm a failure."  When I had to explain what happened to friends and family, I told people the guidance counselor was to blame for advising me to take calculus.  I oscillated back and forth between blaming myself 100% and blaming the counselor 100%, but usually defaulted to feeling like I was completely to blame for listening to him in the first place and thinking I was smart enough to handle that class, my self talk became negative and my confidence in my abilities in math disappeared, and I changed majors.

 After some time passed, I started feeling like maybe it was both our faults for failing calculus, so even though the failing grade permanently imprinted on my transcript caused me much embarrassment, I was able to get passed the feelings of guilt and inferiority.

Much later in life when I learned that there are many pieces to the responsibility pie, I was able to think back on failing calculus and see that it wasn't just my fault, wasn't just the counselor's fault, but many circumstances set that failing grade in motion.  My high school trigonometry class didn't adequately prepare me, my parents limitations in math prevented their helping me, the university class size of 250 students was not conducive to helping those falling behind, my friends who wanted to hang out instead of encouraging me to study, my inexperience in college classes in general, etc etc.  My responsiblity pie looks more like this:

The unhelpful thought distortion "personalization" is one of the many variations on "all-or-nothing" thinking. Thinking "It's all my fault" or "It's all their fault" cause us excessive guilt, anger and resentment and neither promote healthy change after a mistake has been made.

"Our weaknesses are secret doorways to our strengths." --Madeleine L'Engle