From the Therapists Couch: Explosive Anger!

Anger as we all know is a very natural response to feelings of being attacked or deceived, frustrated or treated unfairly, from a personal perspective. Everyone gets angry at sometime, it is just part of being human. While it is often seen as a 'bad' emotion, isn't always, in fact it can be useful, it is designed to help us defend ourselves from dangerous situations by providing a rush or burst of high volatility and energy.

If only all that emotional energy could just be focused, but how to do it?

The first really big step is to recognise that, despite all the evidence to the contrary, in between the stimulus and the response, there is indeed a tiny gap where control or choice is possible.

This ‘gap’ small though it is, offers both the therapist and the patient the opportunity to develop a change in behaviour, working collaboratively, and with understanding, new patterns of behaviour can be learned.

Recognising anger, and acknowledging it, and owning it, and then taking responsible for it and its power, help us all to see it for what it is, often something that has started as a defence that has become dysfunctional and is now in danger of causing disastrous consequences.

Having trained to work with all sorts of presenting conditions, it is a common occurrence to face patients with anger management issues. Some are outwardly aggressive and verbally abusive. Others take it out on themselves inwardly focusing their anger becoming isolated and denying themselves the things most people would consider ‘normal’ basic needs. While others are passively aggressive, and act out  their non conformity, in a sulky or sarcastic way, while not doing anything explicitly angry or aggressive.

Something that I find really useful is a simple demonstration of the violent anger which can be easily understood, as a metaphor or analogy, and used both in trance or out.

“So, how would it be, if … I take this bottle of Coke, and”… (giving  it a good shake) pass it to my patient … who is looking a little bemused … “ask you to open it…. Open it now! … What will happen?”

Think about it, what would happen?

Anger, when it explodes is a lot like the bottle of Coke … it can be totally uncontrollable it can affect everyone in close proximity, and of course it will impact on who ever is holding it.

This wonderful analogy is a strong and demonstrable piece of impact therapy, which when used within the therapy room can help really make a point.

Timing is crucial, but as any good hypnotherapist knows it is easy to use the idea both physically in wakeful state, with an actual bottle of Coke (other fizzy drinks are available) but much better in the trance state to create deeper and more powerful suggestions for change, where the analogy can continue.

What happens when the bottle is left for a while to “rest” ?

What happens when the bottle is given the chance to “breathe?”

Eventually, the bottle can open up, and the contents enjoyed, and with the fun and effervescence, all under control.

So, perhaps the question is how to avoid the unsettling, and the shaking up?

 

That is the easy bit, because once we know what needs to change and have made a commitment to do it, we are already halfway there.

Training with the London College of Clinical Hypnosis which teaches self hypnosis as the first step, followed with symptom recognition, and when stress management is added the important tools just need to be mastered and regularly practiced, with more training all the symptoms can be dealt with and new behaviours learned.

There is a great hand-out from Mind “How to deal with anger” with lots of support and helpful advise which can be downloaded online: www.mind.org.uk

For more information on how you or your company can effectively manage anger, call us on 0800 999 8353, info@lcch.co.uk

Or to talk to someone in your area:

Scotland: +44 141 333 0878

Southwest England: +44 7761 773563

Midlands and Southeast England: +44 203 603 8535

Northern England: +44 7812 196 798

Southeast Asia: + 603 7960 6439

Portugal: +351 933 713 223

Michelle Hague FBSCH
Centre Manager Sourthwest England

www.lcch.co.uk

Tips to Tame your Anger!

Keeping calm when provoked isn’t always as straight forward as it appears. Being able to manage your anger is a skill that everyone can learn. And no, anger management isn’t simply a means by which you internalise and supress your rage, rather it’s a means of acknowledging it, taking control of it, and safely defusing the rage. Remember: uncontrolled anger can take a terrible toll on both your health and your relationships. These 10 tips can help you to get your anger under control and perhaps boost your health too:

1. Engage brain before vocal cords

In the heat of any argument it’s easy to let your mouth run away with the situation, shooting off statements and accusations that later you regret. Take a few slow deep breaths, pause and collect your thoughts for a few moments before saying anything. And remember to allow others involved in the situation to do the same too.

2. Keep calm and calmly express your anger

As soon as you're thinking clearly, express your how you feel in an assertive and nonconfrontational way. Slow deep breaths help. Acknowledge what others are saying, then state your concerns and needs clearly and directly, without hurting others or trying to control them: “ I hear what you say, but this is how I feel…”

3. Work it out

Regular physical activity can help burn off the excess neurotransmitters and hormones such as adrenaline and cortisol that are fuelling your anger.  When anger rears its ugly head, go for a brisk walk or run, or spend some time doing other enjoyable physical activities. Regular exercise helps your body to manage and regulate adrenaline and cortisol more effectively. At the same time, you produce higher levels of the ‘happy hormones’ called endorphins that will help give you the feel good factor and dampen down the anger. 

4. Step away

During the day, give yourself short breaks, especially during stressful times. Moments away from the routine help you to reset your mood and prepare to handle situations more calmly and assertively.

5. Focus on a solution, not a problem

Learn to shift your focus of attention away from what made you mad as hell, and begin to think about working on a resolution instead. Remind yourself that anger won't fix anything and might only make it worse.

6. Make 'I' statements

Playing the blame game only aggravates situations. Use "I" statements to describe the problematic situation whilst being respectful to those involved. For example, say, "I'm upset that you left work without offering to help with the backlog of orders that have piled up" instead of, "You never help or put yourself out to help others! "

7. Keep the Grudge Grinch in its place

Learn to forgive as it’s a powerful tool. Anger leaves no room for positive feelings that can be pushed out of the way as you get swallowed up with bitterness and the perceived injustice of a situation. Learn to forgive and let go. After all, it is unrealistic to expect everyone to exactly how you want them to be.

8. Use the Laughing Gnome to release tension

Resist the temptation to descend into sarcasm. Work on ways of lightening things up with some appropriate humour. In this way, you can help diffuse tension, melt away resentment and lift your own mood too.

9. Practice relaxation skills

Relaxation and anger are totally incompatible bedfellows. Learn to recognise the signs of rising anger within you. When it does rear its ugly head, you can vanquish it through the practice of a variety of exercises such as:

• Breathe deeply, from your diaphragm; breathing from your chest won't relax you. Picture your breath coming up from your "gut." 
• Slowly repeat a calm word or phrase such as "relax," "calm," “peace.” Repeat it to yourself while breathing deeply into and out of your abdominal region. 
• Use imagery; imagine a relaxing experience. It doesn’t matter if it’s based in reality, or simply a figment of your imagination. As you imagine it, so the feelings associated with that place can manifest in your body, turning down the anger. 
• Learn some stretching exercises, or go to yoga or Tai Chi classes. These non-strenuous exercises help you to relax your muscles and make you feel much calmer.

10. Know when to seek help

If your anger really is out of control, then go and see an experienced therapist who can help take you by the hand and teach you how to become a calmer person.

For more information on how you or your company can effectively manage anger, call us on 0800 999 8353, info@lcch.co.uk

Or to talk to someone in your area:

Scotland: +44 141 333 0878

Southwest England: +44 7761 773563

Midlands and Southeast England: +44 203 603 8535

Northern England: +44 7812 196 798

Southeast Asia: + 603 7960 6439

Portugal: +351 933 713 223

Peter Mabbutt FBSCH
Vice-Principal, LCCH 

www.lcch.co.uk

Anger Awareness Week

Today marks the start of Anger Awareness Week, so we at the LCCH thought that we would spend the week exploring anger, highlighting statistics around it’s prevalence whilst also providing some all-important anger management tips.

It’s worth remembering that anger can be positive, motivational and appropriate in many situations. It is, after all, an adaptive survival response that allows us to respond to situations where we face a threat to our physical well-being. However, when expressed out of context it can become a liability.

Anger is expressed on a continuum with calm being the starting point, and blind rage topping the scale. Most people experience graded anger that falls somewhere between these two extremes. Overtly angry people don't, however. Their experience is polemic with no happy medium. They also have difficulty in recognising when they are in a state of anger too. For some, the anger is consistent, simmering away below the surface tainting their everyday lives and the lives of those around them. 

Let’s begin with two simple questions: how do you know if you are an angry person? Can you tell the difference between being genuinely upset and having a real anger management problem? Here’s some pointers to help you find out whether you need to take stock of your anger and do something about it:

Impatient and Interrupting

Angry people have little patience. They often interrupt during conversations as they find difficulty in waiting for others to complete what they are saying. Even when they do let others finish, they sometimes fidget, pretend to listen, whilst not necessarily paying attention to the conversation.

Moan, moan, moan!

People who constantly complain with undue venom about others, who are excessively vehement in their condemnation of politics, sport and life for example, often have a deep wellspring of seething anger that gets projected towards any perceived indiscretions. Rarely is this anger aimed at its source which may well have been lost in the mists of time. 

Holding on to the Grudge Grinch

Never letting go or forgiving someone is a warning sign that anger is bubbling away under the surface. For the overtly angry, past conflicts are never allowed resolution and are kept constantly at the forefront of their mind. The memory becomes distorted and generalised, stoking the flames of anger as they relive the frustration, pain, and resentment each time they recall the wrong - whether it’s real or simply perceived.

Radiating Rage

Our skin is said to be an outward expression of inner turmoil, reflecting our inner emotional state in a way that is sometimes difficult to hide. The classic red-faced angry cartoon character is an exaggeration of the physiological responses to anger. Blood rushes to the face as a visual warning to "back off!" Muscles tense, adrenaline flows, respiration rate rises, and the heart pumps faster. All well and good if you only feel anger occasionally. But so much more of a liability if you are constantly angry. Numerous studies have shown that angry people are more likely to have high blood pressure and to suffer a stroke or heart attack.

Sensitive Souls

Angry people are always hyper vigilant as they monitor their surroundings and the people that inhabit their environment. Throw away comments that most would pay little or no attention to are like a red rag to a bull for a person of an angry disposition. Quick to take offence, they lash out seemingly for no reason. 

Sharing the Schadenfreude

Angry people display a lack of compassion and empathy. Quick to condemn and slow to praise, some revel in the schadenfreude phenomena: taking an inordinate amount of pleasure in the misfortune of others

As a final pointer, here is a list of common physiological and psychological signs of anger. Take note, be aware, and don't let grind anger you down

Facing up to the Physical

Some physical signs of anger include: 

• clenching your jaws or grinding your teeth 
• headache 
• stomach ache 
• increased and rapid heart rate 
• sweating, especially your palms 
• feeling hot in the neck/face 
• shaking or trembling 
• dizziness 

Emotionally you may feel: 

• like you want to get away from the situation 
• irritated 
• sad or depressed 
• guilty 
• resentful 
• anxious 
• like striking out verbally or physically 

Also, you may notice that you are: 

• rubbing your head 
• cupping your fist with your other hand 
• pacing 
• getting sarcastic 
• losing your sense of humor 
• acting in an abusive or abrasive manner 
• craving a drink, a smoke or other substances that relax you 
• raising your voice 
• beginning to yell, scream, or cry

For more information on how you or your company can effectively manage anger, call us on 0800 999 8353, info@lcch.co.uk

Or to talk to someone in your area:

Scotland: +44 141 333 0878

Southwest England: +44 7761 773563

Midlands and Southeast England: +44 203 603 8535

Northern England: +44 7812 196 798

Southeast Asia: + 603 7960 6439

Portugal: +351 933 713 223

Peter Mabbutt FBSCH
Vice-Principal, LCCH 

www.lcch.co.uk

Vaping: a Gateway to Cigarettes?

Those who know me well will know that ‘vaping’, or the smoking of e-cigarettes, is one of my bête noir’s. I make no excuse for taking the stance that I do against it. Of course, I acknowledge that the use of e-cigarettes is a potentially safer alternative to smoking, but we must remember that it is not safe! I find it concerning when I see some in the medical profession advocating its use - and of course, there are many within the profession who don’t and hold similar views to my own.

To reinforce the somewhat insidious nature of vaping, it now appears that vaping is potentially a gateway drug to cigarettes for teenagers. It has been known for years that just as many teens as ever have, despite health education, been taking up smoking, with an increasing number starting to vape. Social pressure and looking cool are just some of the potential reasons why they do it - not forgetting the rebellion factor either (we all remember what it was like to be a teenager…).

Following a survey carried out in South Carolina of around 300 high school eleventh and twelfth graders who had never smoked tobacco, it was found that half of them had used e-cigarettes. For those of us who don’t understand the American educational system, these are teenagers with an average age of 17. At the start of the study a questionnaire was filled out that was designed to evaluate whether the teens had ever smoked tobacco or used e-cigarettes.

The researchers restricted their analyses to those who had never smoked cigarettes.

They also assessed for susceptibility to smoke cigarettes, which was defined as the "absence of a firm commitment not to smoke". When questioned about intention to smoke in the future, students who answered "definitely not" were considered "not susceptible".

The researchers also looked at the social acceptability of smoking within the teenagers' social environment, and took sociodemographic factors into consideration too.

The researchers then invited the e-cigarette users and the non-e-cigarette users to complete a follow-up questionnaire 16 months later, matching by gender, ethnicity and grade. In the final count, the study presented findings from 152 non-e-cigarette users and 146 e-cigarette users.

What they found was interesting and potentially disturbing. They reported that e-cigarette users were 6.17 times more likely to start smoking cigarettes than those who never smoked e-cigarettes. They also noted that around 10 percent of those who never smoked were found to have started smoking cigarettes too. It was also found that e-cigarette users were more likely to start using any combustible product, such as hookahs, cigars and pipes.

The researchers concluded that e-cigarette use in teenagers who never smoked may increase the risk of them subsequently starting smoking cigarettes and other combustible products.

And finally, I want to mention another disturbing trend, one that is not mentioned in the report, but one that I have been made aware of. And that is that e-cigarettes themselves are now being used to smoke recreational drugs. Canabinoid extracts and designer highs have all found favour in the underground e-cigarette market. What the implications are of this for the health of users remains to be seen.

Peter Mabbutt FBSCH
Vice-Principal, LCCH





www.lcch.co.uk
 
For those who want to read the original research:
Barrington-Trimis, J. L., Urman, R., Berhane, K., Unger, J. B., Cruz, T. B., Pentz, M. A., Samet JM, Leventhal AM & McConnell, R. (2016). E-Cigarettes and Future Cigarette Use. Pediatrics, 138(1), e20160379.

Depression is an Inflammatory Thing!

As one of my specialist areas is psychoneuroimmunology, I want to highlight some interesting research that I've been aware of for some time, that takes a new and intriguing view of depression, one that views depression from an immunological point of view.

As any therapist knows, depression can be a devastating illness, plaguing millions of people worldwide with feelings of sadness, hopelessness, apathy and fatigue. The pharmacy industry has made an absolute fortune out of creating drugs that are used to treat the condition. But despite numerous antidepressants being produced, different classes of antidepressants being created, different doses being tried out, as many as a third of patients with depression don’t respond to medication at all. Why this may be the case has remained a conundrum, one that has forced doctors and researchers to step outside the box, as it were, and be more creative in exploring different treatment options for patients, and to revisit the underlying theories that try to explain what depression is.

Researchers have increasingly been focussing on a seemingly unrelated condition, one that has traditionally fallen into the realm of immunology: inflammation. We all know that inflammation can stem from injury or infection. After all, it’s part of our bodies healing response that brings white blood cells and other elements of the immune system to where they are needed. We call it inflammation because the affected area becomes red as blood flows there. What we now know is that emotional issues such as an unhappy relationship or problems at work can result in tissues within our body becoming inflamed. Not to the same extent as when they are injured, but inflamed all the same. It is helpful to remember that some amount of inflammation is generally beneficial to us, as it ramps up production of cytokines - proteins found in our immune system that play a major role in healing and protecting us.

But remember: too much of a good thing can lead to harm! Research has found that excessive levels of cytokines, and the inflammation they bring on, could come at an emotional cost. There are an increasing number of studies that suggest that high levels of cytokines could be a contributing factor in depression. On top of this, some studies are also indicating that anti-inflammatory drugs could potentially be used to reduce cytokine levels and possibly help people recover from depression.

But we need to make sure we aren’t jumping the gun too soon. As promising as anti-inflammatory drug administration might seem to be for depression, using them as a treatment isn’t as straight forward as we could hope. Studies have indicated that only 20 to 30 percent of people with depression have demonstrably high levels of inflammation. Where there is treatment-resistant depression, it’s 45 percent showing high inflammation levels. We need to remember, however, that as yet no clinical treatment guidelines exist to identify who these patients are and what levels of anti-inflammatory medication they may need.

And there is, of course, the question of whether treating depressed patients with low levels of inflammation would be beneficial or detrimental.

This research also brings into question the concept of what depression is. Is it one particular condition, or is the word ‘depression’ a cover-all for a group of different conditions, the characteristics of which are only just being discovered.

Peter Mabbutt FBSCH
Director of Studies, LCCH

www.lcch.co.uk
 
Here are two reviews exploring the role of cytokines in depression for those who want to read more:

Köhler O, Benros ME, Nordentoft M, Farkouh ME, Iyengar RL, Mors O and Krogh J (2014) Effect of anti-inflammatory treatment on depression, depressive symptoms, and adverse effects: a systematic review and meta-analysis of randomized clinical trials JAMA Psychiatry 71(12): 1381-1391

Mills NT, Scott JG, Wray NR, Cohen‐Woods S and Baune BT (2013) Research review: the role of cytokines in depression in adolescents: a systematic review Journal of Child Psychology and Psychiatry 54(8) 816-835

Mindfully Depressed: Mindfulness in the Treatment of Depression

As many of us are aware, mindfulness is one of the third-wave of cognitive therapies that are becoming increasingly popular, not just with therapists, but within the established healthcare arena too. There has been a welcome increase in the amount of research being carried out into its efficacy in treating a wide range of presenting conditions. Recently, one of these studies has indicated that mindfulness-based cognitive therapy (MBCT) may be as good as antidepressant medication at stopping people relapsing after recovering from major bouts of depression.

MBCT was developed by bringing CBT together with mindfulness techniques which, as I am sure we are all aware, encourage individuals to pay more attention to the present moment. In treating depression, MBCT teaches patients to recognise that negative thoughts and feelings will return (known as a relapse prediction), but that they can disengage from them, understand them and accept them, and therefore avoid being dragged down into a spiral leading back into depression.

Current best practice, endorsed by the National Institute for Health and Care Excellence (NICE) is to encourage people with a history of recurrent depression to remain on antidepressants for at least two years. As I am sure those of us who work with depression know, in reality this can be much longer. As may be expected, some patients are very reluctant to keep taking pills, while others find their depression comes back when they finally stop using the tablets.

The study in question was published in The Lancet, and involved a group of 424 adults taken from GP practices in the south-west of England, who were willing to try either antidepressants or MBCT. Half were randomly allocated to each group. Those assigned to mindfulness had eight group sessions of more than two hours plus daily home practice and the option of four follow-up sessions over a year. The course involved mindfulness training, group discussion and cognitive behaviour exercises. This cohort of patients gradually came off their medication. Those assigned to the other group stayed on the tablets for two years.

Interestingly, the relapse rates in the two groups were similar, with 44% in the mindfulness group and 47% for those on the pharmacotherapy. The researchers had thought the study might show that MBCT was more effective than medication, based on a 2008 pilot study where there was a suggestion that MBCT might do better than medication. However, the reality is very different.

What was established was that MBCT is equally as good as antidepressant therapy. This is encouraging as it potentially offers a new option for those who don't want to be on medication for years. The study also indicated that MBCT might work better than antidepressants for those with very troubled histories and who are at the highest risk of relapse. It was found to have protected people with increased risk because of a background of childhood abuse. The researchers hypothesised that perhaps MBCT confers resilience in this group because these patients learn skills that address some of the underlying mechanisms of relapse.

It will be interesting to see what NICE makes of the study, and what recommendations may come from that in regard to the treatment of recurrent depression. As treating depression places an enormous financial burden on the already struggling global healthcare system, the results of this study are potentially significant. In comparison to medication, MBCT is relatively cheap to administer, the more so because it is generally carried out as group therapy.

Despite research, and the increased use of drugs, the long-term outcome of mood disorders has not improved in the 21st century. Having an alternative non-medication strategy to reduce relapse is an exciting and important means to help patients with depression.

And where does hypnotherapy come into all this? Well, it has been said that it is the intent with which you use mindful approaches that determines what you are doing: if the intent is to carry them out using meditation then it’s mindfulness. If, however, the intent is to do so using hypnotic trance, then it’s hypnotherapy. A little controversial, I know. So having lit that particular blue touch paper I will now stand back and let the mindfulness vs hypnotherapy debate take on a life of its own.

Peter Mabbutt FBSCH
Director of Studies, LCCH

www.lcch.co.uk
 

For those who want to read the original research:

Kuyken W, Hayes R, Barrett B, Byng R, Dalgleish T, Kessler D, Lewis G, Watkins E, Brejcha C, Cardy J, Causley A, Cowderoy S, Evans A, Gradinger F, Kaur S, Lanham P, Morant, N, Richard J, Shah P, Sutton H, Vicary R, Weaver A, Wilks J, Williams M, Taylor RS and Byford S (2015) Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial The Lancet 386(9988): 63-73

What We Can Learn from our Pets

It is widely recognized that having pets around can help to calm us when we’re feeling stressed. Scientists have found that increased levels of the “love hormone” oxytocin, associated with strengthening the bond between mothers and babies, are also found in dog owners and their dogs. The highest levels are found in owners whose dogs stared lovingly into their eyes the most!

In the same way that animals are attuned to our positive emotions, they are also good at picking up human stress levels and can be affected by these. This isn’t all bad as a vet at Cornell University illustrates by telling of a parrot who was able to tell when its owner was about to have a seizure and warn her! However, humans and animals share their experience of some of the less desirable effects of stress and anxiety. These include the release of hormones such as adrenaline and cortisol causing us to experience the “fight or flight” response.

A cat or dog might actually be in a situation where they face the potential for physical injury, perhaps in a scuffle with another animal. Generally, where this is the case, once the altercation is resolved, the animal returns to a state of balance, a “rest and digest” state, appropriate to their surroundings. These days it’s relatively rare for humans to face real physical threats. Many of our “fight or flight” responses are triggered by things that we imagine happening. Perhaps worrying about changing jobs, moving house or concerns about health and wellbeing. Often we worry continuously about such things in the background and may not follow the example of our pets, returning to that state of balanced relaxation once a perceived threat is over. We simply replace one worry with another, remaining in a state of background stress. Often one of the biggest worries we have is about feeling stressed!

There are a variety of answers to help us to return to a beneficial state of relaxation. As a hypnotherapist, one of my most important roles is to remind people to make time to relax. One of the simplest methods I can suggest is around paying attention to your breathing for one minute.

Minute Mindfulness

Finding time for relaxation doesn’t have to be a chore. By taking a minute to do the following exercise you can help your body to rebalance itself, becoming more relaxed.

Preparation

• Allow yourself to relax and breathe comfortably
• Begin to breathe in through your nose and out through your mouth
• Find a way of timing one minute – watch, clock etc. and decide when you will begin to time your breathing

When you do:

• Focus on your breathing
• Count how many breaths you take in that minute
• Take note of this number (This is the number of breaths you will take to create you own “Mindful Minute”)

Practice

When you next find yourself beginning to feel agitated:

• Stop and focus on your breathing
• Count the breaths you take until you have reached your “Mindful Minute”
• Note how your body has relaxed through stopping and focusing on your breathing

So, if your pet seems to be anxious, it is worth considering if perhaps they are picking up a “stress” vibe from you. If you think this might be the case then give the minute mindfulness exercise a try. After all if your pet has helped you de-stress why not return the favour?

Julia Lewis

http://www.continuum-hypnosis.co.uk

www.lcch.co.uk