2. Letting Go of “Righteous” Anger with Willingness: Strategies for Working with Anger Rooted in the Past, Present, and Future Andrew P. Santanello, Psy.D. Veterans Affairs Maryland Health Care System Hank Robb, Ph.D., ABPP Private Practice

3. What is an “Anger Problem?” No diagnostic criteria for “anger disorders” High frequency/intensity of anger episodes? Lack of skill in expressing anger “correctly?” History of interpersonal aggression? Defined by a referral for anger management? “Righteous” anger: anger sensations + fusion with cognitive rules about justice, etc. ?

4. Anger Problem or Behavior Problem? Anger is a confusing term that most people use to refer to private events associated with the term “anger” as well as aggressive behavior It may be possible that anger problems are not problems related to anger at all

5. Functional Definition of Anger Problem Narrow, inflexible repetoires of behavior emitted in the presence of anger with potentially “positive” short term consequences and negative long term consequences Refers to repetoires for responding both privately (e.g., fusion with thoughts) and publically (e.g., aggression)

6. Some Problems with Traditional Anger Management (AMT) General goal is to teach clients to “regulate” physiological responding, reduce believability of “trigger thoughts” by proving them false and inhibiting aggressive behavior Good AMT outcomes are defined by decreases in frequency/intensity of anger and inhibition of aggression from pre- to post-treatment Treatment goal involves further narrowing of behavioral repetoire in presence of anger and encouragement of anger suppression Although some evidence that control-based CBT can reduce anger (DiGiuseppe and Tafrate, 2003; DelVecchio and O’Leary, 2006) these interventions miss the point (based on our definition)

7. Oh, and by the way….. How do clients tend to feel about AMT? Is it generally well accepted? How do you feel about doing AMT? Experiential Exercise Imagine situation when someone really pissed you off

8. Pick a rationale that you can get behind A)“Treatment is about helping the client to learn more effective ways of reducing both his/her anger and his/her aggressive behavior.” B)“Treatment is about helping the client experience his/her anger and act in a way that honors his/her values.”

9. Life Management Vs. Anger Management Maybe a better goal of treatment is to help clients learn more workable ways to respond when anger shows up Use action consistent with values rather than frequency/intensity of anger episodes as an outcome measure ACT is an ideal intervention for these goals

10. Goals of Life Management Increase willingness to experience anger sensations as sensations and anger stories as stories Suggest forgiveness as an alternative to holding onto resentment. Teach defusion as an alternative to buying anger thoughts Increase contact with present moment as an opportunity to instantiate your values rather than impulsive, anger “autopilot” (“I’ll fix their fucking wagon”) Increase contact with self as context as an antidote to defending the self-as-content against past hurts Promote behavioral commitments in the service of values as an alternative to behavior in the service of revenge or short term pain reduction

11. Life Management is about VALUES If this work could be about something, what would you choose? If anger didn’t have to decide what you do, what would you like to do? Where does following your anger take you? Would you like to go in a different direction?

12. First Order of Business Can quickly ally self with client, present ACT model, and do inform consent in 4 steps Assess the function of the anger and responses to anger Be vigilant for anything that looks like a value. Uncover leading principles worth fighting for. Validate the heck out of the value Reframe the work of therapy as life management rather than anger management Ask if client would be willing to experience anger, confusion, and other discomfort in the service of building a life worth living

13. Role Play Separate into groups of 3 (1 person is the client, one is the therapist) Client: Take a few moments to contact the situation that you thought of at the beginning of the workshop. Talk to therapist about the experience as you normally would. Be authentic! Therapist: Practice using steps on previous slide. Observer: Watch the interaction and notice opportunities to elicit values. Notice the client’s reactions to interventions. Possibly offering coaching to the therapist.

14. Resentment

15. Anger Rooted in the Past: Resentment Hook Metaphor Rumination Metaphor Essential questions: Who is being hurt by this resentment? What is the goal? What is this in the service of? What do you hope will happen as a result of holding onto this resentment? What would happen if you made the choice to forego vengeance?

16. Forgiveness Does not mean forgetting, condoning, denying, excusing, etc. Forgiveness means no longer holding the facts AGAINST the person, place, thing, etc. that hurt you as justified by the “story” your mind has created ABOUT the facts Letting go of the “story” in order to move on with life It is a move done in the service of one’s values Intrapersonal rather than interpersonal process

17. Graduated Forgiveness Focus on concrete in the moment events (e.g., “the pharmacist was rude to me”) and generalize to abstract, across time events (e.g., “the way the government treated me”) Forgiving in the momentary resentments is the exact same move as forgiving longer term resentments

18. Forgiveness Exercise Get in pairs Push finger as hard as you can against part of neighbor’s body that’s solid Review story that justifies pushing With the story experienced as a story, willingly stop pushing Discuss what that was like to stop pushing Discuss all the things you couldn’t do while you were pushing on other person

19. The Angry Mind

20. Anger Rooted in the Present Patience: Ride the Tiger, Ice Metaphor Question: Are you interested in a positive connection? If so, what are you willing to experience in the service of that? Asserting self in a “positive” way that honors values Defusing from anger trigger thoughts Exercise: Stoking the Fire Anger bully/Drill Sergeant Anger Programming: Jack and Jill

21. Exercise: Defuse to these Statements “I’m not angry.” “I need to let my anger out” “I need to get my anger under control.” “If I see him/her again, I’m going to beat the crap out of them.” “I can’t stand being disrespected.” “Don’t get me angry or else.” “Why should I do what you tell me?” “I don’t have an anger problem. I’m just surrounded by idiots.” “He/She deserves what I did to them.”

22. Anger Rooted in the Future Reconciliation: willing vulnerability Defusion from rumination about future situations Plan for vitality or ruminate about it. Plan for vengeance or ruminate about that. Act on your plan?

23. Now get the fuck out!