One of the more interesting things about psychology is that everything is on a spectrum. We deal with human behavior gone awry- at one level it’s “normal” behavior and at another it’s “pathology.” What makes it even more difficult that symptoms of multiple disorders look similar. I consider myself a diagnositician. That means that I work *very* hard to come up with the correct label, only because the label guides me in the treatment. You can’t hammer screws. If I’m using the wrong tools for the wrong thing, I can’t help you.
Which brings me to one of the more frustrating things that I’m seeing in psychology right now. As most of you know that this point, I work with both civilians and first responders (military, paramilitary, police, fire, etc.) Sometimes, first responder’s jobs will try to help them- and it’s a funny part of the subculture. A first responder’s job can send them to therapy or anger management. It’s not really well known for a civilian job to do that. What I’m seeing is “angry” first responders being sent to anger management, and usually after completing treatment- “relapsing.”
My father is a physician. I grew up with science and with the medical model. He always told me that I only need one question: WHY? He’s not been wrong yet. WHY is anger management not working for these people? I’ll tell you why- it’s not true anger at its core. It’s anxiety. It may also be trauma speaking. Why does this matter? Well, it does and it doesn’t. All three of them APPEAR the same but getting at the core of the problem, using the right label and the right tools, makes all the difference in the world.
Anger, Anxiety, and Post Traumatic Stress (PTS). These three things have a LOT in common:
Anger, Anxiety, and Post Traumatic Stress (which is an anxiety disorder) all share the same brain functions and hormones. What happens, in the short form, is that the stimulus (whatever freaks you out) triggers the “fight or flight” parts of the brain. (For those who are new here, please refer to my blog on the physiology of PTSD: https://catherinemcounseling.com/2017/01/24/why-ptsd-is-not-just-a-mental-issue/ ) With Anger, or anxiety of any kind, the brain sends a signal that you are in danger. This triggers the Amygdala (“deer brain”) which tells you that “Oh, hell, I’m in trouble! GET OUT!” At that point, the Adrenal system is triggered. It releases Adrenaline (this makes your heart race, your lungs breathe shallow, and blood move to core parts of the body in preparation for flight), Noradrenaline (which works to give you energy to flee), Cortisol (this is a big one, it’s responsible for so much: appetite, sleep, heart rate, etc. It maintains the body’s homeostasis, literally “keeping stable” in latin. THIS is the guy that really messes things up when you get “stuck” here.), among numerous other hormones and neurotransmitters. Essentially, anger and anxiety send out distress signals and the body prepares to get out of danger. THEY ALL SHARE THESE ELEMENTS.
So, that being said, it’s understandable that clinicians can get confused. We all do. It’s critical to sort out which it is in order to treat it appropriately. I always tell my clients that anger is a “masking emotion.” It’s the easiest emotion, so we often appear angry when we are actually feeling other things underneath. Anger management isn’t going to work if it isn’t anger at the core and anger management techniques are almost useless against the mechanisms I’m talking about because *reasoning brain has left the building.* Try as you might, you cannot override biology.
How do I know? Well, I see a lot of anxiety in my practice. Anxiety “turns into” anger- we don’t really have the full vocabulary to explain this well, but basically anxiety calls up his wingman anger and says “get this %*^& away from me!” Anger gets loud, and whatever the threat is backs off. (Think hissing cat.) If anger is really the issue, then that’s the end of it. It has done its job and we all move on. If there is something underneath it, then the main issue hasn’t been treated and this happens over-and-over-and-over until everyone gets sick of you and you get a reputation as the angry guy.
How do anxiety and PTS play a role in this? Well, when one is at a “normal” (whatever the hell that means) place, then there is a baseline, an anxiety threshold that ticks you into “gee, I’m nervous,” and a panic button. What happens if one has PTS is that the body gets conditioned that it is ALWAYS IN DANGER. Therefore, you START at the anxiety threshold and there is a much shorter fuse to hit the panic button. This is where people have difficulties with “overreacting.” They’re really just reacting, but the system is off. IF this is what is happening, then anger management might help a little, but not much because the key here is to bring the system back to baseline. In treatment, this is done with “grounding” or letting the body know that it is safe and can come down and not be nervous on a permanent basis. Once the body is brought down, the “anger” problems will subside because there is no perceived threat.
So, if anger management isn’t working for you, take a look UNDER the anger and see if there is something there other than anger. You’ll need to address that before the problems will resolve themselves. Or, as always, give me a call and I’ll see if I can help!