Monday, January 17, 2011

Civility, Anger Management & Emotional Intelligence: Unintended Consequences of Tucson

The tragedy in Tucson has resulted in an avalanche of self-referrals to anger management programs nationwide. Parents who are fearful of the potential for violence on the part of their off spring as well as spouses are asking to be seen individually or in groups. Even neighbors are urging others to seek help for long standing problems in interpersonal relationships.

Mental health providers are experiencing an increase in referrals for anxiety and depression which are oftern precursors of anger and/or impediments to empathy and emotional intelligence. Below are some of the comments from callers.

•I am a Chef and last Sunday my anger was so extreme it freightened me. I just know that it is time to do something that I should have done long ago. Take an anger management class.

•My son is 17 and we are worrying about him because he is always angry to the extent that his friends are even telling him that he needs help.

•My wife wants me to come and, I guess she is right. I find myself over reacting to almost everything.

•I have two small children and I find myself pinching them, throwing things and yelling when they are only being children.

•I am a Priest and a number of my parishioners have privately urged my to seek counseling for my temper. It is embarrassing for a person in my position.

•I am a Professional in Elder Care. I found myself yelling at a neighbor who I later found in terminally ill. I feel so ashamed.

These are just some of the comments. The number of calls have increased dramatically since the cry for civility hit the airways and the Internet. This is a trend that a grieving nation needs.

[from George Anderson, MSW]

For more information, please contact

Dr. Steven J. Sinert
Certified Anger Management Provider & Coach
Nevada Anger Management, LLC
5812 S. Pecos Road, Suite B
Las Vegas, NV 89120
702 353 1750
www.nevadaangermanagement.com

An Enlightened Public Discovers Anger Management Intervention

The recent pattern of referrals to anger management classes shows a dramatic shift in the profiles of the clients enrolled. Over the last ten years most referrals were from the courts for misdemeanor offenses and infractions with aggressive behavior being the most common reason for the court order. Recently, I sat in on a class as a Guest Facilitator. When the group members were asked to introduce themselves and indicate their goals and reasons for seeking anger management, the majority of clients were volunteers who wanted to gain a better control of their expressions of anger and stress, enhance communication skills and learn to be more emotionally intelligent. Several clients were parents who were concerned over their own hurtful behavior towards their children.

EMPLOYER REFERRALS

The second client group was employees who were mandated by their employers to complete an anger management course as a result of aggressive, rude or insensitive behavior at work. These clients were initially resistant to share information about themselves until they had a chance to hear from the larger number of self referrals who view the class as a positive experience to improve their interpersonal skills. Most of the mandated clients expressed surprise that others were coming voluntarily. This realization quickly helps them see their mandated status as a blessing in disguise since they are given an opportunity to learn important new skills at their employer's expense. Those mandated by the courts responded similarly.

COURT MANDATED REFERRALS

The smaller group of clients who were ordered to attend from 10 to 52 weeks of anger management as the result of road rage, simple battery, threats, harassment or some other person- directed aggression are quickly influenced by the other clients to take the course seriously and actively participate.

In summary, the change in referral patterns indicates that the enlightened public is rapidly recognizing anger management as a positive opportunity to learn skills in managing stress, anger and improving communication skills and developing emotional intelligence. Self-referral and employer-referrals are now the norm which reflects the public's acceptance as a legitimate intervention for anger which is too intense, lasts too long or leads to aggressive behavior or to person directed violence.

[from George Anderson, MSW]

For more information, please contact

Dr. Steven J. Sinert
Certified Anger Management Provider & Coach
Nevada Anger Management, LLC
5812 S. Pecos Road, Suite B
Las Vegas, NV 89120
702 353 1750
www.nevadaangermanagement.com

Anger Management, a Neglected Topic in Substance Abuse Intervention

Problems managing anger have always been a concern for patients suffering from addictive disorders. Pioneering research by Dr. Sidney Cohen at the UCLA Neuropsychiatric Institute demonstrated the relationship between, anger, violence and the use of alcohol and or cocaine. One of the most popular articles written by Dr. Cohen, was entitled, "Alcohol, the most dangerous drug known to man". In this and other publications, Dr. Cohen systematically demonstrated the causal relationship between cocaine and alcohol abuse and aggression. Much of this research was done in the 70s and 80s.

Anger has always been a factor in substance abuse. Unfortunately, until recently, it has been overlooked or treated as an after-thought by substance abuse programs nationwide. Substance use and abuse often coexist with anger, aggressive behavior and person-directed violence. Data from the Substance Abuse and Mental Health Administration's National Household Survey on Drug Abuse indicated that 40 % of frequent cocaine users reported engaging in some form of violence or aggressive behavior. Anger and aggression often can have a causal role in the initiation of drug and alcohol use and can also be a consequence associated with substance abuse. Persons who experience traumatic events, for example, often experience anger and act violently, as well as abuse drugs or alcohol. This is currently occurring with recently returned combat veterans from Iraq.

ANGER AND SUBSTANCE ABUSE

Substance abuse and dependence has grown beyond even the bleakest predictions of the past. In the United States alone, there are an estimated 23 million people who are struggling (on a daily basis) with some form of substance abuse or dependence. The toll it is having on our society is dramatically increased when we factor in the number of families who suffer the consequences of living with a person with an addiction, such as:

Job loss
Incarceration
Loss of child Custody
DUI's
Domestic Violence/Aggression
Marital problems/divorce
Accidents/injuries
Financial problems
Depression/anxiety/chronic anger

Unfortunately, most substance abusers may not even be aware that they have an underlying anger problem and do not "connect" their anger problem to their alcoholism, drug addiction and substance abuse. Therefore, they do not seek or get help for their anger problem. But more often than not, their anger is the underlying source of their disorder.

Anger precedes the use of cocaine and alcohol for many alcohol and cocaine dependent individuals. Anger is an emotional and mental form of "suffering" that occurs whenever our desires and expectations of life, others or self are thwarted or unfulfilled. Addictive behavior and substance abuse is an addict's way of relieving themselves of the agony of their anger by "numbing" themselves with drugs, alcohol and so on. This is not "managing their anger", but self medication.

When we do not know how to manage our anger appropriately, we try to keep the anger inside ourselves. Over time, it festers and often gives rise to even more painful emotions, such as depression and anxiety. Thus, the individual has now created an additional problem for themselves besides their substance abuse, and must be treated with an additional disorder. Several clinical studies have demonstrated that anger management intervention for individuals with substance abuse problems is very effective in reducing or altogether eliminating a relapse.

Medical research has found that alcohol, cocaine and methamphetamine dependence are medical diseases associated with biochemical changes in the brain. Traditional treatment approaches for drug and alcohol dependency focus mainly on group therapy and cognitive behavior modification, which very often does not deal with either the anger or the "physiological" components underlying the addictive behavior.

Anger precedes the use of cocaine for many cocaine-dependent individuals; thus, cocaine-dependent individuals who experience frequent and intense episodes of anger may be more likely to relapse to cocaine use than individuals who can control their anger effectively. Several clinical trials have demonstrated that cognitive-behavioral interventions for the treatment of mood and anxiety disorders can be used to help individuals with anger control problems reduce the frequency and intensity with which they experience anger.

Although studies have indirectly examined anger management group treatments in populations with a high prevalence of substance abuse, few studies have directly examined the efficacy of an anger management treatment for cocaine-dependent individuals. A number of studies demonstrating the effectiveness of an anger management treatment in a sample of participants who had a primary diagnosis of post-traumatic stress disorder have been conducted by the Department of Veterans Affairs.

Although many participants in these studies had a history of drug or alcohol dependence, the sample was not selected based on inclusion criteria for a substance dependence disorder, such as cocaine dependence. Considering the possible mediating role of anger for substance abuse, a study examining the efficacy of anger management treatment in a sample of cocaine-dependent patients would be informative.
Anger management as an after-thought.

In spite of the information available to all professional substance abuse treatment providers, anger management has not received the attention which is deserved and needed for successful substance abuse treatment. Many if not most substance abuse programs claim to offer anger management as one of the topics in its treatment yet few substance abuse counseling programs include anger certification for these counselors.

Typically, new substance abuse counselors are simply told that they will need to teach a certain numbers of hours or sessions on anger management and then left to find there own anger management information and teaching material. These counselors tend to piece together whatever they can find and present it as anger management.
Despite the connection of anger and violence to substance abuse, few substance abuse providers have attempted to either connect the two or provide intervention for both. In the Los Angeles area, a number of primarily upscale residential rehab programs for drug and alcohol treatment have contracted with Certified Anger Management Providers to offer anger management either in groups on an individual basis for inpatient substance abuse clients. Malibu based Promises (which caters to the stars) has contracted with Certified Providers to offer anger management on an individual coaching bases.

It may also be of interest to note that SAMSHA has published an excellent client workbook along with teacher's manual entitled, Anger Management for Substance Abuse and Mental Health Clients: A Cognitive Behavioral Therapy Manual and Participant Workbook.

This publication is free and any program can order as many copies as needed without cost. There is simply no excuse for shortchanging substance abuse clients by not providing real anger management classes.

LINITED ANGER MANAGEMENT RESEARCH

What has been offered as anger management in substance abuse programs has lacked integrity. The Canadian Bureau of Prisons has conducted a 15 year longitudinal study on the effectiveness of anger management classes for incarcerated defendants whose original crime included substance abuse, aggression and violence. One of first findings was that in order to be useful, the anger management model used must have integrity. Integrity is defined as using a client workbook containing all of the material needed for an anger management class, consistency among trainers in terms of how the material is taught and a pre and post (training) test to document change made by clients who complete the class.

It is not possible to determine the effectiveness of an anger management course which is fragmented and not based on any particular structure of theoretical base.
Anger management training is rarely integrated into substance abuse treatment

At the present time, anger management is rarely integrated into any model of substance abuse intervention. Rather, it is simply a filler tacked on to a standard twelve step program,

TRENDS IN ANGER MANAGEMENT AND SUBSTANCE ABUSE TREATMENT

Several years ago, the California state legislature established statewide guidelines for all state and locally supported substance abuse programs. This legislation is included in what is commonly referred to as proposition 36. As a result of this legislation, all substance abuse counselors must have documented training in anger management facilitator certification. This training requires 40 hours of core training plus 16 hours of continuing anger management education of a yearly basis.
What is Anger Management?

Anger management is rapidly becoming the most requested intervention in human services. It may be worthwhile to define what anger management is and is not.

According to the American Psychiatric Association, anger is a normal human emotion. It is not a pathological condition therefore; it is not listed as a defined illness in the Diagnostic and Statistical Manual of Nervous and Mental Disorders.

Rather, anger is considered a lifestyle issue. This means that psychotherapy or psychotropic medication is not an appropriate intervention for teaching skills for managing anger.

The American Association of Anger Management Providers defines Anger Management as a skill enhancement course which teaches skills in recognizing and managing anger, stress, assertive communication and emotional intelligence. Anger is seen as a normal human emotion which is a problem when it occurs too frequently, lasts too long, is too intense, is harmful to self or others or leads to person or property directed aggression.

The Anderson & Anderson Anger Management curriculum is currently the most widely used model of anger management in the world. This model includes an assessment at intake which is designed to determine the client's level of functioning in the following four areas, anger, stress, communication and emotional intelligence. The intervention/classes which are provided teach skills in these four areas. A post-training test is administered after course completion to determine the success or lack thereof of the program.

IN SUMMARY

All anger management programs should conduct an assessment at intake for substance abuse and psychopathology and all substance abuse programs should assess all participants for the current level of functioning in recognizing anger, stress, assertive communication and emotional intelligence.

All substance abuse programs should have their intervention staff certified in anger management facilitation.

Guidelines should be established to determine the number of hours/sessions that each client will receive in teaching skill enhancement in anger management, stress management, communication and emotional intelligence.

[from George Anderson, MSW]
For more information, please contact
Dr. Steven J. Sinert
Certified Anger Management Provider & Coach
Nevada Anger Management, LLC
5812 S. Pecos Road, Suite B
Las Vegas, NV 89120
702 353 1750
www.nevadaangermanagement.com

The Etiology of Anger Does Not Offer Solutions to Its Management

“If one comes across a person who has been shot by an arrow, one does not spend time wondering where the arrow came from, or the caste of the individual who shot it, or analyzing what type of wood the shaft is made of, or the manner is which the arrowhead was fashioned. Rather, one should focus on immediately pulling out the arrow.”

-Shayyammuni, the Buddha

It is a popular notion in some anger management programs to focus on identifying "the triggers" that causes a person to behave angrily. It is common to observe participants in anger management groups explaining how someone "pushed my buttons".

This notion takes away the responsibility of the angry perpetrators for his or her aggression and violence. We are responsible for our own behavior, regardless of the circumstances.

Rather than focusing on the cause of one's anger, it is far more productive to learn to recognize the initial signs of irritation, frustration, discomfort or whatever other emotions precede your anger, labeling these feelings and developing tools to stop the anger from becoming destructive to you or someone else.

While assessments are useful in anger management intervention, rarely is it worthwhile to examine "triggers or buttons" which may lead to anger. Think of a Juke Box, if you push the button for a particular tune and something else plays, over time you will give up pushing that button because you do not hear the tune you expected. Similarly, if the person who is responding to the "triggers" ceases to respond, that issue is closed to resolution.

Anger management assessments should assess for anger, stress, communication and emotional intelligence. Skill enhancement in these four areas should be taught in all anger management classes.

[from George Anderson, MSW]

For more information, please contact

Dr. Steven J. Sinert
Certified Anger Management Provider & Coach
Nevada Anger Management, LLC
5812 S. Pecos Road, Suite B
Las Vegas, NV 89120
702 353 1750
www.nevadaangermanagement.com

Anger Management for Marriage and/or Divorcing Clients

Unfortunately, intense or prolonged anger is a core problem in many problem marriages. In addition, mental illness is rarely the cause of divorce. Uncontrolled anger is by far the most frequent creator of conflict in marriages.

Case example 1:

I saw a married couple who were physicians and who came to me ostensibly because of a disagreement over whether or not to have children. One-half of this couple wanted to have children, while the other did not. Both experienced intense, prolonged anger, which resulted in emotional estrangement.

Following an anger management assessment it was determined by both of them that a substantive issue was an irreconcilable disagreement over finances and their lifestyle.

They made a decision to pursue an amicable divorce without fault; hence, the anger management coaching was a success.

Case example 2:

A second case example consists of a surgeon whose wife has a PhD. This couple came to me after a number of years of individual and couples counseling. These resources failed to help with the husband's anger. This case did not proceed to coaching, as the husband lied on both of the assessment instruments and insisted that he did not have any problems whatsoever. Surprisingly, the husband's behavior in the assessment helped the couple decide that he was not motivated to make any changes in his behavior. This resulted in his wife's decision to end the marriage.

Anger management is not a panacea. However, it is an intervention that can be helpful for couples that have problems managing anger, stress, assertive communication and/or emotional intelligence.

[from George Anderson, MSW]

For more information, please contact
Dr. Steven J. Sinert
Certified Anger Management Provider & Coach
Nevada Anger Management, LLC
5812 S. Pecos Road, Suite B
Las Vegas, NV 89120
702 353 1750

Anger Is a Condition in Which the Tongue Works Faster Than The Mind

The way we appraise or see our environment at any given time is important in determining how we respond emotionally. If we appraise a situation as a threat, put-down, or an insult, we are more likely to respond with anger. If we appraise a situation positively, our response will be positive. Two people can appraise the same situation differently. Our feelings are very personal and do not follow rules of logic. We can appraise the same situation differently at different times based on our moods, level of stress, and clarity of thought and consequently respond differently.

If we are hungry, angry, sad, anxious, pessimistic, optimistic or happy, our style of communication will reflect the predominate feelings which we are experiencing. If we perceive the speaker to be hostile, aggressive, demeaning or in some way negative, we will likely respond in kind. If we perceive the speaker to be compassionate, reasonable and understanding, our response will be assertive, emotionally intelligent and appropriate.

When angry, our style of communication is more likely to be aggressive, passive aggressive or passive. All of these three styles of communication are ineffective and not likely to lead to a successful resolution of whatever the conflict may be. The only style or communication which is designed to clearly express what we feel and what we need from the listener is assertive communication.

Communication is one of the four areas of focus in the our program. The style of communication which we use at any given time is, to a great extent, determined by our mood, level of stress and how we appraise the situation in which we find ourselves.

The assertive communicator speaks in a reasonable tone, establishes eye contact with the listener, uses "I" messages, and clearly states his or her needs, feelings and requests. He invites the listener to work towards a mutually satisfactory resolution of the conflict. He consciously influences the listener by his own behavior. He demonstrates skills in emotional intelligence.

Assertive communication can be mastered by any motivated participant in an anger management course in which anger management, stress management, communication and emotional intelligence enhancement skills are taught.
[from George Anderson]

For more information, please contact

Dr. Steven J. Sinert
Certified Anger Management Provider & Coach
Nevada Anger Management, LLC
5812 S. Pecos Road, Suite B
Las Vegas, NV 89120
702 353 1750
www.nevadaangermanagement.com

Friday, January 14, 2011

More on Emotional Intelligence

Emotional Intelligence (abbreviated EQ for intelligence quotient) is an individual's ability to be in touch with their own emotions and the emotions of others and to use that information to improve their relationships. Here are some things common among people with high EQ levels.

High EQ people:

Label their feelings, rather than labeling people or situations. "I feel impatient." vs "This is ridiculous", "I feel hurt and bitter" vs. "You are an insensitive jerk!",
"I feel afraid" vs. "You are driving like a idiot!";

Distinguish between thoughts and feelings. Thoughts: I feel like...& I feel as if... & I feel that...Feelings: I feel:(feeling word);

Take responsibility for their feelings. "I feel jealous" vs. "You are making me jealous";

Use their feelings to help them make decisions. "How will I feel if I do this?" "How will I feel if I don't?";

Show respect for other people's feelings. They ask "How will you feel if I do this?", "How will you feel if I don't?";

Feel energized, not angry. They use what others call "anger" to help them feel energized to take productive action;

Validate other people's feelings. They show empathy, understanding, and acceptance of other people's feelings;

Practice getting a positive value from their negative emotions. They ask themselve, "How do I feel?" and "What would help me feel better?"; They ask others "How do you feel?" and "What would help you feel better?";

Don't advise, command, control, criticize, judge or lecture to others. They realize it doesn't feel good to be on the receiving end of such behavior, so they
avoid it;

Avoid people who invalidate them, or don't respect their feelings. As much as possible, they choose to associate only with other people with high EQ.

[Steve Hein, The EQ Institute]

How is your EQ level?

We now provide a special program for enhancing Emotional Intelligence along with our Anger Management program.

For more information, please contact

Dr. Steven J. Sinert, CAMF
Certified Anger Management Provider
Nevada Anger Management, LLC
5812 S. Pecos Road, Suite B
Las Vegas, NV 89120
702 353 1750
www.nevadaangermanagement.com

A Student's Testimonial

"Dr.Sinert's anger management class is great. When I first started the class I had a lot of anger inside and did not know what to do with it. On occasion I would even have angry outbursts. Through Dr. Sinert's program I was able to control my anger much better, and I have even noticed that I rarely have outbursts anymore.

Learning to control my anger has made a big difference in my life. It is a very liberating feeling to finally have my anger under control.

Dr. Sinert teaches the course in a way that is easy to understand and helpful in the process of getting your anger under control. I believe the class is worth while for anybody who feels like anger is affecting their lives." - JT, LaS Vegas, NV

For more information, please contact

Dr. Steven J. Sinert, CAMF
Certified Anger Management Coach and Provider
Nevada Anger Management, LLC
5812 S. Pecos Road, Suite B
Las Vegas, NV 89120
702 353 1750
www.nevadaangermanagement.com