Josh Hillebrand LCSW

Tag: DBT

  • Working with Anger

    Working with Anger

    I’ve been working on anger with a lot of clients recently. Some people need support in acting on their anger. For these folks, they tend to be conflict-avoidant, will push down their anger, put a smile on their face to keep the peace. Others need help taking a step back from their anger – right now, they’re entire body-mind is getting hijacked by anger and they are lashing out at themselves and others in ways that later elicit a lot of shame and guilt.

    Anger is a powerful emotion. It’s definitely something I have needed to learn to work with time and time again. Even still, I can still go into judgment mode with myself for getting too “irrationally” angry because the pedestrian in front of me is walking so slowly (and I have places to be!!!) or if I get mad about losing a game of online chess and my brain produces all sorts of expletive-poetry.

    a woman who appears to be angry yells into a phone

    For me, it’s also an emotion that has been influenced by multiple social constructs (emotions are never just biological phenomena happening in a vacuum). In terms of gender, men are often sanctioned to be more attuned to and expressive of their anger than other emotions. It’s more expected to see a man yelling in public than crying in public. In terms of religion, anger has Old Testament connotations for me. I was raised in a conservative, fundamentalist Christian household so reading about the wrath and jealousy of angry and just God was a frequent occurrence. In terms of race, my whiteness could give me a sense of entitlement that could manifest as righteous indignation.

    However, it’s important that, like all emotions, there is something inherently valid about anger. At its core, this emotion is about protection: it can motivate us to stand up for ourselves and our loved ones, to take important action when there is injustice. It’s a part of the human experience. Still, it can be a trickier emotion to navigate because of its power. Here are some tips for working with anger in effective ways.

    If you’re someone who tends to avoid anger to an unhelpful degree, reflect on the following questions:

    • What are you afraid might happen if you allow yourself to express your anger? That you’ll lose control, that you will lose relationships, or you won’t be able to tolerate the fiery emotion itself?
    • Think of where and when and from whom you might have learned that it is not okay to express anger. Did you grow up in a family that tended to sweep things under the carpet? Or maybe you a parent who had such explosive anger that it was terrifying and you learned the message that you can never allow yourself to get to that point?
    • See if you can begin expressing your anger to yourself – not necessarily spiraling into a heated form of rumination but rather acknowledging any anger that might be present. Like, “Yup, I’m feeling angry that I lost that chess game and now my cheeks are feeling hotter.” If you work on your ability to mindfully acknowledge and validate anger with yourself, you’ll be laying a foundation to be able to express anger effectively to others when needed.

    If you’re someone who tends to be overcome and overwhelmed by anger, such that you’re feeling out of control, here are a few ideas:

    • First, it might be helpful to learn a few quick and effective self-regulation skills in case your anger is throwing you into fight-flight-freeze mode during which your prefrontal cortext is offline. I would recommend the TIPP skill in particular for a rapid deescalation method that works by activating the parasympathetic nervous system.
    • Next, identify what your common triggers for anger, even for low levels of annoyance and irritability. Information is power, so the more you know about what can set your anger off, the better you’ll be able to recognize it and intervene earlier. If you wait too long to practice regulation skills, the anger will likely take over and be in the driver’s seat. So, it’s important to act when the anger is at a low-moderate leve before it gets high.
    • Imagine how you would like to be able to handle situations more effectively. You can tap into a personal sense of values for this – think about how you would like others to think about you and your relationship with anger. Perhaps there is a part of you that would like to be known as someone who can keep their cool, be flexible, gentle, or kind. Then, imagine yourself acting in those ways in the presence of the triggers. This is call imaginal rehearsal and can increase the chance of you acting in these more effective ways when you encounter these triggers in actuality.
    • Mindfulness practices can be very helpful, as they can help build our ability to sit with discomfort and delaying automatic reactions that get the better of us.

    Feel free to reach out if you’d be interested in doing personal work related to your anger!

  • 4 A’s of Acceptance for Difficult Emotions

    4 A’s of Acceptance for Difficult Emotions

    So much of the world says that if you’re feeling anxious, guilty, shame, angry, sad, or any other painful emotion, then something is wrong with you. Instead, you’re expected to be one hundred percent happy all of the time just like all the smiling faces you see on social media. But this is completely bogus and please throw it out the window. Every emotion – even the painful ones – is there for a reason and trying to give us important information. And going even further, the struggle to not experience these emotions often makes them even more intense and can drive our suffering up. So, the next time you’re feeling an emotion you’d rather avoid, try using the 4 A’s of Acceptance instead:

    A close-up photo of a woman who is crying.
    • Acknowledge the feeling: name it, label it, notice how this particular emotions makes your body feel, say “hello and how are you doing?” to it
    • Allow: give that emotion permission to be there, such as “Okay, anxiety and that corresponding racing heart I will let you be here right now”
    • Accommodate: pretend that painful, distressing emotion is a house guest and try to greet and host the emotion with a sense of hospitality. In practice, you can do this by imagining that you’re opening up space around the emotion as it is showing up in your body. So, if a sense of guilt is giving you a pit in your stomach, close your eyes and bring that pit to mind and then open up around the pit.
    • Appreciate: this can be one of the most difficult and also powerful steps of accepting difficult emotions. Try to connect with even a sliver of gratitude for what the painful emotion is trying to do for you. If it’s anxiety or fear, their likely trying to protect you from or prepare you for something. If guilt or shame, they may be trying to get you to connect with your personal values and to repair meaningful relationships. If it’s anger, it’s also likely trying to protect you, your loved ones, or something else important. If it’s sadness, it could be your body’s way of acknowledging and grieving the loss of something that mattered to you a lot.

    Acceptance can be a radically powerful way of being in the world and you can start practicing it today with your own private feelings. Imagine if we lived in a world where everyone was actively practicing acceptance of painful emotions on a daily basis: I sincerely believe there would be far less war, hate, injustice, poverty, climate change.

  • How to Cope with a Crisis: The TIPP Skill

    How to Cope with a Crisis: The TIPP Skill

    When you experience a crisis – something sudden, unexpected, and immediately threatening, your body will do its job and automatically protect you by sending you into fight, flight, or freeze mode. This can be good and useful if you’re in a situation that demands immediate physical action like jumping out of the way of a car or running out of a burning building. You won’t even have to think, your body will do the work for you.

    However, let’s say you are no longer being immediately threatened and/or you’re having a difficult time calming down even after the crisis has passed. Or, maybe it’s simply no longer helpful to be in crisis mode. You’re going to need a skill to help bring the prefrontal cortex – the most recent part of the brain that evolved and which is responsible for executive functioning, planning, consideration of long-term consequences and benefits – online.

    A woman is yelling and is holding her head with both of her hands.

    To help jumpstart the prefrontal cortex, so to speak (actually, these skills will help down-regulate the body by activating the parasympathetic nervous system). I’d recommend one of my favorite skills from Dialectical Behavior Therapy (DBT), the TIPP skill. But please note you should consult with a medical doctor before using any of these skills if you have a heart condition, are pregnant, or have another health condition that you’re concerned about:

    • Tip your body temperature by putting an ice pack on your forehead, hold your breath, and bend forward so your head is between your knees for 30 seconds. Repeat for several rounds until you begin to notice your body down-regulating. For a more intense version, you could submerge your face (just up to your ears) in a pot of ice water and hold for 30 seconds.
    • Intense exercise: if you have space, do some sprints, or try some burpees, or even just jump up and down for several minutes. Anything to get your heart rate up like you are doing some serious exercise.
    • Progressive Muscle Relaxation: squeeze both feet and curl your toes in as tightly as you can without causing pain and hold for a few seconds and then release and notice the difference. Repeat at least two more times. Then do the same thing with your calves, your upper leg muscles, your core, squeezing shoulders up to your ears, clench your hands into tight fists, squeezing your face so you’re making a tight facial expression. It’s important to pause and notice the relaxed feeling after every “squeeze” round.
    • Paced Breathing: try Box Breathing where you inhale for four counts, hold for four counts, exhale for four counts, hold for four counts, and repeat. Or, try inhaling for about six counts and exhaling for eight counts (you can change the numbers as needed but just make sure the exhale is longer than the inhale). My own opinion is that it’s more helpful to aim for long, quiet inhales and exhales through the nostrils only while keeping the mouth closed.

    Once the body is in a calmer state (even if not totally relaxed), you will be able to think more clearly in order to consider your next steps.