Anger Management

February 14, 2015

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“Anger management is a critical skill for all addiction professionals. These online courses from SAMHSA are important resources.” ~ Terence T. Gorski (The Publications of Terence T. Gorski)

SAMHSA Newsletter on Anger Management Courses

Everyone experiences anger from time to time. It’s a normal emotion. But intense or prolonged anger can jeopardize employment, relationships, education, and even freedom. Those who struggle to control their anger are increasingly finding their way to behavioral health professionals for assistance. It is precisely for this reason that SAMHSA has created resources and a new a online course to help.

We see it in our schools, workplaces, families, and out in public – the person who yells, hits, or throws things – and sometimes sparked by something as small as a missed parking space. In a culture where time is short, anger can surface quickly and with intensity. And anger can erupt into physical violence.

– The Centers for Disease Control’s 2010 National Intimate Partner and Sexual Violence Survey, found that one in ten 9th to 12th graders had been physically hurt on purpose by a boyfriend or girlfriend.

– SAMHSA’s 2012 National Survey on Drug Use and Health: Mental Health Findings revealed that nearly 19 percent of youth receiving mental health services have trouble controlling anger.

– In 2009, the Bureau of Justice Statistics’ National Crime Victimization Survey reported more than a half million nonfatal violent crimes took place at work.

– Prisons and jails are even worse, where 38-50 percent of inmates experience persistent anger and irritability. When the problem results in an arrest or other disciplinary action, there often is a referral or requirement to engage in some therapy or treatment to help manage the intense emotion and prevent additional similar experiences.

The Anger Control Plan
(excerpt taken from SAMHSA’s new Anger Management for Substance Abuse and Mental Health Clients course)

1. Take a time out (formal or informal).
2. Talk to a friend (someone you trust).
3. Use the Conflict Resolution Model to express anger.
4. Exercise (take a walk, go to the gym, etc.).
5. Attend 12-step meetings.
6. Explore primary feelings beneath the anger.

Typically, when someone gets angry, there are responses that are physiological (becoming flushed, burst of energy and arousal, etc.), cognitive (thoughts that occur in response to an event), emotional (feeling afraid, discounted, disrespected, impatient, etc.), and behavioral (sarcasm, swearing, crying, yelling, throwing, etc.).

Problem anger occurs when someone experiences anger as a chronic irritability or a full-on rage – as an emotion experienced too intensely or too often. The consequences of long-term anger issues can lead to arrest, injury (self or others), adverse effects on important relationships, job loss, or treatment program ejection. Some groups have a higher risk of experiencing problems with anger, including individuals with substance use disorders, traumatic brain injury, post-traumatic stress disorder, and personality disorders.

Working with Angry Clients

“Anger management” is currently the most searched term on the SAMHSA website. This reality speaks both to the need for support around this issue and the practical benefit of SAMHSA resources like the Anger Management for Substance Abuse and Mental Health Clients: Participant Workbook and the newly launched Anger Management for Substance Abuse and Mental Health Clients course. The course is especially designed for anyone working with a person who struggles to control anger, but particularly substance abuse and mental health clinicians.

The Five Steps of the Conflict Resolution Model
(excerpt taken from SAMHSA’s new Anger Management for Substance Abuse and Mental Health Clients course)

Step 1: Identify the problem that is causing the conflict.

Step 2: Identify the feelings that are associated with the conflict.

Step 3: Identify the impact of the problem that is causing the conflict.

Step 4: Decide whether to resolve the conflict.

Step 5: Work for resolution of the conflict: How would you like the problem to be resolved? Is a compromise needed?

The online course takes approximately two to three hours to complete and uses a cognitive behavioral approach to working with angry clients. It covers a range of topics including how people respond to getting angry (passively, assertively, aggressively, or passive-aggressively), how to manage anger with people with traumatic brain injury or post-traumatic stress disorder, and how to assess anger and readiness for anger treatment. The course also includes a description of the cognitive behavioral therapy approach, treatment model overview, and other important information about anger management. The course is based on the Anger Management for Substance Abuse and Mental Health Clients: A Cognitive Behavioral Therapy Manual (also available in Korean and Spanish) and the Anger Management for Substance Abuse and Mental Health Clients: Participant Workbook (also available in Korean and Spanish).
In addition to behavioral health service providers, the course may also prove useful for human resource and other managers, school teachers and administrators, those working in the criminal justice system, or anyone experiencing anger issues. Upon completion of the course, certification is provided for continuing education credit.

Resources:
Anger Management for Substance Abuse and Mental Health Clients: A Cognitive Behavioral Therapy Manual (also available in Korean and Spanish)

Anger Management for Substance Abuse and Mental Health Clients Participant Workbook (also available in Korean and Spanish)

Resources on the Internet


Cognitive Restructuring: Why It Works With Addiction

June 8, 2014

Addictive ThinkingBy Terence T. GorskiAuthor

Abstract: This detailed blog by Terence T. Gorski explains the biopsychosocial factors in chemical and behavioral addictions; describes how cognitive restructuring can change addictive thoughts, feelings, and behaviors; and shows how the process can provide organization to the treatment/recovery process while improving the collaboration between the addiction professional and the recovering person. References are provided that show that Cognitive Behavioral Therapy (CBT), the core method upon which Cognitive Restructuring for Addiction is based, is an evidence-based practice.

COGNITIVE means information processing in the brain.

RESTRUCTURING means changing how information is processed by the brain.

ADDICTION, described in DSM IV as Substance Use disorders), is described in DSM 5 as addictive disorders and has been expanded to include: Chemical Addictions (alcohol and other mind altering drugs of abuse); and Behavioral Addictions (gambling and other forms of compulsive mood altering behaviors).

All addictive disorders share a common set of similarities which include:

  • Addictive Beliefs (Addictive use is an effective way to stop my pain and solve my problems);
  • Automatic repetitive addictive thinking patterns (often called addictive rumination) that is difficult to self-regulate;
  • Obsession (Out-of-control thinking about the addiction);
  • Compulsion (the strong irrational urge to engage in addiction seeking behavior and addictive use);
  • Craving (A powerful urge based in a psychobiological response to cues or triggers that activates a powerful urge ton use in order to normalize the uncomfortable feelings caused by the biological symptoms of the craving);
  • Loss of Control (A pattern of compulsive use making it difficult self regulate the quantity, frequency, or duration of addictive use episodes);
  • Secondary life and health problems caused by the loss of control. These tend to be related to the specific addictive release being used); and
  • Continuation of use in spite of adverse consequences and a subjective desire to stop and reduce the use.

Each specific addictive disorder that is organized around a specific drug of choice or behavior of choice has unique differences that need to be considered in treatment. An alcoholic who does not use prescription or illicit drugs will participate in a different addictive culture and have adaptations in their addictive thinking that accommodates the focus of their addiction. The same is true of Prescription drug Addicts who don;t use illicit drugs, illegal drug users also involved in criminal drug-centered culture, gamblers, compulsive over-eaters, etc.

As a result, the above symptoms of addiction are caused by:

  • A complex individualized (idiosyncratic) biopsychosocial responses in each addicted person;
  • The specific substance or behavior that is the primary source of addictive release;
  • The social and cultural reaction to the use, abuse, and addiction to the specific substance or behavior.
  • The degree of addictive brain dysfunction;  and
  • The unique information processing style of the  addict originating in the family of origin and influenced by social and cultural experiences.

These differences, however, are accompanied by a cognitive or information processing styles that are similar in all addicted people and create:

  • Addictive Beliefs/Automatic Thinking based upon the mistaken belief that “addictive use will take away my pain and solve my problems!”
  • Craving which is a strong irrational urge to use addictively in spite of good reasons not to. Cravings usually do not result from rational decision-making. They are usually activated by environmental cues or triggers. and
  • Habitual addiction-seeking behaviors, activated by the cue/trigger and acted out automatically and unconsciously. These addiction seeking behaviors are known as early relapse warning signs. Acting them out puts addicts into high-risk situations that surround then with people, places, and things that will encourage and support their use of alcohol and other drugs.

Cognitive restructuring is a proven method for:

1. Stopping addictive thinking and challenging addictive beliefs;

2. Managing craving;

3. Stopping or redirecting addiction-seeking behaviors;

4. Avoiding or effectively managing high risk situations;

5. Having a well-rehearsed emergency plan to stop addictive use should it begin; and

6. Using a debriefing process (sometimes called a relapse autopsy) to examine past relapse episodes and near-miss experiences in order to learn how to avoid or effectively manage similar situations in the future.

Cognitive restructuring for addiction, which is at the core of Relapse Prevention Therapy (RPT) is a core set of principles, practices, tools, and skills that can be used to enhance recovery and prevent relapse. When used effectively these principles and practices teach people:

  • How to change their thoughts, feelings, and behaviors in ways that eliminate or reduce craving and drug seeking behavior.
  • How to manage high risk situations;
  • How to find a sense of meaning and purpose in recovery that is note satisfying than acting out an addictive lifestyle.

The Cognitive Restructuring for Addiction Workbook contains a series of clear, simple, and effective exercises that can enhance recovery while breaking the cycle of relapse.

The exercises in the workbook can be applied to a wide variety of chemical and behavioural addictions as well as other problems involving the repetitive and habitual use of a specific self-defeating behavior.

The underlying cognitive restructuring process is the same. Additional information that is specific to unique addictive behaviors can increase effectiveness. The manual is based upon evidenced-based Cognitive Behavioral Therapy (CBT) principles and practices that are effective with addiction, depression, PTSD, and a wide variety of other disorders that are lifestyle-related and subject to periodic regression or relapse. (CBT and related therapies are documented as evidence-based practices by SAMHSA-NREPP.

A small investment in this inexpensive workbook can:

  • Organize and structure the recovery/therapy process;
  • Provide home-work assignments that increase progress; and
  • Demonstrate the use of evidence-based practices.

Most importantly, the proper use of the exercises in this workbook can literally make the difference between helping people to move forward in recovery, or to slide backwards into addictive use and the horrible damage than can be caused.

Click here to order: THE COGNITIVE RESTRUCTURING FOR ADDICTION WORKBOOK. This small investment could save you sobriety.

A Home Study that awards CEU’s for studying this workbook are available: email: tresa@cenaps.com or visit Gorski-CENAPS Home Studies 

 


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