Anger Management in a Nutshell. And Why It Doesn’t Fit in a Nutshell.

Do you have anger management problems?  Have you been told that you have anger issues?

 Anger is a natural reaction to some problems in life.  But sometimes it becomes obvious that your anger is bigger, louder and scarier than the average person’s anger.  Sometimes your anger is unpredictable to yourself or others and you end up losing friends or having fiery relationships that do not last or are very dramatic and exhausting. These could be signs that something is amiss with your anger. 

 Let’s be clear about anger issues.  Anger in and of itself is not a diagnosis.  Persistent anger is a symptom. Not only is it a symptom, but it is a symptom of so many things, it is hardly useful to try to zero in on a disorder or diagnosis based on anger alone.

 So if anger is a symptom, it means it is representing a problem. It would seem to make sense to find out what the problem is to get rid of the anger. But here’s the tricky part.  Finding out why your anger is so out of control takes time and you have to get through your life and manage your anger RIGHT NOW. 

 So anger should be treated with a two prong approach.  I describe this two prong approach as “from the top and from the bottom”. Let’s say you get a rash because you are wearing a sweater that irritates your skin.  You probably would not JUST put an anti-itch cream on it because that is temporary relief for the rash only (from the top).  It would be more effective to also change the sweater because that is the root cause of the problem (from the bottom). So the same goes for anger.  You must learn ways to relieve your temper and de-escalate yourself when you are ready to explode (from the top), but you also must find what causes your anger in the first place (from the bottom). 

 Helpful hint: Most people would say that the problem is the other person. For example, your ex-wife is so aggravating or your boss is so stupid.  Get rid of these people in your life and you will not be angry anymore, right?  Maybe.  The reality is that usually we are not at liberty to cut certain people out of our lives. For example, ex-spouses stay in contact because they have children and we cannot fire our boss and it is not always the best or easiest answer to get a new job. Additionally, most people with anger problems will tell you that after you get rid of people you think are the problem, your anger persists with new people or in other areas of your life. If you do not get rid of the real cause of the anger, it will likely come back with a new trigger.

 So how do you get treatment both “from the top” and “from the bottom?”

 Suggestions:

1.      Find a cognitive-behavioral therapy (CBT) guide or workbook. CBT can be very useful for reigning yourself in when you start to get upset. It is also a helpful tool to start looking at why you get so angry.

2.      Get an app that helps you learn how to exercise mindfulness, breathing exercises, and calm states of mind.  The “Calm” app and “Headspace” are two that many people like.  In any treatment for anger, it will be important to learn how to be aware of what you are thinking and feeling and these apps help start those skills.

3.      Get into individual psychotherapy,  Anger problems are not one size fits all.  Each person has experienced the world on their own separate path from everyone else so only you have your brand of anger and no one else. Your own therapy is the best way to find out what is going on with YOU and it is one of the best ways to find relief and make change.

Do You Care for Someone Who Is Bipolar? Four Huge Challenges and How to Start Changing Them

If you take care of someone with bipolar illness you know it affects you nearly as badly as them. It can be devastating to witness someone you care about suffer from bipolar and figuring out how to help them is usually overwhelming. While no two situations between bipolar and caregiver are the same, it is safe to state that relationships are changed forever by this illness.

Also, caregivers may carry as many problems as the people with the illness; they lose work hours or lose their jobs, they often do not care for themselves and do not tend to their own medical problems, they drop their self-care routines, they can become sick, and they often develop depression and anxiety. 

Additionally and beyond all that, people who care for people with bipolar or depression may experience complicated emotions.  Some of these are very intense and difficult to think about. Know that if you or anyone you know has had one or more of the thoughts below, you are not alone.

1-Do I still love this person?  Sometimes it is difficult to love a person who has the illness even if they are your child, spouse, sibling or parent. This is not uncommon.  There is nothing wrong with acknowledging these feelings. In fact, it is natural to feel things like exasperation, hatred, impatience, hurt, and sadness, when someone you love is being irritable, angry, insulting or grandiose toward you. Having negative feelings about that person does not necessarily mean you do not love them anymore. It may still be important to review the relationship due to the occurrence of the illness, but negative feelings in and of itself, does not define loss of love. We often will and should feel negative feelings toward someone with the illness, but it does not mean we do not love them.  Incidentally, this fact holds true for any relationship.

2-Was this my fault? This is a very common thought for parents (but siblings, friends and partners may think it, too). The answer is never clear. It is important to understand that fault and blame are rarely valuable ideas. Life is full of stresses, sometimes thought of as “triggers,” and people react in myriad ways. Some people endure large amounts of stress and trauma in their lives and never develop an illness like bipolar or depression. Some people become ill even when it appears they have lived full and happy lives before that. A definitive cause of the illness is not known so when cause is not clear, fault also, cannot be clear.

3-Was I a bad parent? On the topic of fault, parents, in particular, often wonder if their parenting may have something to do with the development of bipolar or depression in their child. The reason parents worry is parenting has plenty to do with how people turn out.  It is difficult to know how your parenting has affected your child. It is best to take the judgment out of your parenting (unless you are abusive) and know that in all honesty, you have had both positive and negative effects on your child.  That’s life as parent. It is always important to review repeatedly how we parent and change things as the needs arise. Bad parenting, alone, does not cause bipolar illness or depression, and neither do genes alone. Likewise, good parenting does not guarantee no illness will crop up. The best suggestion, just in case, is to periodically review your parenting approach and how things are handled. Not doing this may cause extra stress on your child and family.  All parents should be doing this anyway.

4-Will my loved one ever get their life back? Since every person’s situation and illness is different, it is impossible to answer this question definitively in a blog post. However, the illness usually changes people forever. It is important for caregivers to change their expectations for their loved one/s with the illness. For example, some people may never fulfill the career they thought they would have before they got sick.  Other people will have that career and some may be successful in an entirely different area. Caregivers’ expectations should not be set in stone. This will help both caregivers and the person with the illness to reach their best potential. You can change your expectations over and over again. For example, if someone becomes very sick and hospitalized, it is probably unrealistic to expect them to return to school or work full time. Just making it out of bed each day is the best expectation, at first. As they get better, your expectations and goals for them may change--they may graduate, they may live independently and have a career.  So will they get their life back? We should hope so, but it may not be the same life we thought before the illness came. And it could be a better one.

So what do you do about it?

The four challenges listed above are only some of the complicated emotions related to caring for someone with bipolar illness.  In general, caregiver issues are often not addressed enough.  If you are caring for someone with bipolar illness, caring for yourself is the best way to be a happier, healthier and more effective person for your loved one with the illness.  Some ways to get help are:

1-      Get to a support group for family and friends of those with bipolar illness. (See www.mdsg.org in the NY area or www.dbsalliance.org for a national listing).

2-      Going to your own psychotherapy-this helps you examine how the illness has affected you, how to care for yourself further, get more information

3-      Consult with a mental health professional about how you are doing as a caregiver. A trained professional who focuses on mood disorders can have helpful insights to how best help yourself and your loved one.

By Li Faustino PhD

How to jump start yourself out of depression.

Shortening depression purgatory-the first 3 things you should do if you think you are depressed.

By the time, many people make it into my office, they usually can tell me they are depressed and want to start doing what they can to get better. Although this may seem like a good thing, the problem is that often they have suffered for a very long time before they find their way to treatment. Not only is this awful for the person who goes through it, but sometimes it can make getting better even harder. Wouldn’t it be great if we could shorten the "depression purgatory"-that place where people suffer sometimes indefinitely, and sometimes getting worse, before they get to treatment and start getting better.  So with that in mind, here are 3 things that you can do if you think you might be depressed.

1.      Take a test. Sometimes it can help to see on paper that what you are feeling has a name and has treatment. We often think we can fight depression with pure inner strength and that is certainly part of it.  But people often report that seeing their depression in a measurable way helped them define how they were feeling. If you want, you can even take a test weekly and compare how you are feeling from week to week.

There are several depression tests and screens on line. I like this depression screening test developed by the late Ivan Goldberg MD. http://psychcentral.com/quizzes/depquiz.htm. It can be printed or taken on line.

2.      Tell someone you trust. If you are depressed, chances are, one or more of your own symptoms will stop you from being able to help yourself.  Let someone know how you are feeling. Let them help you figure out what to do.  They can help you make decisions or make doctor appointments for you, or help you get up and out. It will depend on your situation and your relationship with who you tell, but tell someone.  Not telling anyone can also promote isolation in depression so just by virtue of sharing the information you are already doing something good for you.

3.      Try to move or get light. In general it is against my approach to tell someone to move or do something when they are depressed. If you could, you would, right?  Clearly it is more complicated than sheer will power. However, if your depression is mild or moderate, you may be able to find a way to get yourself from where you are, to another place.  Put simply, this means that if you have not left the apartment, try to leave. If you only go to work and home, try a detour through another route. And if you stay in on the weekend, try getting out.  Not only will this increase your chances of something changing, but if you also catch some sunlight, that can help how you feel.

These suggestions are meant to shorten "depression purgatory," the time between how bad you feel and getting help.  Treatment can take many forms (psychotherapy, support group, medication, etc) and take time, but these steps are things you can do yourself that turn you toward whatever will eventually alleviate your depression.

By Li Faustino

Bipolar? 7 reasons to seriously consider a support group.

Is a support group the LAST place you want to go?  If you are bipolar or think that you are, you probably do not want to spend any more time than you have to, thinking or talking about this diagnosis!

But what if I told you that support could be the most important aspect of getting and staying better?  And support groups in particular, have benefits that often go far beyond what people expect.  Here are my 7 favorite ways that support groups help:

1. They prevent isolation.  Isolation can be one of the worst enemies for any mental health issue including bipolar. Isolation is associated with depression, risk of suicide, and an increase of many symptoms like too much sleep and negative thinking.  But meeting with others and connecting can help you feel less alone in your illness.  Many people say they feel better just by showing up to a group and seeing the others there.

2. People can catch you if you are slipping.  Often it can be helpful to have other people get to know you because they may be able to tell if you are starting to "slip." Sometimes others can identify a "tell" that usually means someone is starting to get sick again. So while we can feel our own moods, bipolar has a way of getting out of control quickly so it is a good idea to have more people around who know you well and can help prevent things before they get bad.  

3. Get information.  In a support group you can learn from others just like you.  You can get the inside scoop on what the illness is, how to treat it, and how to live with it.  You can get real life info and recommendations for therapists or psychiatrists, and ask questions about anything from dealing with family to relationships to work.

4. Groups provide hope.  Without anyone ever actually saying 'don't give up,' being around others and hearing their stories has a way of keeping people going. And you never know how your presence in a group can help someone else, even if you are not trying.

5. Practice socializing.  Many people with bipolar also have many social anxieties and difficulties interacting with others. A support group is a place where everyone understands what it is like and getting to a group each week and talking is a great way to exercise your socializing skills.  Very often people make friends or form a community out of the group and this can help your socializing life as well.

6. Make real friends.  Bipolar support groups are one of the rare places where you can be real.  Very often the normal niceties and small talk of social interactions may not be necessary. If someone says "hi, how are you?" you can say "Kinda down this week. Thanks" with total honesty.  In addition, there is obviously no need to hide your illness and you can relax and be real with each other.

7. Learn strategies.  You can pick up valuable "tricks of the trade" from others who have been through what you go through. They have strategies such as when and how to tell someone you are dating you are bipolar.  Or when to start a new medication in case you get side effects. Or how to screen for a good therapist or psychiatrist.

So while getting to a group for the first time may feel daunting, many will tell you that attending a group regularly has changed their experience for the better. 

How to find a support group: If you are in the US, you can check the Depression and Bipolar Support Alliance (www.dbsalliance.org) to find a group near you.  If you are in NYC, you can check the NY chapter, Mood Disorders Support Group-NY (www.mdsg.org) for information.

by Li Faustino PhD

The best way to treat your anxiety...and it is not what you expect.

Anxiety disorders are often thought of as the common cold of mental health issues. They include generalized anxiety disorder, panic disorder, phobias, social anxiety and many more. They are some of the most popular disorders out there and some of the most popular treatments are cognitive-behavioral therapy, relaxation techniques, re-conditioning, and breathing techniques. But what if I told you anxiety can be treated in psychotherapy without ever discussing it directly? 

First, let's be clear.  Most of the treatments named above are very effective. They teach people how to prevent, manage, and arrest panic and anxiety attacks.  The techniques themselves are well researched to be helpful for anxiety and NOT using them in treatment could be considered malpractice.  However, in my experience, the longevity of their successes is limited.  Just as quickly as symptoms subside, they can return quite suddenly and often worse than before.  

That is because treating any form of anxiety with a superficial approach, is like treating an infected toe with a splinter in it, with antibiotics, and leaving the splinter in.  You simply have not reached the cause of the problem.

That is why I endorse a practice where those treatments are offered as a much needed survival technique and then psychotherapy can proceed by treating the whole person. Every single part of a person is connected to the other parts. Much like a woven rug, it is all intertwined. So through the exploration, every part of the person gets treatment, even if it seems, at first, to be unrelated to anxiety.  I have seen people who are awakened every night with panic attacks.  I have worked with people who walk around everyday with a pit of anxiety in their stomach. Many spend their days paralyzed hourly with worry and fear.  Through this type of approach, and often without discussing their anxiety directly, their symptoms subside. Forever.

by Li Faustino PhD