1. Identify Your Feelings.

Start with your upsetting feelings. Identify those feelings.  Use your recognition of those feelings as a STOP Sign!  Upset feelings are a sign or signal that your self-talk (internal dialogue) is escalating your upset feelings.

2. Identify Your Thoughts.

Identify your upsetting thoughts or internal dialogue that are contributing to your anger about the situation or person.  Question yourself and ask…

1.  “Why must I get my way?”

2.  “Why should others do what I want?”

3.  How would you answer those questions?

3.  Reframe Your Thoughts.

Counteract your upsetting/angry thoughts with a positive self-message.  Put the brakes on your feelings.  You no longer have to react to your first impulse.  Tell yourself, “Slow down, easy does it.”

4.  Clarify the Situation.

Take the time to clarify the situation for yourself.  Ask yourself, “What is really going in this situation?”  Then, you may acknowledge feeling disappointed or hurt by the person or with the situation.  Being enraged is self-defeating and no longer an option.

5.  Set Realistic Goals.

Ask yourself, “What alternative solution(s) can I use to resolve this situation?”   Set more realistic goals for yourself in regard to the problem.  Be specific and concrete.  What can you do to change the situation?

6.  Develop Options.

List the constructive options you have in order to reach your goals.  Ask yourself, “What constructive actions can I take to reach my goals?”

7.  Take Positive Action.

Choose a constructive option to reach your goal and act on it.  The end result of the ABCD process is positive action on your part!

The Three Steps of Anger First Aid

1.  Recognize you feel angry.

2.  Take a cleansing breath.

3.  Take a break, a “time-out” or a “cool-down.”

1.  Recognize Anger

Say to yourself “I feel angry.” This is frequently the hardest step to take. Our conscious thought processes are clouded by the limbic system during anger. This requires self-awareness, one of the four basic principles of emotional intelligence.  Learn to notice the early signs of anger so that you can intervene before slipping into a rage!

2.  Take a Cleansing Breath

A cleansing breath is a long, slow breath, in through your nose, held for a heartbeat, then a slow exhale, silently through your mouth.  If in a safe situation, close your eyes while you breathe.  It can help to think “peace” during the inhale and “release” during the exhale.  Five cleansing breaths, counting mentally down from five to one, can be a quick relaxing experience –   especially powerful for handling an unexpected stressor.

Purpose of a Cleansing Breath:  Anger is an activating emotion. It sends your body and mind into a state of excitement.  The purpose of a cleansing breath is to send a signal of calmness to your body and limbic system. This signal will begin a process of deactivation that enhances a return to a calm state.

Impact of a Cleansing Breath:  Breathing in through the nose slows the inhale, slowing respiration – the opposite of angry breathing.  Holding the breath for a heartbeat or two distracts the mind from the target of anger and also helps slow breathing.  Exhaling is a relaxing experience. Exhaling through the mouth loosens jaw and facial muscles, enhancing relaxation, the opposite of the activation that comes with anger.

3. Take a Time Out

Whatever situation triggers anger, angry people are in no state of mind to resolve it effectively.  When agitated, the limbic system circumvents judgment and the ability to reason during anger.  It is most effective to wait until one has calmed down before attempting to resolve the situation.

Three Elements of a Time-Out:

1.  Tell the other person that you are taking a time-out. 2.  Tell the other person how long your time-out will be. 3.  Actually take a mental time-out. Do not focus on the problem or how you have been wronged – this will only make things worse!

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TLWentz, PhD

“It’s an important study because we are beginning to understand how anger and other types of mental stress can trigger potentially lethal ventricular arrhythmias,” said Dr. Rachel Lampert, associate professor at Yale University School of Medicine. The study looked at 62 people who needed the use of defibrillators to regulate their heart’s electrical functions. They were hooked up to a heart monitor and were asked to recall situations in which they felt angry. The individual’s electrical heart data was then recorded and the people were released.

“We’ve known that anger affects the heart for a while now, but the mechanisms were still not fully understood,” said Lampert.  Over a three-year period, individuals in the study were watched and their susceptibility to arrhythmias were recorded. What the study showed was that individuals who were more prone to anger easily also had a higher chance of having arrhythmias.

“This data suggest that therapies and evidenced-based, Anger Management classes  focused on helping patients deal with anger and other negative emotions may help reduce arrhythmias,” said Lampert. Doctors have known for some time that anger and stress negatively impacted heart functions, but this is the first study to confirm that mental stress can predict arrhythmias and influence the heart electrically.

“We’ve known stress can increase adrenalin, constricts arteries, increases blood pressure and make blood platelets more sticky,” said Dr. Randall Zusman, director of the division of hypertension. “These symptoms decrease the amount of oxygen getting to the heart and can cause heart disease and ultimately a heart attack.”

http://www.thebostonchannel.com/health/18778540/detail.html

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The American College of Physician Executives and the American Organization of Nurse Executives are joining forces to stamp out disruptive behavior. The two organizations are providing resources and guidance to foster excellence in nurse and physician relationships throughout the country.

The issue is so widespread that The Joint Commission published a Sentinel Event Alert addressing intimidating and disruptive behaviors in July 2008. In addition, The Joint Commission issued a statement requiring that health care organizations adopt zero tolerance policies for disruptive behavior by January 1, 2009. According to an ACPE survey, more than 95 percent of respondents said they had witnessed disturbing, disruptive and potentially dangerous behaviors among physicians on a regular basis. (Contact: Carrie Weimar, ACPE, cweimar@acpe.org or (800) 562-8088)

http://www.jointcommission.org/NR/rdonlyres/CBF07DE6-E28C-4C1D-AAE0-AE4BED99834A/0/tmp_05_09.pdf

www.andersonservices.com, www.angertrends, www.anger-management-resources.org, amecbi.com, T. L. Wentz, Ph.D.,

Organizational Anger Management training for businesses and individual Anger management classes for “at risk” workers led by a Certified Anger Management Facilitator (CAMF) in conjunction with a comprehensive model of Anger Management which includes an assessment of functioning – pre and post, a workbook, and stress and stress management, communication skills and emotional intelligence will reduce workplace anger and increase worker safety.

Other risk factors include:

• The prevalence of handguns and other weapons among patients, their families or friends;
• The increasing use of hospitals by police and the criminal justice system for criminal holds and the care of acutely disturbed, violent individuals;
• The increasing number of acute and chronic mentally ill patients being released from hospitals without follow-up care (these patients have the right to refuse medicine and can no longer be hospitalized involuntarily unless they pose an immediate threat to themselves or others);
• The availability of drugs or money at hospitals, clinics and pharmacies, making them likely robbery targets;
• Factors such as the unrestricted movement of the public in clinics and hospitals and long waits in emergency or clinic areas that lead to client frustration over an inability to obtain needed services promptly;
• The increasing presence of gang members, drug or alcohol abusers, trauma patients or distraught family members;
• Low staffing levels during times of increased activity such as mealtimes, visiting times and when staff are transporting patients;
• Isolated work with clients during examinations or treatment;
• Solo work, often in remote locations with no backup or way to get assistance, such as communication devices or alarm systems (this is particularly true in high-crime settings); and
• Poorly lit parking areas.                                                                                                                                                                                                   

For many years, health care and social service workers have faced a significant risk of job-related violence. Assaults represent a serious safety and health hazard within these industries. OSHA’s violence prevention guidelines provide the agency’s recommendations for reducing workplace violence, developed following a careful review of workplace violence studies, public and private violence prevention programs and input from stakeholders. OSHA encourages employers to establish violence prevention programs and to track their progress in reducing work-related assaults. Although not every incident can be prevented, many can, and the severity of injuries sustained by employees can be reduced. Adopting practical measures such as those outlined here can significantly reduce this serious threat to worker safety.

Violence Prevention Programs
A written program for job safety and security, incorporated into the organization’s overall safety and health program, offers an effective approach for larger organizations. In smaller establishments, the program does not need to be written or heavily documented to be satisfactory.

What is needed are clear goals and objectives to prevent workplace violence suitable for the size and complexity of the workplace operation and adaptable to specific situations in each establishment. Employers should communicate information about the prevention program and startup date to all employees.

At a minimum, workplace violence prevention programs should:

• Create and disseminate a clear policy of zero tolerance for workplace violence, verbal and nonverbal threats and related actions. Ensure that managers, supervisors, coworkers, clients, patients and visitors know about this policy.
• Ensure that no employee who reports or experiences workplace violence faces reprisals.⁽⁶⁾
• Encourage employees to promptly report incidents and suggest ways to reduce or eliminate risks. Require records of incidents to assess risk and measure progress.
• Outline a comprehensive plan for maintaining security in the workplace. This includes establishing a liaison with law enforcement representatives and others who can help identify ways to prevent and mitigate workplace violence.
• Assign responsibility and authority for the program to individuals or teams with appropriate training and skills. Ensure that adequate resources are available for this effort and that the team or responsible individuals develop expertise on workplace violence prevention in health care and social services.
• Affirm management commitment to a worker-supportive environment that places as much importance on employee safety and health as on serving the patient or client.
• Set up a company briefing as part of the initial effort to address issues such as preserving safety, supporting affected employees and facilitating recovery.

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In fact, the researchers analyzed a variety of measures related to anger, including cynicism, hostile temperament, aggression and suppressed anger. Only expressed anger — described as Anger Out on the rating scale — had predictive value, and only when the age, diabetes or dyslipidemia risk factors also were present.  “Our results appear to differ from the literature on males, particularly young males, in which hostility scores are found to be associated with coronary artery disease. However, the new data, combined with our previous findings, indicate that anger and hostility in women, as in men, do tend to cluster with adverse risk factors,”

Journal of Women’s Health, Published Online Dec. 2006, “Anger, Hostility, and Cardiac Symptoms in Women with Suspected Coronary Artery Disease: The Women’s Ischemia Syndrome Evaluation (WISE) Study” http://www.sciencedaily.com/releases/2007/01/070114185909.htm

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Work bullies can ruin a culture, destroy productivity and make your life — and those of everyone else they target — miserable.
And it’s not just bullying bosses who are the problem. Co-workers and employees also use bullying behavior, which creates a hostile workplace.
Excluding lethal weapons, here are the top dozen techniques bullies use to ruin a workplace.
-Yelling, physical threats and throwing things. This in-your-face method makes targets think actual physical attacks will follow.
-Verbal abuse, emotional intimidation and personal insults in private and public. This includes put-downs and demeaning, rude or cruel comments.
-Harassment based on race, religion, gender and physical attributes. Sexual contact, lewd suggestions, name-calling, teasing and overtly nasty personal jokes. Stealthy bullies often follow their put-downs or threats by laughing and saying “I was just kidding” to make it hard for their targets to fight back.
-Backstabbing, spreading rumors, manipulating, lying, distorting, hypocrisy and exposing your personal problems and performance mistakes. Repeated character assassination is another favorite technique.
-Taking the credit for the work of others. Never accepting blame, but instead spreading the blame to blameless employees. Withholding information and then cutting targets down for failing in a task because they didn’t know the crucial information.
-Anonymous attacks and cyber-bullying — flaming e-mails, personal innuendos, threats and porn. Invading the personal space and privacy of targets by rummaging through desks, listening to phone calls, asking personal questions and eating their food.
-Hypersensitive over-reactions, throwing tantrums. Bullies want to train others to walk on eggshells, back off in order to avoid a scene or beg forgiveness as if they really did something wrong.
-Dishonest evaluations, through praising and promoting favorites and destroying the careers of targets.
-Demeaning meetings: yelling, pointing fingers, interrupting, ignoring, derisive laughter or snorts, and nonverbal comments behind targets’ backs, such as rude noises, facial gestures, answering a phone or text messaging, or working on a computer.
-Forming cliques and ganging up to harass and demean. Perpetuating turf wars about budgets, hiring, etc.
-Micromanaging everything. Bullies make it clear they believe other people are so stupid and incompetent that the bully has to do everything to make sure it’s done right.
-Managing in a panic. Waiting until the last minute so everyone moves from crisis to crisis. Making every task a matter of life or death, so people are continually pressured.

Most bullies use combinations of these methods. The relentless application of these techniques reinforces humiliation, pain and fear. It can make the targets feel helpless and that the situation is hopeless.  We’ve all seen the effects of bullies and the hostile workplaces they create. Teamwork, productivity, responsibility, efficiency, creativity and reasonable risk-taking decrease. Promotions are based on sucking up to difficult people, not on merit. The best people leave as soon as they can.

Your operational system may look wonderful on paper, but the wrong people in the wrong culture always can find ways to thwart it. Your pipeline leaks money and profits plummet. It’s possible to turn these terrible situations around. But it takes time, perseverance and processes tailored for each specific situation. You also need a leader dedicated to wiping out these behaviors.

A common mistake in dealing with bullies is trying to educate, explain, understand, accept, forgive, beg, bribe, ignore, reason with or appease them. These approaches won’t convert dedicated bullies into reasonable, civil and professional people. These approaches only stop people who aren’t really bullies, but have behaved badly one time.

Determined bullies don’t take your understanding and acquiescing as kindness. They take your giving in as weakness and an invitation to abuse you more. Bullies bully repeatedly and without real remorse. They might appear to apologize sincerely, but you should accept only behavioral change, not good acting.

The best way to stop a bully is to stand up to them. Expose and isolate them. Or catch them doing something outrageous or illegal in front of witnesses.

Author, BEN LEICHTLING, a Denver-based leadership adviser.

Again, stress is the mismatch between the demands in our lives and the resources we have to deal with those demands – at that moment in time.

The stressor could be a positive or a negative event. The type of response that results depends upon each person’s reaction to the stressor. Thus, the primary purpose of Anger Management is to identify and change one’s reactions to stress!

Stress is Physical.

When we are under stress, our bodies react with the “fight, flight, or freeze” response. Adrenaline and other hormones are pumped into the bloodstream. Breathing becomes shallow and rapid, muscles tense up and your body prepares for action. In most cases, though, the body is all geared up with no place to go. If we do nothing to reverse the physical stress reaction, we can remain in an almost constant state of unproductive tension.

Stress is Mental.

Stress is not all in your head, but that is where it begins. Different individuals perceive stressors differently. For one person, an event may be viewed as a challenge; for another, it may be viewed as a severe threat or problem. Therefore, events do not cause stress, the ways we interpret and react to them does, again which may lead to Anger Management classes — proactively or reactively.

Some Stress May Be Beneficial.

Many people do their best work under pressure. A moderate degree of stress is a powerful force for growth; we often learn the most when we are forced to do so. Some students do their best studying when they have a deadline to meet. Athletes report that they sometimes have an adrenaline ”rush” when they need it most.

The relationship between levels of stress and mental performance such as learning or decision-making is measureable.  Stress varies with challenge; at the low end, too little breeds disinterest and boredom, while as challenge increases it boosts interest, attention and motivation – which at their optimal level produce maximum cognitive efficiency and achievement.  As challenges continue to rise beyond our skill to handle them, stress intensifies; at its extreme, our performance and learning collapse.”  (Goleman, pg. 271, 2006)

Cited from Anderson, G. and Elder, J (2008). T Wentz, PhD, CAMF, (Ed).  The Practice of Control: Executive Coaching/Anger Management for Physicians.

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