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When It’s Time For Anger Management

SHRM Online By Linda Wasmer Andrews

Turnout was good at Aon Services in Chicago when the company brought in a psychologist to give workshops on anger management. But Chet Taranowski, the company’s internal employee assistance program (EAP) coordinator, noticed something odd: "A lot of people who came had someone else in mind. They were there because someone in their lives had an anger problem, not because they felt they had a problem themselves."

That’s one of the ironies of addressing anger in the workplace. Employees certainly aren’t oblivious to the hothead sitting in the next cubicle or standing by them on the production line. “But people who have anger problems don’t necessarily recognize it in themselves,” Taranowski says. “They’re often surprised and shocked when someone confronts them with it.”

In the past, many companies conspired with employees to look the other way. After all, confronting an employee in denial is a thankless job, and it’s likely to make an anger-prone person...well, angry. But in a security-conscious world, this nonsolution is a nonstarter, so more companies are looking for ways to help employees get their anger under control. A 2003 Society for Human Resource Management survey illustrates this trend: Of 270 HR professionals responding, 16 percent reported that their companies offered anger management courses to employees, double the percentage in 1999.

“The real impetus for this growth came after 9/11,” says George Anderson, director of Anderson & Anderson, a Brentwood, Calif., firm that has taken a lead role in training anger management facilitators. Recent, highly publicized incidents of workplace violence also raised the field’s profile. “Then came the movie ‘Anger Management,’ which popularized it,” says Anderson, referring to a 2003 comedy for which he served as technical adviser. Today, more HR professionals are looking for practical ways to keep a lid on workplace anger.

It’s a Mad, Mad, Mad, Mad Workplace

Anger is undoubtedly a factor in some of the 1.7 million violent victimizations—mostly assaults—that Americans experience while working each year. (This includes incidents involving customers, clients, students and other nonemployees.) Employers that don’t address potential problems could pay a heavy price.

If an employer ignores warning signs leading up to a violent incident, it could be held legally liable. “But even if the company has done things right, the cost of defending itself averages $700,000,” Anderson says. Clearly, it’s in a company’s best interest to deal with hostile employees before they become violent perpetrators.

Fortunately, the majority of angry employees aren’t assailants in the making. “Most of the people I see are not violent,” says anger management provider Ari Novick, president of the AJ Novick Group in Laguna Beach, Calif. “Instead, they’re simply people who have a difficult time expressing anger in an appropriate way.” For some, rage is less an explosion than a slow burn.

“Yet even lower levels of chronic anger and worker conflict can increase absenteeism and decrease productivity,” says Bernie Golden, a clinical psychologist and founder of Anger Management Education in Chicago. “It creates a less cohesive workplace and damages morale. Anger also competes with focused attention, so it impairs judgment and increases reaction time.” These effects, in turn, raise the risk of critical errors and accidents.

Plus, intense or long-lasting hostility has been linked to medical problems—such as high blood pressure, high cholesterol and heart attacks—that may drive up health insurance premiums.

Stop the Madness

For employees who are always simmering, anger management training may help them control their feelings and keep them from boiling over into destructive behavior.

Many employees are referred to training directly by HR, while others come via their company’s EAP. Since anger per se is not a diagnosable mental disorder, health plans typically don’t cover anger management treatment. Instead, the employer or EAP usually picks up the tab, although some companies require employees to pay it for themselves. The training is typically presented in either small group classes or one-on-one coaching sessions.

Not surprisingly, group training is the less expensive alternative. Since the field is so new, there are no statistics on average fees nationwide. As a benchmark, though, Anderson says his classes generally run about $500 per employee: $70 for the initial assessment, $30 for a client workbook, and $40 per hour for an average of 10 one-hour classes. Anderson also provides one-on-one coaching, but, at $250 per hour, he says, most companies reserve this option for executives.

Despite the expense, however, some providers argue that individual coaching may be more cost-effective in the long run. “It can be tailored specifically to what that person’s issues and dynamics are,” says W. Barry Nixon, SPHR, executive director of the National Institute for the Prevention of Workplace Violence in Lake Forest, Calif. “People aren’t going to reveal themselves as much with other people around.”

Whether the anger management program consists of group training or one-on-one coaching, most providers space out the sessions at weekly intervals. Some also offer accelerated classes that cram several hours of training into a single day. At times, there may be pressing reasons for choosing this route. For example, Anderson has one large corporate client that takes its employees off the clock until they complete their training. Obviously, it’s important to get employees back to work as quickly as possible. “But if someone were to ask me if I recommend this approach, I would say no,” Anderson says. “If the option is there, it’s best to spread out the training over time, because one key to good results is practicing between classes.”

Anger Management 101

At a typical anger management session, you won’t see people analyzing how their parents’ botched approach to toilet training warped their personality. The focus of an effective session is on teaching people life skills, not providing therapy. Unlike depression and anxiety, anger is not recognized as a disorder in the Diagnostic and Statistical Manual of Mental Disorders, the main reference manual of the mental health professions.

“We are there to help people unlearn negative ways of dealing with anger and learn more positive ones,” says Nixon. “You don’t teach a person not to get angry—it’s a natural emotion. The goal is teaching people how to channel their anger and how to behave when they do get angry.”

Most anger management training incorporates skills such as stress reduction, communication, conflict resolution and problem-solving. In theory, this sounds like a good mix, but hard data on outcomes are lacking. “The effectiveness of many anger management programs is simply not known,” says Jerry Deffenbacher, a psychology professor at Colorado State University who has researched anger for more than two decades.

One possible drawback to group classes is that it may be difficult to reach all of the participants. For example, class participants may include both people who are psychologically ready to change and those who are still in denial.

“These are two very different types of people,” Deffenbacher says. “They may be equally angry, but putting them together in a common class may not be the best way to go. Also, there’s good literature in other areas of psychology to indicate that, if you aren’t ready to change, the intervention probably won’t take hold.”

Keep in mind that anger management training is geared to folks with garden-variety anger issues. At times, though, angry or irritable behavior may be a symptom of a more pervasive psychological problem, such as addiction, post-traumatic stress disorder or depression. Any anger management program should include an initial assessment that sorts out people who are likely to benefit from anger education from those who really do need therapy or medical treatment.

Warning Signs

How do you know when an employee might be a good candidate for anger management training? Some warning signs are relatively straightforward, such as being chronically irritable, impatient, short-tempered, argumentative or sarcastic. “Fellow employees may report that there is frequent conflict, or increased tension or lack of cooperation,” Golden says. “There might also be increased absenteeism or tardiness.”

Be alert, too, for signs of “cold contempt,” says Anna Maravelas, president of TheraRising in Arden Hills, Minn., and author of How to Reduce Workplace Conflict and Stress (Career Press, 2005). “At work, a lot of anger isn’t expressed by yelling, because people don’t want to get fired or disciplined for it.” Instead, some employees may express their anger in less direct ways, such as backstabbing, rumormongering and turf wars.

Angry employees are found on every rung of the corporate ladder, from minimum-wage workers to top-level executives. But according to Golden, one thing many of these employees have in common is unrealistic expectations.

“Let’s say their firm is downsized, and suddenly they’re doing not only their own job, but also the tasks of others who have left,” Golden says. “They maintain the expectation that they will be rewarded for the extra time and effort.” While that might be a reasonable expectation, it is not necessarily a realistic one in the current economic climate.

When employees don’t get the rewards they expect, they can wind up disillusioned, resentful and angry.

Practical Pointers

Suggesting that an employee go to anger management training is one thing. Getting the employee to actually show up is another.

In some cases, you may be able to mandate attendance as a condition of continued employment—for instance, if an employee has behaved in a way that would otherwise be proper grounds for discipline or termination.

But a caveat: If the employee’s behavior might have been caused by a “mental impairment” as defined by the Americans with Disabilities Act (ADA), you’ll need to take special care, warns Karen Karr, an employment attorney at the Steptoe & Johnson law firm in Phoenix.

“If an employee acts violently, the employer may suspend or terminate that employee, even if the behavior results from a disability. The ADA does not require an employer to accommodate an individual who poses a direct threat,” says Karr. But a dilemma arises when an employee whose behavior might be caused by a mental impairment merely threatens violence. Says Karr, “In this case, the employer may discipline the employee only if there is objective evidence that would lead a reasonable person to conclude that the employee is a threat to the workplace. Otherwise, the employer must accommodate the disability.”

One way to gather objective evidence is with a formal threat assessment. If the assessment indicates that a particular employee is at risk for becoming violent, the employee may be disciplined—or, alternatively, sent to anger management training. Says Nixon, “If, as a result of the threat assessment, it’s determined that this employee needs to work on anger issues, that is something the company can require.”

In most cases, though, you’ll probably be strongly encouraging an employee to go to training rather than actually requiring it. Often, the response you get may come down to how you present the situation. “You wouldn’t want to enter into a power struggle with an employee who already has anger issues,” says Steven Uhrik, an HR consultant from Villa Park, Ill. Instead, ease into the conversation with a few positive comments. Then state the problem, and be ready to back up your points with documentation. “Base everything on performance or attendance,” Uhrik says. Spell out the consequences for continued problems as well as the potential benefits of addressing them.

“Document everything, but be careful about what you put in the employee’s permanent record,” Uhrik adds. “Use nonjudgmental, behavioral descriptions of the employee’s actions, and be able to demonstrate their effect on the workplace.” Instead of writing that “the employee was referred to anger management class,” Uhrik recommends using the phrase “appropriate company resources were provided to the employee.” That way, if the employee’s file is ever seen by anyone, including the employee or an opposing attorney, it doesn’t contain anything that might be construed as defamatory.

Finding Help

Finding someone qualified to help your employees can be trickier than it sounds.

The ideal is a professional with substantial training and experience in anger management. But since anger isn’t recognized as a mental disorder, strategies for managing it aren’t a big part of the education that most mental health professionals receive. Therefore, it’s important to make sure that people advertising anger management services really have the requisite background.

Anderson & Anderson has a network of certified facilitators who use its model of anger management. Also, a small group of facilitators and providers banded together in 2004 to form the American Association of Anger Management Providers. Both organizations offer directories of providers on their web sites.

In addition, since many anger management providers take referrals from the courts, Golden suggests calling probation offices or social services agencies for recommendations. Look for a provider who not only has the necessary education and experience, but who also does an initial assessment and has a well-defined training approach.

Once you’ve found a qualified provider, don’t hesitate to refer employees when they need it. “Sometimes, just the process of identifying anger as a problem is a helpful experience for employees, because they’re clueless,” says Taranowski. So, do the company hotheads—and the company—a favor, and clue them in to anger management.

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Anger and Stress Management Classes

www.selfgrowth.com By Ari Novick

Anger is one emotion we all have. For some of us anger is the primary way we express our needs when we get upset. What is interesting about anger is that it is usually a response to some other emotion we are having. Really give it some thought. Think about the last time you were really upset. Were you upset because someone hurt your feelings? Perhaps it was because you felt blamed or were minimized? Anger is usually a secondary response on the "emotional food chain". There is usually some other emotion that precedes it. Learning to understand our true feelings that get masked by anger is the first way to understand how we can express our anger more effectively.

Taking a class in anger management can be really helpful. Anger management classes are not just for people that broke the law and get sent by the courts. Anger management classes are used by corporations, managers, law offices, school personal, families and volunteer. Most good anger management classes teach skills that many of us just don't learn in school or in life. You will learn better ways of communicating so that your true feelings and needs get expressed.

Most anger management classes teach skills in assertiveness. Learning to be assertive will help get your feeling, needs, and mood expressed in the most appropriate way. When we speak assertively, we do it in a reasonable tone, we don't use profanity, we make good eye contact, and we feel good about ourselves. The opposite of being assertive is being aggressive, passive-aggressive or just passive.

You will also learn ways to reduce stress. When we reduce stress we feel better. We also help increase our life expectancy because high levels of stress over prolong period of time can have damaging effects to our bodies (and our minds). Anger management classes will often teach you the skills you need to identify and mange stress in ways you never thought possible.

Most anger management classes also teach skills in increasing our empathy. When we increase our empathy we are better able understand the feelings other people might be experiencing. Becoming more empathic gives us the ability to not get as frustrated with others and have better insight into our own feelings. Many anger management classes teach these skills. They are valuable because they help us become better working with others as well as having stronger more rewarding relationships.

The bottom line is, don't wait to have anger ruin a valued relationship. Anger is an emotion that can be understood. Bad behavior can be unlearned and replaced with more positive and appropriate actions. The more you can understand about your own anger the faster you will be able to do something about it. Most people let anger control their lives. In many cases anger has ruined lives by destroying relationships and dissolving partnerships. Learning skills in an anger management class could change your life for the better. Enroll in a class and try it out. Getting the help you need could save you more than realize. Visit www.ajnovickgroup.com for more information.

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Treating Anger for Profit

Los Angeles Times

Courts: Many judges order offenders to take courses to control their tempers. But there are no standards for such classes and teachers may have no training in the field.

By ANNA GORMAN, TIMES STAFF WRITER

Sandra Whatley threw a soda at a police officer who stopped her for jaywalking. Kazutoshi Yakota brawled with a fellow college student over a woman. Moheb Helmy got into a shouting match with his mother and yelled at the cop who came to break it up.

The explosions landed all three in Los Angeles courtrooms--and as a result, in anger management classes. At the weekly sessions that are part of their sentences, they discuss their outbursts and describe their feelings in their anger control workbooks. The aim is to learn how to reduce rage by taking timeouts, breathing deeply and using such phrases as "I did wrong" rather than "When will you ever learn?"

Criminal and traffic court judges in California are increasingly using such programs to punish--and treat--defendants convicted of battery, road rage and disturbing the peace. Anger management classes, however, are not certified or monitored by state or local agencies. With the exception of Orange County , there are no court-approved lists of programs or guidelines on class length, curriculum or teacher qualifications. In fact, some teachers have no training at all.

"Anybody can set up a program, call it anger management and hope to get court referrals," said Los Angeles County Superior Court Judge Peter Meeka. "You keep your fingers crossed and hope they are doing a good job."

Anger management classes are an offshoot of domestic violence programs, which are subject to legislative standards, including required levels of training and experience for teachers. Meeka, who spent five years presiding over a domestic violence court, said he would support statewide legislation to apply the same standards to anger management classes.

An advisory committee of the Judicial Council of California is reviewing the use of court-mandated anger management classes statewide.

Aside from the lack of standards, there are virtually no data on whether the classes actually help reduce recidivism. Because statistics are unavailable on how many people are being sentenced to anger management, authorities cannot gauge whether the programs work.

Skeptics say it's nearly impossible to change people who are angry by nature. Supporters maintain that willing participants learn useful techniques to calm themselves.

"These people are still in the terrible twos, even if they are 45 years old," said Sandra Cox, an anger management teacher and executive director of the Coalition of Mental Health Professionals in South-Central Los Angeles . "The classes give them positive ways to channel their anger rather than acting out violently."

University of Wisconsin researcher Pamela Hollenhorst, who has reviewed studies of anger management programs throughout the country, said classes help some minor offenders but do not work for most violent criminals or as the sole treatment for spousal abusers.

"Anger management is sort of a Band-Aid approach," said Hollenhorst, assistant director of the university's Institute for Legal Studies. "It doesn't address the underlying problems."

Critics cite Eric Harris and Dylan Klebold as extreme examples of anger management failures. Before the teens opened fire on fellow students at Columbine High School in Colorado , they had been ordered by a court to attend anger management classes for breaking into a van and stealing electronic equipment.

Some Judges Like the Idea

Though road, air and workplace rage are hardly new behaviors, psychologists and judges finally started identifying them as common problems in the late 1990s.

Some judges see the classes as an ideal sentence for first-time offenders convicted in bar brawls or fistfights with fellow motorists. Those judges say classes can help teach defendants how to keep their emotions in check, as well as ease crowded jails and clogged court calendars.

Defendants are typically sentenced to from 10 to 52 weekly classes as a condition of probation or as an alternative to time behind bars.

Because there are no approved lists, defendants must find their own classes, often by surfing the Internet. Probation officers keep a list of agencies that offer approved batterers' programs and might also provide anger classes.

In recent years, several celebrities who pleaded no contest to criminal charges in connection with temper flare-ups have been ordered by judges to attend anger management classes. Actress Shannen Doherty hurled a beer bottle at a car window outside a West Hollywood bar; rapper Tone Loc smashed a woman's car with a baseball bat in Los Angeles ; boxer Mike Tyson struck two drivers after a traffic accident in Maryland .

"It's sort of this self-feeding frenzy," Hollenhorst said. "It gets a lot more publicity every time an athlete or a movie star gets sent to anger management."

The number of referrals further increased with a road rage law that took effect in January. The state law, written by Assemblyman Herb Wesson ( D-Culver City ), gives judges the authority to order defendants to complete a "court-approved anger management or 'road rage' course" in addition to suspending their driving privileges. Wesson, however, admitted recently that he was not aware that court-approved programs don't exist in most counties.

Wesson said he will talk to members of the Assembly Judiciary Committee about setting statewide standards. "If you don't have these things in place, it could lead to abuses," he said.

Los Angeles Superior Court Commissioner Roberta Kyman estimates she has sentenced more than 200 defendants to anger management classes over the last four years. She advised them to choose a class from the approved list and report back after finishing. Until late August, she didn't realize there was no such list.

No Standards, Many Differences

With no standards, classes differ widely in length, format and curricula. Some programs resemble therapy groups, while others teach specific skills in a classroom setting. Teachers' qualifications also vary. Some have doctorates in psychology and others do not even have a college degree.

Sharon Hartwig studied music and theater for two years at a community college and spent 1 1/2 years as a social services counselor before starting an anger management class recently at Joint Efforts Inc., a San Pedro nonprofit agency that serves low-income families.

In preparation, she attended a one-day seminar taught by a fellow teacher and wrote a manual of policies and procedures.

Some say any standards are unnecessary because many anger management teachers already lead domestic violence courses and have met the state requirements to do so.

Cox, the South-Central Los Angeles anger management teacher, insists that her clients benefit, even if it takes them a while to get the message. She said the courses also help participants lower their blood pressure or stop the progression of diabetes or heart disease.

"We know it works," said Cox, who has a doctorate in social psychology. "They block us for three to four months. Once they let that guard down, they start hearing us. And they start telling us, 'I heard your voice telling me to check my anger."

David Davies, a bureau chief with Los Angeles County Probation, said all his department can do is keep tabs on whether defendants attend class. They give the Probation Department certificates of completion, which the department passes along to the court.

In Orange County , probation officials took the initiative four years ago by preparing guidelines for courses and identifying teachers qualified to deal with volatile clients. The Probation Department conducts annual reviews.

The 10-week Orange County courses cost up to $50 a week and last 90 minutes each. Instructors focus on the telltale signs of potentially violent anger: upset stomach, clenched fists, dry mouth. Then they provide tips on how students can tame their tempers.

Colorado State University psychology professor Jerry Deffenbacher, who has studied anger management, said programs work only if the participants want help. Even then, he said, the classes may help lower their anger but won't turn them into pacifists.

Each Week, a New Skill

On a recent Tuesday night in Brentwood , Whatley the jaywalker, Yakota the college student and Helmy the shouter sat in a circle holding their workbooks, "Gaining Control of Ourselves." Each week, George Anderson or one of his fellow teachers covers a new skill: Active listening. Identifying high-risk situations. Controlling negative emotions.

This week: Communicating effectively.

The participants took turns introducing themselves, telling why they got referred to the class and what they could have done differently to prevent getting arrested. Then they watched a video about communication styles and practiced ways to express anger and frustration without provoking a fight.

Anderson described the pretend situation: You've cooked a nice meal and your partner comes home two hours late and the food is ruined. His students' responses--though a bit formal--hit the mark: I feel hurt when you come home late for dinner because it makes me feel like you don't value our time together.

Moheb Helmy, 22, said his rage consumes him and he is constantly slamming doors, cursing and fighting with his family. "I have so much anger," he said. "I would love to change because it hurts everybody around me."

Helmy, who has been ordered by a judge to attend 12 weeks of classes, said the skills he is learning seem logical. "But when it comes time to do it, I forget it all," he said.

Anderson, a clinical social worker and former UCLA lecturer, has been teaching anger management for three years and currently has about 200 students at four Los Angeles locations. "I don't know if it works or not," he said. "But anger management teaches practical skills. I think if they come for a long period of time, they'll benefit."

Some clients come voluntarily, but most are required to attend and aren't happy about it. Inevitably, a few bring along an attitude: I don't have a problem. I don't need to be here.

Sandra Whatley, a native Texan with a self-described temper problem, had those exact feelings when she first started the class. She thought the police officer needed anger management more than she did.

But during a year of classes, Whatley said, she has realized that she has to take take some responsibility for getting arrested. Now, she leaves her workbook open on her dresser to remind her to take a deep breath when she is about to explode.

"I've had an aggressive personality my whole life," said Whatley, 40. "It's in my blood. I need this. But I cannot even begin to tell you I have toned myself down."

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Working it out

Art is one avenue being used to help young people better manage anger and fear.

By THERESA WALKER The Orange County Register

John's anger explodes in a red-orange fireball that bursts from the canvas.

It surrounds a lone, shadowy figure as impenetrable as the dark cave that frames his drawing.

The 17-year-old's soft voice seems at odds with the emotions revealed in his painting: "I just feel like there should be nothing that can get in my way. If it does, I could just bring on destruction. But I don't. I'm just blazing out in the middle of nowhere."

Neither his drawing nor his explanation surprise Laurie Zagon, founder of Art & Creativity for Healing and leader of the workshop Zach attends.

Nine other kids in the class display similar intensity in the images they create when Zagon gives them time to paint "My Anger" while Dvorák's Symphony No. 9 plays in the background.

CALMING BREATHS

Taking a deep breath can make all the difference between acting on an angry impulse or pausing for more thoughtful action.

But not just any deep breath. Here is the correct method from Lynne Gaylord, marriage and family counselor.

Breathe out first, squeezing all the air out of the lungs.

Breathe in through the nose, out through the mouth for two breaths. Then breathe only through the nose. The stomach goes out on the "in breath" and in on the "out breath." Place one hand on your stomach and one on your chest to learn to regulate your breathing.

Count to 4 on the in breath, to 3 while holding, and then to 7 or 8 while breathing out slowly.

Practice in a peaceful place.

Zagon has conducted five workshops that let adolescents focus on their anger and fear. Classes always start and end the same: Kids sit sullenly, then open up as they begin to paint.

"They get back to that 5-year-old stage where they feel free to express themselves on canvas, then they want to tell you about it because they are excited about what they did," Zagon says.

Zagon's workshops have proved popular with parents, therapists and youth diversion programs. It's one more avenue in the stepped-up search for ways to help angry kids.

From one-day workshops to ongoing weekly sessions, anger management for kids is in demand.

South Orange County Family Resource Center recently added three classes for kids 8-11 to its anger-management curriculum. They filled up quickly. Another is planned in August.

Ari Novick, who offers groups for kids 13-18 through his Laguna Beach-based A.J. Novick Group, says he has seen a dramatic increase in referrals from diversion programs, schools and parents - anywhere from three to 10 a week, just in the past couple of months.

So are kids more troubled these days, or are parents and youth leaders paying more attention to warning signs?

The answer is both.

ANGER IN MANY FORMS

Angry kids can act out at home or school through aggressive body language and gestures, verbal abuse, physical assault.

Or they seethe quietly and one day explode. Shootings at Columbine High in Colorado and at Santana High in San Diego County , awakened parental concern about those kids, says George Anderson of Anderson Services. He has traveled the world for 10 years teaching anger management.

"We have people who for the first time are recognizing that a child suffering from depression may not be less dangerous than someone who is overtly acting out," he said.

Novick, one of two people in Orange County trained in Anger Management, says the demand for his services has a lot to do with parents and therapists intervening before serious problems surface.

"I don't think it's necessarily that kids are getting into more trouble," Novick said. "There's just more attention being paid to kids that have problems in managing and controlling their anger."

BIOLOGY AND CULTURE

Alexa Foster, a clinical psychologist who teaches younger children at the Family Resource Center, believes more kids have attention deficit disorder and anxiety these days. Anger is a symptom of both.

Broken homes and parents who provide little structure breed children who test limits in ways parents can't handle.

"In the big picture of the culture, there just are more kids who are difficult," Foster says. "It's a hard time to be a parent." And, she adds, more kids today are treated like little adults from an early age.

"They don't have the same level of respect. Parents are confused about how to reinforce the values that they want because they themselves don't know how firm to be."

Then there are kids whose parents fight with each other, says Mary O'Connor Harris, who sees those teens in her 10-week anger-management program at Family Assessment Counseling and Education Services in Fullerton .

Or they are lonely or burdened with the care of younger siblings, or they take a back seat to parents' addictions.

"They've got all this bottled-up anger watching their moms and dads and they don't know what to do with it," Harris says.

John's anger stems from his parents' divorce eight years ago and custody and child-support battles, says his mother, Joan of Mission Viejo .

John once got so angry he swung a golf club at his mother. He has Asperger's syndrome, a form of autism, and has suffered with depression. He goes to school at a therapeutic residential center in Colorado .

John's brother Nick, 15, came along with his brother to Zagon's workshop. Henderson describes John as "normal, charming." But he said the workshop helped him, too.

"I always feel out of place when I'm expressing anger," he says, "kind of like I'm making a fool of myself. So I usually try to hold my anger and try to be contained."

Suppressing his anger has led to a couple of explosive rages. Now he has an outlet besides violent video games.

"I guess I got a lot out of the class. I can draw my feelings instead of going into a rage."

Henderson kept her sons' artwork on the dining table as conversation pieces. She shared John's work with his therapist: "This is great material, great grist for the mill. It's a jumping-off point to your traditional therapy."

NEW DIRECTION

Instead of sending angry, impulsive kids to counseling, experts advocate teaching them to talk and get along.

Foster tries to teach the kids to recognize why and when their tempers flare and, rather than just react, to relax through deep breathing. Then think about what to do.

Parents learn to be their children's emotional coaches. In some cases, they also learn how to handle their own anger. "If you're mad and you yell and you make a big fuss, you actually encourage the child to do more," Foster says. "It's attention and a parent's passion is energizing for the child."

Instead, make a point to notice good behavior and praise it, she says.

Teaching kids how to change their thinking is effective but only half the answer, Novick says. Parents need work too. "Because usually," he says, "the breakdown in communication is learned from parents."

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Managing Stress and Recovering from Trauma: Facts and Resources for Veterans and Families

A National Center for PTSD Fact Sheet by Julian Ford, Ph.D., Executive Division, White River Junction

Symptoms of Posttraumatic Stress

Have you ever

• felt so tense, discouraged, or angry that you were afraid you just couldn't cope?
• had an extremely stressful experience that you try not to think about, but it still continues to bother you or is repeated in nightmares?
• felt constantly on guard or watchful, or been on edge or jumpy more than you really need to be?
• had a family member who seemed troubled in these ways?

If so, this information is for you.

Everyone Experiences Stress

Stress is a normal response of the body and mind. Everyone feels stress when gearing up to deal with major life events (such as marriage, divorce, births, deaths, or starting or ending a job) or handling everyday hassles like arguments, financial headaches, deadlines, or traffic jams.

Physical signs of a stress response include:

• Rapid heartbeat
• Headaches
• Stomach aches
• Muscle tension

Emotional signs of stress can be both positive and upsetting:

• Excitement
• Exhilaration
• Joy

and

• Frustration
• Nervousness
• Discouragement
• Anxiety
• Anger

Stress Can Become a Problem

Repeated stress drains and wears down your body and mind. Stress is like starting a car engine or pushing the accelerator pedal to speed up. If you keep revving up the car, you'll burn out the starter and wear out both the brakes and the engine.

Burnout occurs when repeated stress is not balanced by healthy time outs for genuine relaxation. Stress need not be a problem if you manage it by smoothly and calmly entering or leaving life's fast lane.

Managing Stress

Stress Management involves responding to major life events and everyday hassles by relaxing as well as tensing up. Relaxation actually is a part of the normal stress response. When faced with life's challenges, people not only tense up to react rapidly and forcefully, but they also become calm in order to think clearly and act with control.

Techniques for managing stress include:

• Body and mental relaxation
• Positive thinking
• Problem solving
• Anger control
• Time management
• Exercise
• Responsible assertiveness
• Interpersonal communication

Physical benefits of managing stress include:

• Better sleep, energy, strength, and mobility
• Reduced tension, pain, blood pressure, heart problems, and infectious illnesses

Emotional benefits of managing stress include:

• Increased quality of life and well-being
• Reduced anxiety, depression, and irritability

Can stress become unmanageable?

Trauma can cause severe stress, which may become unmanageable despite the best efforts of good stress management. Let's look at why this happens and what you can do about it.

Traumatic events cause severe stress reactions that are particularly hard to manage. Trauma involves a unique kind of physical/emotional shock that escalates the "fight-flight" stress response (feeling angry or scared) into "super-stress" (feeling terrified, stunned, horrified, like your life is passing before your eyes, or so overwhelmed you blank out).

Trauma occurs when a person directly experiences or witnesses:

• Unexpected death
• Severe physical injury or suffering
• Close calls with death or injury
• Sexual violation

If you have ever experienced or witnessed war, disaster, a terrible accident, sexual or physical abuse or assault, kidnapping or hostage-taking, or life-threatening illnesses, you know the shock of trauma.

Nothing in life ever seems quite the same again, even if everything works out for the best. Trauma leaves a lasting imprint of terror, horror, and helplessness on the body and the mind. The world no longer seems safe, manageable, or enjoyable. People no longer seem trustworthy or dependable. Self-doubt and guilt eat away at your self-esteem. Faith and spirituality are shaken or lost.

Traumatic stress can be managed, but special steps are necessary.

Steps in Managing Traumatic Stress

Step One is recognizing the signs of posttraumatic stress. Trauma is so shocking that it causes memories that are impossible to forget or sometimes impossible to recall. Trauma memories often repeatedly come back when you are not trying to think about them. Memories arise as unpleasant thoughts or nightmares. Sometimes you may feel as if you cannot stop reliving the event. The shock of trauma also may create blank spaces in your memory because it is too much for the mind to handle, and so the mind takes a time out.

Traumatic stress reactions are normal responses to abnormal events. Most people experience posttraumatic stress reactions for days or even weeks after a trauma. Usually these reactions become less severe over time, but they may persist and become a problem.

Step Two is recognizing the ways of coping with traumatic stress that are natural but don't work, because they actually prolong and worsen the normal posttraumatic stress reactions. The ways of coping that do not work include:

• Trying to avoid people, places, or thoughts that are reminders
• Shutting off feelings or connections to other people that are reminders
• Being hyper-vigilant or on guard

Trying to avoid bad memories, trying to shut out feelings or people, or trying to stay always alert may seem reasonable. However, they don't work because trauma controls your life if you run from it.

Step Three is to get help from one of several special VA services for veterans (and their families) who are coping with traumatic stress reactions or PTSD (Posttraumatic Stress Disorder). Trauma memories cannot be erased, but the stress they cause can become very manageable.

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A National Center for PTSD Fact Sheet

Why is anger a common response to trauma? Anger is usually a central feature of a survivor's response to trauma because it is a core component of the survival response in humans. Anger helps people cope with life's adversities by providing us with increased energy to persist in the face of obstacles. However, uncontrolled anger can lead to a continued sense of being out of control of oneself and can create multiple problems in the personal lives of those who suffer from PTSD.

One theory of anger and trauma suggests that high levels of anger are related to a natural survival instinct. When initially confronted with extreme threat, anger is a normal response to terror, events that seem unfair, and feeling out of control or victimized. It can help a person survive by mobilizing all of his or her attention, thought, brain energy, and action toward survival. Recent research has shown that these responses to extreme threat can become "stuck" in persons with PTSD. This may lead to a survival mode response where the individual is more likely to react to situations with "full activation," as if the circumstances were life threatening, or self-threatening. This automatic response of irritability and anger in individuals with PTSD can create serious problems in the workplace and in family life. It can also affect the individuals' feelings about themselves and their roles in society.

Another line of research is revealing that anger can also be a normal response to betrayal or to losing basic trust in others, particularly in situations of interpersonal exploitation or violence.

Finally, in situations of early childhood abuse, the trauma and shock of the abuse has been shown to interfere with an individual's ability to regulate emotions, which leads to frequent episodes of extreme or out of control emotions, including anger and rage.

How can posttraumatic anger become a problem?

Researchers have described three components of posttraumatic anger that can become maladaptive or interfere with one's ability to adapt to current situations that do not involve extreme threat:

• Arousal: Anger is marked by the increased activation of the cardiovascular, glandular, and brain systems associated with emotion and survival. It is also marked by increased muscle tension. Sometimes with individuals who have PTSD, this increased internal activation can become reset as the normal level of arousal and can intensify the actual emotional and physical experience of anger. This can cause a person to feel frequently on-edge, keyed-up, or irritable and can cause a person to be more easily provoked. It is common for traumatized individuals to actually seek out situations that require them to stay alert and ward off potential danger. Conversely, they may use alcohol and drugs to reduce overall internal tension.
• Behavior: Often, the most effective way of dealing with extreme threat is to act aggressively, in a self-protective way. Additionally, many people who were traumatized at a relatively young age do not learn different ways of handling threat and tend to become stuck in their ways of reacting when they feel threatened. This is especially true of people who tend to be impulsive (who act before they think). Again, as stated above, while these strategies for dealing with threat can be adaptive in certain circumstances, individuals with PTSD can become stuck in using only one strategy when others would be more constructive. Behavioral aggression may take many forms, including aggression toward others, passive-aggressive behavior (e.g., complaining, "backstabbing," deliberately being late or doing a poor job), or self-aggression (self-destructive activities, self-blame, being chronically hard on oneself, self-injury).
• Thoughts and Beliefs: The thoughts or beliefs that people have to help them understand and make sense of their environment can often over exaggerate threat. Often the individual is not fully aware of these thoughts and beliefs, but they cause the person to perceive more hostility, danger, or threat than others might feel is necessary. For example, a combat veteran may become angry when others around him (wife, children, coworkers) don't "follow the rules." The strength of his belief is actually related to how important it was for him to follow rules during the war in order to prevent deaths. Often, traumatized persons are not aware of the way their beliefs are related to past trauma. For instance, by acting inflexibly toward others because of their need to control their environment, they can provoke others into becoming hostile, which creates a self-fulfilling prophecy. Common thoughts people with PTSD have include: "You can't trust anyone," "If I got out of control, it would be horrible/life-threatening/intolerable," "After all I've been through, I deserve to be treated better than this," and "Others are out to get me, or won't protect me, in some way."

How can individuals with posttraumatic anger get help? In anger management treatment, arousal, behavior, and thoughts/beliefs are all addressed in different ways. Cognitive-behavioral treatment, a commonly utilized therapy that shows positive results when used to address anger, applies many techniques to manage these three anger components:

• For increased arousal, the goal of treatment is to help the person learn skills that will reduce overall arousal. Such skills include relaxation, self-hypnosis, and physical exercises that discharge tension.
• For behavior, the goal of treatment is to review a person's most frequent ways of behaving under perceived threat or stress and help him or her to expand the possible responses. More adaptive responses include taking a time out; writing thoughts down when angry; communicating in more verbal, assertive ways; and changing the pattern "act first, think later" to "think first, act later."
• For thoughts/beliefs, individuals are given assistance in logging, monitoring, and becoming more aware of their own thoughts prior to becoming angry. They are additionally given alternative, more positive replacement thoughts for their negative thoughts (e.g., "Even if I am out of control, I won't be threatened in this situation," or "Others do not have to be perfect in order for me to survive/be comfortable"). Individuals often role-play situations in therapy so they can practice recognizing their anger-arousing thoughts and applying more positive thoughts. There are many strategies for helping individuals with PTSD deal with the frequent increase of anger they are likely to experience. Most individuals have a combination of the three anger components listed above, and treatment aims to help with all aspects of anger. One important goal of treatment is to improve a person's sense of flexibility and control so that he or she does not feel re-traumatized by his or her own explosive or excessive responses to anger triggers. Treatment is also meant to have a positive impact on personal and work relationships.

This fact sheet was based on:

Chemtob, C.M., Novaco, R.W., Hamada, R.S., Gross, D.M., & Smith, G. (1997). Anger regulation deficits in combat-related posttraumatic stress disorder. Journal of Traumatic Stress, 10(1), 17-35.

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Stressed Out

For women, having it all may come at a steep price.

By Nguyet Le Thomas

Most women have had tear-your-hair-out days, when juggling the responsibilities of work and family seems more challenging than a triathlon: the alarm clock jangling before you are rested, racing to get the kids ready for school, sitting in stop-and-go rush-hour traffic, carrying demanding workloads, running around town to finish errands, scurrying to fix dinner, helping the kids with homework, making sure the dog is walked, worrying about crime, disease and terrorism - all while paying bills and doing the laundry. Single women also face stress with the demands of busy careers and social lives. As modern "conveniences" blur the line between work and personal time, the stress level is liable to hit Olympic highs.

Many women get through the stress mill with a few headaches and short-tempered remarks, but for others the pressure can be overwhelming. Nina Kim knew things were out of control when she walked into her office barefoot one morning. In the frenzy of getting dressed, making lunch and preparing her daughter for day care, the 29-year-old medical billing manager simply forgot to put on her shoes - and made it all the way to work before she realized something was missing. "I walked from the car, through the parking lot and into the building before I looked down and realized, 'Oh no,'" she said. "I went barefoot until lunchtime when I went to a store and bought some slippers."

"Are we an over-stressed nation? You bet," says Kathy Hogan Bruen, spokeswoman for the National Mental Health Association. "It has become such an expected part of our lives that we've blurred the line between what is normal stress and out-of-control stress."

It's not as though stress is anything new. "Our grandmothers had to cope with wars and the Great Depression," Hogan Bruen says. The main additional stressor today, she says, is the multiple (and often competing) roles women play. "In the past we focused on the home. Now we have home, family, career and money to worry about, and often aging parents as well."

Add in growing anxieties about the state of the world and the stress load can be crushing. A poll conducted in 2003 for the Robert Wood Johnson Foundation and America's HealthTogether, a non-profit health and healthcare organization, found that four in 10 Americans reported feeling more stress and anxiety in their lives today than they did before the September 11th World Trade Center attacks - a number that's higher than a similar poll taken in November 2001.

What is stress? Stress is the "wear and tear" our bodies and minds experience as we adjust to our continually changing environment, a part of our every day lives, said Dr. Gus Alva, MD, past president of the Orange County Psychiatry Society and chief psychiatrist at UCI Medical Center . Stress has been around since the dawn of history but not until the mid 20th century was the word coined by endocrinologist Hans Selve, MD. He theorized that in primitive times, stress was the short-term response to survival and the body's physical reactions, both visible and unseen, to a perceived threat to its safety.

Today, the stress response remains helpful for short-term crises by keeping us on our toes for moments like giving a speech or reacting quickly when a child reaches for a hot teakettle. Believe it or not, stress actually is a healthy way of pushing ourselves to accomplish tasks at hand - a rush of adreniline, a racing heart pumping more blood to muscles and brain and sharpened attention give us the edge we need. The problem is, the three major things that trigger the stress response - loss of control, uncertainty and conflict - have become so pervasive and constant that "we're no longer aware that we're stressed all the time," says Dr. Alva. Genetics can compound the problem. "Some people have an underlying susceptibility to stress," says Alva.

Dr. Shalizeh Shokooh, MD, a cardiologist and medical director at St. Joseph's Women's Heart Center, says five decades of research have focused on a biobehavioral response to stress called "fight-or-flight," which was predominantly male-focused. In 2000, however, a new paradigm emerged called "tend-or-befriend," which fits into the way women responded to stressful situations. The "tend" part of the model is a woman's nurturing behavior of protecting themselves and their young. The "befriend" part of the model points to a woman's need to form alliances with a larger social group, particularly other women. The concept rings true, Shokooh says: under stress, females are more likely to hunker down, care for their offspring, and turn to other females for social support, rather than to fight or flee.

When Stress Makes Us Sick

While stress is not considered an illness, it can cause specific medical symptoms serious enough to send women to the emergency room or their doctor's office, says Dr. Shokooh. In fact, 43 percent of adults suffer adverse health effects from stress, and 75 to 90 percent of all physician office visits have stress-related components, according to the American Psychological Association.

Susan, a 45-year-old mother of two from Irvine who wanted to remain anonymous, says stress and anxiety took over every aspect of her life. A self-proclaimed "worrier," Susan strived for perfection.

"I spent a lot of energy trying to make things perfect," the software program manager says. "My over-functioning caused my family to under-function and sometimes feel diminished."

It got to the point where Susan's anxiety made it hard for her to go to work or complete day-to-day tasks. She frequently experienced heart-pounding, lightheadedness, fatigue and insomnia. She became so accustomed to her high anxiety level that it wasn't until she suffered physical symptoms, including weight loss, abdominal pain and severe diarrhea, that she sought medical treatment. She visited numerous doctors and underwent countless tests, searching for a diagnosis. She was told everything was "normal" but she didn't feel normal.

Cases like Susan's are not rare, Dr. Alva says. There's mounting evidence that the day-to-day pressures in life are literally making us sick. "Stress can compound anxiety and depression - or it's the other way around," Dr. Alva says. "It's a vicious cycle of which came first, the chicken or the egg." Excessive stress creates anxiety which adds more stress.

More than 20 years of research from the federal government's National Institute of Occupational Safety and Health (NIOSH), the U.S. agency responsible for conducting research and making recommendations for the prevention of work-related illness and injury, suggests that chronic stress plays a major role in everything from headaches to stomach ailments to depression. In one study at Wake Forest University Baptist Medical Center , stress was found to contribute to an increase in the most common type of uterine cancer.

Still other studies suggest prolonged exposure to stress can lead to heart disease as well as infertility and an increased risk of giving birth prematurely, according to Dr. Shokooh. Heart disease is still the single largest cause of death for females in the U.S. , claimimg the lives of nearly 506,000 American women annually, while all forms of cancer combined attribute to 267,000 female deaths.

"There's a defined role in how stress is a contributor to an unhealthy lifestyle, for example, smoking or overeating [in response to stress]," she says. "Those are all contributors to heart disease that's indirectly caused by high level of stress."

A 2002 Harris Interactive poll backs up Dr. Shokooh's claim. More than half of the female respondents confessed that when they're under stress, healthful eating goes out the window.

In the same poll, 63 percent of Americans said that being under stress also leaves them feeling depressed, which in turn can lead to more self-destructive behavior.

Interestingly enough, gum disease is another illness reportedly caused by high stress. A study published in the July 1999 issue of the Journal of Periodontology found that people who experience high levels of financial stress and have poor coping abilities have a doubled risk of developing gum disease, which is one risk factor for heart disease, respiratory disease and diabetes complications.

When 9-to-5 became 24/7

Lack of time grinds us down most often, according to NIOSH. The study reported that 25 percent of workers view their jobs as the number one stressor in their lives, and job stress is more strongly associated with health complaints than stress related to financial or family problems. Meanwhile, downsizing and other economic pressures have forced many Americans to take on multiple jobs to make ends meet. It's one area where women are achieving undesirable equivalence with men: Today, about 47 percent of women are holding down more than one job - up 20 percent since 1973, according to the

AFL-CIO, a national labor union organization.

"Women set such high expectations for themselves," said NMHA's Hogan Bruen. "Since the days of women's liberation, we've been taking opportunities to work towards, or surpass, our male counterparts in work. Still, we're expected to manage the home front, care for our parents and be social butterflies."

Pamela Purcell, a 36-year-old mother of two who works full time, says she sometimes feels trapped between bring a "dependable employee" and "super mom." With her husband working up to 70 hours a week and putting in 50 hours herself, Purcell often feels like a "single mom" carting her two daughters to school, daycare and softball practice, while maintaining a steady home.

"But with the economy the way it is and the pressure of a family needing two incomes just to survive, it's just expected," says the La Habra resident.

Technolgy has sped up the pace of life in the 21st Century, bombarding us with an endless stream of information from cell phones, personal computers, round-the-clock news and 500-channel satellite dishes. How often have we felt "naked" without our PDAs, cell phones, or other technological-wonders-turned-fashion-accessories? "The information overload we experience on a weekly basis far surpasses what our grandparents experienced in a lifetime," she said. "It's little wonder so many American's feel unable to cope."

Then again, contemporary life seems to build itself around stress. Complaining about our busy lives and being "more stressed" than the next person has become almost fashionable. In fact, many of us boast that we're workaholics, wearing our stress as a badge of honor.

"The first thing I do in the morning is check e-mail, before shower or hair combing," said Terri Langhans, a Westminster resident who owns her own home-based, marketing business and conducts public speaking seminars. "My daughter busts me all the time for 'being on the computer.'"

Making hard choices

Before starting her marketing business, Langhans was CEO of a Fortune 100 company. For years, she thrived on the demands of her high-pressure job. Then one day, something snapped.

While sitting in a Washington , D.C. hotel room, Langhans watched an advertisement depicting a young girl asking her mother, "Mommy, when I'm all grown up, will I get to be an important client?" Langhans thought of her then 12-year-old daughter at home.

"My daughter used to ask me when I woke her up in the mornings, 'Will you be home tonight, Mommy?'" Langhans says. Sitting in the hotel room, she broke down and cried.

Within a month, she resigned from her six-figure job. Today, Langhans says she's still busy with her home business but recognizes that being at home more has changed her family's dynamics for the better.

Hogan Bruen, who until July was senior director of prevention for NMHA, also resigned to be a stay-at-home mom.

"I just didn't have enough time to do both jobs well," said Hogan Bruen, who remains a spokesperson for health organization. "The stress of juggling a demanding career and my family was harder than I anticipated."

Other women, like Irvine resident Julie Osborn, a clinical social worker who teaches cognitive behavior therapy class at UCI Medical Center , has gone a different route to stabilize her life. Her husband, Anthony, a former computer sales representative, stays home with their two daughters, ages nine and six, allowing Osborn to pursue her psychology practice. She knows her situation is rare, something she noticed when PTA parents recognize her husband by first name and not her.

"I don't think there's much empathy for working moms or stay-at-home dads," Osborn noted. "But it was the best decision we've made."

Seeking Help

Women have always been more inclined to seek help when stressful situations come up, whether from a personal friend or a professional therapist, Dr. Alva says, which is one of the main reasons why women tend to work through their problems more easily than men. Still, we sometimes need help with managing hectic lifestyles that threaten to consume us. Fortunately, experts have identified stress-management strategies that anyone can adopt.

During the turmoil of an event, especially an event over which you have little influence, you may feel helpless, incapable of making decisions, and out of control. How will you get through this? First, take a deep breath, says Ari Novick , a certified anger management counselor who teaches stress and anger management classes in Laguna Beach .

"Concentrate on the immediate things you are doing and on sustaining yourself," he says. "Try to get perspective on the situation. What is important, what is not? Do what you can to step back, assess the situation, sort out your options and emotions and seek assistance and support. Perspective allows you to acknowledge the gravity of an event while finding solutions to handle both the situations and yourself."

Then prioritize. Try as you might, you just can't fit 26-hours worth of life into 24, suggests Osborn. "To reduce stress and introduce more pleasure into your life, decide what's really important to you," she says. "Start by writing a complete to-do list. Include everything from work projects to carpools to picking up the dry cleaning."

For women, a social network is crucial in working out problems. "Women need strong social ties to improve their emotional and physical well-being and protect themselves against stress and depression," says Dr. Alva.

Next, reframe. Is your glass half-empty or half-full, asks Novick? "Everyone has a tendency to view life events with a positive or negative slant," Novick says. "Taking a moment to stop, reassess and reframe will help you manage stressors in a positive and effective way."

Specific techniques that are stress-relievers and stress-preventers include yoga, deep breathing, stretching, meditation and visualization.

If all else fails, seek professional guidance. If you, or people close to you, think that your stress has gotten out of control, it is time to ask for help. A psychologist, psychiatrist, social worker or counselor can help you learn to eliminate stress and respond differently to some of the stressful situations in your life that aren't going to go away.

Susan, the "worrier", finally sought help in the form of Cognitive Behavioral Therapy (CBT), in which she attended "talk therapy" sessions. CBT, one of the mostly widely used forms of therapy today, has helped people overcome everything from fear of heights to Irritable Bowel Syndrome. Its goal is to change the way we think and act in certain situations that result in damaging or unpleasant consequences. (See "The Invisible Epidemic: Post-Traumatic Stress Disorder")

"I learned to address the thoughts I had in response to a situation and recognize what triggered my emotions," Susan said. "I'm calmer now, less anxious, which permits my family to behave differently around me. I wish I'd taken steps to reach this point many years ago." OCM

Nguyet Le Thomas is a Huntington Beach-based writer.

How stress hurts your health

The body takes a beating from chronic stress. Some of the effects of stress on long-term health and well being include:

Depression: By altering levels of the brain chemicals norepinephrine, serotonin and dopamine, stress may predispose women to depression. One out of eight women have an episode of major depression at some time in their life, according to the April 2003 issue of the Harvard Mental Health Letter. Depression raises the risk of death after a heart attack or stroke by a factor of five, possibly because it triggers the release of stress hormones, causes heart rhythm disturbances, increases blood clotting or weakens the immune system.

Weakened immunity: In a series of studies on humans and animals, researchers at Ohio State University discovered that stress can substantially slow the healing process and can spur infection. The study, published in the journal Brain, Behavior and Immunity, found that the wounds on the stressed animals healed one-third more slowly than those on non-stressed animals.

Memory loss: Stress hormones, sometimes called glucocorticoids, work on the hippocampus, the part of the brain responsible for memory formation. While they help sharpen memory in the short term, repeated exposures impair it over time. In one recent study from Washington University in St. Louis , researchers used magnetic resonance imaging to measure the hippocampus of 48 women aged 23 to 86, half of whom had a history of clinical depression, half of whom did not. The women with depression had smaller hippocampi and scored lower on memory tests than the non-depressed group, regardless of age.

Heart disease: In a 2002 study of 73,424 men and women conducted in Japan and published in the American Heart Association's journal, Circulation, researchers found that women who report high levels of mental stress have double the risk for stroke- and heart-related deaths as those reporting low stress levels. A separate report shows a link between stress and a greater likelihood of storing fat in the abdomen, which attributes to having an apple shape.

Gum disease: A study published in the July 1999 issue of the Journal of Periodontology found that people who experience high levels of financial stress and have poor coping abilities have a twofold risk of developing gum disease, which is a risk factor for heart disease, respiratory disease and diabetes complications. OCM

-By Nguyet Le Thomas

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HR Primer 12/04/2006

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Angry Employees

Paula Santonocito

Everybody has the occasional bad day, but how does management address the chronically angry employee?

Getting to the source

Although the inclination may be to avoid an angry employee, there are good reasons for management to get involved. Left unaddressed, anger can affect other employees, department productivity, and even corporate goals.

The angry person also puts him/herself at risk. A study conducted by Daniel Vinson, M.D., at the University of Missouri, published earlier this year in the "Annals of Family Medicine," finds anger greatly increases a person's chance of injury, especially among men.

Vinson and his colleagues interviewed patients at three emergency rooms over a two-year period. Anger more than quadrupled a person's odds of being injured, they found.

The first step in addressing anger in the workplace is at the direct report level, according to Ari Novick, Ph.D., a Certified Anger Management Professional and trainer. However, if anger is chronic it will need to be addressed by human resources, he says.

Novick conducts workshops and seminars for both public and private sector employers and is coauthor of the highly acclaimed workbook on anger management, "Anger Management for the Twenty-First Century."

He finds companies are increasingly interested in helping employees manage anger. Frequently, they refer people to outside help. With proper assistance, people can learn to manage anger, Novick says.

But there is one caveat: A person has to be willing to take responsibility for his or her anger. "If a person doesn't view it as their problem, that it's everyone else, then it's usually not helpful," Novick says.

Focusing on treatment

Conversely, if a person sees that his behavior is a contributing factor, he can be helped.

People can be treated in groups or one on one. Treatment sometimes depends on the person's level in the organization. If an executive or other employee with a lot of managerial responsibility has anger management issues, he can benefit from one-on-one anger management coaching, Novick says.

Individual treatment allows for a detailed assessment of that individual, he explains. The focus includes looking at how well the person manages stress, how much empathy he has, how impulsive he is, whether he is aggressive or passive, and his overall communication style.

Some people are not comfortable when singled out and prefer to work in a group situation, Novick says. Regardless of the approach, it's important to understand what anger management involves.

"Anger management and psychotherapy are very different," says Novick, who is also a licensed psychotherapist. "Anger management by definition is educational in nature. It teaches them skills."

Finding new tools

These skills, or "anger control tools" as Novick calls them in his book, include stress management, empathy, and communication, among others.

"We also teach skills in forgiveness, which can also be a big problem in the workplace," Novick says. In addition, there are skills on how to manage expectations by adjusting them to an appropriate level. Anger management training also teaches skills that can help a person stay calm.

"People with chronic anger don't want to be angry," Novick says. "They just default to whatever they've learned."

The objective is to help them to unlearn some bad behaviors and apply new skills, he explains.

Good companies tend to refer out as to a qualified provider, as opposed to another approach, which is giving an employee unpaid leave, Novick tells HRWire.

But he cautions employers, and employees, about appropriate treatment. "Anger management is not meant to be long term," Novick says, indicating eight to 10 individual or group sessions will be sufficient for "a reasonably intelligent person who is motivated, regardless of how good the provider is or the program is."

Novick's practice, the AJ Novick Group, created in response to demand for anger management training, gets a lot of employee referrals. In working with employees, Novick finds that most people want to take a look at anger management.

Which employees are most frequently referred for training? "Mostly middle and upper management, mostly because the stress level is so high for them," Novick tells HRWire.

Those who manage many employees frequently face situations they're just not trained to address; they don't have the skills, he says.

Determining a course of action

Anger management training can be a very effective way of teaching skills and improving morale, and it can be cost effective, even one on one, Novick says.

Indeed, in the book, "Anger Management for the Twenty-First Century," Novick and coauthor Anthony Fiore cite the business cost of unmanaged anger. "Studies show that up to 42% of employee time is spent engaging in or trying to resolve conflict. This results in wasted employee time, mistakes, stress, lower morale, hampered performance, and reduced profits and/or service," they write.

However, employers should evaluate potential providers. "Anger management as a field is fairly unregulated. If a company is shopping around, ask about training and level of education," Novick advises.

Employers may also want to consider online training. Novick has found his group's online training offers a number of advantages. "It's really effective because the employee doesn't have to leave work," he says. Because training is broken into modules, a person can also approach it at his own speed.

Regardless of training method, anger management can be successful. "The employees that I see, when I'm done treating them, they are just so thrilled that their employers allowed them to do it," Novick says. Employer feedback has also been positive.

Nevertheless, before signing on, employers and employees should understand the goal of anger management training.

"Anger management is not about teaching someone not to be angry anymore," Novick says. "It's about how to handle those emotions in a more appropriate way."

Contact: Ari Novick, Ph.D., Certified Anger Management Professional and trainer, the AJ Novick Group, [email protected].

Online: "State Anger and the Risk of Injury: A Case-Control and Case-Crossover Study," by Daniel C. Vinson, MD, MSPH and Vineesha Arelli, BS, Annals of Family Medicine, http://www.annfammed.org/cgi/content/full/4/1/63; AJ Novick Group, including online anger management classes and workplace programs, http://www.ajnovickgroup.com/Home/tabid/36/Default.aspx.

© 2006 Thomson/West

Can Court Orders Stop Celebrity Rage?

By NADINE RUBIN

March 20, 2007 — Psychologists agree: Show business is a high stress job, one that greatly reduces a person's ability to manage small irritations.

Now, as a number of showbiz headliners experience public temper tantrums, some are taking anger management classes to get a handle on their emotions and avoid legal consequences.

For big time stars, fighting with invasive paparazzi is one thing — in certain situations it could even be considered self-defense. But attacking the general public when things aren't going your way is quite another.

This week, British supermodel Naomi Campbell is doing community service coupled with two days of anger management classes in New York to avoid trial on a second-degree felony assault charge.

Campbell risked deportation after she threw a jewel-encrusted Nokia cell phone at her maid's head; the maid was hospitalized. If her charge had gone to trial, she would have faced a sentence of up to seven years in prison.

Breenzy Fernandez, the director of the one-day anger management program run throughout the New York metropolitan area by Education & Assistance Corporation (EAC), says that it promotes responsible behavior in individuals arrested for crimes precipitated by anger.

"It is used as a sentencing alternative by the courts," she said, "and offers intervention with individuals who have responded with excessive aggression resulting in conflict-related offenses."

Over the last three months, rappers Foxy Brown and Busta Rhymes and TV stars Isaiah Washington ("Grey's Anatomy") and Jason Wahler (MTV's "The Hills" and "Laguna Beach: The Real Orange County") have all been ordered to attend anger management classes for terms ranging from two days to six months as an alternative to serving time behind bars.

Group-Structured Social Work

Fernandez would not confirm whether Campbell was taking the EAC's anger management course, but she did say that what happened in her program was probably similar to what the supermodel was experiencing.

The day begins at 9 a.m. with a group of 20 to 25 offenders along with a teacher and a social worker. Class members might be attending for anything from road rage to reckless behavior that involves an assault, Fernandez said.

"The group setting gives people the opportunity to discuss feelings and emotions. And the teacher and social worker ask the group questions that help them to work out how they could have addressed the situation in a different way," she said.

Psychologist Ari Novick, who runs the AJ Novick Group, has co-authored one of the most widely used curriculums for anger management programs in the country. He says that while the term "anger management" was coined in 1976, the field has really grown over the last five years.

Novick currently sees between 300 to 400 offenders sent to him by the courts.

Campbell Has Taken Classes Before, but Do They Work?

Of course, this isn't the first time Campbell has taken anger management classes — in 1998, she pleaded guilty in Toronto to assaulting another employee.

During an interview with Barbara Walters in June 2000, Campbell broke down and confessed: "Anger is a manifestation of a deeper issue. … And that, for me, is based on insecurity, self-esteem and loneliness. … I was really unhappy. I realized I was going to lose the people who really loved me if I didn't find out what was making me do the things I did."

Despite taking anger management courses at a rehab clinic in Arizona after the 1998 offense, she has repeatedly been accused of abusing other hired help.

Her alleged inability to harness her emotions raises the question that perennially faces that industry: Does anger management work?

"While small-scale studies and anecdotal reports show the programs have helped some people cope with stress, I haven't seen any studies that show anger management programs prevent crime," said Pamela S. Hollenhorst, associate director at the Institute for Legal Studies at the University of Wisconsin Law School. "Sending people to these programs as an alternative to jail does avoid additional jail crowding, so the programs work in the sense they avoid consuming scarce resources that could be used for more serious criminals."

But Novick believes the duration of the court-mandated classes is part of the problem, saying that just two days of anger management is "absurd."

"While there are still no conclusive studies to show that anger management works in the long term, we do know that a cognitive behavior approach has positive results," he said.

When it comes to determining how much anger management fits the crime, the responsibility rests with the judge.

"There are no state laws or federal laws governing anger management," Novick said. "That's why there's a discrepancy between the amount of time people should spend in a program."

So how much time should it take to let go of anger?

"It's really hard to absorb anything in two days, let alone something that should take eight to 10 weeks," Novick said. "Anger management programs are not psychotherapy, they're educational. They rely on participants learning a skill, practicing it in their lives and then returning the next week to discuss it. A good program should provide skills for stress management, empathy, assertiveness, forgiveness and better judgment. It should also address how better to manage expectations and self-talk."

Campbell Says She's Sorry

Reports from Campbell's first day in rehab suggest that she's serious about turning over a calm new leaf.

"I cannot believe I am sitting here," she told the class, according to a report in Tuesday's New York Post. "I have said it before, but this time I truly mean it. I feel sorry and I am really going to learn from my mistakes."

One 30-year-old classmate described Campbell, 36, as "So, so nice," according to the Post.

The classmate said Campbell spoke about the incident in class, telling them, "I was angry. I was angry all day really, and then it just got to be too much."

But Novick remained skeptical, saying that fame had a way of altering people's self-awareness and possibly leading to the anger management issues that many stars seem to have.

"I don't mean to generalize, but there's a certain omnipotence that occurs in those who have been treated differently for a really long time. Their flawed thinking is ingrained from early childhood. It takes years of preferential treatment to treat people poorly with no consequence. And it takes a long time to learn to behave differently."

With the jury out on whether Campbell's head-bashing days are over, one thing remains certain: These days, anger management is more than just a movie.

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Develop your anger management skills

by David Leonhardt, the Happy Guy

For those who have a tough time controlling their anger, an anger management plan might help. Think of this as your emotional control class, and try these self-help anger management tips:

ANGER MANAGEMENT TIP #1

Ask yourself this question: "Will the object of my anger matter ten years from now?" Chances are, you will see things from a calmer perspective.

ANGER MANAGEMENT TIP #2

Ask yourself: "What is the worst consequence of the object of my anger?" If someone cut in front of you at the book store check-out, you will probably find that three minutes is not such a big deal.

ANGER MANAGEMENT TIP #3

Imagine yourself doing the same thing. Come on, admit that you sometimes cut in front of another driver, too ... sometimes by accident. Do you get angry at yourself?

ANGER MANAGEMENT TIP #4

Ask yourself this question: "Did that person do this to me on purpose?" In many cases, you will see that they were just careless or in a rush, and really did not mean you any harm.

ANGER MANAGEMENT TIP #5

Try counting to ten before saying anything. This may not address the anger directly, but it can minimize the damage you will do while angry.

ANGER MANAGEMENT TIP #6

Try some "new and improved" variations of counting to ten. For instance, try counting to ten with a deep slow breathe in between each number. Deep breathing -- from your diaphragm -- helps people relax.

ANGER MANAGEMENT TIP #7

Or try pacing your numbers as you count. The old "one-steamboat-two-steamboat, etc." trick seems kind of lame to me. Steamboats are not the best devices to reduce your steam. How about "One-chocolate-ice-cream-two-chocolate-ice-cream", or use something else that you find either pleasant or humorous.

ANGER MANAGEMENT TIP #8

Visualize a relaxing experience. Close your eyes, and travel there in your mind. Make it your stress-free oasis.

NEW BONUS ANGER MANAGEMENT TIP #7

I ran this one in my Daily Dose of Happiness: Here is how one of your fellow subscribers handles Anger:

"If ever I am angry towards some other people, I've learned not to just utter bad words but rather I write on a journal all what I could have said to somebody and after going through it again and again I sort of get relieved and forgive and forget what the other person did to me. That has saved me a lot."

I then ran a follow-up:

A short while ago, I ran an item from a subscriber about using journaling techniques to dispel anger, in much the same (or opposite?) way that one would use a gratitude journal. Here is a reply another of our subscribers shared with me:

"I am one of those people who pour everything they think and feel into my journals. I also write out my frustrations and anger and when it is all out of my system, i burn the pages,purging not only the journal of the negativism, but also myself......... I don't have to relive the event, or the feelings for they are gone and no longer a part of my life. I leave my journals with a raggedy edge here and there, and i know that i must have had a bad day, but that it passed and i moved on to the rest of my abundantly happy and fulfilling life."

NOTE: If you want to journal away your anger, you might find the 5 year journal very useful.

One thing I do not recommend is "venting" your anger. Sure, a couple swift blows to your pillow might make you feel better (better, at least, than the same blows to the door!), but research shows that "venting" anger only increases it. In fact, speaking or acting with any emotion simply rehearses, practices and builds that emotion.

If these tips do not help and you still feel you lack sufficient anger management skills, you might need some professional help, either in the form of a therapist specializing in anger management or a coach with a strong background in psychology

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Is Your Company Ignoring Workplace Stress?

Paula Santonocito

If so, it isn’t alone. Research shows that although many companies recognize workplace stress is an issue, few do anything about it.

What surveys find

Two studies from Watson Wyatt Worldwide, a leading global consulting firm, find stress has significant impact on the workplace.

Nearly half of all surveyed U.S. employers, 48 percent, say stress caused by working long hours and doing more with less is affecting business performance. Yet, only 5 percent are addressing this concern, according to Watson Wyatt’s 2007/2008 Staying@Work report.

By the same token, more than one-quarter of employers, 29 percent, indicate widespread use of technology that expands availability, such as cell phones and personal digital assistants, is a cause of employee stress that impacts business performance. However, only 6 percent are taking strong action.

In addition, managers’ inability to recognize stress comes into play. Twenty-four (24) percent of employers indicate this is an issue at their organizations. But only 7 percent are doing anything about it.

Watson Wyatt points out that one of the ways stress affects business performance is through employee retention. And work-related stress does indeed motivate people to look for alternative employment.

Stress is the most frequently cited reason U.S. workers give for why they would leave a company, according to Watson Wyatt’s 2007/2008 Global Strategic Rewards report. Forty (40) percent of respondents say it is one of their top three reasons.

Nevertheless, the same report shows employers don’t see the correlation between stress and retention. Employers fail to list stress among the top reasons they think workers leave their jobs. Instead, employers cite insufficient pay, lack of career development, and poor supervisor relationships.

Employer inaction

So what is it about workplace stress that keeps it off the employer radar screen?

“Oftentimes employers won’t address issues until it becomes a liability for them,” says Ari Novick, Ph.D., a licensed psychotherapist and owner of AJ Novick Group, a leading national provider of anger and stress management training.

There’s another factor that makes stress difficult to address. “Stress is an intangible,” Novick says. An employee may say, “I feel stressed,” but unless that stress affects the workplace in a tangible way employers tend to overlook it.

“Employers don’t start addressing the issue until it becomes a problem. They’re not as proactive as they should be,” Novick tells HRWire.

Inaction on the part of employers can lead to psychological and/or physical problems for employees, which in turn can impact business results.

Contributing factors

Today, there are more potential work-related stressors. As Watson Wyatt study findings show, availability is a big one.

“When you’re accessible literally 24 hours a day that can be nerve-wracking,” Novick says.

Yet, in a lot of companies, ongoing availability has become part of the culture.

For employees, the issue is difficult to address. If an employee says s/he doesn’t want to be reached, it may lead to a negative perception.

“The employer needs to create better boundaries. It’s not up to the employee to create them,” Novick says.

Constant availability doesn’t allow a person to have a balanced life, which in turn can lead to stress. Novick cites the movie, “The Devil Wears Prada” as an example. “In that movie we saw exactly how stress can erode the human spirit,” he tells HRWire.

Corporate culture plays a major role in workplace stress, but so does American culture. If you look at other countries and the way they value time off and time with family, and you compare vacation time and time away from work, the United States, for all its greatness, is clearly lacking, Novick says.

Still another factor that contributes to workplace stress is something simple that’s overlooked: everyone’s coping skills for managing stress are different.

Stress is a disconnect between the demands in life and resources to meet those demands, Novick explains. And a stressor for one person isn’t necessarily a stressor for another.

That’s why some people can maintain these high-stress environments, he says; their coping skills for stress are different. Therefore, employers shouldn’t expect that everyone can manage the same amount of stress.

In addition, Novick points out, “Everyone has different variables that employers aren’t aware of.”

When stressed

Still, whether or not employees have a high tolerance for stress, Novick says everyone has a breaking point.

How will employers know when that point has been reached? “Look for employees who are vocalizing their discontent or their stress,” Novick advises. “Most people will verbalize it.”

However, there are some employees who will internalize stress, and Novick cautions that this can be especially problematic. If an employee internalizes stress and gets to a breaking point and lashes out, it can lead to another liability issue. “You can create a dangerous work environment,” he says.

Although stress isn’t contagious per se, it can have an adverse effect on morale and infect the workplace.

“Typically when people are stressed out they may be short-tempered, sleep-deprived, agitated or anxious. They can be very difficult to be around,” Novick says.

Because stress is a person’s perception of his/her environment, stressed out co-workers can essentially contribute to the stress of other staff members.

Becoming proactive

Morale, health care costs, productivity. They’re all bottom-line issues and still employers often look the other way when it comes to stress.

“Stress is a feeling that is hard to prove,” Novick says.

Physiologically and psychologically stress can take a toll. But unless an employee is diagnosed with stress-related high blood pressure or other illness employers tend not to react to stress.

Still, stress in the workplace is an issue, and it appears to be widespread, as Watson Wyatt’s studies show. The majority of referrals Novick gets from employers also typically have something to do with stress.

Novick finds it is only the more progressive companies that are addressing stress on a proactive basis. Interestingly, a lot of the companies that do so are smaller employers. Novick says he believes that in smaller companies it’s easier to see when there is an issue.

Regardless of company size, Novick recommends a proactive approach to stress management, whether it’s a stress management workshop or executive coaching.

“You’ve now given your executive or employee some incredible coping skills. And the cost is nothing compared to lost productivity or losing the employee altogether,” Novick says.

Contact: Ari Novick, Ph.D., licensed psychotherapist and owner AJ Novick Group, [email protected].

Online: Watson Wyatt Worldwide, Staying@Work report, http://www.watsonwyatt.com/research/resrender.asp?id=2007-US-0216&page=1; Watson Wyatt Worldwide, 2007/2008 Global Strategic Rewards report, http://www.watsonwyatt.com/research/resrender.asp?id=2007-US-0164&page=1; AJ Novick Group, stress management information, training, and coaching, http://www.ajnovickgroup.com.

Older News and Announcements:

Breaking News: Ari Novick, Ph.D. - Keynote for Law Enforcement Conference

Dr. Ari Novick was selected as the Keynote speaker for the 28th annual California Law Enforcement Statewide Conference in Palm Springs, CA October 8th-11th, 2008. The CSLEA represents more than 7,000 public safety professionals within 19 affiliate groups-dedicated, highly trained state workers who make up California's safety net. Dr. Novick was chosen because of his expertise in the field of anger and stress management and his dedication to collborating with law enforcement. Visit our blog for more information. For information on our stress and anger management classes or to schedule a presentation at your corporation or annual conference, please contact our office at (949) 715-2694

Dr. Novick Featured in HR Wire Cover Story on Stress Management

The June, 2008 issue of HR Wire features anger and stress management expert Dr. Ari Novick in the lead cover story, "Is Your Company Ignoring Workplace Stress" by Paula Santonocito. Dr. Novick was chosen due to his expertise and training working with both large and small corporations who are dealing with anger and stress related issues. For more information on the AJ Novick Group's Workplace Programs or Executive Coaching, please contact our office at 949 715-2694

Weekend Anger Management Class Workshops are Selling Out!

Due to the popularity of our agency and established anger management model, our weekend anger management workshops have been sold out one week prior to the event date for the last 3 months. Anyone interested in taking one of our anger management classes in a workshop format must register at least two weeks prior to the class. These Anger management classes are an intensive 4-hour workshop aimed at exposing participants to some of the basic skills needed to better manage and control anger. It is recommended that participants attend two of these weekend classes to complete all the material. These classes are ideal for employers seeking an anger management class for their employees, those with a court order as well as for persons seeking personal growth.