Fix my trigger temper?
December 14, 2011 9:02 AM   Subscribe

Resolving temporary hyperarousal without resorting to anti-anxiety drugs?

I've recently undergone a series of stressors that while a small blip on the radar of horror that can define human existance has had a major impact on my relatively free from dramatic stress life up until now. As mentioned in a previous post i have had multiple people close to me die this year. I am 35 and never brushed death before these events. I made it through all of it so far with only one major scary side effect- hyperarousal set in after the last death in november. I have always been a bit passive (sometimes passive aggressive) and not prone to direct confrontation, angry outbursts or drama scenes in public. Now if mcdonalds is out of the salad dressing i want (unexpected event) i FLIP OUT. There is crying and swearing and yelling at innocent ppl and making a scene. I feel like i have no control over the process once i am triggered and trying to talk myself down (really? Cmon its salad dressing just breathe and relax) is failing. It really feels like a seething burning rage at the slightest thing that does not go as planned/my way. From my google research this appears to be hyperarousal and while more commonly seen with ptsd it can show up with enough stress even if its not been mortal danger situations. All articles suggest it may be temporary (i hope so) until the nervous system settles back down and that drugs can dampen the symptoms until natural recovery occurs. I really do not want to start taking psychopharmacologicals even temporarily. Any other suggestions for dealing with this problem? I am acting like a monster and will drive ppl away if i cannot get a handle on my behavior. Plus poor sales clerks of the world do not deserve my tantrums. And how long is too long before i suspect its not going away on its own?
posted by TestamentToGrace to Health & Fitness (38 answers total) 2 users marked this as a favorite
What you need is therapy.
posted by sunshinesky at 9:16 AM on December 14, 2011 [1 favorite]

Therapy - particularly someone who is good with grief counseling. Also, trying to get a bit of meditation or other more mindful 'grounding' things into your routine might help.
posted by rmd1023 at 9:19 AM on December 14, 2011 [1 favorite]

Therapy and exhausting yourself/finding catharsis with exercise, maybe?
posted by devymetal at 9:21 AM on December 14, 2011

It sounds more to me like "hyperarousal" is just a fancy way of saying "your emotions are so desperate to get out that they are going to jump on ANYTHING as an excuse."

This does not make you a freak, first of all. You don't need to learn how to stop it, you just need to learn how to manage it. And what that means, then, is: you need to learn how to let that rage and emotion out in a situation OTHER than "when you don't get the salad dressing you want."

Therapy will help, but you also may find helpful something I did when I was in college and needed a little help finding an outlet - look for a song that gets you really, really wrenchingly worked up. Get a copy of that song. Then clear a night -- preferably, the night you get the song -- and go home to be by yourself. Put that song on the music player of your choice, and set it to "repeat."

And then - let fly. Sing along, dance along, as loud and as violently as you can. Over and over again, as long as you need to. Sing until the singing starts to become screaming or crying; dance until the dancing starts to become kicking and thrashing. (If you think you really may go crazy, maybe round up a whole lot of pillows so you can kick or throw them in your rage rather than reaching for something more breakable.) Then when you start to come down from it, play another song that chills you out, and sit still, listen, and just breathe. If you feel like singing along to that (maybe the lyrics are comforting and hopeful and make you feel good), then cool. Then turn off the stereo or whatever, and do something soothing.

Do that frequently. What is happening is that all that emotion that's building up in you just really REALLY wants to come out; if you let it out this way, there's less of a chance it'll be waiting the next time you run out of salad dressing, which means there's less of a chance you'll lose it then. It'll take time, becuase you've had a LOT happen to you, but you'll get there.

Good luck.
posted by EmpressCallipygos at 9:23 AM on December 14, 2011 [1 favorite]

In addition to therapy, meditation might be really helpful. If you can find a serene place while you're meditating, sometimes you can attempt to return to that place/those feelings later when life's circumstances are affecting you.
posted by thankyouforyourconsideration at 9:25 AM on December 14, 2011

Yeah, another vote for therapy.

In particular, there are some styles of therapy that can be especially helpful for this kind of thing. My experience with EMDR (commonly used to treat PTSD, strongly scientifically supported) was literally life-changing, so I'd recommend it as a way to get into right relation with your emotions.
posted by rosa at 9:27 AM on December 14, 2011 [3 favorites]

Yes, therapy with a definite angle toward PTSD, whether that's EMDR or something else. This is what it is for.
posted by Lyn Never at 9:29 AM on December 14, 2011

Hyperarousal is an issue with the nervous system where its temporarily stuck in fight or flight mode all the time. I do not see how therapy (usually for handling deep emotional issues) is the right solution to address this matter fwiw. I am looking for more practical in the moment solutions. I have plenty of ppl to talk with about my grief and feel i am on fine footing there.
posted by TestamentToGrace at 9:29 AM on December 14, 2011

If you like the music approach described by EmpressCallipygos, check out "The Tao of Music" by Ortiz. Music can affect your emotions and moods.

I agree with the other posters that you could try therapy, although it sounds like you want something to help, right now.

If you wish to try a pharmaceutical approach and your doctor agrees, you might think about a trial of a low-dose beta blocker: it can block the surge of adrenaline and help keep you from going over the top. It is interesting that you mentioned PTSD. There is some recent work that has been done with PTSD patients indicating that beta blockers are helpful.

On a longer term basis, you might find mindfulness meditation of help. You can check other postings on this site for good resources.
posted by PickeringPete at 9:38 AM on December 14, 2011

If you are adverse to therapy (and why I can't tell, as it is exactly for stuff like this) medications are your other option. Really, there isn't much more to do. Therapy can teach you practical skills and other techniques to keep you calm.

Otherwise the medication route. Good benzodiazapams such as Ativan (short term), valium, xanax and a few others might be your other option if you don't feel like learning new coping skills. In all actuality medications can be very useful short term, but it is not going to address the under lying problem. Sorry if this isn't what you want to hear but those are your options.
posted by handbanana at 9:39 AM on December 14, 2011

From my google research this appears to be hyperarousal

Therapy helped me with ptsd. But I don't think anyone can give you advice unless you get a diagnosis from a doctor.
posted by marimeko at 9:39 AM on December 14, 2011 [3 favorites]

People are suggesting therapy because therapy is commonly used for people with issues like yours. Many of the answers refer to specific flavors that address this type of problem.

Also, your question mentions death death death as something you've suddenly had to deal with - then you claim you are on solid footing as far as grief. It's hard to come to an answer that's not therapy.
posted by Lesser Shrew at 9:40 AM on December 14, 2011

i just went back and re-read your previous post. Yes, this sounds like ptsd, I am not a shrink of any kind. If you're in a good safe supportive environment with people who care your ptsd manifestations will probably abate with time.

In the meantime, if you don't want therapy or meds, you might want to try something like yoga, or some other exercise routine every day. Get a massage every few days. Pray, meditate.

I hope you feel better soon.
posted by mareli at 9:42 AM on December 14, 2011

In addition to therapy, meditation, and physical activity keep a healthy balanced diet. The food you eat affects how you feel as well. The very intention of taking care of what you put in your body is a huge accomplishment and does wonders for your emotional state. Stay away from processed food, sugar, fried foods and select organic options of fruits and veggies and drink lavender and camomile infusions. This will all help you sleep better and is only part of the whole healing process.
posted by i_wear_boots at 10:05 AM on December 14, 2011

therapy (usually for handling deep emotional issues) - There are a lot of varieties of therapy that are focused on helping people cope in the moment, rather than trying to get at deep-seated whatever. I've had good experiences getting practical techniques from therapists for dealing with flipping out over smallish stuff. They all take practice, of course, but just having something more structured can help.

Anecdata: I was in a car crash last month. (Nothing very serious physically, but my truck was totaled.) I've been very emotionally worked up since then, and I've found that what I've learned in therapy is VERY helpful. In fact, when I did see my regular therapist, she reminded me to go look up the relaxation techniques that I already have written down. (Plus, it was an opportunity to rant, freak out, cry, etc in a totally safe space. You may also find this useful; I found it a huge relief. IME, it's a little easier to let go completely with someone who isn't part of day-to-day life.)

FWIW, "foursquare" breathing has been the most useful specific technique: breathe (from the belly) in for four counts, hold for four counts, breathe out for four counts.

I do wish I could get, and will recommend, lots of strenuous physical activity -- as much as you're able. For me, it helps to burn off the worst of the crazy-feeling.
posted by epersonae at 10:13 AM on December 14, 2011

Not to be contentious, but what you're essentially asking for here is for anonymous strangers to give you what a licensed therapist would give you, except without being able to see or talk to you, and for the most part without any training whatsoever. If you'll rely on the advice of strangers, why not seek the counsel of someone who deals with folks in your situation for a living?
posted by facetious at 10:15 AM on December 14, 2011 [7 favorites]

I do not see how therapy (usually for handling deep emotional issues) is the right solution to address this matter fwiw. I am looking for more practical in the moment solutions.

Therapy has lots of different flavors, and they're not all the psychoanalysis deep seated issues types -- many types will take a practical approach, and will work with you to figure out the best in-the-moment solutions as well as long-term fixing the problems. CBT is an option, but not the only one. But yes, this is exactly what therapy is for.
posted by brainmouse at 10:15 AM on December 14, 2011 [4 favorites]

Relaxation and mindfulness exercises may well help you out, as well as getting yourself a nice camomile tea habit. But the real answer is definitely talking it through, and maybe getting some drugs to sort it out as well.
posted by ambrosen at 10:42 AM on December 14, 2011

Hyper-arousal is a symptom. It can be a symptom of a lot of different things, PTSD among them. It is also treatable, using specific strategies that you learn from a therapist in therapy. Diaphragmatic breathing is one of those strategies, and while you can learn that in yoga or voice lessons or by playing the clarinet, therapy helps you harness that breathing and use it when you're having out-of-scale reactions to things around you. It's only one of many strategies that you may employ in working on adjusting your responses.

A lot of folks recommend CBT, and I usually do, too. But in this case I'd recommend a subset of CBT known as DBT, which focuses on helping you learn to control your emotions. There are four modules: mindfulness (awareness of what's going on around you, and what's going on inside you); distress tolerance (learning skills that help you to deal with negative stimuli without yelling at the McDonalds casher); emotion regulation (learning to control your emotions! yes, really!); and interpersonal effectiveness (strategies for interacting with others, regardless of what your mood may be). While DBT is commonly used in aiding people who suffer from BPD, it is by no means limited to BPD sufferers and is also widely used in diverse clinical settings to treat people suffering everything from depression to schizophrenia.

Yes, sometimes folks just sort of erupt, and emotions bleed out into daily life. But yelling at the cashier at McDonalds isn't ideal, and you've asked for suggestions other than medication. Most folks would say you turn to therapy before you turn to meds, and that's why you're getting so many therapy recommendations here.

It's not because people think you're broken or bad or crazy, but because a therapist can teach you valuable skills that will help you figure out the roots of these feelings and the way to quash the behaviors that come with them. You can still be super-pissed about salad dressing, but ideally you'll (a) understand that there is something else going on, (b) be aware of what it is that is happening, and (c) modify your behavior so that you don't yell or snap at people.
posted by brina at 10:57 AM on December 14, 2011 [3 favorites]

Hyperarousal is your own diagnosis of what's happening to you, right? Not the diagnosis of a professional? I ask because there's often more to symptoms than what can be seen on the surface. In my case, I experienced a condition quite similar to what you describe when I was in my late 20s and it was related to depression. Like you, I'm a pretty passive person who avoids conflict but at that time in my life, I'd fly into a violent rage if I opened the refrigerator and there was no milk in it. Given that you've had a high-stress, loss-filled year, you might allow yourself to consider that depression would be a pretty reasonable response to that. And depression can manifest in lots of ways; not being able to get out of bed is only one of them, screaming and pitching fits is another. A good therapist can help you get over this hurdle without unpacking your whole life; they can suggest strategies and coping mechanisms while dealing only with the presenting issue.

If you're really sure that this is a condition of the nervous system that you're experiencing, then you should see a medical doctor. You wouldn't hesitate if your heart were beating wildly, so don't delay just because it's another organ system that's behaving erratically.
posted by GreenEyed at 11:14 AM on December 14, 2011

I came to recommend DBT as well - I found it really effective in helping me cope with overly-strong emotions that I felt somewhat out of control with (as well as create strategies to prevent feeling overwhelmed). Even if you don't find a practitioner right away, you can always look for distress tolerance tips as ideas for what to do in the meantime. I found strategies like sticking your hands in cold water really helpful for snapping me out the emotional state I was in at the time. But I concur with everyone else who suggests getting outside help rather than trying to tough it out all by yourself.
posted by Neely O'Hara at 11:33 AM on December 14, 2011

Alright. I've made an appt with a counselor at my church. We will give therapy a shot.

But I am skeptical. Prior to my IT career switch, I worked in the mental health field and my background is in clinical psychology so I'm sort of burned out on the efficacy of clinical therapy (numerous studies show that for most clinical approaches absent an organic etiology simply discussing the issue with one's social network peers of close familiarity in a supportive environment has equal to better outcomes than that of structured clinical therapy).

Seems like the emotional support aspect of therapy I am already getting from my social network quite adequately. And the practical therapy tips (relaxation techniques, coping strategies, etc) I should be able to pick up from self-help or clinical psych literature or from those who have knowledge of it already (hence why I asked here on metafilter) without having to invest time in sitting across from a licensed therapist. I am a do-it-myself person and like to learn things from books or research whenever possible and skip the middleman.

But we will give it a shot. Certainly can't hurt I guess.
posted by TestamentToGrace at 11:59 AM on December 14, 2011 [1 favorite]

Seems like the emotional support aspect of therapy I am already getting from my social network quite adequately.

If it really were working "adequately", then you wouldn't have this problem, would you?

I don' t mean to be harsh by saying that, and I understand your reluctance to consider outside help from a therapist. But the fact that this is happening means that the emotional support you are getting from your social network -- even though it is very important -- simply may not be quite enough for the size of the problem. You need some extra help above and beyond what your social network is doing, otherwise you wouldn't be here.

You've ruled out drugs, so that leaves us with "speak to someone who's more trained in helping people with these kinds of difficulties."

And that person is...a therapist.

That honestly and sincerely is the only reason why so many people are suggesting that route. I understand your background in clinical psychology is making you think "well, hell, I don't need that," but a clinical psychologist does very different sort of work from a grief counselor. We're not suggesting therapy because "you've obviously got a mental illness," we're suggesting therapy - the grief-counselor kind of therapy -- because "your friends may be great, but they can only take you so far -- someone who does that kind of consoling for A LIVING may be able to help you get the rest of the way."

We really are pulling for you. Good luck.
posted by EmpressCallipygos at 12:09 PM on December 14, 2011 [1 favorite]

Things that worked for me during a somewhat similar period:

1. Vigorous daily exercise, the kind that leaves you stupefied. My personal favorites:

- Crazy improvisational dancing to high-energy music, both happy songs and angry songs, played at high volume. Done until I couldn't do it anymore. Bollywood works for me.

- Heavy weightlifting to similar music. Done for a challenging number of reps but not overdone, because injury is not what you need right now.

- Outdoor exercise (in the bright sun, if possible). My preference is biking hard and fast, but even a long walk at a brisk pace helps, if you can keep from ruminating as you walk.

- Hitting things hard. I split a lot of firewood during a difficult period. Tennis or squash might work as well, or one of those boxing workouts where you actually hit things.

2. Magnesium and calcium. A big bowl of steamed kale calms me down.

3. Valerian, kava, or cornsilk tea. They're all considered calming. Cornsilk makes me downright giggly. Don't overdo it--valerian supposedly increases depression if used a lot; kava might be hard on the liver. For cornsilk, buy a cob of corn and steep some of its silk just as you'd make any other tea. Packaged cornsilk is available in some health food stores or co-ops.

4. As others said, learn to watch your breathing and make sure it's deep and calming as much as possible. Plus progressive relaxation, meditation, all that.

The answer on Metafilter is nearly always "get therapy," but I've had my share of conventional therapy and understand your reluctance. I think going through your church is a great idea, so you can include your faith in the discussion, and a faith-based counselor might take an approach to grief that's more relevant for you.
posted by ceiba at 12:15 PM on December 14, 2011 [1 favorite]

TestamentToGrace: "Alright. I've made an appt with a counselor at my church. We will give therapy a shot."

Unless this counselor is licensed and has a Master's degree, I would strongly urge you to reconsider. Too often, church counselors just say things like "you're not praying hard enough" or "it's the devil trying to get you down." Even if the counseling is superficially helpful, it is not going to solve the problems long-term. I speak from experience - church counseling did not help me at all, a licensed therapist did.
posted by IndigoRain at 12:47 PM on December 14, 2011 [2 favorites]

Hmm. I normally jump on the therapy bandwagon, but I think you might actually do fine with a self-help approach first. Get on Amazon and order some books about reducing stress and anxiety; learn how to meditate; take yoga; exercise every day.

Where a therapist can help you is acting as a sort of coach as you take all of these steps. But if you don't feel you need a coach, then you might be fine.
posted by yarly at 1:13 PM on December 14, 2011

Too often, church counselors just say things like "you're not praying hard enough" or "it's the devil trying to get you down."

While I do not deny that this may have been true in your case, I am somewhat skeptical that it is universally true. As ceiba mentions, TestamenttoGrace's using someone from hir faith support network may in fact allow hir to incorporate some things which s/he already strongly believes.
posted by EmpressCallipygos at 1:26 PM on December 14, 2011

Anger is part of grief. Grief is a many-headed hydra and can strike in many places and at any time. I have received bereavement counselling. The bereavement counselling was ... not brilliant, but gave me a safe and unemotional space to talk openly and freely about the person who had died. The service I used was a voluntary one attached in some way to the local hospital, and I made a donation after the dozen or so weekly sessions were finished. It helped me in ways I was not expecting - I didn't think I needed anyone except my other half / family / friends to talk to but having a neutral third party ask some questions and reflect back on some of the things I was saying helped unblock a grief that had been bottled up for the sake of others.

Like you say, you've got nothing to lose, and you might find like I did that it did have an unexpectedly positive outcome.
posted by Martha My Dear Prudence at 2:41 PM on December 14, 2011

When I get hypervigilant or panic-attacky, I play a little game with myself called "Where Am I?" I close my eyes and use my other senses- what do I smell? what do I hear? what do I taste? what do I feel with my hands? my feet? what's going on in my body?

There is more to your sympathetic nervous system than fight or flight. It is freeze. Be still. "Where Am I?" is how I do it. It helps me focus.
posted by kamikazegopher at 2:45 PM on December 14, 2011 [3 favorites]

You may want to try Ye Olde classic, "counting to ten".

I think basically you want to distract yourself in whatever way possible long enough to let the salad dressing issue (for example) go -- physical redirection might work too. When you start to feel the teensiest bit hyper-vigilant, when the circuits start going 'she better not be telling me they're out of Thousand Island' change your focus to your stomach and the sensation you feel as you inhale and exhale and your stomach presses against your waistband, or the feeling of the breath as it leaves your nose, or start inventorying your soundings 'brown haired girl, white sweater', 'red Mazda', 'man with shirt hanging out of his pants', etc.

Anger has momentum, so you might try looking for things that screw up the momentum.
posted by A Terrible Llama at 3:19 PM on December 14, 2011 [1 favorite]

'inventorying your surroundings' was what I was going for there.
posted by A Terrible Llama at 3:20 PM on December 14, 2011

I really think you should see a physician. Radical personality changes can have organic causes, including Lyme disease, epilepsy, head injuries, tumors, etc. I realize these are unlikely, but you may want to rule them out before going to a church counselor who likely does not have these causes on her radar.
posted by Wordwoman at 3:32 PM on December 14, 2011

Having had a bout of PSD after this happend (my house is the one in the background where the firefighters are starting to go through the rubble) what you describe sounds pretty PSD to me. I only had about 2 seconds of what I'd call fear - mostly it was just that any semblance on normalcy in my little world got piddled upon long and hard. Sort of how I might feel if several people close to me had died.

For me it was therapy, talking about it with a number of my friends, and an occasionally half of a 0.25 mg Xanax for maybe a month or three afterwards, particularly when I was feeling edgy about nothing or found myself getting out of bed and "checking for Vietcong in the living room*" because there was a noise somewhere. So, anyhow, I'll be the first to agree that going on psychoactive because you feel slightly blah is a bad thing, but if your as miserable as you sound and lashing out at the people around you, I'd reconsider if I were you. It's one thing to whine about nothing, or to carpet bomb your personality with a heroic dose of something drug or another, but if your limping badly after a month, that's why they make crutches.

*Also, while I'm using the phrase in sort of a tongue in cheek way, Vietnam veterans who got home and then felt the need to check in the Vietcong in the living room for years to come seem perfectly reasonable to me. A mile in my shoes, as they say.
posted by Kid Charlemagne at 4:02 PM on December 14, 2011 [1 favorite]

I got in a pretty bad way when I smoked enough hashish to induce a weeks-long panic attack, and had to abruptly stop smoking said hashish. I hope these help you, these worked for me:

1 - NO COFFEE! NO CAFFEINE IS ALLOWED! It's subtle and more dangerous than you think!


3 - Meditation does work. It really does. See if you can't find calm times when you can get in a bit of meditation.
posted by krilli at 4:13 PM on December 14, 2011 [1 favorite]

If you're dealing with grief, then talk therapy with someone affiliated with your church may be just fine. The over-reaction, anger, crying, etc., is all a sign that you're in over your head. Take especially good care of yourself - exercise, get sunshine, eat nutritious food, take a multivitamin, and get enough sleep. Make sure you have a good balance of time with friends and quiet time.

Panic attacks can be stopped with a cold, wet washcloth to the face. There's a physiological response called the mammalian dive reflex that slows your heart and affects blood pressure. I've used it successfully. However, a visit to the doctor, and a prescription for Xanax as a coping aid for the next few months is not a terrible idea. These are not easy times, and people live in a way that we don't seem to be evolutionarily equipped to deal with. Using anti-anxiety medication on an as-needed basis is a reasonable thing to do.

You can also investigate yoga, meditation, and what I would call mindfulness breathing to help you get your body to chill. Meditation can be tricky when your emotions are so volatile, so take it slow.
posted by theora55 at 5:34 PM on December 14, 2011

I'll tell you my experience with anti-anxiety drugs just so you can have it to read in case you change your mind. I went through something similarly traumatic, where my worldview was rocked. Even though my mind kept trying to put it in context: "this is no big deal in the scheme of things, this too will pass, etc." my body was stuck in complete "omg! fight or flight! freak out!" mode, which could be triggered by almost anything. I took an anti-depressant that also worked well to calm anxiety for a few months and it was a game changer. It didn't affect my processing of the deep emotions involved at all. I was still able to grieve exactly the way I needed to. But it absolutely short-circuited those moments where my body dumped out all those excess emotions in inappropriate moments. It really is a medicine just like any other, and doesn't change anything about your personality or emotions. Just fixes the actual problem (the broken connection between the external stimulus and the internal reaction) and lets you get back to the real process of grieving.
posted by MsMolly at 9:28 AM on December 16, 2011 [1 favorite]

Just wanted to follow up and let everyone know that the stress symptoms (trigger anger and other inappropriate reactions) went away mid February on their own. I did visit my pastor at the end of Dec and seek additional consolation and advice on handling the attacks and she gave me some great practical advice for dialing things back down in the moment (some of which is similar to the advice given in this thread). I was *really* afraid I was never going to be the same again and I am overjoyed that my joy, optimism, and general happy go lucky nature has returned after a long absence. Thank you for taking the time to answer my question.
posted by TestamentToGrace at 2:58 AM on June 13, 2012 [1 favorite]

Glad to hear it.
posted by rmd1023 at 7:11 AM on June 13, 2012

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