Easily Upset, Angered, with Emotional Responses; What Therapy?
September 28, 2021 1:12 AM   Subscribe

I react emotionally to things. Most humans do, but my emotions overtake me too easily when dealing with negative feelings. I would like to understand the therapeutic treatment approach(es) I ought to be exploring and considering to improve this side of myself. Details below.

I'm in my mid-50's and realized that I react emotionally for negative emotions such as sadness, anger, hurt, and fear. When I get upset, I have a huge anxiety rush and I'm out of control emotionally. If I get angry, I'll blow my top and leave my family damaged in the process.

I don't get physically violent but do enough damage with my sharp tongue and choice of words. When I'm in this state, my words are hurtful and abusive. When I'm out of the state, I am guilty and ashamed for my behavior.

While I hope I've mellowed over the years, there are occasions each month where I react emotionally to out-of-control levels. I lose any sense of logic, so the generic tools like pausing 10 seconds, deep breathing for control, and so on aren't even on my radar. This isn't fair to my family and I want to work on this issue.

I'm currently taking Desvenlafaxine (Pristiq) and Quetiapine (Seroquel) for depression, anxiety, and OCD. Beyond the medication, I'm looking for a therapeutic approach for figuring out what's going on with me.

I'm already in therapy, working with someone on a broad array of topics (fear of abandonment, not liking myself, and so on). We've spoken about my anger/anxiety/upset issues over the years, but I don't think we're hitting the "sweet spot" of what's going on with me.

Finally, I've tried researching "anger management" courses. Not sure that's a fit; where I live in the US, those courses seem to be more of a mechanism for court-mandated anger treatment.

I believe I'm wired this way and would like to undo the wiring. I'm not seeking specific steps for improving my responses. Instead, I'm looking for feedback and suggestions on therapeutic approaches or areas where I should be researching to seek improvement as I'm new at researching this topic.
posted by anonymous to Human Relations (23 answers total) 15 users marked this as a favorite
It's often trotted out as a mental health panacea these days, but if you dig deep into a mindfulness practice, it might help over time. So, not just downloading the headspace app, but signing up for one of the 8 week MBSR (Mindfulness Based Stress Reduction) courses. It's usually 8 weeks of one evening a week, with homework to meditate daily in between, not full time.

You say that your anger comes right out of the blue, so you can't remember to use any techniques in the moment, but what this may mean is that you're oblivious to the signs that it's coming. Maybe there's a very slight quickening or shallowing of your breath, or your pulse starts to creep up, or you enter a certain specific pattern of thoughts, and bam! 10 seconds later you've lost control.

What mindfulness does is gradually train you to become more aware of your physical sensations, and your thought patterns, in real time. First you learn to become more aware of those things during a meditation. Then, the more you practice, you start to be more aware of them during every day life. Then, you start to be able to recognise them in times of difficulty or stress. Then, eventually, you're able to notice them, interrupt them, and make a different choice in your behaviour.

It's not an immediate fix, same way you wouldn't go out to run a marathon without first running round the block, doing a 5K, a 10K, half marathon, etc. But it can really make a difference if you commit to it over time, and perhaps find a supportive community of others to join you on the journey.
posted by penguin pie at 3:46 AM on September 28, 2021 [12 favorites]

Talk therapy has helped me a great deal with a similar issue, and maybe you just haven't found the right approach. Personally I found psychodynamic therapy most helpful and did not react at all well to CBT, but ymmv.
posted by branca at 4:33 AM on September 28, 2021 [1 favorite]

People I know with issues like this have found a lot of value in mindfulness (as penguin pie mentions, learning the sensations that often accompany an eruption) and learning to identify their common triggers so that they are performing self-soothing techniques, say, when they get into the car during rush hour, so they aren’t caught off-guard about being hungry and stuck in traffic. Any little bit of daylight that you can get in those responses makes other therapeutic techniques easier.
posted by tchemgrrl at 4:39 AM on September 28, 2021 [3 favorites]

Backing up penguin pie's mindfulness suggestion, meditation is not a quick fix and it's not a panacea but, done right, it's a fantastic tool to have in your mental health tool box.

Meditation and Buddhist philosophy have done a lot for me. Meditation was fine but 3 years of meditation never got me into the present moment. That happened after I started consuming books and podcasts that when more to the philosophical side of meditation.

Meditation is the formal practice of mindfulness. Of sitting, and knowing that you're sitting. So you sit, and you put your attention on your breath. Feel it go in, feel it go out, feel it go in, feel it..., I wonder what's for dinner, what did that person mean by that comment the other day, wasn't I watching my breath, feel it go in, feel it go out.

That's an excerpt of a typical session. You site and put your attention on a focus, after a bit you notice that you're distracted and you put your attention back on your focus. Repeat until the timer goes off. Meditation is not so much sitting and watching your breath as it is noticing that you've stopped watching your breath. The distraction isn't a failure, it's a thing the brain does, but noticing the distraction is victory.

This is all just repetition, exactly like doing your reps at the gym. But over time your brain is learning to pay attention. It's learning to be present and pay attention to what's happening internally. And eventually it starts to happen off the cushion too. So one day that surge of emotion hits and rather than explode you notice it, and have the opportunity to act differently.

The philosophy teaches you about stories. Specifically that all the shite going on in your head is mostly BS stories that your brain made up, and that you believed, and that are the actual source of your unhappiness. The philosophy teaches you that you don't choose your emotions, they just pop into your head out of no where, so maybe there's no reason to get so caught up in them. They're ephemera, if you don't feed them with more stories they don't last long.
posted by Awfki at 4:47 AM on September 28, 2021 [6 favorites]

Are you a person who might be going through perimenopause? If so, maybe keep a diary for a few months, see if your overwhelmed times cluster during luteal phase.

I've dealt with heightened negative emotion as part of PMS for a long time, but perimenopause has made it sharply worse. Tracking the schedule (as much as possible) helps me keep a lid on it.
posted by humbug at 5:11 AM on September 28, 2021 [4 favorites]

Are you getting enough sleep? Are you getting regular cardio exercise? Are you eating foods that help your blood sugar stay steady? These can help tremendously in stabilizing a person’s mood. You can also try practicing breathing when you *aren’t* upset to lower the overall reactivity of your nervous system.
posted by mai at 5:24 AM on September 28, 2021 [3 favorites]

If I get angry, I'll blow my top and leave my family damaged in the process.

I don't get physically violent but do enough damage with my sharp tongue and choice of words. When I'm in this state, my words are hurtful and abusive.

Can you try picturing yourself in a circumstance where your anger is triggered while you're in the presence of people more powerful than yourself - say, a boss who could potentially just fire you on the spot - and imagine (or, better still, remember) not letting fly with the sharp tongue and hurtful choice of words?

If that's something you can plausibly imagine yourself doing, then you'd pretty much be forced to conclude that the loss of self-control you exhibit around your family absolutely is a choice, and that the only reason you'd be telling yourself that it isn't one is that you've fallen into the super common human trap of believing your own bullshit.

Believing our own bullshit is really dangerous and can even wind up killing us. Something to ponder, at any rate.

When my own family has triggered white hot rage in me (doesn't happen terribly often, but definitely has done) my standard response has long been to excuse myself and leave the premises (while exerting all remaining willpower on not stomping or slamming doors on the way out) to go for a good hard walk, not returning until I've calmed down. Least said soonest mended and so forth.
posted by flabdablet at 5:43 AM on September 28, 2021 [3 favorites]

Dialectical Behavioral Therapy is an approach I think you should look into. I am familiar with it's application for emotional regulation, and specifically in people I know dealing with anger issues.
posted by wellifyouinsist at 5:56 AM on September 28, 2021 [9 favorites]

By the way, a regular mindfulness practice is super helpful as an adjunct to the process of determinedly and deliberately seeking to spot, dispute and dispel internal bullshit. The more practice you get at routinely intercepting and reality-checking your own self-talk, the less difficult it becomes to retain the ability to do so even in quite emotionally overwhelming states.
posted by flabdablet at 5:56 AM on September 28, 2021 [1 favorite]

"Finally, I've tried researching "anger management" courses. Not sure that's a fit; where I live in the US, those courses seem to be more of a mechanism for court-mandated anger treatment."

I am very close to someone who took one of those court-mandated anger management courses, even though, for them, it was not at all court-related. It was an excellent course and turned out to be very worthwhile for them.
posted by SageTrail at 7:01 AM on September 28, 2021 [1 favorite]

Mod note: From the OP:
I'm not undergoing perimenopause. My behavior has been recurring for years, regardless of sleep or diet, suggesting something hard-wired.

Finally, I have become angry with and around my boss, but the point is well taken that caution around family is advised. I'm hoping to get to a point where I can introduce enough of a delay that leaving the situation is an option.

All feedback so far has been useful and I'm grateful for the responses.
posted by travelingthyme (staff) at 7:19 AM on September 28, 2021

Seconding DBT. Where I work, we run a 24 to 30 week cycle of DBT. It can be intense, with weekly meetings, mandatory homework, and lots of accountability. You have to start at the beginning and follow through to the end of the cycle.

It starts with 2 weeks of mindfulness training, followed by 6 to 8 weeks of Distress Tolerance, then 2 more weeks of mindfulness, then 6 to 8 weeks of Interpersonal Effectiveness (relationships and communication), then 2 more weeks of mindfulness, and finally, 6 to 8 weeks of Emotional Regulation. It has been shown to be highly effective in helping people make the changes they want and then maintain over time.
posted by SamanthaK at 7:23 AM on September 28, 2021 [3 favorites]

Did you undergo extensive trauma as a child? Or have no outlet or voice for difficult things that happened?

Both my primary parent and a former friend were like this as a result of unresolved trauma where they had no voice or outlet for said trauma. The trauma continued for both of them over many years. In both situations, others were aware of said trauma but did not do anything other than pretend it did not exist or that it was not happening.

Any repeat of anything that reminds them of said trauma (such as being ignored, invalidated or not listened to) or any bad moods would cause them both to react in a similar manner to yours.

Consider your feelings or emotions that happen in the days, hours and moments before those responses.

For example, a former friend reacted very negatively to me leaving a job where we met because she thought I was abandoning her and spent many hours trying to convince me to stay.
posted by Ms. Moonlight at 8:05 AM on September 28, 2021 [3 favorites]

To add: the therapy you may seek may have to be trauma based if this is the case. Either a talking or a body/feeling therapy like Somatic experiencing.
posted by Ms. Moonlight at 8:07 AM on September 28, 2021

I have become angry with and around my boss

The point is to compare the kind and amount of withering verbal abuse you directed at your boss when that happened against the amount you directed at the last family member you became angry with, and work out whether there was a meaningful difference between the two. If there was, that gives you evidence that there is some kind of gap between anger and response into which you can begin to work the thin end of a conscious choice wedge.

The anger itself will never be under conscious control, because that's just not how emotion works; there's no point wasting time on looking for ways to exert conscious control over emotion per se. But in all likelihood you can improve your ability to exert conscious control over the behaviours you perform while in the grip of that emotion and really, those are the only thing that affect people other than you.

And to the extent that part of those behaviours include internal self-talk, you can learn to modify that in ways that avoid re-triggering the anger. If you get really good at that, you could wind up with anger that lasts only as long as your body's physiological response to it dictates: about 90 seconds on average.
posted by flabdablet at 8:45 AM on September 28, 2021 [4 favorites]

Here's my best layperson understanding of what can be going in situations like this (and apologies if you already know this; skip down to the part where I talk about a book): our bodies respond to threats by surging with hormones like cortisol and adrenaline. Back when the threats were lions or falling out of a tree, this gave us some extra juice to run, fight, or pull ourselves back up. Nowadays the most common "threats" (which is to say, stressors) aren't lions or tigers, but traffic, squabbling kids, a boss who treats you unfairly, a spouse who is upset because you left your socks on the floor, etc. So our bodies might surge with these hormones (you may have heard of fight/flight/freeze/fawn), but then they have nowhere to go, and they manifest as anger, shouting, etc.

It's especially common to have these reactions when there's a childhood experience of trauma, abandonment, neglect, etc. Which is to say, you may have faced some real threats and dangers as a child, and your body learned to be incredibly sensitive to any kind of perceived threat. As a child, this was an adaptive behavior that kept you safe. Respectfully, I'm not sure you are wired this way unless that means you learned this behavior as a protective mechanism early in life. Which means you can work to change the wiring.

Because now, that adaptive behavior isn't serving you well. In fact, it's hurting you and those you love. Your mind and body are screaming "DANGER!" at you when the threat is minor, and then you have an oversized reaction.

The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma is a book written by a talented psychiatrist and researcher that looks at the long-term impacts of trauma and suggests other than just therapy for dealing with your trauma and how it's manifesting in your life now. I haven't read it yet (it's sitting on my coffee table), but this interview of the author, Bessel van der Kolk, on the Ezra Klein show was excellent, and what motivated me to buy the book. He also talks quite a bit about shame (which you mentioned experiencing), and how that shame can keep us from being in community with others and healing.

van der Kolk has suggestions that aren't therapy. He talks about (based on the podcast interview) how we need to reconnect our bodies and minds, often through physical activities, often in community with others. As I write this, it sounds a bit woo, but this is a research-based approach to trauma and he's a well-regarded doctor of psychiatry.

Listen to the podcast, and see if it resonates, and then buy the book if so. You could talk to your therapist about this, or perhaps find one who focuses on trauma. I do wonder if part of your shame reaction is keeping you from being fully truthful with your therapist about the anger and yelling that's going on, and, if so, perhaps the podcast and book will help you on a path to move past that and learn to rewire your brain and body.
posted by bluedaisy at 1:37 PM on September 28, 2021 [5 favorites]

One thing to look into may be Rejection Sensitivity Dysphoria. The medications that treat it are supposed to help open up that space where there could be time to apply a technique.
posted by Former Congressional Representative Lenny Lemming at 4:27 PM on September 28, 2021 [1 favorite]

Left-field suggestion based on my own experience, but have you considered something like ADHD?

Anxiety, depression, getting "out of control emotionally" and then later feeling "guilty and ashamed for my behavior" are all things that can associate with ADHD. OCD possibly too. "Fear of abandonment" might also chime with RSD as Former Congressional Representative Lenny Lemming mentioned, which is also an ADHD thing.
posted by Pink Frost at 4:46 PM on September 28, 2021 [2 favorites]

Yes - see an anxiety specialist who will screen for things ADHD and ASD as well as everything else
posted by Flitcraft at 5:19 PM on September 28, 2021

Mod note: From the OP:
Thank you for everyone for your responses. I'm so glad I asked and appreciate everyone's considered feedback.

Currently I'm in process of searching for DBT-based programs in my area. Seems popular, so I may be delayed in getting started but I'm committed to personal improvement.
posted by loup (staff) at 1:59 PM on September 29, 2021 [1 favorite]

Sorry I missed it, but scrolled down to say: Go straight to DBT, do not pass Go. If you are working to find a practitioner, in the meantime, this book is an excellent guide - do the exercises.
posted by Miko at 9:02 PM on September 29, 2021

I also have a hair trigger temper. I know that I have some modicum of control over it because I've never broken anything at work, but I've come close. (I tend to smash things and slam doors and stuff when I'm seeing red (literally). I am also ashamed of it.) I'd like to second the suggestion to get screened for ADHD. There's something about the ADHD brain (rejection sensitive dysphoria is part of it) that our emotions are bigger and faster than most people's and can completely overwhelm us. Some people find alpha agonist drugs helpful in regulating this aspect of ADHD.

(Also if the bit above about most people's anger lasting 90 seconds made you laugh, that is further reason to get screened for ADHD. Especially by someone who understands ADHD in women. When I get angry, it can take me 3-4 hours to calm down again. That is not a personal failing--it's literally how my brain is wired.)
posted by purple_bird at 9:22 AM on September 30, 2021

When I get angry, it can take me 3-4 hours to calm down again. I have ADHD too, and often experience these heightened, lingering emotions... and I do think it's related to the stress hormones I've mentioned above. purple_bird, if you haven't, I want to suggest that, in a period of high emotions like this, try doing some movement and muscle contractions (even just squeezing your fists and releasing them while breathing slowly--that's what my therapist recommended for situations where I couldn't jump up and down, take a walk, etc). I think it helps our bodies use and process all those extra hormones flooding our system, because we are having a physical reaction to a stressful emotional situation. Maybe you've tried this already, but if not, maybe it could help a bit? I don't mean right in the moment, but when it's 20 minutes later and the situation is semi-resolved but you still feel agitated.
posted by bluedaisy at 10:32 AM on September 30, 2021 [1 favorite]

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