Welcome my name’s Leanne Humphreys and today we’re speaking with Professor David Forbes who’s the Director of Phoenix Australia. We’ll be talking about the experience of anger in the aftermath of disaster. This recording is just a brief summary of the relevant points so for those of you who’d like to understand more about the topic please feel free to explore the materials and the resources on the page.
Hello David thanks for joining me for this conversation.
David: Thanks Leanne, thanks for having me.
Leanne: David as well as being an international expert in trauma and disaster and post-traumatic stress disorder, you’re also a clinician you’re a clinical psychologist who has extensive experience in the assessment and treatment of mental health problems following trauma and I know you have a particular interest in the issue of anger. So David, can you tell us, is anger a prominent issue in post-disaster presentations?
David: Look, thanks Leanne. Look yeah, anger is very common and prominent post disasters and in terms of why, you know in the short term these feelings are prompted obviously by the perception of threat, resulting in a high arousal state, which can be really adaptive in terms of mobilizing us for action to be dealing with the threats or the stresses.
But apart from the threat itself of the disaster your anger post disaster also can be driven by a sense of unfairness about what happened the losses and suffering that it’s caused and sometimes how the events have actually been responded to.
Secondarily it can also relate to what we call the secondary stresses of disasters, which is the stresses associated with the consequences so rebuilding homes, dealing with administrative processes, insurance, dealing with insurance processes, other stressful consequences.
So when we see that you know angers are as a result of disaster. One is the threat, two is also what happened as a consequence but also then dealing with the subsequent stresses that is that resolve out of it.
Leanne: Right, right so given that it’s common, when does it tip into being a problem?
David: It is a natural reaction and it’s common and it becomes the problem really when the person feels it very often.
They feel it very intensively or explosively or if it lasts a long time. And it starts, and when it starts to interfere with their personal relationships, with their social relationships, with their work, with their study, interfering with their function.
On average you know what we know from research is on average after a disaster about 10 percent of people will experience anger at problematic levels like I’ve just described.
It’s also a significant concern because problem anger is associated with increased risk for aggressive behaviours and also for suicidality as well.
On the, on this platform, you’ll be, the viewers will be able to see something called the DAR-5 or the dimensions of anger reactions five and that’s a brief scale that actually has five items and a score of twelve or more on the DAR-5 is a good indicator of problematic anger levels.
So that might be useful for clinicians as well to be used.
Leanne: Okay, okay, folks with anger can also be hard to engage with treatment so can you tell us a little bit about that?
David: Look that, that is true. That folks with anger are often harder to engage in treatment than folks for example with anxiety, depression or indeed straight out PTSD.
Anger is an outward facing emotion, and those who are experiencing anger are often – see the other external events as the drivers of their anger and less is something they need to necessarily work on within themselves.
Perhaps less awareness of the distress it’s causing them or they’re causing others and more really focused on those external events. And often can be brought into therapy by others who are experiencing the consequences of their anger rather than necessarily seeking treatment themselves.
So a really important part before we even get onto the interventions in anger, is being able to provide in people, information about anger to help them understand its adaptive and its maladaptive components, the pros and cons of anger if you like to help shift people’s awareness and motivations towards seeing anger potentially something that they need to work on if indeed it is at those problematic levels and it’s interfering with their life.
Leanne: Okay so I guess that leads into interventions what are, what are the most helpful strategies that mental health practitioners can employ?
David: Look thanks for that. The first strategy is because it’s an outward-facing emotion is in working on self-monitoring.
Again people with anger are often less aware of the fluctuations in their anger than people who experience anxiety, depression might be. So getting people to monitor their anger over the course of the day, what are their cues and triggers, when in the day is it more elevated than others so they get a sense of their own personal signature of anger if you like.
Then around interventions it’s important to be able to be starting with brief intervention so a person can get relief and feel that that their anger is safe in the first instance. And those brief interventions can be physical interventions like controlled breathing or isometric muscle relaxation exercises, they can be cognitive like self-talk or calming self-talk, self-statements and they can also be behavioural for things like for example timeout strategies where the person gets a cue – I know when I feel a certain way just to withdraw from that situation in order to feel a sense of safety for them and others around them.
The short-term strategies are important to build on those they build a lot of confidence but really important is also continuing to work on the longer term strategies about dealing with the themes and beliefs that are underlying the anger in a cognitive sense more generally.
Changing kind of life behaviours to lower baseline physiological levels of arousal through relaxing and productive activity and other emotion regulation strategies more broadly.
Leanne: Okay thanks David that’s really clear.
For those of you who are interested please feel free to have a look at the materials and the resources on the page and we hope you find them helpful.
David: Thank you Leanne.