There are three aspects / functions of the autonomic nervous system (ANS) 

• Co-regulation

Our biological need to be connected to other human beings or other mammals

• Neuroception

This is the process of taking in cues of safety / danger from the environment; this process operates below the level of conscious perception; it is always functioning in the background. We need to bring conscious perception to our neuroception, and to have an awareness of our ANS hierarchy.

• Hierarchy (traffic lights model) 

red traffic light

(the most primitive part of the ANS; reptilian; immobilised with fear)

examples of physiology:

• decreased heart rate and blood pressure (perhaps fainting), decreased energy – shutdown, exhaustion, chronic fatigue, sleepiness; muscles floppy, low tone, facial expression – pallor, lengthened muscles and lacks expression; voice – quieter, lacking in tone and emotional content; hearing – can’t focus on the human voice, sounds not registered

examples of feelings:

• helpless, despairing, abandoned, shut down, alone, powerless, ashamed, unreal, empty, unworthy, blank, no motivation, depressed, cold, futile, rejected

examples of behaviours:

• submission, grovel, don’t resist, don’t do anything, take the blame, be the victim, be helpless, numb emotions, don’t stand up for self, self-sacrifice / martyr, silent, apologise for everything, appease, show you’re not a threat,

life position

You’re OK – I’m not OK and/or I’m not OK – You’re not OK

amber traffic light

(next oldest part of the ANS; vertebrate; fight/flight – mobilised with fear)

examples of physiology

• increased heart rate and blood pressure, increased restlessness, can’t wind down or relax, agitated, muscles are tense and tight; facial expression – blushing, taut and inflexible; voice – louder, monotonous and strident; hearing – cannot focus on human voice, sounds are overwhelming

examples of feelings

• angry, fearful, edgy or on the edge, panicked, out of control, manic, confrontational, nervous, hot, crazy, anguished, wanting to run, tormented, belligerent, hot rage

examples of behaviours

• demanding, shouting, screaming, kicking up a fuss, fighting to defend territory or integrity, running away, rigid boundaries, escalating emotion, threaten, attention seeking, use emotions Vs words to attract help, avoidance

life position

• I’m OK – You’re not OK 

green traffic light

(newest part of the ANS; mammal; social engagement – mobilised or immobilised without fear)

examples of physiology:

• normal heart rate with good heart rate variability and normal blood pressure; energy – normal; muscles – relaxed; facial expression – flexible, nuanced; voice – volume is normal and appropriate, has good tone and emotional content; hearing – can tune out background noise and focus on human voice
• examples of feelings
• safe, secure, connected, loving and loved, curious, playful, in the flow, OK, encouraged, competent, calm, belonging, appreciative, funny, open hearted
• examples of behaviours
• pro-social, friendly, sociable, mutuality, give and receive help, communicate well, genuine apology, appropriate expression of emotion, team player, accurate reality checking, problem solving, learning
• life position
• I’m OK – You’re OK

We are all in and out of these three states, often on a daily basis; it is helpful to become aware of, to ‘map out’ the feelings, thoughts, behaviours and life positions operate in each of the three states so that we can assist ourselves to be able to ‘come home to green’.

Historical experiences (trauma) can prevent us from going home and cause us to get stuck in amber or red states.

COVID-19 is challenging our biology.

Our ANS (not our brain) is running the show. 80% of information flows from the body to the brain, ‘bottom up’ where the brain makes up a story.

Looking at the same situation (paying a cheque into the bank during COVID-19) through the lens of the three different states, we will always have three stories e.g.

red traffic light

“what’s the point?” “it doesn’t matter, forget it”.

amber traffic light

“I won’t be able to pay my bills, I’ll be in overdraft”, “I’ll be bankrupt”

green traffic light

” I’ll work it out”, I’ll put it in the post”’ “I’ll find out what my bank is doing at this time to help customers”

It is helpful to become familiar with our ANS; to be curious about what pulls us into red or amber states. To be compassionate with ourselves, to identify the trigger and what needs to happen to change our state and return us to green. It is a good idea to practice, when we are running a story in red or amber states, to ‘check in’ with the other two states’ stories. 

We can become skilled in noticing our state, and state changes, by noticing cues; the nature of the story we are telling ourselves; how we feel, what’s our attitude, how hopeful/hopeless do we feel/ how competent/incompetent do we feel? l How much energy do we have? Are we agitated, flopping or settled and balanced?

Whilst sheltering at this time can feel good, we need to maximise our safety cues; what uniquely makes mefeel safe? This is different for different people; and we need to minimise danger cues. Watching the news can be a safety cue for some people (green) but a danger cue for others (amber/red); similarly, socialising on the internet can feel safe and connecting for some people (green) but agitating (amber) or overwhelming (red) for others.

This is an opportunity to befriend our ANS; to become more deeply connected to our bodies and better able to attend to, and care for, our ANS as we connect to family, friends and clients. It could be helpful to ask ourselves in any situation, “is this fitting for my ANS? Do I

• Accept it?
• Adapt it?
• Reject it

 Our green state is challenged during COVID-19; survival fears take us out of green so we can’t connect with others; being isolated reduces our opportunities to connect with others. Usual ways of connecting are gone. He choice to position ourselves on this continuum taken away from us

SOLITUDE——————————————–SOCIAL CONNECTION

 It can be frightening to have

• no context – unpredictable, end unknown which triggers us into a similar level of survival.

• limited choices – presently, severely limited; ANS senses danger; in our amber state we can feel trapped and experience the need to DO something or experience a collapse on our red state.

It is biology that drives our stories; attempting to change our story is not as effective as changing our state. We need to change our state before changing our story. I would add, that changing our state naturally changes our story.

Nuggets

• Talk about ‘biology’ not body – “how is your biology responding?”
• Prioritise creating safety and stability
• Find some green anchors; things that feels nourishing / soothing (e.g. human, animal, aesthetics, nature). The idea of ‘who’ ‘what’ ‘where’ and ‘when’ e.g.
  • who – a person / pet (in person or in mind);
  • ‘what’ – a behaviour, an object that comforts;
  • ‘where’ – a remembered / imagined place or actual place in home;
  • ‘when’ – a memory
• Notice the glimmers (tiny green experiences) and build of them; 20-30 seconds of green experience is constructing new neural pathways.
• Sending out and receiving glimmers e.g. an emoji / meme / very brief ‘thinking about you’ message.
• Be aware of our environment and optimise it for safety cues
• Being at home can involve a deeper level of intimacy with ourselves which we need to come to terms with.
• The need for us to be regulated; any environmental clues that cause a change of state need to be noticed, named and addressed if necessary, in order to help us regulate ourselves. Naming what has happened out loud is welcomed by the ANS, it is the opposite of trauma which goes unseen and unacknowledged.

Based on

Deborah Dana’s work, The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation, 2018, New York, Norton & Norton

Carolyn Spring’s work, Working with Shame, an online training, 2020

Sue Parker Hall’s work: Anger, Rage and Relationship, 2008, London, Routledge

I am relational psychotherapist with over twenty years experience and I’m passionate about us moving beyond binary thinking about gender to a place where we can see each other as unique human beings.

My experience has shown me that, given a non-judgmental and empathic environment where cultural and familial psychological defences can be put aside, men and women both suffer, face the same existential issues and have human relational needs.

If all of us are to be liberated then we need to recognize that all possible personal characteristics exist in both sexes. For example, if there is to be true equality, both men and women need to allow themselves to

• have equal access to all emotions
• be strong and vulnerable
• be protective and protected
• be out in the world or at home
• support and be supported

Since the 1960’s feminists have drawn our attention to all the ways in which they perceive women to be disadvantaged and to suffer inequality. There are many ways in which men experience inequality which go mostly unnoticed e.g. mental health and physical health (including rate of suicide), expectations to do dirty and/or dangerous jobs, shorter life expectancy, inappropriate school curriculae and being most likely to be estranged from their children.

Since 1995 I have researched the issues of rage and anger and have developed therapy models for understanding and working with them. I am author of ‘Anger, Rage and Relationship: An Empathic Approach to Anger Management (2008, Routledge). I have a particular interest in intimate partner violence (IPV), the defining and treatment of which has, in my opinion, been over-influenced by feminist ideology rather than evidence based practice. Men are assumed to be the aggressor when research has consistently shown similar levels of violence in both sexes and that the majority of IVP is co-created. I have no doubt than men under-report IPV; those I have worked with in my psychotherapy practice have often not realized that they are being abused and have said very matter-of-factly, ‘but that’s what relationships are like!’

I have found many cult-like qualities operating in the Integrated Domestic Abuse Programme (IDAP), the commonest state-funded intervention for IPV; I conceptualise it as an instrument of thought reform, more commonly spoken of as ‘brain washing’. The men I interview who have attended these programmes describe a regime of humiliation, punishment and retribution that bullies them into change (which is superficial and cannot be sustained).

Through my research I have identified a double standard operating here; ‘treating’ men for IPV is not governed by any of the usual quality and outcome standards required by for example NICE or other psychotherapy, counselling or psychology professional bodies’ guidelines. Billions of dollars worldwide is spent on these interventions that my, and others’ research has consistently found to be ineffective and to shame men rather than offer them a compassionate environment that could support long term and stable change.

I am sure that if women were being treated in this way there would be uproar and it would be recognized for the Human Rights issue that it is.

I am uncomfortable that men are being treated badly and I cannot remain silent about it. I am grateful to an inexhaustible list of men, who have done an inexhaustible list of good deeds in my life and who have been kind, protective, supportive, taught me and generally enriched my life including

• my father
• my brother
• my husbands
• fathers to my children
• my teachers in school and university
• my GP
• babysitter for my children
• actors & musicians
• those who have listened to my problems and given me help
• those who have listened to me when I’m on my soapbox about something
• those who have encouraged and appreciated me being me
• he who introduced me to sailing
• those who let me use the bathroom first
• helped me change my wheel at the side of the road
• picked up lambs that were in the road in front of our car and put them safely back in the field
• have opened doors for me
• have treated me to meals and drinks
• have shared housework, cooking and child care – often after having worked all day
• gave me a lift home when I missed the last bus
• who have entrusted me with their vulnerability

It occurs to me that all these deeds (if you substitute mother for father, sister for brother etc.) can be done by either sex but men did them and I thank them for that.

I’m heartily tired of the battle between the sexes; in my opinion, if we are to have healthy nurturing relationships with each other, whatever our sex, we need to respect our own sex and that of others equally.

In my experience as a therapist, thinking badly about another person or group of people is usually rooted in our own insecurity and lack of respect for ourselves; we elevate ourselves by degrading others. As human beings, we all have so much to offer each other; if we can cultivate a high regard for both sexes, rid our culture of misogyny and misandry, we create an environment where all can flourish and everyone is set free to live to their full potential.

The high expectations we can have of Christmas, the requirement to spend more time with people we may struggle to get along with at the best of times and stepping outside of a routine which normally keeps us steady, can be very unsettling to say the least.

If rage is an issue for you at this time then, paradoxically, the greatest gift you can give yourself and those around you is to take very good care of yourself.

Take the time to think about what kind of Christmas do you want? How much time do you want to spend with person A, person B and how much time do you want to spend on your own?

People who struggle with rage issues tend to find all relationships challenging; their organism is so stressed that they don’t experience human encounters as supportive but as making demands on them which they cannot fulfil. For this reason, alone-time is vital, an opportunity for the body to, at the very least, not experience more stress and at best to relax a little.

Another element of Christmas self-care is to regularly communicate feelings to at least one other person; reflecting on and describing with words what is going on inside to another human being has the effect of softening and relaxing us, making space where there was previously none.

While Christmas is a time for giving anyone can become rageful if they give too much of themselves away; resentment is never far away if you are pleasing everybody else and neglecting yourself. Most people aren’t mind readers and if you are not asking for anything – time out, another slice of turkey, a mince pie, a go on the video game, help with prepping the veg or washing up – others will assume you are happy and may not volunteer.

Ask and you have a better chance of receiving!

For more information about leading UK anger specialist, Sue Parker Hall’s work kindly visit http://empathic-anger-management.co.uk

on the third and final day of my ‘Anger & Rage Personal Therapy Retreat for counsellors and psychotherapists we were talking about the inner critic…..….

– firstly…..we came to more deeply understand it’s care taking role in the face of trauma….how it keeps our innocent original self protected from any further aggression or neglect; how it is benevolent as well as aggressive….Donald Kalsched in his book ‘The Inner World of Trauma’ uses the concept of a Daimon (angel and demon….see photo) to describe it’s benevolent and malevolent nature…….

Here are a few of the differences between shame and guilt that I have identified and which I find useful to keep in mind while I practise……..

SHAME Vs GUILT

what I think others will think about me Vs what I think about myself

relationships with myself and others are ruptured Vs I maintain relationships with both

pre-separation and individuation developmental stage Vs post-separation and individuation developmental stage

Child ego state Vs Adult ego state

involves the psychological defence of splitting Vs involves whole of self

I have been researching the issues of anger, rage & shame for 20 years…please come along to my London nd Manchester trainings in November

Anger, Rage & Relationship (LONDON)

Friday and Saturday 6th & 7th November 2015

The Link between Rage & Shame (LONDON)

Sunday 8th November 2015

Anger, Rage & Relationship (MANCHESTER)

Friday and Saturday 20th & 21st November 2015

The Link between Rage & Shame (MANCHESTER)

Sunday 22nd November 2015

The difference between managing a symptom and transforming it can be explained by talking about ‘first order change’ and ‘second order change’ as described in Andrew D. Solovey and J. Scott Fraser‘s book, Second-Order Change in Psychotherapy: The Golden Thread That Unifies Effective Treatments (2007).

First-Order Change

Solovey & Scott Fraser: ‘solutions that do not change the problem but that create stability’

Sue Parker Hall: ‘a goal set and achieved which is already in the client’s existing frame of reference; management Vs transformation; not sustainable under stress conditions.

Second-Order Change

Solovey & Scott Fraser: ‘resulting in a resolution of the problem’

Sue Parker Hall: ‘an outcome which is beyond a person’s existing frame of reference, that cannot be imagined at the outset of therapy; the difficulty is transformed through processing the underlying emotional cause of a client’s difficulty; sustainable under stress conditions’

Sue Parker Hall’s Empathic Anger, Rage & Shame trainings

for counsellors and psychotherapists…..come and join me!

Anger, Rage & Relationship (LONDON)

Friday and Saturday 6th & 7th November 2015

The Link between Rage & Shame (LONDON)

Sunday 8th November 2015

Anger, Rage & Relationship (MANCHESTER)

Friday and Saturday 20th & 21st November 2015

The Link between Rage & Shame (MANCHESTER)

Sunday 22nd November 2015

For many of us, shame was and still can be a crucial survival mechanism; it keeps us safe by propelling us to hide aspects of ourself that would not be approved of by the folk who we depend on. In our shame state we cannot connect with ourself, we have trouble self-referring and the following aspects of us go into hiding-

– thoughts and feelings (we may look to others to tell us or show us what to think and how to feel)

– wants and needs (“what would you like?” or “what do you need?” are trick questions)

– imagination, creativity, joy and playfulness (our organism needs to feel safe, secure and unself-conscious to enter these dimensions).

Shame is an unconscious process and therefore operates our of awareness. We need the help of another to bring it to consciousness. It’s really important that therapists can identify shame; how it manifests in individuals and the impact it has on a person’s capacity to process information and emotions, their self-concept and relationships.

In my opinion, it is helpful for therapists to have a definition of shame so that they and their clients can become more conscious of it; further, it also helps to have an agreement for both parties to name it when they suspect it may be operating in the room.

Psychologists and psychotherapists agree that an increased awareness of the presence of shame helps a person to put some distance between the phenomenon and themselves; to objectify the experience. Psychologists would typically say that when we a gain a little space from our shame we can choose our response to it. This is a top-down, cognitive approach. As a relational psychotherapist, I take a bottom-up, expressive approach.

From my practice I have come to believe that it is important to use the objective space, not to increase the distance between me and my shame but, to allow myself to

– get closer to it

– express it and

– release it

When the other feels met and understood in their shame they release it. This is not a one off process and shame is typically revisited numerous times as therapy progresses; on each occasion that shame is felt, named and met by the other, it is released and previously hidden aspects of the person (for example their true feelings, thought and desires) come out of hiding.

Examples of empathic interventions that have helped my clients to stay with their shame long enough to transform it are

– “that sounds excruciatingly painful” or

– “that feels really shitty” or

– “you are covering your face and look like you want to disappear”.

We can manage shame by choosing a different response or using strategies to push it away but we can only transform shame when we experience it deeply and communicate it’s impact as accurately as possible to an empathic other. There is a well known therapy maxim which I have yet to reference ‘shame does best in the dark’. When the depth of disturbance and distress that the shameful person is experiencing is reflected back to them, their organism softens and they release it. In relational psychotherapy, the co-created relationship is not only the crucible or environment in which shame is transformed, it is also the means by which it is transformed.

It is only safe to come out of hiding when shame is released.

Details about

– my 2 day Anger, Rage & Relationship training for counsellors and psychotherapists can be found here (LONDON) 30th & 31st October 2015 and here (MANCHESTER) 20th & 21st November 2015

– my 1 day The Link between Rage & Shame training for counsellors and psychotherapists can be found here (LONDON) 1st November 2015 and here (MANCHESTER) 22nd November 2015

Anger & Rage Personal Therapy Retreat, exclusively for qualified counsellors or psychotherapists in Stroud, Gloucestershire here 27 / 28 / 29 November 2015

]]> https://empathicangermanagement.wordpress.com/2015/05/15/hiding-in-shame-when-is-it-safe-to-come-out/feed/ 0 empathicangermanagement shame behind a tree https://empathicangermanagement.wordpress.com/2015/03/06/why-im-campaigning-for-j4mb/ https://empathicangermanagement.wordpress.com/2015/03/06/why-im-campaigning-for-j4mb/#respond Fri, 06 Mar 2015 22:41:27 +0000 http://empathicangermanagement.wordpress.com/?p=308

I am a relational psychotherapist with twenty years experience and I’m passionate about us moving beyond binary thinking about gender to a place where we can see each other as unique human beings.

My experience has shown me that, given a non-judgmental and empathic environment where cultural and familial psychological defences can be put aside, men and women have more similarities than differences; they have identical relational needs and experience themselves, each other and the world in very similar ways.

If all of us are to be liberated then we need to recognize that all possible personal characteristics exist in both sexes. For example, if there is to be true equality, both men and women need to allow themselves to

• have equal access to all emotions
• be strong and vulnerable
• be protective and protected
• be out in the world or at home
• support and be supported

Since the 1960’s feminists have drawn our attention to all the ways in which they perceive women to be disadvantaged and to suffer inequality. There are many ways in which men experience inequality which go mostly unnoticed e.g. mental health and physical health (including rate of suicide), expectations to do dirty and/or dangerous jobs, shorter life expectancy, inappropriate school curriculae and being most likely to be estranged from their children.

Since 1995 I have researched the issues of rage and anger and have developed therapy models for understanding and working with them. I am author of ‘Anger, Rage and Relationship: An Empathic Approach to Anger Management (2008, Routledge). I have a particular interest in intimate partner violence (IPV), the defining and treatment of which has, in my opinion, been over-influenced by feminist ideology rather than evidence based practice. Men are assumed to be the aggressor when research has consistently shown similar levels of violence in both sexes and that the majority of IVP is co-created. I have no doubt than men under-report IPV; those I have worked with in my psychotherapy practice have often not realized that they are being abused and have said very matter-of-factly, ‘but that’s what relationships are like!’

I have found many cult-like qualities operating in the Integrated Domestic Abuse Programme (IDAP), the commonest state-funded intervention for IPV; I conceptualise it as an instrument of thought reform, more commonly spoken of as ‘brain washing’. The men I interview who have attended these programmes describe a regime of humiliation, punishment and retribution that bullies them into change (which is superficial and cannot be sustained).

Through my research I have identified a double standard operating here; ‘treating’ men for IPV is not governed by any of the usual quality and outcome standards required by for example NICE or other psychotherapy, counselling or psychology professional bodies’ guidelines. Billions of dollars worldwide is spent on these interventions that my, and others’ research has consistently found to be ineffective and to shame men rather than offer them a compassionate environment that could support long term and stable change.

I am sure that if women were being treated in this way there would be uproar and it would be recognized for the Human Rights issue that it is.

I am uncomfortable that men are being treated badly and I cannot remain silent about it. I am grateful to an inexhaustible list of men, who have done an inexhaustible list of good deeds in my life and who have been kind, protective, supportive, taught me and generally enriched my life including

• my father
• my brother
• my husbands
• fathers to my children
• my teachers in school and university
• my GP
• babysitter for my children
• actors & musicians
• those who have listened to my problems and given me help
• those who have listened to me when I’m on my soapbox about something
• those who have encouraged and appreciated me being me
• he who introduced me to sailing
• those who let me use the bathroom first
• helped me change my wheel at the side of the road
• picked up lambs that were in the road in front of our car and put them safely back in the field
• have opened doors for me
• have treated me to meals and drinks
• have shared housework, cooking and child care – often after having worked all day
• gave me a lift home when I missed the last bus
• who have entrusted me with their vulnerability

It occurs to me that all these deeds (if you substitute mother for father, sister for brother etc.) can be done by either sex but men did them and I thank them for that.

I’m heartily tired of the battle between the sexes; in my opinion, if we are to have healthy nurturing relationships with each other, whatever our sex, we need to respect our own sex and that of others equally.

In my experience as a therapist, thinking badly about another person or group of people is usually rooted in our own insecurity and lack of respect for ourselves; we elevate ourselves by degrading others. As human beings, we all have so much to offer each other; if we can cultivate a high regard for both sexes, rid our culture of misogyny and misandry, we create an environment where all can flourish and everyone is set free to live to their full potential.

I will be supporting J4MB in Nottinghamshire for many reasons. I have long campaigned for a non-gendered approach to domestic abuse where it is understood to originate in traumatised individuals who need a therapeutic intervention rather than in sexist men who wish to dominate and control women and who need to undergo a thought reform programme. I wholeheartedly embrace J4MB’s approach to this issue.
Further, I don’t want to live in a society that is not sufficiently pro-men, where indifference or hatred towards men is embedded in a dominant ideology that denies or demeans their humanity and dignity and is blind to their human rights. There is no doubt in my mind that it is possible for both sexes to be respected and have their needs met; it does not need to be either/or, where one group wins and the other group loses.

Finally I am delighted to campaign for a political party that mentions ‘love’ in their strapline. Love is not a fluffy, romantic concept for me, it’s a robust phenomenon that bonds us together, that changes ‘me’ and ‘you’ into us; it’s about growing and healing together and harnessing our goodwill, creativity and potential to form a synergy where we can all thrive.

Please visit the Justice for Men and Boys website

‘an untold story; an emotional response to life experience, whether of epic or apparently trivial proportions, which has not yet been processed’ (Parker Hall, 2008).

Janet (1907) defines trauma simply as

‘there was nobody there’.

I take this to mean there was literally nobody there, or that whoever was there couldn’t help because they were also traumatised or because they were an abuser. I extend this to more subtle organismic disturbances including carer misattunement (experienced as ‘there was nobody there’ who saw me) as well as in-utero, birth and trans generational forms.

Trauma is always a shock to the body and mind, it is unanticipated and cannot be defended against. We are porous when it strikes; there is no separation between the impinging hostile environment and ‘me’ (see ‘the creation of shame’ model below). In that moment I become imprinted with the bad environment and consequently become ‘bad’. If the trauma is not processed, I can remain ‘bad’ for decades. In my practice I have consistently noticed that the first response to a trauma is “what did I do wrong?” This inability to understand that ‘something bad happened to me’ rather than ‘I’m bad’ is shame. I use the models below to explain to clients how shame occurs and how to recover from it.

My present working definition of shame is
‘an emotionally and sometimes physically painful affective state caused by the initial impact of any kind of pre-conception, pre-natal or postnatal experience of an environment that is hostile or failing (trauma); it is experienced personally, as a ‘fall from grace’. Shame ruptures the relationship with self, others and the wider environment’.

Shame is an involuntary, unconscious phenomenon that therapists need to be aware of in order to help their clients’ process trauma. If the cause of trauma is that ‘there was nobody there’ then it follows that the remedy is somebody being there who can offer a reparative environment that allows shame to be transformed (see healing shame through the therapeutic relationship’ model below) and for the ‘untold stories’ to be told with the emotion that couldn’t be felt at the time.

The ‘good environment’ is a co-created therapeutic relationship founded on mutual trust where the therapist uses their own process to offer empathy and to support their client, through bilateral stimulation of the brain (EMDR is grounded in this principle) to put left brain language to their right brain unprocessed experience, to tell their untold stories and integrate them into a new expanded narrative. In the ‘good environment’ *you cannot not process experience. Clients internalize this new supportive relationship and subsequently offer it to themselves. *double negative alert

Janet P, 1907, the major symptoms of hysteria
Parker Hall S, 2008, Anger, Rage and Relationship: An Empathic Approach to Anger Management

The Harvard School of Public Health researchers have analysed eighteen years worth of data and, in a study published in the European Heart Journal they say ‘at a population level, the risk with a single outburst of anger is relatively low – one extra heart attack per 10,000 people per year could be expected among people with low cardiovascular risk who were angry only once a month, increasing to an extra four per 10,000 people with a high cardiovascular risk’.

But the risk is cumulative, meaning rage-prone individuals will be at higher risk still.

Dr Elizabeth Mostofsky and colleagues calculate that five episodes of anger a day would result in around 158 extra heart attacks per 10,000 people with a low cardiovascular risk per year, increasing to about 657 extra heart attacks per 10,000 among those with a high cardiovascular risk.

Rage often precedes an attack and may be the trigger, say the US researchers who trawled medical literature; they identified a dangerous period of about two hours following an outburst when people were at heightened risk. In the two hours immediately after an angry outburst, risk of a heart attack increased nearly five-fold and risk of stroke increased more than three-fold, the data from nine studies and involving thousands of people suggests.

The study did not directly blame anger as the sole trigger for heart attacks, but suggested it was a contributing factor, and further research is planned to study whether anger can affect the long-term prognosis for heart attack sufferers. They say more work is needed to understand the link.

Doireann Maddock, senior cardiac nurse at The British Heart Foundation said ‘people who have existing risk factors, such as a history of heart disease, are particularly susceptible.’

It follows the that GP’s and heart specialists need to pay attention to a patient’s rage patterns and consider offering interventions for their rage issue such as empathic anger management therapy, statins and beta blockers, 

References

Mostofsky E, Penner EA & Mittleman AM, 2014, Outbursts of anger as a trigger of acute cardiovascular events: a systematic review and meta-analysis, European Heart Journal online