Workshop Imagery-guided Directed Anger Protocol
WorkshopImagery-guidedDirected Anger ProtocolTrauma Training In ScotlandGlasgowNovember 2017Herman VeerbeekEMDR practitioner / consultant rbeek@gmail.com
VideoJust notice your bodily reactionsand reflexes.Distancing or approaching?
WHAT DO YOU NEEDIF WANTING TO VENTILATEANGER?
Pitfalls in the therapeutic alliance:Not acting as a psychotherapist but as a:-Detective: ‘it ‘s not true, you’re a liar!-Prosecutor: ‘look the harm you caused’!-Victim: ‘you need punishment and you mustexpress remorse!’-Distance, judgement and lack of empathy andinterest
Strategy with angry patients:1: Ventilate and Validate2: Reality check
RECIPROCITY AND EQUALITYIN RELATIONSHIPSGIVEANDPROVIDEWRONGDOING:- GOAL BLOCKING- INJUSTICE- HUMILIATION/HARMGIVEBACKForgive?Forget?Get even?
Wraak en de hefboomPerpetratorCause werlessFearfullEmbarresedBuilding ofAngerResentment&Revenge
TRAUMATICEVENT /EPISODETREATMENT /GETTING STRONGER /DANGER IS OVERFEARANXIETYOrth & Wieland (2006)ANGERtime
PTSDsubtypesInternalizing Externalizingsymptoms AUMATICANGERSelf BlamingBlaming othersFeeling as aHostilityVictimUrge to RevengeHigh State-Anxiety Anger RuminationAvoidance andImpulsiveSubmissionAggressionWinkel (2011)
Standard EMDRprotocolFear andParalysingPowerlessnessAnger protocolAnger,ResentmentRevenge andRagingpowerlessness
TopdownMEMORY PROCESSINGEXPLICIT MEMORY: NARRATIVE, VERBALTOP-DOWN THERAPIES: COGNITIVE THERAPYIMPLICIT MEMORY: NON-VERBAL, SENSORY,AUTOMATIC, TRIGGERS, BODILY REACTIONSBOTTOM-UP THERAPIES: EXPERIENTIAL,RELAXATION, SENSORIMOTOR, EMDRVan der Kolk (2002), Bergman (2012)Bottomup
Steuwe et al (2014) Effect of direct eye contact in controls and PTSDDMPFC: Dorsomedial Prefrontal cortexSC: Superior ColliculusPAG: Periaquaductal GrayLC: Locus Ceurulous
1000 wattLading: 60 wattAROUSALTRIGGER 2Bodily sensationsHow does he takeher remarks?AROUSALTRIGGER 1PastNowEvent
ANGER SYMPTOMS TREATED AS: ‘ unwanted disruptions of “normal”functioning that need to be harnassedby reason rather than treated asreactivated, unintegrated fragments oftraumatic states. Top down processingfocuses on inhibiting rather thanprocessing (i.e. integrating) unpleasantsensations and emotions ’(van der Kolk, 2002, p. 71)
Level of Arousal and ontroleBOTTOMUPINTERVENTIONSAROUSALDIMINISH AROUSAL FIRST
Result of “incomplete action responses”:“Incomplete actions of defense may manifestas chronic symptoms”(Ogden, 2006)“Each component of the ordinary response todanger, having lost its utility, tends to persistin an altered and exaggerated state longafter the actual danger is over”(Herman, 1992)
RESOLVING THE CHRONIC SYMPTOMS“The patient can feel the full, completedexperience of his or her capacity to defendthrough physical action instead ofrepeatedly re-experiencing the truncated,aborted defense responses”(Ogden, 2006, P.273)
Looking for a BOTTOM-UP approach for anger problemsCatharsis is effective when (Geen & Quanty, 1977):1. Anxiety towards the wrong-doer is absent or low2. Anger is directed towards the wrong-doer, not towards asubstitute3. Anger is expressed by oneself, not by others (angeris in YOUR body).
Why have serial killers a notdimishing urge to kill?
Anger Protocol (1): Anger, Urges to Revenge and Revenge Fantasies areNORMAL symptoms after damaging experiences The generalized anger has to be split into angertowards those who where responsible fordamaging experiences:“Focussing on the persons who have treated you wronglyor who have damaged you. You may say, the people whohave messed up your life.”
Inventory of Wrong-doersO Baby-sitterwas extremely sadistic, maltreatingO Fatherpunishing harsh, never supportingO Mothercold, didn’t allow cryingO Imam,sexual abuseOBaby-FatherMotherImamsitter10 9Girl-Friend humilating patientGirl-friend710 6
Anger Protocol (2): The patient vents in an imaginary film all thebodily energy towards the person he/she isangry with . You are in the lead You are allowed to do everything yourbody wants to do You have to do it yourself You have to feel safe all the time Look in the eyes of the person Feel what your body wants to do and do it!!
Anger Protocol (3): First exercise the ‘Break’ (footage) Stop is Stop Within the limits of the therapist
Measuring treatment progress
In conclusion-Notonly for forensic patients (fight-divorces)-Appliedon a large scale in the Netherlands-Notyet evidence based-Andnow: excersise!
Looking for a BOTTOM-UP approach for anger problems Catharsis is effective when (Geen & Quanty, 1977): 1. Anxiety towards the wrong-doer is absent or low 2. Anger is directed towards the wrong-doer, not towards a substitute 3. Anger is expressed by oneself, not by others (anger is in YOUR body).
worksheets to complete homework assignments, and space to take notes for each of the ses . about anger, anger as a habitual response, and the introduction of the anger meter used to monitor anger. I. Purpose of the Group . 1) Learn to manage anger effectively. 2) Stop violence or the threat of violence.
Recognise whether you may be experiencing anger problems. Understand what anger is, what causes it and what keeps it going. Find ways to understand, manage or overcome your anger. Contents of this self help guide . Strategies that you could use to overcome your anger problems: 1. Understanding more about anger
Muay Thai Championship between universities volunteered for the study. “The Trait Anger and Anger Expression Scales” by Spielberger was used to determine the trait anger and anger expression styles of participants. Kruskal Wallis H and Mann Whitney U tests were
& Anderson, 2004), conceptual framework of imagery (Paivio, 1985), and the PETTLEP model (Holmes & Collins, 2001) serve as guides to follow. . improvement in performance through imagery intervention compared to athletes with a poor imagery ability (Robin et al., 2007). Furthermore, imagery ability is also directly associated .
NextView Imagery End User License Agreement (EULA) a. General Terms 1. This clause applies to all unprocessed sensor data and requirements-compliant processed imagery, imagery services, imagery-derived products and imagery support data licensed under this Contract. No other clauses related to intellectual property or data rights of any sort shall have any
ANGER MANAGEMENT. for Substance Use Disorder and Mental Health Clients Overview of Group Anger Management Treatment. Definitions . In the most general sense, anger is a feeling or emotion that ranges from mild irritation to intense fury and rage. Many people often confuse anger with aggression. Aggression is behavior
cause injury, harm or damage, whilst anger is an emotion. Anger, hostility, bitterness & aggression It can be helpful to define the key words that relate to anger, so that you can better understand your difficulties and better describe what you experience. Anger is an emoti
The API Standard 2000 5th Edition takes into account Tank Volume, Liquid Flow, and Temperature Change. It was written as a basis for the pressure control of hydrocarbons, and considered industrial tanks as well. It is this 5th Edition that is probably in widest use today. In 2009, this was updated to the API Standard 2000 6th Edition.
