Anger Management Using DBT (E33)

anger management DBT

Anger Management with DBT

Does your anger sometimes turn into rage? Do you say things in the heat of the moment that you later regret? Are you hoping to find techniques to get your temper under control?

In this episode of the Men’s Self-Help Podcast, Dr. John explores the emotion of anger and makes the case that anger has gotten a bad wrap in contemporary society.

As part of the show, you’ll learn about two powerful techniques to help you prevent anger turning into rage that come to us from the world of Dialectical Behavior Therapy (DBT). Episode sponsored by Better Help.

Finally, you’ll hear from a listener who is unable to go to the bathroom in public places because of shy bladder syndrome.

Take Aways from Show

  • The benefits of anger
  • How to use thought projection (thought observation) to observe emotions before acting on them.
  • How to conduct the DEAR MAN technique for problem resolution.
  • A quick overview of shy bladder syndrome and common approaches to treatment.

Resources Mentioned in Show

BLOCK A – DBT For Anger Management

Hello and welcome – or welcome back – to episode 33 of the Men’s Self-Help Podcast. My name is Dr. John Moore and I’m a licensed therapist out of Chicago, Illinois – and I’m so happy you’re here.

Today, we’re going to be talking about the topic of anger and how – when channeled productively – it can be used as a catalyst for action.

I’ll be going into this topic more in just a moment, but before we get there, I’d like to welcome any new listeners to the show, which is being sponsored by Better Help.

Did you know this podcast has a mission? Yep, it sure does and it’s to reach three specific groups of men:

Group one are guys who are all about health and wellness and are attracted to self-improvement pods like a moth to a flame.

So, that’s group one.

Group two are men who may be working with a therapist right now or perhaps at some point in the past – and use the material shared here as part of their journey.

That’s group two:

And then we’ve got group three – a group of men who frankly aren’t going to be knocking on the door of someone like me, a therapist, to reveal things going on in their life – it’s just not happening – but – these same men might be curious enough to tap on an app and listen to a show because the issue resonates.

But regardless of what brought you here today, I’m thrilled you are here and that you matter! And if you are a woman who happens to be listening, your presence matters here too. The reality is a lot of women hit that subscribe button for this show because many of the topics we explore have universal application. So welcome.

Now quick disclaimer – this podcast isn’t designed to act as a substitute for counseling or medical advice and I’m not your personal therapist.

Alighty, let’s slide back to today’s show topic: Anger. Yep, that’s right – anger. And right off the bat, I’d like to ask you some questions:

  • Are you a man who has a bad temper?
  • Do you go from 0 to pissed in a nano-second?
  • Has your anger gotten you into trouble, like in a relationship, with your children or even your job?

If you can relate, I’m right there with you. But can I be real with you? Our society has done a terrible job of addressing the emotion of anger and frankly, it’s gotten to the point that it’s almost become a dirty word.

And that’s a crying shame, don’t you think?

Here’s the full-on truth – anger is a normal, healthy human emotion, just like happiness and sadness. Anger is what lets you know you’re alive – and that something doesn’t feel right.

But how can you take anger and express it in healthy ways so that it doesn’t become destructive – to yourself or someone you love? Can you channel this feeling into something more productive, like action?

Well, I’m going to go over an approach from the world of dialectical behavior therapy – or DBT for short – called the DEAR MAN technique – which may be helpful.

But wait – there’s more.

You’ll also hear from a listener who is struggling with shy bladder syndrome – or fear of peeing in public – and isn’t sure what to do.

We’re going to be covering a lot of ground today and I’m going to be getting all woo-woo on you! So fasten your set belt men – let’s take a ride.

BLOCK B: Anger Management with DBT

Almost as if it were yesterday, I can still remember one of the first times I went off another human being. Even now, I still have a lot of shame around my behavior.

It was during one of my first relationships and I didn’t even recognize the person who doing the yelling. Don’t get me wrong, the person was me all right – but a me who was filled with rage and totally out of control.

Somehow, I had gotten into my mid 20’s and not figured out how to get control of my temper. Now look, it’s not like I had never been angry – I had. But this was a full-on rage, replete with smashing plates and kicking furniture. Yeah guys, it wasn’t pretty – and I’m not proud of my behavior.

And hey, I can still have my moments, but I’ve taught myself how to avoid the impulse to go after a person’s jugular – in a matter of speaking. Oh, in case you are wondering, I’m no stranger to being on the receiving end of destructive rage. It’s not fun – is it?

At the start of today’s show, I mentioned that the word anger has gotten a bad wrap in society. I can’t tell you how many times I’ve had patients share with me a desire to get rid of their anger, almost as if it’s a tumor that needed to be cut out of their body. I’ve even had patients lower their voice when they say that word anger, almost like it’s a taboo topic.

And it doesn’t help when you go on social media, where there are a contingent of folks constantly perpetuating the idea that there’s something wrong with you if you aren’t living a life of blissful happiness, 24/7. Haha – if only.

Here’s the straight-on truth. Anger – in and of itself – is not a bad thing. It’s part of the spectrum of human emotions, just like joy and just like sadness.

And there are a number of positives associated with anger. There’s a great article on the Good Therapy website authored by Moshe Ratson on this topic that I’ve linked to in show notes.

I’m just going to mention three of them.

The first one is this: All of us have been equipped with anger as a kind of evolutionary leftover that has been purposely implanted into your nervous system to protect you from aggression. And anger is the same emotion that empowers you to fight back against an attack, similar to how early man fought back against the threats they faced.

Second, anger can help you to create change. For example, if you felt invisible as a kid, it’s that anger you experienced back in the day that can empower you in the here and now to get your workout bodybuilding on – know what I mean. Can vanity also be at play here? Sure, but if you look for the root cause and its likely you’ll find anger somewhere in the mix.

Third, anger has a discharging effect. In other words, when you discharge anger, it’s almost always followed by feelings of calm.

So, there are some positives and I do hope you’ll check out that article.

Now – with all of that said, the problem with anger is that most of us have learned to suppress it to the point that when it does surface, things get ugly.

I’m thinking now of the famous Swiss Psychiatrist Carl Jung, who once said, What we resist persists. The dude was kind of right – don’t you think?

At any rate, you are probably wondering how you can channel your anger in ways that are more productive? Is there a way to communicate your feelings without hurting someone you love, like a partner or child? Finally, how can you turn down your internal temperature so that you don’t go from zero to seriously pissed off in a nano-second.

Welp, I’m about to share with you a two-part tool that comes to us from the land of Dialectical Behavior Therapy or DBT; a $10 dollar term used to describe an offshoot of cognitive therapy that combines mindfulness, acceptance, and emotional regulation as part of the dynamic.

Do you remember when I said at the start of the show that I was going to get all woo-woo on you. Welp, that moment is here because I’m going to teach you two powerful tools: The first is thought projection and the second is the Dear Man Technique.

Now let me be clear – this approach requires that you step outside of your comfort zone and tap into your active imagination.

And if you’re worried about writing anything down – don’t – because I’ve included a link to everything I’m about to say in show notes, which can be found on the Guy Counseling Blog.

Here’s Part One: Thought Projection

I want you to think about how anger manifests in your body. For example, you might get a tightening in your gut or feel it in your face.

I know for me that when I feel anger coming on, I feel a warmth in my chest and my fists start to clench.

I’m mentioning all of this because wherever you feel that anger in your body, stop for a moment and ask yourself: Does this feeling have a shape? Does it have a color?

If so, I want you to project that shape and color above your head, similar to a thought cloud. Within that shape, imagine writing out the words that describe what’s behind the anger you are feeling.

For example, you might imagine yourself scribbling out words like: disrespected, minimized or threatened.

Here’s why you want to do this: By identifying where that anger resides in our body and projecting it outward, you give yourself the opportunity to observe it.

In turn, this allows you to mindfully observe what’s happening instead of impulsively acting on it. It’s kind of like Yoda from Star Wars. Remember how he taught Luke Skywalker to notice his emotions, but not act on them? Well, it’s like that.

Make sense?

OK, so that’s the first tool. The second tool is the Dear Man Technique. But before we get to that, here’s a special offer Better Help that you won’t want to miss.

Stick around …

BLOCK C: BETTER HELP PROMO

Special offer for listeners to the Men’s Self-Help Podcast where you can get 10 percent off your first month of therapy sessions with Better Help.

BLOCK D: Anger Management – Dear Man Technique

Are you ready to learn about the Dear Man technique? Well, I’m about to share it with you. Let me just quickly say that this approach was created by Dr. Marsha Linehan, an American Psychologist who developed Dialectical Behavior Therapy or DBT for short.

It’s an evidence-based form of psychotherapy, meaning there’s scientific, measurable research to back it up. But here’s the thing – it’s also skill based.

In other words, everything you have learned thus far will require focus and practice to build on the coping strategies you are learning.

You remember the thought projection activity we went over in the previous segment? Well, that’s an example of a coping strategy you’ll want to spend time with because it can be used in conjunction with the DEAR MAN Technique you’re going to learn about right now.

Keep in mind that each letter of DEAR MAN represents an action you’ll be taking. And yes, there’s a link in Show Notes that walks you through everything I’m about to mention.

Alrighty, let’s start with the “D”.

D stands for Describe. Here, you clearly and concisely describe the facts of the situation as you see it. Let’s say you have a roommate who habitually leaves their dirty dishes in the sink and never cleans them up.

Here, you would simply state the facts: I notice that after you’re done eating, you leave your plates in the sink and let them pile up – leaving me to do them. 

See how I did that? I simply stated the facts. Pure and simple.

E is for Express. Using “I” statements, you express what you are feeling in calm and intentional way.

So, for this one, you might say something like: I feel taken advantage of when you leave your dishes in the sink or I feel resentful whenever I see that pile of dishes stacking up. 

Notice the “I statement” here as part of expressing.

A is for Assert. Here, you use very specific language to request what you need to want.

Example: I need you to wash your dishes and put them away after eating.

Now warning folks – don’t fall into the trap of being passive aggressive for the “A” part and say things like, “It would be nice if you washed the dishes occasionally.” In a calm tone, just come right out and state your need.

Now let’s go to R.

R is for Reinforce. In other words, you reinforce a desired outcome with your words and body language.

Example: You know, I think we’ll get along better around here because when you do your part, it demonstrates that you care our living space. Plus, it helps to reduce some of the negative energy I put out there because I’m feeling resentful.

So, you can use a variation of the R example I just gave, but the idea is to say it in a calm, open, and relaxed way.

Now look, I’m no fool. None of this means that the person you are speaking to isn’t going to come back with comments like:

“It’s the dishes dude – it’s not a big deal – relax” or worse, “Oh, Wah – stop being a big baby.”

I mean I hope that doesn’t happen, but we can only control our own behavior, right?

Should you get this kind of response, the best thing you can do is use that same calm tone and say back: I hear you – but I really would like us to resolve this issue.

So, that’s the DEAR Part. Here’s the MAN part.

M stands for mindfulness. For this strategy, mindfulness means leaning into techniques, like the thought projection activity we discussed earlier, so that you don’t get your anger get the best of you.

As part of the “M”, you may have to employ the DBT strategy of opposite action. Here, you do something opposite of what that anger impulse is telling you to do.

For example, let’s say the hypothetical roommate we’ve been discussing gets all loud and aggressive, you avoid matching their behavior with hostility.

A good way to do this is to simply say: I’m going for a 15-minute walk. Let’s both return to this later when we’re both calmer OR I’m feeling really pissed off right now so let’s take a break.

There’s much more I could say here but I think you get my drift. The idea is to not let the other person’s behavior pull you off track from what you’re trying to accomplish.

OK, time for A.

A stands appear confident. This means standing up straight, or leaning slightly forward if you’re sitting, and making eye contact when you speak. Now guys, this isn’t a permission slip to stare the other person down or use your body language to intimidate.

OK finally N.

N stands for Negotiate. All this one means is knowing the limits to what’s possible and being open to a middle-ground. Let’s go back to that roommate.

If you’re roomie were to say: “I’ll try to get those dishes done if you’ll mop the floors once a week,” be willing to meet the request.

In the end, you have a goal you’re trying to reach and sometimes you’ll have to compromise. Make sense?

As an aside, if you the DBT strategies we’ve discussed here, I’d like to recommend a resource to you. It’s called the Dialectical Behavior Therapy Skills Workbook by McKay, Wood and Brantley.

It is full – and I mean full – of strategies and worksheets that you can use for a variety of emotional challenges. It’s also something I regularly recommend to my patients. You’ll find the link to the book in show notes on the Guy Counseling blog.

All right, before we close this block out, let’s take a moment to quickly recap each of those letters:

D is for describing the facts.

E is for expressing your feelings with I statements.

A is for assert by clearly stating your need.

R is for reinforce with words and body language.

 

M is for mindfulness.

A is for appearing confident.

N is for negotiate.

When you combine thought projection with the DEAR MAN technique, you open yourself up to possibilities.

What would it be like if you practiced these skills? Imagine how you might grow – and change.

BLOCK E: Shy Bladder Syndrome

Our listener email comes to us from a man living in Chicago who is struggling with a unique problem. I’m going to go ahead and read to you what he sent to me, and then share my reply.

Are you ready? Check it out:

Hi, Dr. John,

I just recently subscribed to your podcast and am so glad I found your show.

I’ve got this problem that I’m ashamed to talk about with anyone, so I figured I’d try my luck here – and I hope that’s OK.

I’m 30-years old and cannot pee in public. This issue has been an on and off problem for most of my life. Last week, I was at a Cubs game and had to go real bad, but for the life of me, I couldn’t go.

This kind of thing happens to me anytime I’m in public place, like the gym or a bar. But the weird thing is, I have no problem with it at home.  

Please Dr. John – I’m desperate.

– Sergio in Chicago

So, that was this young man’s email to me. And you know, in reading his problem, I just feel overwhelmed with compassion with him. The truth is a lot of men live with this challenge, which is commonly referred to as Shy Bladder Syndrome or in clinical speak: PAR-U-RECES.

And can I be real with you? It’s a problem that’s not often talked about and widely misunderstood.

I’m reminded right now of a man – we’ll call him Enrique – who contacted me around two-years ago with a similar problem. In his case, he was terrified of having to take a 3-and-a-half-hour flight from Chicago to Phoenix.

And the reason he felt so much anxiety was because the thought of being on a plane for that long without the ability to relieve himself was overwhelming.

 

At any rate, I’m going to read to you what I sent back to Sergio, with some paraphrasing.

Hi, Sergio,

I really appreciate you subscribing to the pod and that you took the time to send me this note. I know it’s not easy to talk about.

I’m not a medical doctor so let me say right out that it’s important to let your physician know what’s going on as a way of ruling out any medical causes for your problem. I’m not suggesting there is one, but it doesn’t hurt to do this all the same.

Barring any medical reasons for your situation, it sounds like you may be struggling with Shy Bladder Syndrome or Paruresis.

That may sound like a scary word, but it’s really a fancy term used to describe a condition where a person is unable to urinate because their sphincter muscles lock up. And it’s those muscles that control the flow of urine from your bladder.

Once those muscles lock up, it makes it nearly impossible to pee. I’ve worked with people who have had this happen at football games, private house-parties, planes and even in their own home when sense other people are around.

And guess what – nearly 20 million Americans have this problem, according to Web MD. See the link I’ve included in this reply.

At its core, shy bladder syndrome is an anxiety disorder with three main triggers, again, going by the Web MD article:

1 A lack of privacy

2 Who you perceive being around you or may be around you.

3 Your emotions.

So, you may be wondering if this can be treated. The answer is yes. In many cases, cognitive behavior therapy, combined with graduated exposure therapy, can help to reduce the brain’s anxiety response. Clinical hypnotherapy, when used as an adjunct, has also been found to be helpful.

Sergio, I am going to include a link to the International Paruresis Foundation that I’d like you to check out. On the site, you’ll find lots of different resources, including support groups, to help you on your journey. Finding a therapist who specializes in anxiety will be important on your path to healing.

I hope this response helps and again thanks for listening.

Well, there’s my response. As I mentioned earlier, this is a problem that is not often discussed, largely because of shame. I’m so glad this young man wrote.

So, let me ask you a question – are you one of the 20 million people who struggle with PAR-U-RECES? If so, what are you going to do about it?

BLOCK E: Closeout DBT and Anger

Man, oh man, did we go through a lot in today’s podcast, wouldn’t you say? To start things off, we established that anger isn’t a dirty word. Second, we learned about two important tools for transforming anger into action. And finally, we explored the problem of shy bladder syndrome.

Shoot, there was even a Yoda metaphor dropped in along the way.

You can probably tell I love making this podcast – I really do have a passion for it and it makes me happy that you took some time today to listen in.

Did you know there’s lots of ways for us to keep in touch? Yup, there sure is. You can pop by my website, at Guycounseling.com and sign up for my newsletter. You’ll also find information on my book, Confusing Love with Obsession.

And there’s also my social media accounts.

I’m on Instagram at Guy Counseling – and I’m also on Facebook and Twitter at the same handle.

Speaking of Instagram, during the month of August, I am pledging to post one thing a day, every day, that somehow relates to health and wellness. I’m really going to try and do this, and I’d love to see you there.

So, would you like to include a question for the show? Well, just shoot me a note to [email shared on podcast] – that’s [email shared on pod] and I promise that whatever you to send me will be held in confidence. I won’t share it with anyone, unless you give me permission. I promise. That said, it may take me a day or two to write you back, as I juggle my counseling and teaching responsibilities.

You know the other day, a fellow therapist and podcaster named Laurie left a beautiful review on Apple podcasts. Here’s what she wrote – paraphrased:

I’m an experienced sex therapist and the first episode I listen to from Dr. John is about stuff I need to learn. And she went on to say how she’s a subscriber and likes getting the scoop on male psychology.

And see, it’s that kind of feedback that means so much to me, truly! If you like this podcast, please do two things for me. One, hit the subscribe button on whatever app you are listening and two, please leave a review on Apple, or whatever service you are using. Apparently, both of these somehow help boost the show’s listings, which helps folks just like you find this podcast.

I’d like to take a moment to thank our sponsor, Better Help and offer a shout out to Joel, my sound engineer, with East Coast Studio.

As we closeout our time together today, remember your emotions aren’t things to be hidden. Use tools and techniques to help channel your anger productively. Shame only has power over you if you let it.

Take very good care. I’m Dr. John and this has been, another episode of the Men’s Self Help Podcast.

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About John D. Moore 383 Articles
Dr. John Moore is a licensed counselor and Editor-in-Chief of Guy Counseling. A journalist and blogger, he writes about a variety of topics related to wellness. His interests include technology, outdoor activities, science, and men's health. Check out his show --> The Men's Self Help Podcast