How can you help patient and family members when anger management is an issue?
[Lt. Col. Jeffrey Yarvis] One of the areas as a social worker I might see this manifest itself
is in the area of anger management,
which could potentially lead to domestic violence.
One is to educate family members that once
a certain threshold has been crossed,
that engaging in an argument with that person is not going to work.
They have to physically deescalate.
There's nothing that you can say or do.
And then also not to get into that exchange because it's not about you.
This is about the brain being the brain.
And in fact, we can train both the individual and the family members
to recognize the antecedence or precursors to that.
And the flash-to-bang time might be a little shorter now.
So even if they were sort of an irritable person before,
now that fuse is going to be shorter.
So don't use the old mile markers to indicate to you,
"Okay, I can only push their button so far before they get mad."
Now you're going to have to back away from that.
But you can also use verbal cues and behavioral cues
to help shape an outcome before it gets to that point.
So you make it safe.
And really, therapy is about creating sort of that
safe holding environment around that person.
And you say, as subtly as you can,
"You're doing that,"—whatever that is.
"You know—you're sort of verbally giving me your
usual indicators that you're about to go,
why don't you go do this other thing."
And one of the things we want to teach warriors to do
is not only confront themselves and these behaviors, but self-sooth.
And I think warriors are really good at being critical of themselves,
but they're not very good at self-soothing.
And so we can give them cues through therapeutic work
to recognize these things,
and they can get both psychological, behavioral, and physical cues.
So what I like to do is the second that jaw tenses up,
or that hair stands up on your neck,
or your palms start sweating,
those are indicators to you that you need to get up and walk in the other room
because if you lose that moment, if you don't trust that cue,
probably within seconds, minutes—whatever—
depending on the nature of the injury,
you may have lost that opportunity to deescalate that situation.
In the case where it's more serious than that,
that person is probably going to need more help,
and then we're talking about lifestyle changes.
But people can maintain healthy relationships despite that
if they understand why this is happening, and they don't take it personally.
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Lt. Col. Jeffrey Yarvis, PhD is the first integrated service chief of the Fort Belvoir Community Hospital. He is an assistant professor of Family Medicine and director of Social Work at the Uniformed Services University of the Health Sciences.
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