In this Exploring Mental Health series, we shine a spotlight on different aspects of mental health. First up is anger. What’s the difference between healthy and unhealthy anger, and how can we control angry behaviour if it becomes destructive?
 
Why do you experience anger?
 
Anger is a normal, healthy emotion and can be very helpful to experience. It alerts you to situations where you need to take action, motivates you to make changes, and helps you to stay safe when faced with a danger.
 
There are lots of things that can trigger you to experience anger, including:

• Events (such as a bereavement or other loss)
• Being threatened or attacked
• Being treated unfairly or being powerless in a situation
• Not achieving goals
• Substances (e.g. drugs or alcohol)
• Mental illness (e.g. anxiety or depression)

 
What influences your reaction to feeling angry?
 
The way you react to feeling angry can depend on:

• The situation you’re in (if you’re experiencing lots of difficulties or stresses in your life you may become angrier than usual, or find it harder to control your anger)

 

• Your family history (as a child you may have learned unhelpful responses to anger from the adults around you)

 

• Events in your past (if you have suppressed anger from past experiences)[i]

 
What are the symptoms of anger?
 
Anger feels different for everyone. You may experience any number of the following symptoms, to varying degrees:
 
Physical symptoms

• Churning sensation in your stomach    
• Tightness in your chest 
• Increased and rapid heartbeat    
• Tense muscles    
• Feeling hot
• An urge to go to the toilet    
• Sweating, especially your palms    
• Pounding head    
• Shaking or trembling    
• Dizziness
  
  

Cognitive symptoms 
   

• Being tense, nervous or unable to relax    
• Feeling guilty    
• Feeling resentful towards other people or situations    
• Getting easily irritated    
• Feeling a 'red mist' coming down on you    
• Feeling humiliated[ii]    

When is anger unhealthy?

Although anger is a normal, human emotion, it can become unhealthy, affecting your relationships, work, social life, and your physical and mental wellbeing. If you’re unsure whether your anger is unhealthy, ask yourself:

• Do you regularly express your anger through unhelpful or destructive behaviour, hurting yourself or others?
  
  
• Is your anger having a negative impact on either your physical or mental health?
  
  
• Is anger your go-to emotion, blocking out your ability to feel other emotions?[iii]

If you answered ‘yes’ to any of these, your anger has probably become unhealthy. Other signs that anger may be a problem include:

• Regularly feeling angry at an intense and overwhelming level
• Having difficulty controlling your anger
• Feeling you have to hide or hold in your anger
• Feeling distressed as a result of getting angry
• Using alcohol or drugs to manage your anger
• Withdrawing from people or situations
• Regretting things you said or did when you were angry[iv]

What are the different types of unhealthy anger?

There are many different types of unhealthy anger. These include:

• Chronic anger (this is long-term anger, and can impact the immune system and cause physical health issues such as high blood pressure and heart disease)
  
  

• Passive anger (this may be expressed as sarcasm, sulkiness, apathy or a refusal to engage with people or tasks)
  
  
• Overwhelmed anger (this is caused by life demands that are too much to cope with)
  
  
• Self-inflicted anger (this is directed inward towards yourself, and may be caused by feelings of guilt)
  
  
• Judgmental anger (this is directed outward towards others and may come with feelings of resentment)
  
  
• Volatile anger (this involves excessive, violent or aggressive anger responses)[v]

How can you manage your anger?
 
Using anger management techniques can help you control your anger outbursts when you experience them. While longer-term strategies can help to reduce your overall feelings of anger and prevent outbursts.
 
In the heat of the moment you can manage your anger by:

• Looking out for symptoms of anger, giving warning signs of an outburst (see ‘What are the symptoms of anger?’ above)
• Counting to 10 before responding to the person or situation
• Clenching and unclenching your fists and other muscles throughout your body to release physical tension
• Scribbling on or tearing up paper
• Screaming into or hitting a pillow
• Taking deep, controlled breaths, focusing on the sensation of breathing to take your attention away from the situation
• Removing yourself from the situation for at least a few minutes
• Doing something to distract yourself, such as having a shower or dancing to music
• Writing out your thoughts and feelings

 
In the longer-term you can control your anger by:

• Exercising regularly to reduce stress and tension levels
• Practising good sleep hygiene
• Having a balanced diet
• Avoiding drugs and alcohol
• Learning your anger triggers (keeping a diary can be helpful for understanding these and noticing any patterns)
• Identifying your thought patterns and challenging automatic negative thoughts (a therapist can help you do this if it feels tricky to identify and make changes to these)
• Talking to people around you about your feelings, before they become overwhelming
• Improving your communication skills so you can express your thoughts and feelings, without using anger or aggression

 
When to seek help
 
If you’re experiencing unhealthy anger, and it has become difficult to manage or is having a negative effect on your life and those around you, there is lots of support available.
 
The first step is to speak to your GP and explain what’s been happening and how you’re feeling. They can refer you for NHS counselling or to an anger management course. Your local Mind branch may also provide free counselling or anger management services. Alternatively, you can contact a private therapist and pay for counselling sessions. Your workplace may also offer access to counselling.
 
If you’d like to explore your feelings of anger, get in touch to make an appointment.



[i] NHS Moodzone, Why Am I So Angry?, Available: https://www.nhs.uk/conditions/stress-anxiety-depression/about-anger/

[ii] Mind (2018), How to Cope With Anger: Anger Symptoms, Available: https://www.mind.org.uk/information-support/types-of-mental-health-problems/anger/anger-symptoms/#.XGl3mNHgo_V

[iii] Mind (2018), How to Cope With Anger: What is Anger?, Available: https://www.mind.org.uk/information-support/types-of-mental-health-problems/anger/about-anger/#.XGlal9Hgo_U
 
[iv] Headspace, What is Anger and Its Effects on Mental Health, Available: https://headspace.org.au/young-people/what-is-anger-and-its-effects-on-mental-health/

[v] PsychGuides.com, Anger Symptoms, Causes and Effects, Available: https://www.psychguides.com/guides/anger-symptoms-causes-and-effects/

In the second part of this handy A to Z guide exploring different aspects of mental health and wellbeing, we go from NHS to Zen.
 
If you haven’t read Part one, which takes you from A to M, you can catch up here.
 
N is for NHS – The NHS provides important mental health support and treatment. From your GP - who can give a diagnosis, prescribe medication, and make referrals to support services such as IAPT (see Part 1 of this A to Z guide) - to crisis teams, psychologists, psychiatrists and addiction services. Accessing these NHS services may involve visiting your GP surgery, health centre, hospital or mental health clinic.
 
O is for Online – The internet can be a useful tool for finding mental health information and getting support. But it can also have a negative impact on your mental health if you experience trolling, find you’re comparing yourself to others on social media, or you read misinformation about a diagnosis or treatment options. Always use reputable websites (e.g. charities or NHS Direct) when searching for information, and consider taking time away from social media if it’s becoming unhelpful.
 
P is for Panic – Panic attacks are an anxiety response to stress and fear. They cause symptoms that can mimic physical illness, such as a heart attack, and can be very frightening to experience. Techniques like controlled breathing and grounding can help you manage and control panic attacks when they occur, while therapy can help you to address your triggers and develop coping strategies.
 
Q is for Quiet – In the rush of daily life it’s important to take time out to look after yourself (see Y a bit further down). Taking 5-10 minutes to yourself a couple of times a day can help you manage anxiety and stress, and improve your mental wellbeing. It could be going for a walk, focusing on your breathing or sitting in silence on your own.
 
R is for Relationships – Good relationships are vital to your mental health, whether they’re with people around you or they’re virtual relationships with people you’ve never met. Healthy relationships provide support and security, and help you to thrive. While loneliness and isolation have a negative impact on both mental and physical health. Unhealthy relationships can also negatively affect your mental wellbeing, creating low self-confidence and contributing to feelings of isolation.
 
S is for Stress – Stress can be caused by pressures in your life, unexpected events, change, or by feeling you have no control over a situation. When this happens, hormones are released in your body that trigger the ‘fight or flight’ response, putting your body on high alert. If this happens continually over a long period of time, it’s known as ‘chronic stress’. Positive relationships, changes to lifestyle and practising self-care can all help to reduce the symptoms of stress.
 
T is for Therapy – Therapy provides a safe, confidential space for you to explore your thoughts, feelings and behaviours, without judgement. It can help you identify the roots and triggers of your mental health problems, and develop healthy coping strategies. There are many different types of therapy available, depending on the issues you’re experiencing and on personal preference. Read more about how to choose the right therapist for you.
 
U is for Understanding – When you’re struggling with your mental health, having someone take the time to understand your illness and how you’re feeling can make a big difference. It’s important to apply this understanding to yourself too. Be compassionate with yourself, especially if you’re having a difficult day. Treat yourself in the same way you would treat a friend – it’s only you that is expecting perfection from yourself.
 
V is for (in)Visible - Many symptoms of mental illness can’t be seen. This can make it difficult for others to understand what you’re experiencing. Giving them information about your mental illness can help change this. More widely, high profile campaigns such as those by members of the Royal family are working to make mental health a more visible public issue and to reduce the stigma associated with it.
 
W is for Work – It can be tricky to manage work when you’re experiencing mental illness. Wherever possible, talk to your boss about whether changes can be made to your workload or working conditions. You may also be able to get occupational health support following a period of absence. Health and Safety legislation and the Equality Act 2010 means employers have a duty of care towards employees if they have mental health problems. Unions and ACAS can provide advice and guidance if your workplace is unsupportive.
 
X is for (e)Xtraordinary - which is quite simply what you are. You’re amazing for getting through each difficult day, no matter how impossible it feels.
 
Y is for You – Looking after yourself will have a positive impact on your mental health. This means eating a balanced diet and exercising (see Part 1 of this A to Z guide), as well as having good sleep hygiene. Importantly, spend time each day doing self-care. Giving yourself the time and space to do something that nurtures your mental, emotional or physical wellbeing can improve your mental health and help prevent relapse.
 
Z is for Zen – Mindfulness and meditation can help you reduce feelings of stress, cope with negative thoughts and improve your sense of wellbeing. Using mindful breathing techniques can also help control feelings of panic. You can learn mindfulness through books, online guides, one-to-one sessions or group courses. Search the UK Mindfulness Network to find a qualified teacher in your local area.
 
Choosing what to put in this A to Z guide has been tricky. You’ll see it doesn’t include any mental health illnesses, which could easily become an A to Z list all of their own. Instead, it’s a guide of things associated with mental wellbeing.
 
You might choose to include different things. I’d love to hear what you’d have in your A to Z. Leave a comment below to let me know.

A handy, two-part guide helping you explore different aspects of your mental health and wellbeing, from Anger through to Zen. Part one takes you from A to M.
 
A is for Anger – Anger can be a reaction to an event; a response to a substance; or a symptom of anxiety, depression or other mental illness. It may be directed at others or inwardly at yourself. Using anger management techniques can help you control your anger while you work out what triggers it and why.
 
B is for Brain – Brains are complex and can sometimes go a bit wrong, whether it’s faulty communication between neurons or an imbalance in chemicals. For example, your brain can unnecessarily put you into ‘fight or flight’ mode by misinterpreting the degree of threat you’re facing, leading to feelings of anxiety and panic. Therapies such as CBT can help you retrain your cognitive processes, while chemical imbalances are usually treated using medication.
 
C is for Confidence – Low self-confidence can be both a symptom and trigger of mental illness. A therapist can help you recognise and take control of your critical inner voice, and make changes to build your self-esteem.
 
D is for Diagnosis – A mental health diagnosis is given by a doctor and will be based on what you tell them and/or your answers to questionnaires or forms. Getting a diagnosis can be a relief but may also feel negative and scary. Showing information about your mental health condition to those around you can help them understand your diagnosis, while talking to others with a similar experience or diagnosis can help you feel less alone.
 
E is for Exercise – Exercising releases chemicals in the brain, such as serotonin and dopamine, that help to regulate and boost your mood. You could go for a walk, join a dance class or do some gardening. Whatever you choose, just make sure it’s something you enjoy – that way you’re more likely to keep doing it regularly.
 
F is for Food – Diet plays an important part in mental wellbeing. Sugary food and drinks create energy highs that leave you feeling tired and low when they’ve worn off, while slow-release energy foods, such as pasta and oats, can prevent drops in energy levels and mood. Avoiding stimulants like caffeine and drinking plenty of fluids is also beneficial. Importantly, some foods shouldn’t be eaten with certain medications – your GP can advise you about this.
 
G is for Goals – Setting goals can help you plan and move forward. But it’s important they’re realistic so you don’t set yourself up to fail. Consider having a different set of goals for difficult days, such as having a shower or getting dressed - achievements come in all sizes. And remember, when you achieve your goal take time to be proud of what you’ve done.
 
H is for Happiness – Looking after your mental health has a bigger impact on how happy you feel than money or material possessions.[i] But when you’re mentally unwell, it can feel like you’ll never be happy again. Keeping a gratitude journal and writing down three things you’re grateful for each day can provide small rays of sunshine as you go through your journey of recovery.
 
I is for IAPT – Improving Access to Psychological Therapies (IAPT) is the NHS therapy programme for adults with anxiety and depression. To receive it, your GP has to refer you for an IAPT assessment. Counselling is free, but sessions are limited and you have no choice over the type of therapy you receive (only cognitive behavioural therapy is used). Waiting times to start therapy can also vary. As well as individual therapy, IAPT also runs group therapy and online courses.
 
J is for Journal – Journaling provides a practical and creative way to help you manage your mental health. You can use a journal to write down your thoughts and feelings, or to help track your mood, diet, exercise and sleep. You can also use it to identify triggers and plan self-care, as well as to organise, plan and set goals.
 
K is for Knowledge – As the saying goes, knowledge is power. Spend time finding about your mental health condition to see whether there are common triggers, symptoms or helpful treatments. And find out what sources of support are available. Knowledge of yourself is important too, learning about your own personal triggers and symptoms.
 
L is for Low – Life events, illness and changes in season can all cause you to experience low mood. But if that feeling persists and doesn’t improve, you should make an appointment to speak to your GP. They’ll chat to you about how you’ve been feeling and make suggestions for appropriate treatment options. If you’re having thoughts of suicide or self-harm, you should seek immediate help from your GP, NHS 111 or the Samaritans.
 
M is for Medication – Medication is a treatment option for many mental health conditions, and may be used in combination with counselling, hypnotherapy or alternative therapies. Your GP, psychiatrist or other mental health professional will prescribe and adjust your medication as required. Self-medication - using drugs and/or alcohol to cope with the symptoms of mental illness – can make your mental health worse. If this sounds familiar, your GP or therapist can provide support.
 
Part two, taking you from N to Z, is coming soon. In the meantime, if you’d like some confidential support, get in touch to make an appointment.


[i] BBC News (2016), Mental health and relationships 'key to happiness’, Available: https://www.bbc.co.uk/news/uk-38285223

Talking about a loss is difficult at the best of times. But what about those losses that can’t be openly acknowledged or shared? The experience of being deprived the chance to openly grieve a loss is known as disenfranchised grief. The article explores when disenfranchised grief can occur, the effects it can have and how to cope with it.
 
When disenfranchised grief can occur
 
1. The relationship with the deceased isn’t recognised

• Death of an ex-spouse or ex-partner
• Death of a same sex spouse or partner
• Death of an unacknowledged partner
• Death of a lover
• Death of a step-child or step-parent
• Death of a foster child or foster parent
• Death of ex-in laws
• Death of a child given up for adoption
• Death of a birth parent of an adopted child
• Death of an unannounced baby (e.g. miscarriage or stillbirth)
• Death of an estranged family member
• Death of an imprisoned family member or friend
• Death of an abuser
• Death of a gang member

 
2. The loss is viewed as unimportant

• Death of a pet
• Death of a co-worker
• Death of a neighbour
• Death of a classmate
• Death of a childhood friend
• Death of an online friend
• Death of an extended family member
• Death of a family member that occurred before you were born
• Death of a professional figure (e.g. doctor or teacher)
• Death of a celebrity or public figure
• Losses that don’t involve death (e.g. moving house, a child moving out of home, physical illness, redundancy or retirement, end of a life stage, infertility, menopause, divorce or relationship breakdown, change in financial status etc.)

 
3. The nature of the death is stigmatised

• Death by suicide
• Death by murder
• Death from substance misuse
• Death from HIV/AIDS
• Death from drink driving or drug driving
• Abortion

 
4. The griever is not acknowledged

• They are physically or mentally unwell
• They are physically or mentally disabled
• They are elderly
• They are a child or young person

 
The effects of disenfranchised grief
 
The disenfranchised grief process is typically more complicated than for socially accepted or acknowledged bereavements. The loss can leave you feeling alone, isolated, unworthy and unsupported.
 
Other effects can include depression, anger, frustration, and intense and prolonged sadness. You may also experience physical, behavioural, cognitive and other emotional changes as you continue to grieve in silence.
 
How to cope with disenfranchised grief
 
If you experience disenfranchised grief, you may become ‘stuck’ in the grief process. Having no opportunity to talk about and work through your thoughts and emotions means it can feel impossible to move forward. It may also be difficult to understand why the loss continues to be so painful.
 
The first step is to confide in someone about how you’re feeling. This may be a friend, family member, co-worker, therapist, your GP, or a support organisation such as Cruse Bereavement Care. Voicing your loss can help to acknowledge its significance, and to validate and normalise how you’re feeling.
 
Other steps may include having your own personal ritual or ceremony to say goodbye, particularly if you were excluded from the public burial or cremation service, or creating a memory box. You should also focus on your own physical and mental health through sleep, diet, exercise and self-care, including requesting compassionate leave from work if applicable.
 
Remember, no loss is insignificant, no matter who or what it is and what the circumstances are. After any loss, you’re entitled to give yourself time and permission to grieve.
 
If you’ve experienced a loss and would like someone to talk to, get in touch for an appointment.

This year’s Mental Health Awareness Week, which runs from 14th to 20th May, is focusing on stress. To help you prevent and reduce stress, and to improve your ability to cope with it, here are some tips for creating your personal stress management toolkit.
 
Stress is something we all experience at some point in our lives. It’s a key factor in many mental health problems, yet too often we fail to recognise (or choose to ignore) we’re experiencing it until we reach crisis point.
 
Stress can be caused by:

• being placed under pressure
• facing big changes
• worrying about something
• not having control over the outcome of a situation
• having responsibilities that are overwhelming
• not having enough work, activities or change in your life
• times of uncertainty[i]

 
Stress can affect how we feel and behave. It can also create a wide range of physical symptoms, including: panic attacks, muscle tension, difficulty sleeping, headaches, nausea, indigestion, and chest pain.
 
You can improve your ability to cope with stress by:
 
1) Managing external pressures – to do this, identify your stress triggers, look for ways to address the cause(s), realistically plan your available time, ask for help and support, and accept the things you can’t change[ii]
 
2) Developing emotional resilience – to do this, look at making lifestyle changes (e.g. taking up a hobby), look after your physical health, be kinder to yourself, take a break, and build up your support network[iii]
 
To help you with these, it can be useful to create a personal toolkit of resources and materials.
 
Your stress management toolkit can be made up of:

• To-do list or task planners
• Time management schedulers
• Communication tips and reminders to be assertive
• A journal (to help track and identify stress triggers)
• Meal planners
• Self-care items (e.g. relaxation colouring books, bubble bath, favourite books, records, recipes etc.)
• Favourite sayings, mottos or quotes
• Memory prompts (e.g. objects or photos of family, friends and favourite places as a reminder of relaxed times in your life)
• A list of hobbies you enjoy doing
• A list of places you enjoy visiting
  
• Mindfulness meditations
  
• Sleep hygiene tips (read more about how to sleep better)
• Phone numbers of friends
• A list of support organisations and helplines (e.g. for housing, finance, debt, insurance, work union, student support, addiction, abuse etc.)
• Contact details for your GP
• Contact details for a therapist (here are my contact details)
  
• Anything else you find helpful!

 
As well as helping to improve your ability to cope with stress, regularly using your stress management toolkit can help you to identify triggers and prevent stress before it occurs. The result: improved mental health and wellbeing.


[i] Mind, How To Manage Stress: What causes stress?, Available: https://www.mind.org.uk/information-support/types-of-mental-health-problems/stress/causes-of-stress/#.Wu7iJ8gh2gQ
 
[ii] Mind, How To Manage Stress: How can I deal with pressure?, Available: https://www.mind.org.uk/information-support/types-of-mental-health-problems/stress/dealing-with-pressure/#.Wu7mxMgh2gQ

[iii] Mind, How To Manage Stress: How can I be more resilient?, Available: https://www.mind.org.uk/information-support/types-of-mental-health-problems/stress/developing-resilience/#.Wu7mxsgh2gQ