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Venting to manage anger? This might work better

We can all feel angry from time to time and people often think that venting anger will help us.  This might not be the case.  A recent study looked at what worked better to manage anger: activities that increased arousal (venting) or activities that decreased arousal (calming activities).

What was the study? (1)

Bushman and Kjærvik reviewed 154 studies including 184 independent samples involving 10,189 participants.

What were the results? (1)

The authors found that effects calming activities were more effective at managing anger than venting activities.

What are examples of calming and venting activities in this study? (1)

Examples of calming activities that helped manage anger, or activities that decreased arousal were: deep breathing, mindfulness, meditation.

Examples of activities that increased arousal that did NOT help manage anger were: hitting a bag, jogging, cycling.

What are some caveats? (1)

  • See the full study for further details (1).
  • The authors found that the results were stable over time for participants of different genders, races, ages, and cultures (1)
  • It also did not matter how the activities were delivered or taught:  (e.g., digital platforms, researchers, therapists),  group or individual sessions, field, or laboratory settings (1).
  • This means that one could teach themselves calming activities to help manage anger or learn it from technology or others, including professional settings (1).

Where or how can I learn these calming techniques? (1)

Check out previous posts or this link (3).

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By Ryan S Patel DO, FAPA

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. Kjærvik SL, Bushman BJ. A meta-analytic review of anger management activities that increase or
    decrease arousal: What fuels or douses rage? Clinical Psychology Review
    Volume 109, April 2024, 102414.  https://doi.org/10.1016/j.cpr.2024.102414
  2. https://news.osu.edu/breathe-dont-vent-turning-down-the-heat-is-key-to-managing-anger/?sfmc_key=0032E00002tKfusQAC
  3. Mental Health: Proven Techniques (lifehacks, biohacks) and Expert insights  for specific tools and techniques to learn calming strategies such as deep breathing, mindfulness, meditation, etc.

Mindfulness meditation vs escitalopram for anxiety

Mindfulness meditation has been shown to have various mental health benefits. For example, a review of 13 studies showed improvement in ADHD symptoms with mindfulness meditation (1).

Also, 41 trials show mindfulness meditation helped improve stress related outcomes such as anxiety, depression, stress, positive mood, etc. (2)

A review of 14 clinical trials shows meditation being more effective than relaxation techniques for anxiety (3).

A recent study looked at whether mindfulness based stress reduction (MBSR) was as effective as an anti-anxiety medication Lexapro (escitalopram) (4).

Who was in the study? (4)

  • 102 participants in MBSR and 106 participants in the escitalopram group, with a mean age of 33 years (4).
  • Participants were mostly female (4).

How was anxiety measured (4)?

  • Clinical Global Impression of Severity scale (CGI-S) was performed by blinded clinical interviewer at baseline, week 8 end point, and follow-up visits at 12 and 24 weeks (4).
  • Primary patient reported measure was the Overall Anxiety Severity and Impairment Scale (OASIS) (4).

What was the intervention? (4)

  • Participants were randomized 1:1 to 8 weeks of the weekly MBSR course or the antidepressant escitalopram, flexibly dosed from 10 to 20 mg (4).
  • MBSR group was taught MBSR as a manualized 8-week protocol with 45 minute daily home practice exercises, weekly 2.5-hour long classes, a day-long retreat weekend class during the fifth or sixth week (5).
  • Participants were taught several forms of mindfulness meditation, such as breath awareness (focusing attention on the breath and other physical sensations), a body scan (directing attention to one body part at a time and observing how that body part feels), and mindful movement (stretching and movements designed to bring awareness to the body and increase interoceptive awareness) (4,5).

What were the results? (4)

Participants who completed the trial at week 8 showed noninferiority for CGI-S score improvement with MBSR compared with escitalopram (4)—meaning MBSR was as effective as escitalopram.

What are some caveats?

  • This is the first study to compare MBSR to medication (4).
  • The study did not use commonly used instruments to measure anxiety in clinical settings such as GAD-7, Hamilton rating scale for anxiety or the Beck anxiety inventory, etc.
  • Participants had any anxiety disorder, not a specific type of anxiety disorder such as generalized anxiety disorder, panic disorder etc (4) which make it difficult to generalize results for other populations.
  • Participants (4) were mostly female in the 30’s which makes it difficult to generalize results for other populations.
  • MBSR is a specific type of manualized meditation taught by qualified instructors (5) and it may be difficult to find qualified instructors or qualified classes in your area.
  • In addition to work, school, and life obligations, people may find it difficult to schedule 45 minutes of daily meditation plus 2.5 hours of weekly class plus a day long retreat.
  • Different people may benefit from different types of meditation, and this area is being further researched.
  • Practicing meditation regularly may lead to improved benefits, and some people may see benefits with shorter duration of meditation.
  • Some people may find that mindfulness or too much mindfulness may worsen their symptoms (6), so you should check with your mental health professional if MBSR is appropriate for you.
  • Some mental health conditions may not be appropriate for MBSR, check with your mental health professional.

Want to learn more about meditation?

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By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. Poissant, H., Mendrek, A., Talbot, N., Khoury, B., & Nolan, J. (2019). Behavioral and Cognitive Impacts of Mindfulness-Based Interventions on Adults with Attention-Deficit Hyperactivity Disorder: A Systematic Review. Behavioural neurology, 2019, 5682050. doi:10.1155/2019/5682050
  2. Goyal M, Singh S, Sibinga EMS, et al. Meditation Programs for Psychological Stress and Well-Being [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 Jan. (Comparative Effectiveness Reviews, No. 124.)Available from: https://www.ncbi.nlm.nih.gov/books/NBK180102/
  3. Montero-Marin, J., Garcia-Campayo, J., Pérez-Yus, M., Zabaleta-del-Olmo, E., & Cuijpers, P. (n.d.). Meditation techniques v. relaxation therapies when treating anxiety: A meta-analytic review. Psychological Medicine,1-16. doi:10.1017/S0033291719001600
  4. Hoge, Elizabeth A et al. “Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders: A Randomized Clinical Trial.” JAMA psychiatry, e223679. 9 Nov. 2022, doi:10.1001/jamapsychiatry.2022.3679
  5. Santorelli  SF, Kabat-Zinn  J, Blacker  M, Meleo-Meyer  F, Koerbel  L. Mindfulness-Based Stress Reduction (MBSR) Authorized Curriculum Guide. Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School. Revised 2017. Accessed December 14, 2017. https://www.bangor.ac.uk/mindfulness/documents/mbsr-curriculum-guide-2017.pdf
  6. Britton, W. B., Lindahl, J. R., Cooper, D. J., Canby, N. K., & Palitsky, R. (2021). Defining and Measuring Meditation-Related Adverse Effects in Mindfulness-Based Programs. Clinical Psychological Science, 9(6), 1185–1204. https://doi.org/10.1177/2167702621996340

Returning to campus and mental health during COVID

According to a public opinion poll conducted March 26 – April 5, 2021, among a sample of 1,000 adults 18 years of age and older, released by the American Psychiatric Association (APA), young adults, ages 18 to 29 (49%) are more likely to say they are more anxious now compared to last year, despite available vaccinations for COVID-19. (1)

The American Psychological Association recommends the following strategies to cope with Covid related stress as a student (2):

PRACTICE SELF-CARE (2)

FIND WAYS TO FOCUS (2)

  • You might feel unmotivated now. Recognize that the current circumstances are hard for everyone. Don’t judge yourself; just do the best you can.
  • Establish a routine. Get up, go to bed and do your work at the same time every day.
  • Frequent breaks can help you re-engage in your work.
  • Try to create a separate work space, although you should reserve your sleeping area for sleeping. If family members are distracting you, use “I statements” to explain the problem—“I’m worried about my exam next week”—and work together to develop solutions.
  • Resources to improve focus:

SEEK OUT SOCIAL SUPPORT (2)

HELP OTHERS COPE (2)

  • Your classmates and family members may be anxious, too.
  • You don’t have to fix their problems. It’s enough to let them know they’re not alone.
  • Our mental health support options may be helpful:

FIND WAYS TO MANAGE DISAPPOINTMENT (2)

  • Grieve losses, then reframe how you think about these life events. Think about how you can honor what you’ve achieved.
  • Find new ways to celebrate. Consider recreating important events once it’s safe.

LIMIT YOUR MEDIA CONSUMPTION (2)

  • While it’s important to stay informed, too much news—especially social media—can add to your anxiety. To avoid being overwhelmed, set limits on your media consumption and smartphone use.
  • Resources on technology and mental health: https://u.osu.edu/emotionalfitness/2020/12/11/593/

FOCUS ON THINGS YOU CAN CONTROL (2)

  • Your classmates, friends, or family members may be disobeying the rules about physical distancing or doing other things that add to your stress.
  • While modeling good behavior and staying safe yourself, recognize that you can’t control what other people do.
  • Instead of worrying about our ambiguous future, focus on solving immediate problems.

Other thoughts:

  • While returning to campus during COVID can be anxiety provoking for some, practicing self-care and being realistic with your self can help.
  • With this in mind, it may be useful to have a back-up plan, or willingness to adjust if things are not going as well as expected, despite your best effort.
  • Mary DeCenzo, LISW-S, ACTRP-C, OSU CCS Embedded Clinician, Fisher College of Business says, “Avoid making Value judgements, think twice speak once”, and consider becoming involved in OSU student organizations.
  • Check out the Buckeyes Back Together Workshop on Wednesdays, facilitated by OSU-CCS therapist, Claire Simon MSW, LISW-S.
  • Dr Stefanie Day, EdD, PCC-S, Embedded Clinician, OSU College of Engineering, and OSU-CCS, suggests looking into a student organization called SKY Campus Happiness.

If you would like to be notified of a new post (usually once per month), please enter your email and hit the subscribe button.

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. https://www.psychiatry.org/newsroom/news-releases/new-apa-poll-shows-sustained-anxiety-among-americans-more-than-half-of-parents-are-concerned-about-the-mental-well-being-of-their-children
  2. https://www.apa.org/topics/covid-19/student-stress.pdf