HEAT
Group
Protocol
Last Updated: 3 DEC 07
1
Table of Contents
p. 3
Session #1: Survival Mode and the 5 Parts of Anger
p. 6
Session #2: Control and Anger
p. 7
Session #3: How the Mind Creates Anger
p. 9
Session #4: Patience and Assertiveness
p. 11
Session #5: Using Forgiveness to Let Go of Resentment
p. 14
Session #6: Values and Commitment
p. 16
Handouts
p. 17 "What is Survival Mode?" (Session #1)
p. 18 Anger Interview (Session #1)
p. 19 Survival Mode Diary (Session #1)
p. 20 Where do you have control? (Session #2)
p. 23 Techniques for working with an angry mind (Session #3)
p. 24 "The Facts" Exercise (Session #5)
p. 26 Forgiveness is a form of realism (Session #5)
p. 27 Values/Commitment Exercise (Session #6)
p. 29
Note Templates
Last Updated: 3 DEC 07
2
Session #1: Survival Mode and the 5 Parts of Anger
Welcome to new members:
-distribute orientation handout
-give brief description of HEAT group
Review Commitments from Previous Week:
-ask if group members followed through on commitment identified in values
exercise in previous session
Discussion:
-Discuss the nature of threat and connection with anger
Discussion Point: What is threat? What is it like to feel threatened? What sorts of
things can seem threatening to you? Have you noticed that you tend to feel
threatened very easily? Do you find yourself reacting as if you were threatened
without even knowing why? In your experience, is there any connection between
feeling threatened and feeling angry?
-Discuss survival mode
Handout: “What is ‘Survival Mode’?”
-
everyone has an instinct to react to life threatening situations by going into
“survival mode.” Survival mode works when it is triggered in situations that are
actually life threatening. However, survival mode doesn’t work as well in other
situations.
-
This response includes heightened arousal, a hostile appraisal of events, a loss in the ability to
engage in self-monitoring or other inhibitory processes, and resulting behavior produced to
respond to this perceived severe threat.
First, when you are in survival mode, your body feels tense and on edge. Your heart might
race, your blood pumps harder, you may sweat, your muscles tense (especially the ones in
your face and shoulders), you may feel hot, you may even feel dizzy.
Second, you may notice that you have a lot of hostile thoughts. You are likely to interpret the
actions of others or circumstances as threatening. You may also notice that harsh judgemental
thoughts are more available, or even images of past or imagined injuries. Most importantly,
you may have a hard time distinguishing what is happening versus what you think is or might
happen.
Third, you may feel like there is a point where you go into auto-pilot and become aggressive.
It may feel like you are being physically pulled toward being aggressive.
These processes lead the veteran to see threats in the civilian environment that do not
objectively pose any significant danger, and he or she may respond in an aggressive manner
to such threats. This “survival mode,” while adaptive in combat situations, typically becomes
maladaptive when the individual interacts with his or her environment in civilian life.
-
-
-
Last Updated: 3 DEC 07
3
-
Discuss 5 Parts of anger
Discussion Point: Do you ever feel overwhelmed by anger and feelings of threat?
Does it seem impossible to confront these experiences? Do they seem stronger or
more powerful than you? What if these experiences were actually made up of
many parts that could be dealt with one at a time? Might it be more reasonable to
deal with the individual parts of these experiences rather than the whole thing?
Discussion Point: Have you ever noticed that there are different parts to your
anger? Is the idea that there is a difference between the feeling of anger/impulses
to act and angry behavior? Would you be willing to try to find the 5 parts of anger
the next time anger or threat shows up?
-
5 Parts of Anger: Pre-anger feelings (guilt, shame, anxiety, stress, sadness,
frustration, threat, etc.), Anger Trigger Thoughts (especially judgments about
others, “shoulds,” memories, etc.), Anger Feelings (bodily sensations, thoughts),
Impulses to Act (what do you feel drawn to do when you feel angry?), Anger
Behavior (isolation, aggression, suppression, assertiveness, etc.)
Experiential Exercise: Survival Mode Diary
-Present “How Does that Taste Metaphor”
Describing your feelings is kind of tricky. Most people confuse descriptions of how
they feel with judgments about if what they are feeling is good or bad. For example,
if you ask someone who is smiling how they are feeling, they are likely to say
“good.” That is fine, but it really doesn’t give us a lot of information other than the
person approves how he/she is feeling at the moment. The trick is to try to describe
how you are feeling just like you would describe how something tastes. If someone
asked you what ice cream tasted like, you would probably describe the temperature,
the texture, the flavor, the smell, etc. If you just say “it tastes good,” people are likely
to repeat the question and ask, “ok, I’m glad you like it, but how does it taste.” In
order for you to be able to describe how something tastes, you need to keep in your
mouth for long enough to experience it.
-
Noticing the five parts of anger is just like noticing and describing how something
tastes. When describing how something tastes, you would want to talk about the
texture, the temperature, the “mouth feel,” the flavor, the smell, etc. When
noticing and describing anger, you want to notice pre-anger feelings, trigger
thoughts, anger feelings, urges to act, and angry behaviors.
-
in order to be able to pick out the different parts of anger, you have to be aware of
how you are feeling. In this exercise, we are going to ask you to remember a
recent incident when you felt angry and/or threatened. Then, we will ask you
some questions to help you notice the 5 parts of anger that we spoke about in
session today. We would like you to write down answers to these questions on
Last Updated: 3 DEC 07
4
the Survival Mode Diary we just gave you. When we are finished, we will talk a
bit about your reactions to this exercise.
Veterans are asked to sit comfortably in their chair, direct their eyes at the floor, and
take a few slow, deep breaths to help them get "centered." Then the facilitator will
ask them to recall a recent situation in which they felt angry and/or threatened. Next,
the veterans are asked to form groups of 2. They are then instructed to interview each
other about their experiences in the 5 domains of anger using the "Survival Mode
Interview" sheet.
- Process
Weekly Commitment: Group members invited to commit to completing the Survival
Mode Diary during the following week and to commit to supporting the other group
members in their commitments.
Last Updated: 3 DEC 07
5
Session #2: Control and Anger
Welcome to new members:
-distribute orientation handout
-give brief description of HEAT group
Review Commitments from Previous Week:
-ask if group members followed through on commitment to complete survival
mode diary
Discussion:
-Discuss the connection between control and anger
Discussion Point: What are some things you can control? Do you believe there is an
association between control and being angry? What are some situations where we
have no control?
-Discuss 2 areas where control efforts do not work and can lead to anger
Discussion Point: When we try to control others we are operating under the
assumption that other people should behave, think, and act like we think they should.
We can’t control other people because people don’t like feeling controlled.
Discussion Point: Its natural to think that you should be able to control angry
thoughts and feelings. How does this usually work?
Experiential Exercise: Control Self-Assessment
-Group members complete "Suppression and Control" and "Trying to Control
Other People" inventories (pp. 55-56; 61-62 in ACT on Life, Not on Anger)
Experiential Exercise: Imaginal Review of Control Strategies
- Group members imagine recent situation in which they were angry and complete
the "Control Exercise" worksheet
- Process
Weekly Commitment: Group members invited to commit to completing the "What I Can
and Can't Control" checklist and "Control Exercise" (pp. 70-71 in Act on Life, Not on
Anger) worksheet during the following week and to commit to supporting the other group
members in their commitments.
Last Updated: 3 DEC 07
6
Session #3: How the Mind Creates Anger
Welcome to new members:
-distribute orientation handout
-give brief description of HEAT group
Review Commitments from Previous Week:
-ask if group members followed through on commitment to complete "What I Can
and Can't Control" checklist and "Control Exercise" worksheet
Discussion: Stories that Fuel Anger
-Discuss the connection between triggers, thoughts, and anger
Discussion Point: What does your mind do when something triggers you? Have
you ever noticed that it knows exactly what to say to make you get angry? Stay
angry? Do you notice that certain thoughts 'hook' you and make it easier for you
to get angry or even aggressive?
- Discuss types of thoughts: mental images, "should stories" (thoughts that
involve some sort of rule that is being violated), cause/effect stories (they are a
jerk and that caused them to act this way toward me), blaming/labeling thoughts
(putting someone into a category, mind reading)
-Discuss automatic nature of thoughts
Discussion Point: Do you ever notice that anger trigger thoughts tend to show up
out of nowhere? Do you notice that many of these thoughts have a "should" in
them, or have a righteous quality? Ever wonder where these "rules" come from?
Experiential Exercise: What are the numbers? Mary had a little…..
- Discuss cost of buying into anger triggers thoughts
Discussion Point: Where does buying into your anger trigger thoughts lead to?
Does it lead you to a place that feels vital, open, and alive? Does it lead to more
or less suffering? Does it ever lead to long term solutions to your problems?
- Discuss cost of ruminating (Chewing on Vomit Metaphor)
Discussion: Relating to anger stories differently
Discussion Point: What are your options when dealing with anger trigger
thoughts? What if you could deal with your trigger thoughts in a way that didn't
require you to argue, change, or stuff them, would you be interested in learning
about that?
Last Updated: 3 DEC 07
7
Experiential Exercise: Defusion
- Drill sergeant metaphor: "when you were in the military, one of the first people you met
was your drill instructor. You learned very quickly that you had to do everything that the
drill instructor told you to do or else there would be harsh consequences. If he said jump,
you said "how high?" If he insulted you and yelled at you, you just stood there and
listened politely. This was adaptive. This kept you from suffering more than was
necessary. This helped you to learn that following orders kept you alive.
Our minds are like drill instructors. They bark orders and evaluations at us all day long.
Some of the information is good and can be helpful. Some of it is just plain mean. Some
of it doesn't make any sense. And some of it can get us in to trouble if we buy into it.
Following the drill instructor and your commanding officers is a good idea when you are
in the military. But would you feel like you had to obey your drill instructor if he came
up to you on the street and started barking orders at you today? Imagine what that would
be like. If you just let him shout and follow you for a while, wouldn't he just go on his
way?
Imagine that your mind is like a drill instructor. When you are angry, the drill instructor
starts screaming orders at you and throwing insults and evaluations your way. Do you
need to respond?
- Process
Homework: Trigger Thought Worksheet
Weekly Commitment: Group members invited to commit to completing during the
following week and to commit to supporting the other group members in their
commitments.
Last Updated: 3 DEC 07
8
Session #4: Patience and Assertiveness
Welcome to new members:
-distribute orientation handout
-give brief description of HEAT group
Review Commitments from Previous Week:
-ask if group members followed through on commitment to complete " Trigger
Thought Worksheet " worksheet
Discussion: Doing something impulsively requires lots of time and effort in the long run
Discussion Point: Does anger seem to demand a quick solution? What are the
consequences of picking the quick solution? What does the quick solution
promise to deliver? Relief? What does your experience tell you about how this
usually works out? Do quick solutions to anger (impulsive/suppression) increase
or decrease the amount of time you need to spend solving anger-related
problems in the long run? Even if you do get relief in the short term, is this a
good trade?
- Exercise: Anger Map (on board, diagram hypothetical results of impulsive
responses to anger; give one example of suppression and one of aggression; pull for
responses that indicate that this responses tend to result in an increase in problems to
be addressed/more frustration/more discomfort)
Discussion: What would you need to make a different choice?
-Quote: one moment of patience may ward of great disaster
- Discuss patience as a response to feelings of anger. This move opens up the
possibility for more effective action. It is essentially slowing down so that you
can see what is happening before taking action. Taking deliberate steps versus
taking hasty steps.
Experiential exercise: Take yourself for a walk
(participants asked to walk quickly from one end of the room to another, then to
walk back at a much slower pace.
Discussion point: What would you have to do to slow down when you are
feeling angry?
Experiential Exercise: Mindfulness of ice
Last Updated: 3 DEC 07
9
Discussion: Taking Assertive Action
Discussion Point: Anger is usually about something. There is an issue, problem,
or opportunity that requires a response. Each response is like a step. What
direction do your steps take you? Assertiveness is taking steps toward the
solution to the problem with your anger.
- steps to assertiveness: identify the problem by examining pre-anger feelings/anger
triggers (hand out "what's behind anger" picture), visualize the desired solution,
brainstorm about ways to move toward the solution that cause the least amount of
additional problems, take action
Homework: Patience and Action
- this week, just notice where you take your body. If you find yourself rushing through
life or acting on autopilot, slow down. If you are walking fast, slow down your pace. If
your are struggling with your feelings, slow down and label them. If you find yourself
making snap decisions, take a few moments to consider the alternatives. If your anger
reaches a level that is too high for
Weekly Commitment: Group members invited to commit to completing during the
following week and to commit to supporting the other group members in their
commitments.
Last Updated: 3 DEC 07
10
Session #5: Using Forgiveness to Let Go of Resentment
Welcome to new members:
-distribute orientation handout
-give brief description of HEAT group
Review Commitments from Previous Week:
-ask if group members followed through on commitment to complete (homework)
Discussion: Cost of Resentments
-Discuss Hiroo Onoda Story
(resentment is like continuing to fight when war is over)
Discussion Point: What reactions do you have to the idea of forgiveness?
What does holding onto past hurts and resentments accomplish? Who does
plotting revenge hurt? Does holding onto past hurts and resentments help
you?
- Discuss ACT definition of forgiveness. forgiveness is one of the most elegant forms of
willingness many people who struggle with anger problems are fighting old battles in the
hope that the hurt that started these battles will be alleviated; most people have difficulty
with forgiveness because it sounds like a change in judgment or evaluation
-It sounds like, "I used to think you were wrong, but now I've changed my mind."
- Or even worse, it may sound like emotional avoidance: forgetting old angers and hurts,
excusing, denying But the word forgive actually suggests a more positive way to
approach this topic: Taken literally, it means to "give that which came before" It means
repairing what was lost. Give and Gift come from the Latin word Gratis which means
free. In that sense, fore-giving is not earned: it is free.
-However, the gift of fore-giveness is not a gift to someone else. Giving what went before
is most particularly not a gift to the wrongdoer. It is a gift to oneself. If one cannot give
the grace that went before a wrongdoing, even if it was valuable, then life's injustices are
made permanent. And they are made permanent by the victim's action-not by the actions
of a perpetrator.
Discussion Point: What are the costs of holding on to a resentment? Does it ever
bring the peace and satisfaction that you are hoping for? Who does it ultimately
hurt?
Last Updated: 3 DEC 07
11
Hook Metaphor
When we are hurt because of the actions of another person or of ourselves, it's like we are
caught on a fishing hook. The pain seems to grab us and limit our movement. Our usual
reaction to "try to get revenge" by getting the person who may have caused our pain to
feel the same pain: by hooking them. However, the problem with this strategy is that we
usually wind up sticking them with the same hook that we are caught on. It's like we are
on the hook, and they are on top of us. Unfortunately, this keeps us on the hook. You
can't get yourself off the hook, let go of the pain, because they are blocking the way. If
you are completely invested in keeping the other person on the hook, you are also 100%
never going to be able to get yourself off the hook because that person will always be
blocking the way out. Forgiveness is letting the person off the hook so that you can get
yourself off the hook. It is a gift to yourself, not the other person. It does not require you
to change the way you feel, how you think, or whether or not you approve of what
happened. It is simply a choice you make to let that person go so that you can move on
with your life.
If forgiveness was a choice that you could make, one that would allow you to move past
old hurts, would you take it?
Experiential Exercise: "The Facts"
- "The Facts" exercise sheet handed out
- Exercise has the following steps:
1) Have participants write down facts about a resentment that they are holding.
"Facts" include the people/places/situations involved, beliefs about what
happened and what should happen, thoughts about the people/places/situations
involved, impact of the triggering event on person, emotions involved in
resentment, etc. (basically anything of personal relevance)
2) Participants take facts sheet and press it against the wall with pointer finger.
Facilitator suggests that resentment is just like this: Holding the facts against the
person who "caused" them.
3) Facilitator asks participants to consider whom this action (i.e., holding the facts
against the wall) ultimately hurts. Participants are focused on the pain
experienced as a result of keeping the facts pinned against the wall.
4) Participants also asked to consider their ability to do other things besides
holding the facts against the wall if they are 100% engrossed in this activity. Ask
participants to notice that they have little or no freedom to do anything else if they
are committed to holding the facts against the wall.
Last Updated: 3 DEC 07
12
5) Ask participants if they are willing to stop pushing the facts to the wall and if
they are willing to stop holding the facts against the wall in the service of
increasing their freedom.
6) As participants stop pushing the facts against the wall, ask them to simply hold
the facts in their hands and note the difference between the experience of doing
this versus doing the previous action.
7) Suggest that forgiveness is the same action. Forgiveness does NOT mean
changing the facts about an event that triggered a resentment (e.g., condone what
was done, suddenly feel "ok" about what happened, have positive feelings a
transgressor, etc.). Rather, it means making a conscious choice to STOP holding
the facts against the transgressor in the service of giving yourself the gifts of relief
and freedom.
- Process
Homework: Repeat "the facts" exercise.
Weekly Commitment: Group members invited to commit to completing "the facts"
exercise during the following week and to commit to supporting the other group members
in their commitments.
Last Updated: 3 DEC 07
13
Outline for Session #6: Values and Commitment
Orientation and Introduction:
- welcome new members of the group, review rules of group, discuss homework
assignment from previous session
- brief review of previous weeks topic and introduction of current session topic
Presentation of Topic: Values and Grounding
Metaphor: Digging Your Feet in the Sand
The experience of being angry is kind of like this. Imagine that you are at the
beach. It's one of those days where the water is choppy and the waves are coming
in strong. As you wade out into the water, you feel the waves crash at your front
and the undertow tugging at your feet, pulling you out farther. When you just try
to go with the flow, allow yourself to get pushed around by the waves and pulled
by the undertow, you get tossed around and pulled deeper into the ocean.
However, if you put your feet down, literally take a stand, you can prevent
yourself from getting carried away. Taking a stand doesn't make the ocean stop
hitting you with waves, nor does it stop the undertow from trying to pull you out
to sea. These forces are still going to act on you no matter what you do. The
difference is that, when you take a stand, you can still feel these forces AND not
get carried away by them. Anger can sometimes feel like a combination of forces
pushing you and pulling you in different directions. It can feel like you can't
stand up, can't get on with your life until the feelings and sensations associated
with anger "calm down." But what if another way to deal with these moments is
to simply "stand up" for something that matters to you: your values?
Experiential Exercise: Standing Up for Something
-
Group leaders introduce values exercise as a way to learn more about what each
person would like to "stand for." The exercise has 4 parts. The first three parts are
done individually and the last part is done as a group exercise.
o The first part involves writing about any issue that the individual has been
struggling with. Although group members are encouraged to focus on an
anger-related issue, any issue is just fine. Group members are told to write
about whatever comes to mind about this issue, and to write continuously
for 5 minutes. If they run out of things to write, they are instructed to start
over and rewrite the things that they have already written.
o The second part involves filling out the VLQ. Group leaders give a brief
set of instructions on how to use this instrument and group members spend
about 5 minutes filling out both sides.
o The third part of the exercise involves picking 2 values and writing about
what each of those values means to the individual.
o The fourth part beings with group members forming a tight circle with
their chairs in the middle of the room. Group leaders explain that this
Last Updated: 3 DEC 07
14
exercise in an opportunity to make a commitment to do something in the
service of one's values. Group members are given several guidelines for
participating in this exercise. Also, group leaders model the appropriate
behaviors by participating. First, group members are told that they have
the opportunity to commit to working toward one, specific, behavioral
goal in the service of one of their values during the next week. This
process involves literally standing up in group, making eye contact with
each individual in the group, and then stating what their commitment will
be. Group members are informed that giving some background about the
value they are serving is permissible, but that the main focus of this
exercise is to state something that they will actually do. Second, group
members are given guidelines for their behavior when other members are
making commitments. Group members are asked to give their undivided
attention and support to the individual who is speaking. They are asked to
behave in a way that communicates to the individual that what he or she
talking about is extremely important and that members of the group are
genuinely interested in what he/she is saying. Also, group members are
informed that there are only 2 types of feedback that are permissible. The
first type of feedback is a simple acknowledgement that an individual has
heard what the person speaking has said. In other words, simple
validation is permitted. The other type of feedback is given when a
member of the group does not think the person committing to a goal has
actually verbalized a specific, measurable, behavioral course of action. In
this case, a group member may ask the person standing up to clarify or to
be more specific. This type of feedback is done with an air of respect and
curiosity, not of judgment or criticism.
Process: Once the exercises have been completed and each person has committed to a
course of action for the following week, group members are asked to share their reactions
to the group. After conversation dies down or time is almost up, group leaders remind
the group about the "Digging Your Feet in the Sand" metaphor.
Homework: Group members are encouraged to review the VLQ, continue journaling
about other valued domains, and to follow through with behavioral commitments made in
group.
Last Updated: 3 DEC 07
15
Handouts
Last Updated: 3 DEC 07
16
What is "Survival Mode?"
- Survival mode is a psychological and physical
response to THREAT
- It can be triggered by ACTUAL threats to your
life or by PERCEIVED threats (things that your
mind tells you might be a threat)
- Survival Mode has important parts:
1) It feels like you need to do something
NOW
2) Your body feels tense and "pumped up"
3) Your mind becomes focused on finding
and predicting threat
4) You experience strong feelings of anger
that seem to come out of nowhere
5) You are much more likely to be
aggressive
6) You loose track of what you are doing
*People who experience trauma are more likely
to go into Survival Mode when it is not likely to
be helpful. This is because it is easier for them
to judge a situation to be threatening.
Last Updated: 3 DEC 07
17
Anger Interview
What pre-anger feelings were there the split second before you became
angry? Anxiety? Fear? Frustration? Sadness? Guilt? Shame?
What trigger thoughts were going on in your mind? Did your mind feel
fast (lots of thoughts) or slow (few thoughts)? Were there a lot of different
thoughts or were there just a few thoughts that seemed to repeat themselves?
Was your mind blank? Were there a lot of judgmental thoughts? Thoughts
about how things "should" be?
What did being angry feel like? What was going on in your body? Was
your heart racing or pumping harder? Did it feel like your veins were
throbbing? Were your muscles tense? Were you sweating? Were you
breathing harder? Were you holding your breath? Did you feel hot or cold?
Did you feel dizzy or confused? Did your insides feel tense?
What urges to react did you have? What were your impulses telling you to
do?
What did you do? Think about what you did on the outside (talking, yelling,
staying quiet, being assertive, being aggressive, etc.) AND on the inside
(noticing how you were feeling, trying to get rid of how you were feeling,
talking to yourself, etc.)
Last Updated: 3 DEC 07
18
Survival Mode Diary
Event 1 Event 2 Event 3 Event 4 Event 5
Times of the
day, I felt like
I was in
survival mode
Pre-Anger
feelings
Trigger
thoughts
(actual threats
or perceived
threat)
Anger
feelings (what
is going on
mentally and
physically?)
Impulse to
act
(what urges
did you have
to react?)
Anger
Behavior
(what did you
do?)
Last Updated: 3 DEC 07
19
Where do you have control?
*Remember a recent situation when you were angry. Get in touch with each of the
following parts of that experience. Describe the actions of others or emotions that
triggered your anger. Describe the emotions and sensation in your body that showed up
when you were triggered. Described the way you coped with that situation.
People Triggers:
Feeling Triggers:
Emotions and Bodily Sensations:
Anger behavior (how you coped):
* Review the things you wrote down on the other side. As you review each section, ask
yourself these questions and write your answers down.
Last Updated: 3 DEC 07
20
People Triggers:
Is there anything that you REASONABLY could have done to CHANGE or PREVENT
the person from saying or doing what they did BEFORE they did it?
Did you expect them to follow a rule or expectation that you had in your mind that they
may not have know about?
What effect did trying to control the other person's actions have on your anger?
Feeling Triggers:
Is there anything that you REASONABLY could have done to CHANGE or PREVENT
the feelings you had BEFORE they showed up?
Did you try to RESIST or CONTROL these feelings?
What effect did trying to RESIST or CONTROL these feelings have on your anger?
Last Updated: 3 DEC 07
21
Emotions and Bodily Sensations:
Is there anything that you REASONABLY could have done to CHANGE or PREVENT
the anger feelings or sensations in your body you had BEFORE they showed up?
Did you try to RESIST or CONTROL these feelings?
What effect did trying to RESIST or CONTROL these feelings have on your anger?
Anger behavior (how you coped):
Is there anything that you REASONABLY could have done to CHANGE the way you
acted or coped in this situation?
List as many different things that you could have done (even if they seem "out of
character" for you)
Last Updated: 3 DEC 07
22
Techniques for Working with an Angry Mind
1) Treating your "mind" as if it is almost a separate person. When you notice
judging, blaming, and assuming thoughts, saying to yourself, "there goes my mind
again."
2) Put your thoughts into categories such as blaming, should story, and cause/effect
story, focus your attention of what you need or want in a situation, make a
decision about what to do based on what is most likely to get your needs met.
3) If you notice yourself "buying into" judgmental or blaming thoughts or
assumptions, ask yourself, "have I bought into this thought before?" "Is this an old
and familiar pattern?" "In my experience, will it help to continue buying into this
thought?"
4) Ask yourself this question: "Will buying into this story lead to a more vital and
fulfilling life, or will it lead to more pain and suffering in the long run?"
5) If strong "should" or "must" thoughts show up, imagine that it was someone you
don't take seriously (Joe Pesci or a drill sergeant) and then imagine them standing
there repeating the "should" or "must" thoughts to you.
6) When you notice that your mind is buzzing with judgmental or blaming thoughts
or assumptions, imagine that your mind is a radio station and that these thoughts
are just "background music."
7) Label your thoughts as thoughts. For example, if you are thinking, "Bob is a
jerk," say to yourself, "I am having the thought that Bob is a jerk."
8) Treat your thoughts like a story. Make a decision about what you are going to do
based on what you want or need in a situation, not on what makes sense according
to the story.
9) Watch mental images like you would watch commercials on tv.
10) Imagine that mental images are like movies on the DVD player. Imagine using
the volume controls, fast forward, rewind, and pause buttons. Do this until you
recognize the image for what it is: a made up story in your mind.
11) Repeat your thoughts out loud. Say them in a silly voice.
12) Notice when you are being "hooked" by a thought and choose to become
unhooked.
* The general purpose of these exercises is NOT to challenge, eliminate, or change your
thoughts. It's more about noticing when your mind is giving you anger trigger thoughts
and stories and seeing them for what they are: stories. Try these exercises to see if they
help you get unhooked from unhelpful stories, and if they decrease the impact they have
on your behavior.
Last Updated: 3 DEC 07
23
Forgiveness Exercise
Write about a resentment that you have. What are the
"facts?" What happened? Who was involved? How
did the incident affect you?
Last Updated: 3 DEC 07
24
What do you think motivates you to hold onto this
resentment?
Describe any costs or lost opportunities that have
been the result of holding onto this resentment.
Has holding onto this resentment given you any
peace or satisfaction? Has it helped you?
If it were possible to make the choice to let go of this
resentment in the service of something you care
about, would you do it?
If forgiveness means no longer holding the "facts"
against the person, place, or thing you resent (rather
than forgetting the facts, changing the facts, making
yourself like the facts, etc.), would it be possible for
you to choose to forgive?
Last Updated: 3 DEC 07
25
Forgiveness is a form of realism. It doesn't deny, minimize, or justify what others have
done to us or the pain that we have suffered. It encourages us to look squarely at those
old wounds and see them for what they are. And it allows us to see how much energy we
have wasted and how much we have damaged ourselves by not forgiving.
Forgiveness is an internal process. It can't be forced, and it doesn't come easy. It brings
with it great feelings of wellness and freedom. But we experience this only when we want
to heal and when we are willing to work for it.
Forgiveness is a sign of positive self-esteem. We no longer identify ourselves by our past
injuries and injustices. We are no longer victims. We claim the right to stop hurting when
we say, "I'm tired of the pain, and I want to be healed." At that moment, forgiveness
becomes a possibility-although it may take time and much hard work before we finally
achieve it.
Forgiveness is letting go of the past. It doesn't erase what happened, but it does allow us
to lessen and perhaps even eliminate the pain of the past. The pain from our past no
longer dictates how we live in the present, and it no longer determines our future.
It also means that we no longer need resentment and anger as an excuse for our
shortcomings. We don't need them as a weapon to punish others nor as a shield to protect
ourselves by keeping others away. And most importantly, we don't need these feelings to
identify who we are. We become more than merely victims of our past.
Forgiveness is no longer wanting to punish those who hurt us. It is understanding that the
anger and hatred that we feel toward them hurts us far more than it hurts them. It is
seeing how we hide ourselves in our anger and how those feelings prevent us from
healing. It is discovering the inner peace that becomes ours when we let go of the past
and forget vengeance.
Forgiveness is moving on. It is recognizing all that we have lost because of our refusal to
forgive. It is realizing that the energy that we spend hanging on to the past is better spent
on improving our present and our future. It is letting go of the past so that we can move
on.
We all have been hurt. And at one time or another most of us have made the mistake of
trying to run away from the past. The problem is that no matter how fast or how far we
run, the past always catches up to us-and usually at the most inopportune time. When we
forgive, we are dealing with the past in such a way that we no longer have to run.
For me, learning how to forgive wasn't easy. But I did learn, and my life is better for it even here on death row."
Michael B. Ross
Death Row
Somers, Connecticut
Last Updated: 3 DEC 07
26
H.E.A.T. Group Values Exercise
Part 1: Please write about a problem that you are
currently struggling with. It can be a problem that
involves anger or one that doesn't involve anger.
Last Updated: 3 DEC 07
27
Part 2: Please fill out the Valued Living
Questionnaire.
Part 3: Please write about two values in the space
provided below. Write about what these values mean
to you. Write about the person you would like to be
in terms of these values.
Value #1: ____________________
Value #2: ____________________
Last Updated: 3 DEC 07
28
Note
Templates
Last Updated: 3 DEC 07
29
H.E.A.T. Group Note
TOPIC #1:
Survival Mode Functioning and the 5 Parts of Anger
Leader presented information about survival mode, the connection between threat
perception and anger, and the 5 parts of anger. Discussed cognitive, physiological, and
behavioral aspects of anger. Each participant also took part in an experiential exercise
in which he or she was asked to remember an anger-provoking incident and identify the 5
parts of anger. Participants were asked to practice the skill of noticing the 5 parts of
anger by completing a Survival Mode Diary each day.
Mental Status:
Appearance and behavior were appropriate.
Speech was coherent and related to the presented topic.
Attention and concentration were adequate.
Mood was congruent with affect.
DX: PTSD
GAF: NA, patient is in a residential program
Current concerns/stressors:
H.E.A.T. Group Note
TOPIC #2:
Problem with Control
Leaders presented information about problems with control, and the
importance of recognizing what can and cannot be controlled. Discussed
behavioral aspects of controlling, people, and emotions. Leaders
demonstrated the puppet metaphor, and the polygraph metaphor so that
participants could visually see that people and/or emotions cannot be
controlled.Participants were asked to complete a self-inventory of
suppressing/controlling pain, and a self-inventory of controlling other
people.
Mental Status/Concerns:
Appearance and behavior were appropriate.
Speech was coherent and related to the presented topic.
Attention and concentration were adequate.
Mood was congruent with affect.
DX: PTSD
GAF: NA, patient is in a residential program
H.E.A.T. Group Note
TOPIC #3:
How the Mind Creates Anger
Group facilitators facilitated a discussion about the connection between thinking and
anger and presented 4 models of thinking/anger relationships. Group members learned about
the automaticity of anger-related thoughts, the arbitrary nature in which many thoughts
are "programmed" into our minds, and techniques that allow an individual to avoid "buying
into" thoughts that may not be helpful. For homework, group members were asked to assess
their own anger trigger thoughts and to practice applying defusion skills.
Mental Status/Current Concerns:
Appearance and behavior were appropriate. Speech was coherent and related to the
presented topic. Attention and concentration were adequate. Mood was congruent with
affect.
DX: PTSD
GAF: NA, patient is in a residential program
H.E.A.T. Group Note
Last Updated: 3 DEC 07
30
TOPIC #4:
Patience and Acceptance
Group facilitators presented information concerning the usefulness of patience in working
with thoughts and feelings related to anger. Group began with a dicussion of different
quotes/proverbs related to patience. The "chinese finger trap" exercise was used to
illustrate the notion that patience creates the "space" in which humans can choose how
they will act when uncomfortable emotions are present. Patience was linked to acceptance.
Group members were given the opportunity to practice patience by participating in an
exercise in which each participant allowed a piece of ice to melt in his hand. For
homework, group members were instructed to practice patience with their emotions.
Mental Status:
Appearance and behavior were appropriate.
Speech was coherent and related to the presented topic.
Attention and concentration were adequate.
Mood was congruent with affect.
DX: PTSD
GAF: NA, patient is in a residential program
H.E.A.T. Group Note
TOPIC #5:
Resentment and Forgiveness
Group facilitators led a group discussion about resentment. Several meanings of the term
"resentment" were solicited from group members. Participants were invited to participate
in an experiential exercise concerning the costs of resentments and the possibilities
offered by forgiveness. Barriers to forgiveness were discussed and participants were
invited to consider using forgiveness to work on resentment over the course of the week.
Mental Status/Current Concerns:
Appearance and behavior were appropriate. Speech was coherent and related to the
presented topic. Attention and concentration were adequate. Mood was congruent with
affect.
DX: PTSD
GAF: NA, patient is in a residential program
Current concerns/stressors:
H.E.A.T. Group Note
TOPIC #6:
Values and Commitment
Group facilitators led a group discussion about values and commitment. Group members
learned that choosing anger behavior is one option among many, and that choosing valued
behavior is an alternative. Group members then participated in an extended values
identification exercise, and were given the opportunity to state a commitment for the
following week. For homework, group members were instructed to follow through with their
commitments and to support other members of the community with their commitments.
Mental Status:
Appearance and behavior were appropriate. Speech was coherent and related to the
presented topic. Attention and concentration were adequate. Mood was congruent with
affect.
DX: PTSD
GAF: NA, patient is in a residential program
Current Concerns:
Last Updated: 3 DEC 07
31
Last Updated: 3 DEC 07
32