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Section 10
Cancer Caregivers' Mood

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In the last section, we discussed three interventions for caregiver’s guide to well being.  They are seeking support, understanding and compromise, and handling unwanted advice.

In this section, we will discuss mastering the dynamics of anger.  Five techniques for mastering the dynamics of anger are use visualization, talk to yourself and translate the meaning, be empathetic, not defensive, do not allow abuse and using anger to fuel energy in a positive direction.   Because life changing illnesses like cancer can trigger emotional outbursts like anger, this section provides anger management interventions for the caregiver. 

5 Techniques for Mastering the Dynamics of Anger
First, let’s discuss mastering the dynamics of anger.  As you know, anger can drive even the closest people apart.  When cancer strikes, there are many areas that people get angry about.
Rob and Renee were in couples therapy with me when Rob’s father had been diagnosed with testicular cancer.  His prognosis was poor at best.  I asked Rob and Renee to write down five things they were mad at.  I stated, "Repeat this exercise whenever you notice that you’re raising your voice, clenching your fists, or feeling aggravated." 

5 Things You are Mad At
Collectively, Rob and Renee wrote:
1. "The cancer itself, the new responsibilities, people, the losses, and the limited choices."
2. Second she wrote, "Each other’s way of handling the disease."
3. Third, "The policies of the insurance company, the employer, or the government."
4. Fourth, "Life in general."
5. And finally Rob wrote"My wife’s behavior triggers feelings from the past, and I get angry, but I can’t pinpoint why." Clearly, these anger targets led to arguments between Rob and Renee.

Here are some additional techniques clients I have used with dealing with client anger:

♦ Technique # 1 - Use Visualization.
I stated to Rob and Renee, "Whenever either of you is attacking the other, try to stand back.  Visualize the fight as a movie.  Picture a tiny director in your head as he asks you: "Where are we going with this?" "What is this going to accomplish?" "Is this really worth fighting over?"
Every time you argue, take two minutes.  Think about your director.  Have him stop you.  This may be difficult at first.  Hopefully with practice it can become a habit, a tool that enables you to be more objective and less emotional."

♦ Technique # 2 - Talk to yourself and Translate the Meaning.
Dr. Decker suggests you hold a running dialogue with yourself.  He tells his clients, "Continually tell yourself that hostile comments have nothing to do with you.  Say: ‘This is not really about me. This is about my wife’s disease, or her feelings about the disease.’
"You have to translate the person’s comments.  It’s not always easy.  When someone kicks you in the shins, it still hurts, regardless of why he or she kicked you."

♦ Technique # 3 - Be Empathetic, Not Defensive
I stated to Rob, "When Renee says things that trigger past feelings, consider reacting to the resulting anger in an empathetic way.  If you respond by being angry and defensive, a fight will most likely escalate."  Rob asked, "And how do I respond in an empathetic way?"  How might you have responded to Rob? 

I stated, "Lower and relax the tone of your voice.  The louder Renee gets, the quieter and calmer you need to be­come.  Although it sometimes feels great to yell back, do you agree that you usually pay for it later?  Lowering your voice, staying calm, and being understanding will defuse a great deal of the hostility.  Also, relax your shoulders, put your hands in a comfortable position, and take three deep breaths.  In a later session, Renee stated, "It’s hard to yell at Rob when he’s all peaceful and understanding!"  Think of your Rob and Renee.  Could empathy help your client master the dynamics of anger?

♦ Technique # 4 - Do Not Allow Abuse
I stated to Renee, "Leave the room if you or Rob can’t control the anger.  You’re not running away—you’re conserving energy to tackle the issue when the intensity of the situation is defused.  Before you leave, say something like, ‘I need to stop this conversation. I don’t want us to hurt each other. Let’s continue this when we’re not so upset.’  Anger can be associated with cancer, but abuse and violence are not acceptable ways to express it.  Also, consider using brief caring statements to defuse an argument."  Renee used brief caring statements such as, ‘I love you.  Can we find a way to discuss this that makes us both feel good?  We already feel bad enough about the cancer.  That’s my real enemy, not you."

♦ Technique # 5 - Using Anger to Fuel Energy in a Positive Direction
Do you agree that clients can use anger as fuel to gain control over situations in posi­tive ways?  For example, Elise, age 47, was mad at her husband’s family.  Elise stated, "When they came to see him, they stomped right over me, expecting me to cater to them!  Could I bring them something to eat or get the TV Guide or move furniture around to make them comfortable!?  They wouldn’t dream of asking me if they could help him.  They thought their visits were help enough!  As if I should be grateful that they graced us with their presence!  And they berated me for how I took care of him.  Nothing I did was ever right!"

Finally Elise exploded.  Fortunately, it was during one of our sessions and not one of the family visits.  Taking the advice of the other group members, Elise read some books on being assertive.  She practiced the tips they suggested and began to incorporate them into her behavior.

Eventually Elise became assertive with her husband’s parents.  They respected her attitude.  Elise stated, "Can you believe they even asked me how they could help?"  Elise used her newly acquired skills with doctors, insurance representatives and anyone else who would have previously upset her.

Think of your Elise.  Could some type of Assertiveness Training benefit your client who has a loved one with cancer? 

In this section, we discussed mastering the dynamics of anger.  Five techniques for mastering the dynamics of anger are use visualization, talk to yourself and translate the meaning, be empathetic, not defensive, do not allow abuse and using anger to fuel energy in a positive direction.  

In the next section, we will discuss time management.  In my practice, I implement six interventions that can help foster productive time management.  These six interventions are the daily to-do list, direct delegation, familial delegation, Avoiding the Supercaregiver Trap, research services and scheduling phone time. 
Reviewed 2023

Peer-Reviewed Journal Article References:
DuBenske, L. L., Gustafson, D. H., Namkoong, K., Hawkins, R. P., Atwood, A. K., Brown, R. L., Chih, M.-Y., McTavish, F., Carmack, C. L., Buss, M. K., Govindan, R., & Cleary, J. F. (2014). CHESS improves cancer caregivers’ burden and mood: Results of an eHealth RCT. Health Psychology, 33(10), 1261–1272. 

Gan, Y., Zheng, L., Wang, Y., & Li, W. (2018). An extension of the meaning making model using data from Chinese cancer patients: The moderating effect of resilience. Psychological Trauma: Theory, Research, Practice, and Policy, 10(5), 594–601.

Garrido-Hernansaiz, H., Rodríguez-Rey, R., & Alonso-Tapia, J. (2020). Coping and resilience are differently related depending on the population: A comparison between three clinical samples and the general population. International Journal of Stress Management, 27(3), 304–309.

QUESTION 10
What are five techniques for mastering the dynamics of anger? To select and enter your answer go to Test.

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