Dr. Anita Sukhwani is a Consulting Psychiatrist with over 23 years of professional experience. She is the founder of Mann Healthy Mind Centre, a Centre with a holistic and team approach to mental health. She is the incoming President of Bombay Psychiatric Society for the year 2020-2021. Her areas of interest are Children, Women, and Family therapy.

Q no.1: How common is anger management issues in people that come to you. Do you see an uptick in such cases during the lockdown?

Anger is a common symptom in various clinical syndromes we come across in daily practice. It is seen in anxiety disorders, psychotic disorders, substance abuse, family and relationship difficulties, adjustment issues among adolescents and their parents, children having academic difficulties, being physically abused, etc. It is seen commonly in our daily practice. Since the beginning of lockdown, I’ve been on various helplines and have received calls from various parts of India. Among the people who have reached out are some who were stuck alone away from home and family, people who are forced to be home for 24 hours, and some who do not necessarily get along with each other. The geriatric population with no help suddenly left to their means. I had adolescents calling and asking me how to deal with parents. They’re unable to tolerate it for 24 hours, and mothers who are upset with their children spending too much time on screen and children who have lost their space and freedom to play and run around. This lockdown has left many feeling vulnerable because of the stress changes in routine, tons of worries about daily living, financial instability, and rumours on WhatsApp, don’t seem to be helping them. All this has resulted in various uncertainties leading to fear, irritability, anxiety, disturbed sleep patterns, frustration, depression, and this is sometimes expressed in anger and violence. So, anger levels are higher in the general population.

Qno.2: How can mental health professionals effectively treat their clients with anger management issues online, especially children?

When we manage anger through online sessions, especially with children, we must keep a few things in mind.

• Understand the problem from the parents first in the case of minors.
• Video sessions are preferred to hold their attention.
• Ensure they are in a comfortable environment with privacy, which will help build a rapport with them and facilitate a safe space where they open with you comfortably.
• Assure children of confidentiality. It makes them ventilate and encourages sharing of their experiences.
• Suggests journaling and drawing, scribbling as a medium of ventilating.
• Certain strategies that I suggest to children are squeezing a softball, kicking a ball around, punching an anger pillow, counting backward from 10 to one, doing certain breathing exercises, taking deep inhalation and exhalation.
• Visual imagery helps. Through visualization, you can take children to their happy place, which could be a beach, a garden, or mountains. This visualization can help them relax.
• Teach them a few affirmations to remain positive. Some of them could be I am not angry, I am happy, I am strong, I am confident.
• Please speak to the parents to guide them to understand the child’s anger by being patient, encourage positive changes, and using positive statements in their communication with children.

Q no.3: Mental health professionals are people too. What can they do to manage their emotions, especially anger coming from their frustrations with a client?

Do professionals need to take care of their mental health to avoid getting frustrated and angry?

• First, take charge of your life.
• Make physical exercise a part of your routine.
• Resort to meditation and breathing exercises.
• Try and have fixed hours of work.
• Take breaks between patients and in general.
• Stay connected with your social support systems.
• Adopt and practise mindfulness techniques.
• Maintain a healthy lifestyle.
• Understand your anger triggers.
• Get good sleep.
• Take care of your immediate environment, like keeping things organized and de-clutter your space.
• Channelize and release your anger into something positive.
• Remember a few things when you are with patients: Take a good detailed history and mental state examination.
• Get facts from family members if the patient gives consent.
• Watch out for transference and countertransference difficulties.
• Remember the three A‘s be aware of your triggers, thoughts, emotions, and feelings, be mindful of them, and learn to be present.
• Acknowledge your thoughts, emotions, and feelings. It’s ok to feel what you feel.
• Remind yourself that we, too, are humans.

Accept all the above without judging yourself. Remember, if you are mindful, you should be able to help your patients better without getting angry and frustrated.