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Section 8
Blue and Angry: Treating Agitated Depression with
the 'Order on Chaos' Technique

Question 8 | Answer Booklet | Table of Contents | Printable Page

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In the last section, we discussed Positive Responses to Anger.  The two types of responses we discussed were active response and passive response.

In this section, we will discuss anger and depression.  I find that the key points in the relationship between anger and depression are intrapersonal dynamics and the vicious cycle.

Anger and Depression - 2 Key Points

#1 Intrapersonal Dynamics 
As you know, when an anger management client experiences loss, depression can be a consequence.  Clearly, one of the intrapersonal dynamics behind this depressed state can be suppressed anger.  When Lori’s anger was suppressed, she experienced retarded depression.  Lori’s retarded depression left her feeling as though she lacked the energy to act out on angry feelings.  Do you have a client whose depression feeds his or her anger?

Lori, age 51, suffered from agitated depression. She had sudden emotional outbursts. Lori stated, "I was an architect for fifteen years.  The damn company I worked for downsized me out of my job.  I used to be happy.  Now I’m either blue or so damn angry I can’t think straight.  When I get mad like that, I go to my basement and fume.  After awhile, I start getting real sad, and then mad all over again.  I’ve started spending hours down there because I don’t want to take it out on my family like I used to.  That’s what got me here.  Feeling down and angry at the same time makes me violent. "  Have you had experience treating an anger management client with depression like Lori? 

#2 The Vicious Cycle of Anger and Depression
In addition to intrapersonal dynamics, we will discuss the vicious cycle of anger and depression. 

Three Stages of the Vicious Cycle

--Stage One: First, as you know, anger can lead to depression, which can lead back to anger.  This vicious cycle can be perpetuated by chemical, behavioral and perceptual means.  With Lori, anger and depression altered her chemical balance.  Neurotransmitters in Lori’s brain, such as serotonin, were affected by both anger and depression.  Depression lowered Lori’s chemical levels, while anger raised her chemical levels.  Would you agree that this compensation may help explain Lori’s vicious cycle? 

--Stage Two: Second, anger can change the behavior of a depressed client.  Lori’s depression was characterized by passivity and inaction.   Lori’s anger caused her to act in ways which were self-serving and self-protective.  However, when angry, Lori felt like her former, non-depressed self.  The fact that anger can eliminate feelings of depression temporarily lead to Lori’s continuous aggression. 

--Stage Three: Third, depression altered Lori’s perceptions.  Altered perceptions resulted in mood changes.  Lori became cynical, then she became paranoid.  For example,  Lori was angered by house guests.  Lori stated, "I hate coming home to a house full of people.  My family knows that.  They probably invite people over to piss me off so I’ll hide in the damn basement and they can be rid of me.  No wonder I’m so screwed up!"  As you have probably experienced, altered perceptions such as paranoia can lead to anger.  I stated to Lori, "You may be caught in a vicious cycle of anger and depression perpetuated by your perceptions."

3-Step Order on Chaos Technique
To help Lori with her agitated depression and stop her vicious cycle, I asked Lori to try the Order on Chaos cognitive therapy intervention.  The goal of this intervention was to switch Lori’s focus from depression and anger to more positive activities.  This intervention helped Lori gain a sense of control. 

--Step One: First, I asked Lori to make a schedule of household activities she could perform instead of retreating to the basement.  For example, Lori’s schedule included fixing broken appliances, painting her house, organizing her record collection, and refinishing some furniture. 

--Step Two: Second, I asked Lori to bring the schedule to her next session to review which tasks she had completed.  When Lori returned, all of her activities had been completed and she had added fixing the roof and waxing the cars.   Not all clients accept Order on Chaos as quickly as Lori. 

--Step Three: Third, I had Lori make a shorter schedule, this time including exercise and diet.  Because she was already feeling a sense of accomplishment, Lori complied.  Lori later stated, "I think I’m still pretty screwed up, but my family doesn’t know it.  Whenever I start getting mad, I just get busy on a project and before you know it, I’m not mad.  Lots of times I can’t remember what I was mad about in the first place."

In this section, we have discussed anger and depression.  The key points are intrapersonal dynamics and the vicious cycle of anger and depression.

In the next section, we will discuss self-inflicted anger.  I have found that clients may self-inflict anger in four ways.  These four ways are compromising morals to gain acceptance, work becomes all-encompassing, developing poor health habits, and substance abuse.

QUESTION 8
What are two key points considering anger and depression? To select and enter your answer go to Answer Booklet.

Answer Booklet
Section 9
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