When Patients Express Anger

IF 3.2 2区 医学 Q2 CLINICAL NEUROLOGY
Danielle Chammas MD, Teddy Scheel LCSW MPH, Mike Polisso LCSW APHSW-C, Keri Brenner MD MPA
{"title":"When Patients Express Anger","authors":"Danielle Chammas MD,&nbsp;Teddy Scheel LCSW MPH,&nbsp;Mike Polisso LCSW APHSW-C,&nbsp;Keri Brenner MD MPA","doi":"10.1016/j.jpainsymman.2025.02.069","DOIUrl":null,"url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Participants will be able to reflect on their reactions (e.g. countertransference) to various clinical examples of anger and utilize that self-awareness to better inform their understanding of a case.</div><div>2. Participants will be able to practice creating a formulation or differential diagnosis of a patient's anger and using that explanatory model to guide a nuanced therapeutic approach to the anger.</div></div><div><h3>Key Message</h3><div>Anger frequently emerges among patients and families facing serious illness. Hospice and palliative care (HPM) clinicians report feeling ill-equipped and under-trained to assess and respond to intense, disruptive anger. This presentation introduces high-yield principles from psychotherapy and psychology, offering effective and nuanced strategies for HPM clinicians to manage and address anger during clinical encounters, thus enhancing skills and sustainability.</div></div><div><h3>Abstract</h3><div>HPM clinicians are routinely prepared to attend to common emotions such as sadness, fear, and disbelief. However, many report inadequate training on how to respond to anger–a prevalent and often normative emotion among patients [1]. Clinician discomfort and insufficient skills on ways to respond to anger can impact patient coping, the therapeutic relationship, and clinician sustainability.</div></div><div><h3>Objectives</h3><div>Designed by two HPM social workers and two psychiatrists, all experienced in psychotherapy and practicing general palliative medicine, this session offers high-yield psychotherapeutic insights for managing anger in palliative care settings. The content will be presented through an interdisciplinary lens, incorporating essential DEI concepts, such as the roles of identity and cultural expressions of affective states [2]. This session aims to provide actionable strategies that clinicians can integrate seamlessly into one's daily practice, thereby enhancing therapeutic effectiveness at the interface of anger.</div></div><div><h3>Engagement</h3><div>Participants will partake in interactive exercises aimed at fostering greater introspective reflection on their reactions to various forms of anger. These activities will illuminate how clinicians’ own emotions, identities, and unconscious biases may affect interactions with patients [3]. Attendees will also develop skills in formulating an expansive differential diagnosis for anger, which will inform a personalized therapeutic approach tailored to each patient's unique needs and coping mechanisms [4, 5].</div></div><div><h3>Conclusion</h3><div>Anger is a common emotion experienced and expressed by patients and families facing serious illness, yet many palliative care providers receive minimal training on effective assessments and therapeutic responses. This session will utilize high-yield psychotherapeutic principles to equip clinicians with a nuanced understanding and management of anger [6]. By moving beyond standard formulaic strategies, this presentation aims to embolden more empathic and efficacious patient-provider interactions, thereby enriching and improving overall care quality.</div></div><div><h3>References</h3><div>[1] Kubler-Ross, Elisabeth. On Death &amp; Dying. 50th Anniversary Edition. Simon &amp; Schuster Touchstone; 201 [2] Chammas, D, Brenner KO. “The Angry Patient.” GeriPal. Podcast audio. Published February 16, 2023. Accessed August 3, 2024. <span><span>https://geripal.org/the-angry-patient-a-podcast-with-dani-chammas-and-keri-brenner/</span><svg><path></path></svg></span> [3] Rosenberg LB, Brenner KO, Jackson VA, et al. The Meaning of Together: Exploring Transference and Countertransference in Palliative Care Settings. J Palliat Med. 2021 [4] Shalev D, Rosenberg LB, Brenner KO, et al. Foundations for Psychological Thinking in Palliative Care: Frame and Formulation. J Palliat Med. 2021 [5] Chammas D. Formulation. GeriPal. Podcast audio. Published December 12, 2016. Accessed August 3, 2024. <span><span>https://geripal.org/improving-serious-illness-communication-by-formulations/</span><svg><path></path></svg></span> [6] Chammas D, Brenner KO, Gamble A, et al. Top Ten Tips Palliative Care Clinicians Should Know About the Psychological Aspects of Palliative Care Encounters. J Palliat Med. 2023</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e453-e454"},"PeriodicalIF":3.2000,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of pain and symptom management","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0885392425001290","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

Outcomes

1. Participants will be able to reflect on their reactions (e.g. countertransference) to various clinical examples of anger and utilize that self-awareness to better inform their understanding of a case.
2. Participants will be able to practice creating a formulation or differential diagnosis of a patient's anger and using that explanatory model to guide a nuanced therapeutic approach to the anger.

Key Message

Anger frequently emerges among patients and families facing serious illness. Hospice and palliative care (HPM) clinicians report feeling ill-equipped and under-trained to assess and respond to intense, disruptive anger. This presentation introduces high-yield principles from psychotherapy and psychology, offering effective and nuanced strategies for HPM clinicians to manage and address anger during clinical encounters, thus enhancing skills and sustainability.

Abstract

HPM clinicians are routinely prepared to attend to common emotions such as sadness, fear, and disbelief. However, many report inadequate training on how to respond to anger–a prevalent and often normative emotion among patients [1]. Clinician discomfort and insufficient skills on ways to respond to anger can impact patient coping, the therapeutic relationship, and clinician sustainability.

Objectives

Designed by two HPM social workers and two psychiatrists, all experienced in psychotherapy and practicing general palliative medicine, this session offers high-yield psychotherapeutic insights for managing anger in palliative care settings. The content will be presented through an interdisciplinary lens, incorporating essential DEI concepts, such as the roles of identity and cultural expressions of affective states [2]. This session aims to provide actionable strategies that clinicians can integrate seamlessly into one's daily practice, thereby enhancing therapeutic effectiveness at the interface of anger.

Engagement

Participants will partake in interactive exercises aimed at fostering greater introspective reflection on their reactions to various forms of anger. These activities will illuminate how clinicians’ own emotions, identities, and unconscious biases may affect interactions with patients [3]. Attendees will also develop skills in formulating an expansive differential diagnosis for anger, which will inform a personalized therapeutic approach tailored to each patient's unique needs and coping mechanisms [4, 5].

Conclusion

Anger is a common emotion experienced and expressed by patients and families facing serious illness, yet many palliative care providers receive minimal training on effective assessments and therapeutic responses. This session will utilize high-yield psychotherapeutic principles to equip clinicians with a nuanced understanding and management of anger [6]. By moving beyond standard formulaic strategies, this presentation aims to embolden more empathic and efficacious patient-provider interactions, thereby enriching and improving overall care quality.

References

[1] Kubler-Ross, Elisabeth. On Death & Dying. 50th Anniversary Edition. Simon & Schuster Touchstone; 201 [2] Chammas, D, Brenner KO. “The Angry Patient.” GeriPal. Podcast audio. Published February 16, 2023. Accessed August 3, 2024. https://geripal.org/the-angry-patient-a-podcast-with-dani-chammas-and-keri-brenner/ [3] Rosenberg LB, Brenner KO, Jackson VA, et al. The Meaning of Together: Exploring Transference and Countertransference in Palliative Care Settings. J Palliat Med. 2021 [4] Shalev D, Rosenberg LB, Brenner KO, et al. Foundations for Psychological Thinking in Palliative Care: Frame and Formulation. J Palliat Med. 2021 [5] Chammas D. Formulation. GeriPal. Podcast audio. Published December 12, 2016. Accessed August 3, 2024. https://geripal.org/improving-serious-illness-communication-by-formulations/ [6] Chammas D, Brenner KO, Gamble A, et al. Top Ten Tips Palliative Care Clinicians Should Know About the Psychological Aspects of Palliative Care Encounters. J Palliat Med. 2023
当病人表达愤怒时
Outcomes1。参与者将能够反思他们对各种愤怒的临床例子的反应(例如反移情),并利用这种自我意识来更好地了解案例。参与者将能够练习为病人的愤怒创建一个公式或鉴别诊断,并使用该解释模型来指导对愤怒的细致入微的治疗方法。面临严重疾病的病人和家属经常会出现愤怒情绪。临终关怀和姑息治疗(HPM)的临床医生报告说,他们在评估和应对强烈的破坏性愤怒方面装备不足,训练不足。本报告介绍了心理治疗和心理学的高收益原则,为HPM临床医生在临床遭遇中管理和处理愤怒提供了有效和细致的策略,从而提高技能和可持续性。pm临床医生通常准备好处理常见的情绪,如悲伤、恐惧和怀疑。然而,许多人报告说,在如何应对愤怒方面的培训不足——愤怒是患者中普遍存在的、通常是规范的情绪。临床医生的不适和应对愤怒的技能不足会影响患者的应对、治疗关系和临床医生的可持续性。目的:本课程由两名HPM社工和两名精神科医生设计,他们都有心理治疗和一般姑息治疗的经验,为在姑息治疗环境中管理愤怒提供高收益的心理治疗见解。内容将通过跨学科的视角呈现,结合基本的DEI概念,如身份的作用和情感状态的文化表达[10]。本课程旨在提供可操作的策略,临床医生可以将其无缝整合到日常实践中,从而提高愤怒界面的治疗效果。参与者将参与互动练习,旨在培养他们对各种形式的愤怒反应的内省反思。这些活动将阐明临床医生自己的情绪、身份和无意识的偏见如何影响与患者的互动。与会者还将发展制定广泛的愤怒鉴别诊断的技能,这将为每个患者的独特需求和应对机制提供个性化的治疗方法[4,5]。结论愤怒是面临严重疾病的患者和家属共同经历和表达的情绪,但许多姑息治疗提供者在有效评估和治疗反应方面接受的培训很少。本课程将运用高收益的心理治疗原则,使临床医生对愤怒情绪有细致入微的理解和管理。通过超越标准的公式化策略,本演讲旨在鼓励更多的移情和有效的患者-提供者互动,从而丰富和提高整体护理质量。参考文献[1]库伯勒-罗斯,伊丽莎白。论死亡《垂死》50周年纪念版。西蒙,舒斯特尔的试金石;[10]张建军,张建军,张建军,等。《愤怒的病人》。GeriPal。播客音频。出版于2023年2月16日。于2024年8月3日发布。https://geripal.org/the-angry-patient-a-podcast-with-dani-chammas-and-keri-brenner/ [3] Rosenberg LB, Brenner KO, Jackson VA,等。在一起的意义:探讨缓和疗护环境中的移情与反移情。[J] .中华临床医学杂志。2021 [10]. sharev D . Rosenberg LB . Brenner KO .等。姑息治疗心理思维的基础:框架与提法。[J] .中国医药科学。2010。GeriPal。播客音频。2016年12月12日发布。于2024年8月3日发布。https://geripal.org/improving-serious-illness-communication-by-formulations/ [6] Chammas D, Brenner KO, Gamble A,等。关于姑息治疗的心理方面,临床医生应该知道的十大建议。[J]中华医学杂志。2009
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
8.90
自引率
6.40%
发文量
821
审稿时长
26 days
期刊介绍: The Journal of Pain and Symptom Management is an internationally respected, peer-reviewed journal and serves an interdisciplinary audience of professionals by providing a forum for the publication of the latest clinical research and best practices related to the relief of illness burden among patients afflicted with serious or life-threatening illness.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信