The physiology of anger

Speaking of temper…  Here’s a blog post that talks about the physiological impact of anger.

This is pretty important, especially for TBI survivors. Anger and temper flares are very widespread among folks who have experienced head injury — even mild traumatic brain injury — but even so, they are woefully under-researched.

Personally, I feel there’s not nearly enough good information out there for folks to use — both survivors, family members, and the doctors who help them. It’s a problem.

I’m in the process of documenting my own anger/temper issues, talking about how I experience them, and describing ways I’ve found to deal effectively defuse — or at least deflect — the temper flares I have. And believe me, I do have them. Especially after my last TBI.

Sudden, extreme, inexplicable temper flares can be emotionally, socially, and physically debilitating. From the blog post I mentioned above, here are some of the ways anger affects our bodies:

  1. Muscles that are needed to fight or flee become very tight, causing an “uptight” feeling.
  2. Chemicals known as catecholamines are released causing us to experience a burst of energy (which causes a sugar deficiency, so that an angry person may “shake from anger”).
  3. Heart rate accelerates: Because of our anger, the usual (average) heart rate of 80 climbs to 180 beats per minute.
  4. Blood pressure rises: An average blood pressure of 120 over 80 suddenly soars to 220 over 130, sometimes even higher.
  5. As the body prepares for survival, it safeguards itself against injury and bleeding. Likewise, an angry person’s body releases chemicals to coagulate (clot) the blood, creating a situation that’s potentially dangerous. Although there is no physical injury, the clot is formed, which can travel through the blood vessels to the brain or heart.
  6. Rate of breathing increases to get more oxygen into the body.
  7. Increased blood flow enters our limbs and extremities.
  8. Attention narrows.
  9. Hormones (adrenaline and noradrenaline) are released which trigger a lasting state of arousal.

Furthermore…

“If anger has a physiological preparation phase during which our resources are mobilized for a fight, it also has a wind-down phase as well. We start to relax back towards our resting state when the target of our anger is no longer accessible or an immediate threat. However, it is difficult to relax from an angry state. The adrenaline-caused arousal that occurs during anger lasts a very long time (many hours, sometimes days), and lowers our anger threshold, making it easier for us to get angry again later on. Though we do calm down, it takes a very long time for us to return to our resting state. During this slow cool-down period we are more likely to get very angry in response to minor irritations that normally would not bother us…. High levels of arousal (such as are present when we are angry) significantly decrease your ability to concentrate.”

Which means, the naturally hyperaroused, hypervigilant, brain fog state in which we already exist is only exacerbated by anger. We need to consider this. We need to see ourselves. We need to make a change.

Our bodies are already stressed, tensed and on edge any normal day. Why make it worse by not controlling our anger? It is, after all, an emotion that is within our capability to focus, modulate and contain.

Indeed.

The long-term effects of too much uncontrolled anger are in the same ballpark as the effects of long-term unaddressed PTSD, from what I can tell. In both cases, the physical system is dragged down, day after day, week after week, month after month, year after year… and what do we have to show for it? Yet more stress.

That being said, I wish I could say I just have PTSD, but my TBI makes it even more difficult for me to parse things through and manage my anger at times. I have to follow specific guidelines to keep myself in check, and I need to keep an eye on myself on a regular basis, lest my anger/temper/freak outs get way out of hand. I’ve lost jobs because of temper flares. And I’ve hurt a lot of people  I care about. Uncontrolled temper flares have done plenty of damage to my heart and the hearts of others. So, I owe it to myself to keep my anger in check.

And I owe it to myself to keep in mind the physical effects that uncontrolled anger has on me. Somehow, my brain finds it easier to wrap itself around objective, non-emotional reasons for staying chilled — like the physiological effects  listed above.

Objective data is one more tool in my toolbox for living well, despite multiple TBIs.

Oct.9.2011 – And here’s one more tool I’ve discovered since I first wrote this: TBI/PTSD anger management by using the breath

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Snap! Anatomy of a TBI temper flare

If you’re a TBI survivor, you may be very familiar with the flares of temper that can sneak up on us unawares. It is very disconcerting, if you’re a pretty even-keel sort of person, or if you really don’t want to pitch a fit, but find yourself flying off the handle against your own will.

This has happened to me as long as I can remember — temper flares that come out of nowhere and decimate not only my relationships with people around me, but my self-esteem and self-confidence, as well.

I recently wrote a post called One Potato, Two Potato… that talks in greater detail about my experience of an intense temper flare that builds up over time.

I actually have identified a number of different kinds of flares I experience:

  1. Flares that originate inside me – and come up suddenly without any warning
  2. Flares that originate inside me, but percolate and develop over time, till I boil over. (That’s what One Potato, Two Potato… is about)
  3. Flares whose source originates very suddenly outside me – they’re knee-jerk reactions to external conditions that actively provoke me.
  4. Flares whose source comes from outside me that percolate slowly until I boil over.

There are other ones, as well, and I’m devoting a fair amount of my time, these days, to thinking about them. Of all the cognitive-behavioral issues I have, my temper flares are some of the most challenging. And since so many people reach this blog by searching for info on TBI and temper, I know I’m not the only one.

For the uninitiated, here’s a general description what happens in one of my TBI temper flares, how I deal with it, and how I pull out of it:

  1. I have a goal in mind — it can be as simple as picking up a pencil, or as complicated as making a three-course dinner.
  2. I turn my attention to the thing I want to do… think about doing it… think about not doing it… and then I decide to do it.
  3. I shift into gear — I reach for the pencil… or I start peeling vegetables for cooking.
  4. Suddenly, something stops me — I drop the pencil, or a potato slips out of my hand and skitters across the floor.
  5. A sudden wave of violent emotion sweeps through me, like a wildfire through dry California underbrush. My eyesight dims briefly, as my heart pounds and adrenaline floods through my veins. I want to strike out, lash out, hurt whatever is getting in my way. I curse the pencil… or I feel a sharp stab of rage directed at the potato. If I were able to kinesthetically direct energy at will — and if my temper had its way — the pencil or the potato would be a smoking little pile of ashes.
  6. In the back of my head, the calm, collected voice reminds me that it’s just a pencil or a potato, and that no one was harmed by this thing slipping out of my hand. I don’t need to strike out and harm anyone, just because I lost my grip.
  7. The part of me that doesn’t care for these temper flares is mortified at my intense reaction. It’s deeply ashamed that I would get so worked up over such a little thing. So what, if the pencil or the potato got away from me? What’s the big deal? The wild animal part of me that flared intensely is cowed and tries to defend its reaction, but when the logical, sensible, even-keeled part of me prevails in its reason, that little animal part of me slinks away to a corner to lick its wounds and chastise itself for being bad… again.
  8. In an attempt to de-escalate my just-add-water instantaneous rage, I pause and take a measured breath. I turn my focus back to the basics — the simple act of picking up the pencil… retrieving the potato from the other side of the kitchen. I focus on the most basic aspects of the moment, waiting till the rage subsides and I can get back to doing what I started out doing.
  9. If all goes well, I can continue with my task and not suffer too much at the hands of my self-recrimination. If things aren’t going well, like if I’m stressed or fatigued or scattered, I may throw something or curse or hit something or lash out… with the consequence of not achieving what I intended to achieve, and descending into a downward spiral of shame and blame and guilt and embarrassment. If I’m lucky, no one is around to see this. If I’m out of luck, someone I love and care for is nearby and is strongly impacted — and quite negatively so — by my sudden rage.

Now, I’ve noticed that if I have built up a lot of momentum around Step 2, my rage response is much more intense, than if I proceed with measured pace, taking things one at a time. I also need to be careful not to indulge every reaction that comes to mind.

It’s helpful if I can sit back and just observe myself, not participate 100% in the whole unfolding drama. But observation doesn’t always work. Especially if I’m tired.

Over the coming weeks (early 2009), I’ll be writing more on this. It may be helpful to others who are dealing with the challenges of TBI temper flares… with greater or lesser success. In fact, some folks have said that what I’ve written so far, is very helpful to them, so it’s my hope that I can help more.

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Temper Guidelines Post TBI

One of the biggest problems I’ve had, related to my TBIs, has been my temper. I can’t tell you how many times it’s gotten away from me and really made life difficult for people around me, and — as a result — for me, as well. I’ve lost jobs because of my temper — which, in these tough times is a real problem. I’ve alienated friends, too — and considering how difficult it is for me to attract and keep friends, I really can’t afford to do that. I’ve hurt the feelings (and really scared) my family members many, many times, and I have to live with that for the rest of my life.

Not only is it very painful for me to lose control of my tongue and say things I know are hurtful to others, but it’s also really tough to be increasingly marginalized by people around you, because of your short fuse. On top of that, my brain doesn’t always realize it’s losing its temper, and I end up often reaping what I unconsciously sow… finding out later that my behavior was volatile and unacceptable, and I didn’t even fully realize it.

Now, interestingly, recent research has uncovered a connection between losing your cool and dementia. Google has something like 145 stories on it (See especially Staying Calm ‘Prevents Dementia’ at BBC News and Dementia Rarer in Calm, Outgoing People at WebMD.) Given this research, and also the fact that dementia runs in my family, it really raises a red flag from me, and it points out even more clearly how keeping calm and not losing my cool will not only help me stay “socially viable” but it will also help keep me from losing my mind.

Here are my personal guidelines for managing my temper:

#1: It is Never Okay to hurt another person because of my temper. I don’t care if it’s accidental or if I can “justify” it in my mind. It’s never, ever okay for me to hurt another person because I can’t keep my cool. The world has enough unavoidable pain and suffering in it, without me adding to the overall amount. No matter how upset I may be, no matter how justified I may think I am, I do not give myself permission to just run around saying and doing hurtful things because of my temper.

#2: Whatever I make wrong, I have to make right. I am only human, and I tend to slip up. But when I do slip up and do/say things that are hurtful to others, I have to make an effort to make it right. I don’t care if I choke on the crow I’m eating. I don’t care how humbling it may be. I have to make right what I’ve done wrong. Either through apologizing, or making it up to the person I’ve hurt, or both.

#3: No matter how right I think I am, chances are I’m wrong, so I may actually not have a basis for blowing up. This is probably one of the most challenging things for me to accept — the fact that my brain is broken, and it may be telling me the wrong things, so I might not actually have a good reason to get upset. But if I forget this, I can end up on one of these “righteous anger” crusades that makes me impossible to work/live with. It’s just no good. And later, when I realize what I’ve done, I feel like such an idiot. It’s just not worth it to me, to go down a road that I’ll regret for a long time, just because I lost sight of the fact that I could be (am probably) wrong.

#4: When I feel myself getting so upset that I cannot keep myself in check, I have to just remove myself from the situation. I’ve been in too many really volatile situations where I’ve lost my head and loosed my tongue and ended up on the business end of life’s cattle prod as a result. I have blown up at co-workers, only to have them turn on me and engineer my layoff… I have blown up at family members, and I spent years afterwards subjected to their passive-aggressive victim revenge. That doesn’t make what they did/do right. It just points out that I need to stop my “downward slide” if at all possible, and if I can’t, I need to just step away and not engage with them anymore. Pick up the conversation later, when I’m cooler. But while I’m still hot, just step away.

#5: When it comes to police, it’s best to keep my mouth shut. I’ve come very close to some intense confrontations with police officers, because I didn’t understand what was going on, and/or I misinterpreted their signals — and they misinterpreted mine. If ever there was a time for me to keep my friggin’ mouth shut, that would be it. There’s nothing like looking back and realizing you came this close to being busted over saying/doing something really stupid, to adjust your perspective. I’ve learned to really chill, when I see a uniform approaching. And to make an extra effort to be polite and as brief as possible. I just can’t afford to get arrested and have a record. Not when I have a family to support.

#6: Don’t get too tired. Or, if I am fatigued, slow the heck down. My thinking gets very foggy, when I’m fatigued. My judgment is off, and my temper tends to flare. I have to be very vigilant about my fatigue level. And when I’m tired — and I know it — I need to take things very slowly and be a lot more systematic about how I do things. If I’m tired, I can’t deviate from my routine. If I do, I tend to get confused and then my fuse gets shorter. And I don’t do well at determining which things matter and which don’t. It just gets messy. And if I’m tired AND hungry, well, then, all bets are off.

#7: Don’t get too hungry. Sometimes, when I’m under stress, I will not have any appetite at all. I just have no interest in food, and I’ll skip meals. That’s not good. I can become hypoglycemic, and then my temper flares. I need to keep my blood sugar pretty constant, and keep my system stable, so I don’t get overwrought over little things and make everyone around me nuts, including myself. When my blood sugar is low, my thinking gets foggy, and I get agitated. It’s not good. So, even if I’m not hungry, I make the effort to eat regularly and make sure I don’t eat a lot of junk food. If I’m still hungry, an hour or two after I’ve eaten well, I have a glass of water, which can cut that sense of being hungry. I really try to keep on a regular eating schedule, no matter how little I want to eat. I often find, also, that starting to eat makes me hungry.

#8: Talk it out — either with someone else, or just with myself. I’m the first to admit that I’m really bad at this. I’m not good at broaching sensitive subjects, and I’m not good at talking about my feelings with other people. I’m not even good at talking about them with myself. I actually spend a fair amount of time doing “self-talk” — in the car while I’m driving to/from work… in the shower, when I’m getting ready for the day… even when I’m making my breakfast or cleaning up at the end of the day. I find that even when I’m not able to really articulate things well with other people, if I’m with a good friend who knows me and my silent signals, they can often coax out of me what’s up. And when I do talk about what’s up with me, I feel better. Like I said, I’m really bad at this, but I’m working at it. Because I have to.

#9: Don’t be stupid by moving too fast. Okay, so I’m head-injured. So what? I still have the basic ability to tell the difference between a smart thing to say and stupid thing. Well, most of the time, anyway. The problem arises, when I move too quickly and don’t look before I leap, or consider what I’m about to say before it gets out into the world. Given time, I can often determine if something is a wise thing to say, or not. But if I’m moving too fast and just “firing at will,” I can get into trouble really quick. This is a particular hazard when I’m actually feeling well… feeling energized… feeling cocky and spunky. I can get turned around, even when I’m feeling good, and suddenly lose it. Because I’ve been moving too fast. And I haven’t been thinking things through before I say/do them. Ironically, the times when I think I’m feeling best are sometimes the times when I’m quite fatigued, but I don’t realize it. It’s that stress-induced analgesia factor again — I’m so pumped up, just trying to move through life when I’m dog-tired, that I don’t even realize how tired I am, and my fatigue can catch up to me. I find that paying close attention to what I’m doing, and slowing down, and not saying/doing things when I’m MOST convinced they are great things to say/do, helps keep me out of a lot of hot water.

#10: Don’t overestimate my ability to deal with stressful situations. Dude, I’m like totally brain-injured. My life, as successful as it appears on the surface, has hallmarks of multiple mild tbi’s all through it. I can never forget that. My brain is broken. I have found ways to compensate and live with my difficulties, but I’m still diminished, compared to where I was 5… 10… 15… 20 years ago… and especially compared to where I could be, if I hadn’t gotten hit on the head so often. As much as I hate and resent the fact, it still is true that I have deficits, and they are often even better-hidden from me than they are from others. Adventures in anosognosia… So, I have to stay humble, stay realistic, stay honest. And not overestimate my capacity for stress. Stress is a killer. It kicks the crap out of me. It wears me down and turns me into someone I do not particularly like. I can never forget that my brain is different, since those injuries, and I can’t take anything for granted. On the one hand, this sucks royally, but on the other hand, it makes me intensely grateful for the times when I am okay, and things are going well.

So, there are my Top 10 Guidelines for surviving my temper-related deficits. I don’t always adhere to them as well as I should, and some of them are constant struggles. But if I can be moderately consistent with them, I find my temper is more easily controlled, and I’m a much better person. I’m also easier to live with, work with, play with, be around.

It’s not much fun, having to constantly play by these rules, but it sure beats the alternative — constant roller coasters of temper flares and jags and violent confrontations.

I’d rather live by the rules and stay out of trouble, than run wild and free and end up persona non grata — or worse, behind bars.

What happened in the field that day

Here’s what I remember:

I was about 8 years old and I was playing up at a field near my family’s house. I was with my younger sibling. The field lay right between two different neighborhoods, and we never went into the other neighborhood by ourselves. We rarely went there at all, period. We were playing about 50-100 feet from the entrance on our side of the field. The line of garages that flanked the alley on the other side of the field were behind us, and we were facing the direction that our one-way street went.

The field was bounded on the other side by a high (maybe 20-foot) chain link fence, and our side was the only “real” entrance to the area.

My sibling and I were there by ourselves for a little while, then two kids appeared on the other side of the field. They crawled under the bottom edge of the fence, slipping through a depression in the ground and looked over at us.

We looked over at them — I’m not sure if we called over to them and said hello. I’m not sure if we even acknowledged their presence.  I suspect we didn’t. The kids weren’t supposed to be there — they had crawled under a fence that was built to keep them out, after all. As I recall, we decided to mind our own business and keep playing.

The kids called over to us a couple of times, but we ignored them and just kept playing. Then they started yelling at us — calling us names. We didn’t respond, and after a while they started throwing rocks at us.

At first the rocks didn’t fall very close to us. It was a bright afternoon, and we wanted to play. We decided we were going to stay put. My sibling wanted to go home and pulled at me to go back home. But I said we needed to stay. Or maybe I just thought that, and my sibling just went along with me. Our dad was really into standing your ground and not backing down from your position, if you were threatened, and I wanted to make my dad proud of me and not give in to bullies. I remember the thought going through my head, that we needed to stand our ground and not just run away.

Several rocks fell closer and closer to us. I think the other kids threw 3 or 4 rocks before they got close. While they were throwing the rocks at us, I remember them laughing and urging each other to get closer. I remember focusing on just ignoring them and not being intimidated by them. It didn’t occur to me that I could be hurt — or maybe I didn’t care?

After a number of times of trying to hit us, they succeeded. I remember the distant feeling of a rock hitting my head — then everything went dark.

The next thing I remember, was looking up to see my sibling sitting beside me, crying. They hovered over me, tears streaming down their face, looking terrified.

I remember being really dazed and foggy as I came to. But I did finally know we needed to go home. The kids on the other side of the field were laughing and cheering that they’d hit me, and when we left the field they were jeering at us. I remember feeling like I’d failed, like I’d given in to being bullied, and I was really disappointed with myself.

I recall being wobbly and woozy on the way home, and my sibling was very upset and crying the whole way there. I was embarrassed by the display of emotion. I wanted to be stoic and take it like a grown-up. I didn’t want to be injured. I didn’t want to be woozy. I didn’t want to be wobbly. And I certainly didn’t want to cry.

When we got home, I remember my sibling telling our mom and dad what had happened. I was embarrassed that I’d been hurt and needed attention, and I was upset that I worried them. I remember Dad telling me to lie down on the couch, and he looked at my head — I don’t remember bleeding — but I recall that I did have a huge lump on my head.

The bump on my head was above my hairline, which made it difficult for my mom and dad to see where I was hurt. The bump was pretty prominent, and they got some ice to put on it, which hurt, because the edges of the ice cubes were hard and felt sharp. I really just wanted to not attract attention and not be fussed over. I just wanted the whole experience to go away, so  wouldn’t worry everyone. My sibling was so upset and crying, our mom had to take them out of the room and get them away from me.

My parents called a friend of theirs who was a registered nurse, and she told them to get a flashlight and check my eyes for any dilation. I seem to remember something about them not being sure if my pupils were dilated or not, but in any case, they had me lie on my left side, facing the back of the couch, and put ice on the bump.

I remember I was so tired, and I wanted to sleep, but my dad made sure I stayed awake. I remember him looking in my eyes several times to see if I had a concussion, and both my parents discussed whether or not I should go to the hospital. If I remember correctly, my dad said he didn’t think I had a concussion, so they didn’t take me.

Things were very foggy for me, after that. And I recall not being allowed to play much, in the coming days.

It wasn’t long after that, that I noticed that the moon was double, when I looked up at it, at night. When I told my parents this, they were alarmed and took me to the eye doctor.

Wrong doctor, I think…

Temper, temper…

I’ve been checking my stats and seeing what search terms people are using to find this blog. “Temper” is a popular one. TBI and temper issues often go hand-in-hand… and for me, it’s been one of the biggest hurdles. I’ve lost jobs and burned bridges over temper outbursts. I’ve gotten into hot water all my life, because of my temper — starting with my parents, who really came down on me very hard for ‘not being able to control myself’.

If they had known that my falls and getting knocked out by that rock didn’t help matters, they might have been nicer to me. But they weren’t. And I was convinced all my life — till a year ago, when I realized that my multiple tbi’s had affected my cognition and behavior — that I was a BAD PERSON who wasn’t entirely fit to be around nice people.

You know what? I wasn’t BAD. I was INJURED.

That doesn’t excuse my behavior, of course, but it explains it. And knowing now that aggression, hostility, rage, temper outbursts, emotional volatility, and impulse control often go hand-in-hand with brain injury — be it mild or moderate or severe — helps me manage myself in ways that keep me and others safe from my outbursts.

So, what do I do about my temper (which has caused me to break many things, lash out, even physically assault people, to the point where I once had a restraining order against me)?

First, I remember that my tbi’s have affected my reasoning and the way my brain reacts to the world around me. I remember that there are mechanisms deep in my brain that react on a very primal level to perceived threats. There’s the amygdala, which is the fight-or-flight switch that seems to work in overdrive with me. And there’s the limbic system, which is about emotion. And then there’s the parts of the brain that control impulse, which are around the area where I got hit in the head (and knocked out briefly) with a rock, when I was eight. People used to believe that when kids’ brains were injured, they recovered better than adults, but now they’ve realized that if you injure a young brain, it affects how it develops for the rest of the child’s life.

So, I try to stay objective, and remember that my brain doesn’t work the way I really want it to.

Next, I try to stimulate my parasympathetic nervous system — the counterpart to the sympathetic nervous system — to chill everything out. The sympathetic nervous system, as I understand it, is the source of the fight-or-flight response that’s making me react so intensely and act out. So, to calm my system down, I need to trigger the parasympathetic system. I’ve been taught that deep breathing causes the lungs to expand, and when they press against the inside of the ribcage, it stimulates the parasympathetic system, so I try to breathe deeply and feel my lungs filling with air and pressing against my rib cage. Also, counting my breaths gets my mind off the turbulence and forces me to focus on something other than what’s pushing me over the edge.

I also rub my neck near the jugular vein — there’s a nerve in there called the vagus nerve that triggers the parasympathetic nervous system. It’s a huge nerve that runs through our whole body — look it up online for more info, as there’s more to it than I can come up with at this point — and one of the treatments for epilepsy to keep people chilled out and reduce danger of seizures, is actually to surgically implant a vagus nerve stimulator in their body. I’m not keen on the idea of having something implanted in me. I’d rather just massage my neck on the right side — but gently, as I’ve heard stories from doctors and nurses about people knocking themselves out by massaging it too hard.

Bottom line: I actively try to stimulate the part of my nervous system that’s built to chill me out. We all have it. We can all use it. And I do.

If this doesn’t work, I try to get my mind off things by doing something. I take a walk. Or I work in my workshop. Or I write something. Or I draw something. It doesn’t have to be perfect, but it needs to be active, and I need to really concentrate while I’m doing it, so I redirect that wild, primal energy/rage/agitation into something productive. Sometimes, I’ll clean my study, which gets to be a total wreck, at times.

I try to get my mind off things that were making me crazy, and do something  positive with my energy.

If all else fails, I remove myself from the situation, if I can, and take a breather. I physically exit the area, and I pull myself together. If I cannot stop the rush of temper with people I do NOT want to hurt (and I really don’t want to hurt anyone), I just walk away and gather myself. I give myself a talking-to. I don’t drive when I’m in that kind of a space, but if I can go into another room and close the door and have some quiet time in a darkened room, I do. I try to stop the cascade before I do/say things I cannot undo or take back.

I try to protect the ones I care about by removing my malfunctioning brain from their presence.

Most of all, I try to not judge myself and be too hard on myself. I’m a long-term multiple mild traumatic brain injury survivor, and the fact that I’m still here means I’ve done something right. I try to learn from my experiences and keep an eye out for things that may cause problems later. I make amends, whenever I can and should. And I do what I can to atone for the things I’ve done that hurt others — without my intending to or wanting to.

I have to remember that I am a good person, but my brain does not work as well as I want it to, and if I had total choice in the matter, I would definitely not do the things that my brain is prompting me to. This is not an excuse for bad behavior. It’s a warning to myself of what I have to pay even more attention to, so I can live the best life possible and, wherever and whenever possible, do no harm to others, but help in any way I can.

Not all of these approaches work 100% all of the time. And I don’t always have the presence of mind to do them when I should. But these things have worked for me and my extreme and volatile temper.

They might work for you, too.

Good luck!