Michael: Hey everyone, and welcome to another episode of Doctors Living Deliberately. I'm Michael Hersh, and welcome to our co-host Dr. Arpita Gupta DePalma. How are you this morning? 

Arpita: I am good, Michael. How are you doing? 

Michael: I am doing great and happy to be back here for a special episode where we are gonna get to talk about one of the things that you really love to coach on which is, anger. And you know, this is, I think, a fascinating topic because anger is not something that we generally enjoy talking about. In fact, we don't really want to identify with a label of angry, and I know in particular for men and for physicians, this is not a label that we want. Yet it comes up a lot for so many of us, and I didn't even realize how common anger was amongst all physicians until I started on my coaching journey. And you know, when I first went into a group coaching call and I heard other physicians talking about how angry they were getting during the day, I was shocked. It was one of those moments where, I thought to myself, oh, I thought it was just me. And so how did you get so interested in coaching on anger?

Arpita: Well thank you for having me talk about this today, first of all. But it really evolved almost effortlessly by itself. And I think what happened was when I got into this coaching world and started becoming more and more enmeshed in learning about how we think about things and how we are in control of things, what I realized was anger had become like this automatic go-to for me. I remember the day when I recognized that I was getting almost like a rush from getting angry. And that was like a, oh crap, this is not right. Something is not right here. Why am I feeling this type of a dopa hit from the anger? And so that was one area where I immediately, when that happened, when I noticed that became aware of me having that, that I was like, I need to check in a little bit because this is not a reaction that I want to continue to have and much less continue to encourage to grow stronger, which it already had. So that was one reason why anger became of interest to me because it was almost giving me a positive emotion as a result of it when it's not really a positive emotion. And then most importantly why it became important to me is because I realized that it was really impacting my relationships with multiple people, but most importantly in most specifically, my kids at home and I mean my husband too, somewhat, but we both were a little bit of hothead, so, you know, it was kind of mirror mirroring off of each other. But with my kids specifically, I was really worried with my daughter leaving for college in the next year and a half that we were not gonna have a good relationship, that she would not be able to feel comfortable coming to me with anything and everything when she was hours and hours away.

And so that was really my incentive to first do the work on myself and then having seen the benefits of that, start to offer that to other people because people don't wanna admit to it. People are afraid of first acknowledging that they're so angry, right? Like, why, especially as physicians we're in, in this kind of mentoring role for other people in the world why we're showing up in a way that's not really acceptable in a sense. So that, that's really kind of how it became of interest to me and why I wanted to make it a change for myself personally first. 

Michael: Yeah, and you were, you were kind of mentioning how it can be difficult to recognize and even more difficult to admit. And it highlights the fact that there is a lot of shame around this emotion of anger, right? So it was you know, Brene Brown describes the difference between guilt and shame. Guilt is I did something bad. Shame is I am bad. And when we have to admit that we showed up angrily than it can be a lot of shame. I'm bad, I'm a bad person. I'm a bad physician because I got angry. And how does that, when you are talking about anger and even in your own experience with this, how did shame play a role?

Arpita: It was a huge role. Huge role because immediately my thought was, I'm a pediatrician. I'm supposed to be a role model, but I'm showing up this way with my own kids for God's sake, right? I hope nobody heard that. I hope the windows weren't open when I was screaming at them. So this shame of I am bad was not just because I was showing up angry, but also because I wasn't able to stop. I wasn't able to change it. Like I recognized after the fact, I regretted the way I showed up. I was aware of the repercussions of it with regards to the connection that I was diminishing with my kids and my, whoever I was interacting with, but I wasn't able to stop. And it like, I would go from zero to a hundred. And I think a lot of people see that, they don't have the ability to change their reaction to whatever's activated them or made them upset and they notice after the fact, they regret how they showed up. But despite all of that, are not able to curb the reaction or change the reaction the next time they're activated again. And so that's where that shame comes in. That's one part of it. 

The other part of it is the shame around just talking about it, right? Because now we have to be vulnerable and express to other people that this is happening and we don't wanna do that. So with that in and of itself, we are not able to make any changes because we're so embarrassed of how we're showing up with that. So that vulnerability component, I know we've talked about that in prior episodes, is huge because that's the first step is being vulnerable and having the awareness that this is happening, but then being able to be vulnerable enough to say, Hey, it's okay. We're human. Everybody does this. I know. I feel a little bit of shame around it, and I'm trying to make a change now. So there's a couple little pieces to that, but 

Michael: Yeah, and I think the curiosity is so important because so many times we kind of recognize something about ourselves and, and maybe in particular something we don't like about ourselves and our immediate reaction is to go to judgment. So we start to judge ourselves for the way that we responded, the way that we reacted, our interactions with other people, we judge ourselves. And again, kind of increase the shame, right? It spirals. So we're feeling more and more shame because we're judging ourselves for how we showed up, but instead of moving into judgment, becoming curious, why did I show up that way? How did things go? And I think that this gets into a little bit about how anger becomes so automatic for us that we're not even thinking about why. So when you are working with clients and helping them to figure out their anger response, talk a little bit about how those automatic reactions come into play and how you help clients to kind of sort through that.

Arpita: Yeah, we talked before a little bit about the neural pathways that we create, and these are these like information highways in our brain, and the more we behave in a certain way, have certain patterns, the stronger that information highway becomes, and so that becomes automatic. And with anger, what happens is when we respond in a way that is making us feel like we're in control, it gives us this false sense of control, or it gives us this false sense of power that's giving that little dopa hit right there. And so every time we get angry, we are doing that most often as a response to fear, underlying fear of something, and fear of loss of control, fear of what might happen. And so the anger is in and of itself trying to be a replacement for creating that sense of control or power in that situation. When we go down that pathway, we get that little dopa hit thinking that erroneously, we're in control, we're in charge now, people are listening to us, and that reinforces that behavior over and over and over. And so what happens is, even though it doesn't feel good at the end, after we've become angry and we've seen the repercussions of it, that repetitiveness of it has become familiar to us. It's become comfortable, it's become automatic. We know how it's gonna end even though it doesn't end well. We'd rather feel that than the unknown of going down the other pathway, which we'll talk about in a minute, is the secondary emotion, what's underneath it, right? 

And so that automatic reaction has become enforced and strengthened over time, and that's what I recognized was happening with me, is that I was having this dopa hit where it was essentially now becoming a positive emotion and like a surge of the dopa from being angry because that was making me feel like I was in control. In reality, I was not in control. I was not demonstrating behaviors that were modeling behaviors to other people. And quite frankly, I was losing respect of other individuals because I was not showing up as a leader, as a nurturing mom, as whatever. And that's what I feel most of my clients end up coming back to. They're like, we have so much skill, we have so much ability to do and be productive, but we're not able to hit that because we show up in a way that's really kind of it turns people off. Right? 

Michael: Yeah. And, and to clarify one of the points that you're making when you're referring to these dopa hits, right? So we are in a situation where something is going on and we feel bad. Something has happened, we feel as you were just kind of highlighting a moment where you felt out of control, but maybe you might feel depressed or sad or, you know bored or any of those things. And so you look for something that is going to make you feel better in the moment, right? And so for you, when you had that kind of outburst or something like that, it gives you that little extra kind of uplifting moment, right? Where it kind of gets you out of the funk momentarily. And so in the moment you feel a little bit better, but then ultimately, you go back to feeling how you were feeling before and sometimes even worse because you showed up in a way that isn't true to who you wanna be, right? So again, you feel just as bad as you did before the outburst, but now you have the added judgment and shame layered on top of it. And then this is how people spiral and why this can be such an issue for people. And so you were mentioning that anger can be a secondary emotion. Talk a little bit more about what that means.

Arpita: Yeah, and you kind of touched on that right now, like that's what it is, is that people don't recognize that there's an underlying emotion, like the depression, the sadness, whatever. But when, honestly, when I started this work, I didn't really realize that or understand that, and most people don't understand that. Rather than feeling the shame or the disappointment, or any of these other negative feelings that we have. Like I have this little feelings wheel, I'm sure people have seen this lovely feelings wheel, but there's so many negative emotions here, and we don't want to feel them because they don't feel good, right? We're afraid we're gonna get stuck in them. We're afraid that they're gonna feel so bad that it's just, we'd rather feel anything else. And so what happens is that is the underlying main emotion that we have, but rather than feeling those negative underlying emotions, we go to anger because we recognize that anger is safe now. We know how it's gonna end up.

So this is a prime example that I give; I remember when my kid, this is a horrible example sometimes it really gets to me. But I remember when my kids were younger, you know, I was the tiger mom always wanting them to really do awesome in school and get the awards and do whatever. And I, I remember it was middle school and my daughter they had the assembly at the end of the year and they had the award ceremony and she didn't get an award.

And I was so disappointed that my girl was not getting an award and she's, albeit in a elite private school, lots of competition, kids are like crazy, crazy smart. But for me it didn't matter. Like I wasn't looking at that. I was just looking at the fact that she didn't get an award and that disappointment that I felt was so strong. I didn't want to feel it. It just did not feel good having that disappointment. And so how it looked to everybody around me was frustration and anger and agitation. So when she came home, rather than being the loving, nurturing mom, giving her a hug saying, you did the best you can, awesome. I was, why couldn't you do a little better? Why don't you think you got the award? Right? So it doesn't necessarily look like a raging demon. It can appear, the anger can appear in so many different ways, but it's covering up what's really painful underneath, what you don't wanna feel. And that is kind of the key to the awareness portion of it. 

A lot of times the first step is building the awareness around, I am angry. Let me process that. But then when you're reflecting after the fact, let me really get down to the nuts and bolts here, the underlying layer of what is going on? Why am I angry? What is my anger covering up? And that's really kind of where a lot of the gold of the work is. I mean I have clients that come all the time, I don't wanna coach with you about anger. That's not what I'm coming for. I'm coming for other things. Inevitably the anger comes out one way or the other with the mother-in-law with something. We all have the anger, but the root cause of it is underneath and that's where a lot of the work is.

Michael:  Yeah. So you, you mentioned first awareness being key here and then curiosity, and then what? Like can you give our listeners a little bit of an idea of what comes after the awareness and the curiosity? How can they be more intentional about how they respond in the moment? 

Arpita: Yeah, I think I have a little protocol, a mini protocol that I kind of just tell people about in detail for what you can start doing now. First is just becoming aware of what tends to set you off. So, you know, for me, I recognize when I'm tired, I'm already gonna be stretched thin a little bit. So I'm more likely to be more reactionary with anger. When I feel like my to-do list isn't getting done. The urgency of that, a feeling of I don't want to feel overwhelmed, so I have this urgency to get it done, and that urgency is what is underlying my anger. So becoming aware of what tends to set you off first is the first step.

Then when you actually are in the situation where you're getting activated, just taking a moment to pause and taking a deep breath right then. Becoming present in the moment and reminding yourself that there is no danger and there's no urgency to respond. That's really key because our brain wants to just react right away. And we are going back to primitive brain mode where we are in danger. The tire's gonna bite our face off and we have to respond, right, or react. And we need to remind ourself that we don't have that danger right now in whatever situation we're in. So we're gonna just take a deep breath, remind ourself that there's no danger, there's no urgency, I can take a minute.

And then you get to make an excuse to leave the situation. You know, with, for example, when I have, we a lot of us have teenagers when the teenager is doing something that's really activating us or setting us off. Okay, buddy, I'm gonna take a minute. I gotta, I'll be right back. I have to run to the bathroom real quick. Oh, I forgot one thing. Let me go take care of it. So remove yourself from that situation as quickly as you can, just to give yourself a moment to regroup. And when you find your little private space, once you've removed yourself, a bathroom, a closet, whatever it is, that's when you really get to take some more intentional deep breaths. Because when we do that, we are signaling our brain that we are safe, that there is no danger. 

So I talk about being very mindful of when you're breathing in, paying attention to the temperature of the air going into your nostrils, and then when you're breathing out, paying attention to the temperature of the air leaving your nostrils and doing that five times, that's just settling your glitter. It's bringing your temperature down. It's bringing all of the agitation down in that moment. 

From there, you wanna label your emotion. So if we haven't done the deep work yet, your emotion might just be, I'm feeling angry because... I am feeling frustrated because... when we verbalize it out loud, we acknowledge it and that helps us settle as well. And then you get to decide do I wanna go back and handle this situation right now? Am I going to be able to show up in a way that's intentional and deliberate how I want to show up, or do I sense when I go back I'm gonna become activated again and not really be my best self? You get to decide if you wanna go back right then and address it, and you may not want to, and that's okay. Then you know, you go back and say, you know what? I really wanna talk about this with you, but this isn't the best time. Let me look at my calendar and we'll figure out another time to meet and talk. You get to retain your control in the situation by calming yourself down first in the moment, deciding and making an intentional plan of how you wanna address it, and then going back to it.

And then lastly, and this might be after the fact, I tell my clients to really just spend a moment reflecting, take a journal out. And that's when we get to that underlying emotion most of the time. Reflect on what actually made you angry in the moment. Ask yourself, what were you thinking? Why were you thinking that? And it goes back to that other episode we talked about with your awareness, like the questions that we ask ourself. But you can incorporate that here to really get down to why am I feeling angry? What's underlying that anger? What emotion is there that I don't wanna feel that I'm afraid of feeling, or it's making me feel like I won't have any control over? And that's where the work is. 

Michael: Well, I mean, that's an excellent framework I think. I think it outlines very, very clearly kind how to manage this. But what do you say to people who just hear that and they're like, oh, but I get, I get so angry. Like, there's not even a moment to recognize, right? Like how do you create the space for yourself to allow the cascade of awareness. 

Arpita: So for those individuals and myself was included, you have to do that awareness work when you're not in an activated state, right? So after the fact, or when you're in a peaceful moment and you reflect back, what set me off? In that moment what was the actual thing? And so one of the things I talk about with some of my talks is that my daughter's eyebrow would go up. Nothing else had to happen, but that me seeing her eyebrow go up, and that would activate me, right? So just building awareness of what it is for the next time and having this plan in place for what you're gonna do the next time It happens because when we're in the heat of the moment and it happens, we don't have time to think through this. We don't have time to figure out what are we gonna do now. You have to have this plan ready to go so that when you're activated the next time you don't have to think about it. You just know what you're gonna do. And that slowly becomes automatic. 

Michael: Yeah, and you bring up some good points here. Number one we can be triggered by all kinds of things, and we don't always have the awareness to know what those things are. And also the people around us are used to us responding in a particular way, and sometimes they are trying to get you to respond in a way, right? And so when you can take a moment after the fact to go back and, and assess like, what happened here? Why did things go the way that they went in this particular situation? It helps you to show up better the next time. But here's the other thing, right? Is that making sure that you know you're not gonna get this right every single time. Do you get this right, every single time? I don't. 

Arpita: No. It's not, and that's part of the beauty of this is knowing that we are gonna be constantly in a state of a work in progress. Right? Part of the, the gift of this, having this awareness and being vulnerable with this is the ability to be able to go and say, Hey, I'm sorry I showed up as an asshole. I didn't mean to be like that and that really wasn't my best self, so I am doing the work and I'm gonna try better next time. That is huge. That's a huge gift that I never was able to do before. So that alone lets my kids, I always refer to my kids cause I feel like they got the brunt of it, but they lets them see that, hey, she's making a difference. 

And another piece that you, when you mentioned that it came to my mind is when I started doing this work, like you said, people are expecting you to behave this way because they've seen that for however long. It's important to have a conversation with the people that might have felt it the most in a peaceful time and say, I'm doing some work on myself. I don't like the way I've shown up, so you might see some changes. You might see me kind of walk away when, where there's situations where I normally would've reacted and gotten angry or had outbursts. You might see me walk away. I'm not trying to be passive aggressive. I'm just trying to make a change so that we as a collective unit won't have to experience the way it used to be. I think that's really important. 

The other piece that's super important that I've recognized, I can go on about this, so many different caveats on it, is, you know, the mirror neurons, I might have mentioned it at the very beginning of the talk, but recognizing that when the people that we're around or the energy that you're around, we kind of reflect that, whether it be happiness or joy or sadness, anger is one of them. So when we are around our spouse who's ticked off about whatever, I caught myself becoming angry for no reason. It's normal. Those are mirror neurons. So having the awareness to recognize when your partners or loved ones are in a pain body when they're in that funk where you can't, no matter what you say, nothing's gonna get better or nothing's gonna change, they're not gonna hear you. Being able to recognize that and step away so that those mirror neurons don't start to fire. That's really important. 

But yeah, I can go on; how to handle kids, how to handle spouses, how to handle your employees and other people in your life. I mean, there's so many different tricks and tools that you can utilize to really just change the way you interact with people so that in the end, you are the one that feels the benefit of it because ultimately when you're angry, you are the only one that's suffering and other people might feel the repercussions of it but internally, physiologically, you are the one that's having the most damage as a result of that. 

Michael: Yeah. And, and there can be a domino effect here as well, right? So when you are somebody who can be easily triggered in a situation, typically you surround yourself by people who are also easily triggered, right? And when you learn these tools to become more aware, to become more curious, to respond better in individual situations, you can be the role model for other people, but this can be uncomfortable for them too, right? Like, just like it's uncomfortable for you to learn how to be curious and aware for yourself in these situations, when you are not responding in a way that the people around you that have, they've grown accustomed to you responding, it can be uncomfortable for them too, right? But it can also inspire them to respond differently in similar situations. So this, again, is not only inspiring for you to create changes in your life, but it can create positive change, changes in the people all around us. 

Arpita: Totally. Totally. I, I've already seen a difference with even my kids and my, my husband, right? I, I can recognize, and I recognize when she has anger a little bit or when she's showing up frustrated and being able to kind of assist through that. It's a hundred percent, we are a collection of the people that we spend the most time with. And so when we can start to make some shifts, they kind of start to do that dance with us. We go from the tango to the waltz, they do the waltz with us too, a little bit. So it's a little bit of that, and that's the beauty of it. So. 

Michael: Well, this has been awesome, you know, for people that are interested and want to know more about what you do, what kind of offerings do you have in your program for clients? 

Arpita: Well I recognize that there is still a lot of shame around just even admitting about having the anger. And so with that, what I did is created an online study course, self-study course so that people can start to benefit from the teachings of this on their own time. And so in addition to one-on-one coaching, or maybe even separate from that, I have an online course. It's called From Reaction to Response, Transforming Your Anger, and there's 12 modules all online. Like I said, self study. The beauty of that course is that I go to all depths and angles of anger, how to create your protocol, how to develop methods of it's called HeartMath coherence with the HeartMath program. I touch on that. I talk a little bit about positive intelligence with that. So there's different modules touching on different kind of tools that you can utilize. You don't have to do 'em all, but there's options, and that's the beauty of that. So yeah, I go to my website, www.thoughtworkmd.com and you can click on programs and the online anger course is there and you can register for that.

And then obviously in addition to that, I always have one-on-one coaching for people who are really wanting to dive deep and maybe get into some of that underlying emotion in more depth to figure out what's really the root of the anger. But, But yeah those are kind of some of the things that I offer. And I look forward to just helping people just start to make a little bit of a shift because it's so, so impactful. That's all I can say is that I, I think that's what was really what drove me to wanna put it out there, is because I never thought that there was a different way of being and I was so thankful when I found it. 

Michael: For sure this work is completely transformative and, and I'm so glad we had a chance to talk about it today. Dr. Arpita Gupta DePalma, www.thoughtworkmd.com. Awesome chatting with you as always. Already looking forward to our next conversation. 

Arpita: Same. Totally. We'll talk to you soon, Michael. 

Michael: You got it. Bye. 

Arpita: Bye.